Canadian Journal of Surgery最新文献

{"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}

{"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}

{"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}

{"title":"Correction to: \"Indication for total knee arthroplasty based on preoperative functional score: Are we operating earlier?\"","authors":"","doi":"10.1503/cjs.014123","DOIUrl":"10.1503/cjs.014123","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E539"},"PeriodicalIF":2.5,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648496","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 outcomes after appendectomy in First Nations and non-First Nations patients in Northern Alberta.","authors":"Ralph Hsiao, Erik Youngson, Alika Lafontaine, Kamran Fathimani, David C Williams","doi":"10.1503/cjs.011222","DOIUrl":"10.1503/cjs.011222","url":null,"abstract":"<p><strong>Background: </strong>Internationally, Indigenous Peoples experience worse surgical outcomes than non-Indigenous patients, but equity of surgical care is less well studied in Canada. This study compares outcomes after appendectomy in First Nations and non-First Nations patients.</p><p><strong>Methods: </strong>In this population-based study, we reviewed administrative data of patients who underwent appendectomy between Apr. 1, 2004, and Mar. 31, 2017, in Northern Alberta. Demographic variables and characteristics of surgical care for First Nations and non-First Nations patients were collected. We identified adverse outcomes by the presence of predefined administrative codes. We identified variables related to a complex postoperative course (at least 1 of wound dehiscence, surgical site infection, abscess, bowel obstruction, pneumonia, deep vein thrombosis, sepsis, emergency department visit, readmission or death within 30 d after appendectomy) through a logistic regression model, and those related to longer length of stay using a Cox proportional hazards model.</p><p><strong>Results: </strong>A total of 28 453 patients met the selection criteria, of whom 1737 (6.1%) had First Nations status. Compared to non-First Nations patients, First Nations patients were younger, lived farther away from the hospital of their appendectomy, were in lower socioeconomic quintiles, and had higher rates of obesity and diabetes (all <i>p</i> < 0.001). After adjustment for age, sex, distance to hospital, socioeconomic deprivation and comorbidities, First Nations status remained independently associated with higher rates of adverse outcomes (odds ratio 1.548, 95% confidence interval [CI] 1.384-1.733) and longer lengths of stay (hazard ratio 0.877, 95% CI 0.832-0.924).</p><p><strong>Conclusion: </strong>Although rurality, comorbidities and socioeconomic status contributed to worse outcomes after appendectomy for First Nations patients, First Nations status remained independently associated with worse surgical outcomes. Surgical care, an integral component of health care delivery, must be improved for First Nations patients in order to achieve equitable health care.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E540-E549"},"PeriodicalIF":2.5,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648495","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 targeted fee increases on the pay disparity between female and male general surgeons in British Columbia.","authors":"Hamish Hwang,&nbsp;Anise Barton,&nbsp;Daniel Jenkin,&nbsp;Tracy M Scott","doi":"10.1503/cjs.000922","DOIUrl":"10.1503/cjs.000922","url":null,"abstract":"<p><strong>Background: </strong>High-level payment data provided by Doctors of BC showed a 19.7% pay disparity in annual payments between female and male general surgeons in fiscal year 2019/20, and this was previously as high as 30% in 2012/13. This study aimed to examine the impact of targeted fee increases on pay disparity by sex over time.</p><p><strong>Methods: </strong>The top 35 fees billed by female general surgeons, representing 76.3% of total payments, were retrospectively analyzed. The pay disparity by sex was calculated for each individual fee from 2000/01 to 2019/20.</p><p><strong>Results: </strong>There were notable billing differences between female and male general surgeons. Female surgeons billed breast oncology procedures, malignancy consultations and visits, and peritoneal malignancy surgical procedures in greater proportions than did their male counterparts. Male surgeons billed hemorrhoid banding and rigid proctosigmoidoscopy in greater proportions than their female counterparts. With targeted fee increases, pay disparity by sex worsened for 17 of the top 35 fees but improved for the other 18 from 2010/11 to 2019/20, to varying degrees, resulting in an overall reduction in pay disparity by sex from 23% to 15%. If across-the-board fee increases had been implemented instead of targeted fee increases, the disparity in 2019/20 would have been 19% instead of 15%.</p><p><strong>Conclusion: </strong>Targeted fee increases reduced pay disparity between male and female general surgeons compared with theoretical across-the-board fee increases in British Columbia from 2010/11 to 2019/20, but not uniformly; some fee increases resulted in increased disparity. Other physician groups should conduct a similar analysis and allocate future fee changes with the aim of improving rather than worsening disparity.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E522-E531"},"PeriodicalIF":2.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10620007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71420999","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":"Considering human cognitive architecture in stressful medical prehospital interventions might benefit care providers.","authors":"Andrew W Kirkpatrick,&nbsp;Jessica L McKee,&nbsp;Robert Barrett,&nbsp;Kyle Couperus,&nbsp;Juan Wachs","doi":"10.1503/cjs.015422","DOIUrl":"10.1503/cjs.015422","url":null,"abstract":"<p><p>People suffering from critical injuries/illness face marked challenges before transportation to definitive care. Solutions to diagnose and intervene in the prehospital setting are required to improve outcomes. Despite advances in artificial intelligence and robotics, near-term practical interventions for catastrophic injuries/illness will require humans to perform unfamiliar, uncomfortable and risky interventions. Development of posttraumatic stress disorder is already disproportionately high among first responders and correlates with uncertainty and doubts concerning decisions, actions and inactions. Technologies such as remote telementoring (RTM) may enable such interventions and will hopefully decrease potential stress for first responders. How thought processes may be remotely assisted using RTM and other technologies should be studied urgently. We need to understand if the use of cognitively offloading technologies such as RTM will alleviate, or at least not exacerbate, the psychological stresses currently disabling first responders.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E522-E534"},"PeriodicalIF":2.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10620006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71420997","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":"RAG time: rapid access general surgery - a shared-care protocol to convert after-hours inpatient to daytime outpatient surgery.","authors":"Hamish Hwang,&nbsp;Chad Rideout","doi":"10.1503/cjs.004022","DOIUrl":"10.1503/cjs.004022","url":null,"abstract":"<p><p>A rapid access general surgery (RAG) pilot protocol was implemented at the Vernon Jubilee Hospital in January 2021 in which surgeons seeing patients in the emergency department (ED) could access operating time set aside once per week. Appropriate patients discharged from the ED were scheduled into this time, usually with a different surgeon than the initial triaging surgeon. In this article, we discuss the outcomecs of the pilot project. This innovative reorganization of existing resources converted many patients from after-hours to scheduled outpatient daytime surgery with decreased hospital bed utilization.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E535-E538"},"PeriodicalIF":2.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10620008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71420998","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}