Canadian Journal of Surgery最新文献

{"title":"Collecting gender and visible minority demographic data: caution with oversimplification of complex variables.","authors":"Kevin Verhoeff, Kieran Purich, Blaire Anderson, Nada Gawad","doi":"10.1503/cjs.99114-l","DOIUrl":"10.1503/cjs.99114-l","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"67 3","pages":"E215"},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11068420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854450","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":"Call to modernize measurement of gender, race, and ethnicity.","authors":"Kaitlyn G Harding, A J Lowik, Sam M Wiseman","doi":"10.1503/cjs.99057-l","DOIUrl":"10.1503/cjs.99057-l","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"67 3","pages":"E214"},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11068421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848032","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 impact of robotic rectal cancer surgery at a Canadian regional cancer centre: a retrospective cohort study.","authors":"Sunil V Patel, Vanessa Wiseman, Lisa Zhang, Shaila J Merchant, Antonio Caycedo-Marulanda, P Hugh MacDonald","doi":"10.1503/cjs.002523","DOIUrl":"https://doi.org/10.1503/cjs.002523","url":null,"abstract":"<p><strong>Background: </strong>Although robotic surgery has several advantages over other minimally invasive surgery (MIS) techniques for rectal cancer surgery, the uptake in Canada has been limited owing to a perceived increase in cost and lack of training. The objective of this study was to determine the impact of access to robotic surgery in a Canadian setting.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study involving consecutive adults undergoing surgical resection for rectal cancer between 2017 and 2020. The primary exposure was access to robotic surgery. Outcomes included MIS utilization, short-term outcomes, total cost of care, and quality of surgical resection. We completed univariate and multivariate analyses.</p><p><strong>Results: </strong>We included 171 individuals in this cohort study (85 in the prerobotic period and 86 in the robotic period). The 2 groups had similar baseline characteristics. A higher proportion of individuals underwent successful MIS in the robotic phase (86% v. 46%, <i>p</i> < 0.001). Other benefits included a shorter mean length of hospital stay (5.1 d v. 9.2 d, <i>p</i> < 0.001). The quality of surgical resection was similar between groups. The total cost of care was $16 746 in the robotic period and $18 808 in the prerobotic period (mean difference -$1262, 95% confidence interval -$4308 to $1783; <i>p</i> = 0.4).</p><p><strong>Conclusion: </strong>Access to robotic rectal cancer surgery increased successful completion of MIS and shortened hospital stay, with a similar total cost of care. Robotic rectal cancer surgery can enhance patient outcomes in the Canadian setting.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"67 3","pages":"E206-E213"},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11068423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854325","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":"Predictors of complication after groin dissection: a single-centre experience.","authors":"Ghader Jamjoum, Thea Araji, Diana Nguyen, Ari N Meguerditchian","doi":"10.1503/cjs.012022","DOIUrl":"https://doi.org/10.1503/cjs.012022","url":null,"abstract":"<p><strong>Background: </strong>Inguinal lymphadenectomy (ILND) has historically been associated with substantial morbidity. The objective of this study was to obtain contemporary ILND morbidity rates and to identify potentially preventable risk factors.</p><p><strong>Methods: </strong>We carried out a retrospective review of medical records for all superficial, deep, and combination groin dissections performed at a single, high-volume academic centre between January 2007 and December 2020. We collected data points for patient, disease, and surgery characteristics, and cancer outcomes. The outcome of interest was any complication within 30 days of surgery. Complications included wound infection, wound necrosis or disruption, seroma, drainage procedure, hematoma, and lymphedema. We performed multivariate logistic regression using SAS version 9.4.</p><p><strong>Results: </strong>We identified 139 patients having undergone 89 superficial, 12 deep, and 38 combined dissection types, respectively. Melanoma accounted for 84.9% of cases. Of these patients, 56.1% had an adverse postoperative event within 30 days. Increasing age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01-1.07, <i>p</i> < 0.01) and number of positive lymph nodes harvested (OR 1.22, 95% CI 1.00-1.50, <i>p</i> = 0.05) were associated with more complications. Patients with deep dissection showed a lower likelihood of complications than those with superficial dissection (OR 0.15, 95% CI 0.03-0.84, <i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Complication rates after ILND remain high. We identified a number of risk factors, providing opportunities for better selection and prevention.