Canadian Journal of Surgery最新文献

{"title":"Pourquoi ignore-t-on encore l’équité entre les genres en chirurgie?","authors":"Edward J Harvey, Chad G Ball","doi":"10.1503/cjs.013523","DOIUrl":"10.1503/cjs.013523","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1b/c6/066E521.PMC10609886.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50157123","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":"Closed incision negative pressure wound therapy following pancreaticoduodenectomy for prevention of surgical site infections in high-risk patients.","authors":"Brittany Greene,&nbsp;Andrew Lagrotteria,&nbsp;Melanie E Tsang,&nbsp;Shiva Jayaraman","doi":"10.1503/cjs.000723","DOIUrl":"10.1503/cjs.000723","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infection (SSI) is one of the most common sources of morbidity after pancreaticoduodenectomy. Surgical site infections are associated with readmissions, prolonged length of stay, delayed initiation of adjuvant chemotherapy and negative effects on quality of life. Incisional vacuum-assisted closure (iVAC) devices applied on closed incisions may reduce SSI rates. The objective of this retrospective review is to evaluate the impact of iVAC on SSI rate after pancreaticoduodenectomy.</p><p><strong>Methods: </strong>A cohort of patients undergoing pancreaticoduodenectomy at a single institution who had at least 1 risk factor for SSI and who received an iVAC were compared with a historical cohort of high-risk patients who received conventional dressings after pancreaticoduodenectomy. The primary outcome was incidence of SSI within 30 days, abstracted from chart review. Secondary outcomes were 30-day readmission, 90-day mortality, rate of postoperative pancreatic fistula and rate of delayed gastric emptying.</p><p><strong>Results: </strong>In total, 175 patients were included, of whom 61 received an iVAC. The incidence of SSI was 13% (8 of 61 patients) and 16% (18 of 114 patients) in the iVAC and conventional dressing groups, respectively (odds ratio 0.81, 95% confidence interval 0.33-1.98). Preoperative biliary drainage was the most frequent SSI risk factor. Binary logistic regression using SSI as the outcome demonstrated no significant association with iVAC use when adjusted for SSI risk factors. There were no differences in rates of postoperative pancreatic fistula, delayed gastric emptying or 90-day mortality.</p><p><strong>Conclusion: </strong>This report describes the outcomes of the integration of iVAC devices into routine clinical practice at a high-volume institution. Application of this device after pancreaticoduodenectomy for patients at elevated risk of SSI was not associated with a reduction in the rate of SSIs.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/50/0c/066E507.PMC10609889.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50157121","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":"Why are we ignoring gender equity in surgery?","authors":"Edward J Harvey,&nbsp;Chad G Ball","doi":"10.1503/cjs.013423","DOIUrl":"10.1503/cjs.013423","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c0/1b/066E520.PMC10609885.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50157124","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":"Improving the quality of care of Canadians waiting for elective surgery: an important health care priority.","authors":"Sam M Wiseman,&nbsp;Jason M Sutherland","doi":"10.1503/cjs.015922","DOIUrl":"https://doi.org/10.1503/cjs.015922","url":null,"abstract":"<p><p>The backlog of cases on surgical wait lists is a substantial problem for surgical patients, their families, surgeons, health care systems and governments. There are several approaches governments can take to improve the health, well-being and surgical outcomes of waiting patients. First, provinces should consider patient-centred approaches to triaging that reflect pain, symptoms or functional gain, and approaches using multidisciplinary teams or centralized triage. Second, governments could provide prehabilitation and mental health supports aligned with patients' and families' preferences during unavoidable waits. Wait times are not going to shorten any time soon; provinces should not only find innovative approaches to reducing waits, but also organize services to improve the health and well-being of waiting patients. Such changes will allow for optimization of patients' surgical outcomes and reduce the complexity of managing the wait list for their surgeons.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/85/a1/066E474.PMC10521809.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41109198","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":"A simple perfused cadaver model for damage control vascular surgery training.","authors":"Shane A Smith,&nbsp;Vivian C McAlister","doi":"10.1503/cjs.98037","DOIUrl":"https://doi.org/10.1503/cjs.98037","url":null,"abstract":"Dr. Rifahi and colleagues have described an elegant training model for endovascular surgery using pulsatile arteriovenous perfusion of a cadaver.1 We reported use of a simple perfused cadaver model to test a novel system for resuscitative endovascular balloon occlusion of the aorta (REBOA).2 Our method is possible in most anatomy laboratories or hospital morgues using commonly available equipment. Red-dyed water was instilled via the carotid artery into the aorta of a fresh or thawed cadaver using the laboratory’s pump, which is normally used to instill preservative. We tested occlusion of the aorta by observing the escape of fluid from the contralateral femoral artery, which had been opened. We have also adapted this simple model to teach the principles of damage-control vascular surgery. Procedures that can be taught with a high degree of fidelity using this simple model include resuscitative thoracotomy, aortic clamp placement above the celiac artery or below the renal arteries, control of intraabdominal hemorrhage, ligation of pelvic arteries, shunting of limb vessels and placement of REBOA. Our nonpulsatile simplified model also had the advantage of simulating hemorrhage in a shocked patient. Dr. Rifahi’s superior model and our simple method both emphasize a partnership with anatomy that is as old as surgery itself but is threatened in modern times.","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/15/db/066E476.PMC10521808.