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"67 3","pages":"E198-E205"},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11068424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853665","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":"Effect of neurosurgical residency programs on neurosurgical patient outcomes in a single health care system: a cohort study.","authors":"Shervin Taslimi, Susan B Brogly, Wenbin Li, Jillian Rodger, Ekkehard M Kasper, Douglas J Cook, Ron Levy","doi":"10.1503/cjs.008522","DOIUrl":"https://doi.org/10.1503/cjs.008522","url":null,"abstract":"<p><strong>Background: </strong>The evidence on the benefits and drawbacks of involving neurosurgical residents in the care of patients who undergo neurosurgical procedures is heterogeneous. We assessed the effect of neurosurgical residency programs on the outcomes of such patients in a large single-payer public health care system.</p><p><strong>Methods: </strong>Ten population-based cohorts of adult patients in Ontario who received neurosurgical care from 2013 to 2017 were identified on the basis of procedural codes, and the cohorts were followed in administrative health data sources. Patient outcomes by the status of the treating hospital (with or without a neurosurgical residency program) within each cohort were compared with models adjusted for a priori confounders and with adjusted multilevel models (MLMs) to also account for hospital-level factors.</p><p><strong>Results: </strong>A total of 46 608 neurosurgical procedures were included. Operative time was 8%-30% longer in hospitals with neurosurgical residency programs in 9 out of 10 cohorts. Thirty-day mortality was lower in hospitals with neurosurgical residency programs for aneurysm repair (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.20-0.44), cerebrospinal fluid shunting (OR 0.52, 95% CI 0.34-0.79), intracerebral hemorrhage evacuation (OR 0.66, 95% CI 0.52-0.84), and posterior lumbar decompression (OR 0.32, 95% CI 0.15-0.65) in adjusted models. The mortality rates remained significantly different only for aneurysm repair (OR 0.19, 95% CI 0.05-0.69) and cerebrospinal shunting (OR 0.42, 95% CI 0.21-0.85) in MLMs. Length of stay was mostly shorter in hospitals with neurosurgical residents, but this finding did not persist in MLMs. Thirty-day reoperation rates did not differ between hospital types in MLMs. For 30-day readmission rates, only extracerebral hematoma decompression was significant in MLMs (OR 1.41, 95% CI 1.07-1.87).</p><p><strong>Conclusion: </strong>Hospitals with neurosurgical residents had longer operative times with similar to better outcomes. Most, but not all, of the differences between hospitals with and without residency programs were explained by hospital-level variables rather than direct effects of residents.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"67 3","pages":"E188-E197"},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11068422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853950","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":"Geographic variation in breast reconstruction surgery after mastectomy for females with breast cancer in Alberta, Canada.","authors":"Yifu Huang, Jenna-Lynn B Senger, Lisa Korus, Rhonda J Rosychuk","doi":"10.1503/cjs.003823","DOIUrl":"https://doi.org/10.1503/cjs.003823","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is the most common cancer affecting females in Canada, and about half of females with breast cancer are treated with mastectomy. We sought to evaluate geographic variation in breast reconstruction surgery in Alberta, Canada.</p><p><strong>Methods: </strong>Using linked population-based administrative databases, we extracted data on all Alberta females aged 18 years and older who were diagnosed with breast cancer and treated with mastectomy during 2004-2017. Analyses included regression modelling of odds of reconstruction at 1 year and a spatial scan to identify geographic clusters of lower numbers of reconstruction.</p><p><strong>Results: </strong>A total of 16 198 females diagnosed with breast cancer were treated with a mastectomy, and 1932 (11.9%) had reconstruction within 1 year postmastectomy. Those with reconstruction were more likely to be younger (adjusted odds ratio [OR] 16.7, 95% confidence interval [CI] 13.7-20.3; aged 21-44 yr v. ≥ 65 yr) and were less likely to be from lower-income neighbourhoods. They were more likely to have at least 1 comorbidity and were more likely to have advanced stages of cancer and to require chemotherapy (adjusted OR 0.55, 95% CI 0.47-0.65) or radiotherapy after mastectomy (adjusted OR 0.59, 95% CI 0.39-0.87) than females without reconstruction. We identified rural northern and southeastern clusters with frequencies of reconstruction that were 69.6% and 41.6% of what was expected, respectively.</p><p><strong>Conclusion: </strong>We found an overall postmastectomy rate of breast reconstruction of 11.9%, and we identified geographic variation. Predictors of reconstruction in Alberta were similar to those previously described in the literature, specifically with patients in rural communities having lower rates of reconstruction than their urban counterparts. These results suggest that further interventions are required to identify the specific barriers to reconstruction within rural communities and to create strategies to ensure equitable access to all residents.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"67 2","pages":"E172-E182"},"PeriodicalIF":2.5,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11052580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847300","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":"Rendement élevé dans le domaine chirurgical.","authors":"Chad G Ball, Edward J Harvey, Mohit Bhandari, S Morad Hameed","doi":"10.1503/cjs.004424","DOIUrl":"10.1503/cjs.004424","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"67 2","pages":"E185-E187"},"PeriodicalIF":2.2,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11052578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848263","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":"High performance in surgery.","authors":"Chad G Ball, Edward J Harvey, Mohit Bhandari, S Morad Hameed","doi":"10.1503/cjs.004224","DOIUrl":"https://doi.org/10.1503/cjs.004224","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"67 2","pages":"E183-E184"},"PeriodicalIF":2.5,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11052577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140851601","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":"Orthopedic surgeons' transition into full-time practice over the last 20 years: an analysis using Ministry of Health billing data.","authors":"Silvio Ndoja, Amirti Vivekanandan, Sophia Frost, Emil Schemitsch, Lyn M Sibley, Steve Papp, Brent Lanting","doi":"10.1503/cjs.002623","DOIUrl":"https://doi.org/10.1503/cjs.002623","url":null,"abstract":"<p><strong>Background: </strong>Underemployment is a reality for many new graduates, who accept locum or part-time work as an alternative to unemployment because of lack of opportunities. We sought to analyze orthopedic surgeons' Ontario Health Insurance Program (OHIP) billing data over a 20-year period as a proxy of practice patterns and hypothesized that billing in the first 6 years of practice would be affected by underemployment and locum.</p><p><strong>Methods: </strong>We analyzed the annual average billing totals of orthopedic surgeons, broken down by year of graduation, year of billings, and number of surgeons billing in that year. We analyzed public census data of the Ontario population size as a proxy of orthopedic demand.</p><p><strong>Results: </strong>A 2019 cross-sectional analysis showed that around 15 surgeons per graduating year were billing in Ontario from the 1995 to 2016 cohorts, while 2017 and 2018 saw an increase to 30 and 36 actively billing surgeons, respectively. The number returned to more historical numbers in 2019, with 20 actively billing surgeons. For those surgeons billing in Ontario, billing trends have been roughly stable, with average billings increasing each year for the first 6 years in practice (<i>p</i> < 0.001). Year of graduation did not have an effect on the first 6 years of billings (<i>p</i> > 0.5). Billings were stable after 6 years in practice (<i>p</i> > 0.09).</p><p><strong>Conclusion: </strong>The Ontario health care system has not expanded to support more orthopedic surgeons despite the aging and growing population; despite our growing population, the number of surgeons being trained and retained has not matched this growth. Further research needs to be done to guide optimal health human resource decision-making.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"67 2","pages":"E165-E171"},"PeriodicalIF":2.5,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11052579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140851732","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":"Defining the Canadian rural general surgeon.","authors":"Lyndsay Glass, Malcolm Davidson, Emily Friedrich, Rebecca Afford, Sarah MacVicar, Quinn Gentles, Peter Miles, Roy Kirkpatrick, Lauren Smithson, Mark Walsh, Stephen Hiscock, Evan Wong, Caitlin Champion","doi":"10.1503/cjs.002123","DOIUrl":"10.1503/cjs.002123","url":null,"abstract":"<p><strong>Background: </strong>A total of 18%-30% of Canadians live in a rural area and are served by 8% of the country's general surgeons. The demographic characteristics of Canada's population and its geography greatly affect the health outcomes and needs of the population living in rural areas, and rural general surgeons hold a unique role in meeting the surgical needs of these communities. Rural general surgery is a distinct area of practice that is not well understood. We aimed to define the Canadian rural general surgeon to inform rural health human resource planning.</p><p><strong>Methods: </strong>A scoping review of the literature was undertaken of Ovid, MEDLINE, and Embase using the terms \"rural,\" \"general surgery,\" and \"workforce.\" We limited our review to articles from North America and Australia.</p><p><strong>Results: </strong>The search yielded 425 titles, and 110 articles underwent full-text review. A definition of rural general surgery was not identified in the Canadian literature. Rurality was defined by population cut-offs or combining community size and proximity to larger centres. The literature highlighted the unique challenges and broad scope of rural general surgical practice.</p><p><strong>Conclusion: </strong>Rural general surgeons in Canada can be defined as specialists who work in a small community with limited metropolitan influence. They apply core general surgery skills and skills from other specialties to serve the unique needs of their community. Surgical training programs and health systems planning must recognize and support the unique skill set required of rural general surgeons and the critical role they play in the health and sustainability of rural communities.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"67 2","pages":"E129-E141"},"PeriodicalIF":2.5,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10980533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140317794","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}