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41111378","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 influence of the COVID-19 pandemic on total hip and knee arthroplasty in Ontario: a population-level analysis.","authors":"Jhase Sniderman, Amir Khoshbin, Jesse Wolfstadt","doi":"10.1503/cjs.016122","DOIUrl":"10.1503/cjs.016122","url":null,"abstract":"<p><strong>Background: </strong>The effects of the COVID-19 pandemic on elective orthopedic surgery have yet to be reported at the population level in Canada. We sought to detail the effect of the pandemic on patients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA), and on surgeons with respect to surgical volume, wait times and health care quality.</p><p><strong>Method: </strong>We compared patient length of hospital stay, revisions, readmissions and emergency department presentations between pre-pandemic (April 2019 to February 2020) and postpandemic (April 2020 to February 2021) cohorts of patients who underwent inpatient THAs or TKAs. Wait times for THA and TKA in Ontario were similarly collected.</p><p><strong>Results: </strong>Case volumes for THA and TKA decreased by 30% during the pandemic. There were significantly fewer medically complex cases during this time period (<i>p</i> < 0.001). Length of hospital stay was reduced from 2.2 to 1.8 days (<i>p</i> < 0.001). Patients were less likely to visit the emergency department within 30 days of surgery (<i>p</i> < 0.001). Patients who underwent TKA were also more likely to be discharged directly home (<i>p</i> = 0.025). There was no difference in rate of revision surgery or readmission within 30 days. The proportion of patients meeting the standard benchmark wait time in Ontario was significantly lower (<i>p</i> < 0.001). The corresponding wait time to treatment increased significantly (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>The effects of the COVID-19 pandemic on elective THA and TKA case volumes and wait times was significant. Patients having surgery during the pandemic were less medically complex, had shorter length of hospital stays and had significantly less health care utilization.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/57/a5/066E485.PMC10521810.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41105825","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":"Cholecystectomy following endoscopic clearance of common bile duct during the same admission.","authors":"Eric Bergeron,&nbsp;Théo Doyon,&nbsp;Thibaut Manière,&nbsp;Étienne Désilets","doi":"10.1503/cjs.008322","DOIUrl":"https://doi.org/10.1503/cjs.008322","url":null,"abstract":"<p><strong>Background: </strong>The recurrence of common bile duct stones and other biliary events after endoscopic retrograde cholangiopancreatography (ERCP) is frequent. Despite recommendations for early cholecystectomy, intervention during the same admission is carried out inconsistently.</p><p><strong>Methods: </strong>We reviewed the records of patients who underwent ERCP for gallstone disease and common bile duct clearance followed by cholecystectomy between July 2012 and June 2022. Patients were divided into 2 groups: the index group underwent cholecystectomy during the same admission and the delayed group was discharged and had their cholecystectomy postponed. Data on demographics and prognosis factors were collected and analyzed.</p><p><strong>Results: </strong>The study population was composed of 268 patients, with 71 (26.6%) having undergone cholecystectomy during the same admission after common bile duct clearance with ERCP. A greater proportion of patients aged 80 years and older were in the index group than in the delayed group. The American Society of Anesthesiologists score was significantly higher in the index group. There was no significant difference between groups regarding surgical complications, open cholecystectomy and death. The operative time was significantly longer in the delayed group. Among patients with delayed cholecystectomy, 18.3% had at least 1 recurrence of common bile duct stones (CBDS) and 38.6% had recurrence of any gallstone-related events before cholecystectomy. None of these events occurred in the the index group. There was no difference in the recurrence of CBDS and other biliary events after initial diagnosis associated with stone disease.</p><p><strong>Conclusion: </strong>Cholecystectomy during the same admission after common bile duct clearance is safe, even in older adults with comorbidities. Compared with delayed cholecystectomy, it was not associated with adverse outcomes and may have prevented recurrence of biliary events.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c1/ef/066E477.PMC10521812.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41109533","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":"Colorectal polyp classification and management of complex polyps for surgeon endoscopists.","authors":"Garrett G R J Johnson,&nbsp;Ramzi Helewa,&nbsp;Dana C Moffatt,&nbsp;John Gerard Coneys,&nbsp;Jason Park,&nbsp;Eric Hyun","doi":"10.1503/cjs.011422","DOIUrl":"https://doi.org/10.1503/cjs.011422","url":null,"abstract":"<p><p>Increasing familiarity with advanced endoscopic excision techniques allows for more colorectal lesions to be removed without major surgery. Endoscopic excision with negative margins is adequate for most polyps and low-risk T1 cancers. The use of modern polyp classification techniques based on size, morphology and pit pattern by an experienced endoscopist allow for an optical diagnosis of these lesions and can predict, with high accuracy, which lesions contain malignant disease and the level of invasion. A surgeon endoscopist must be able to recognize which complex polyps can be resected with advanced polypectomy techniques and which require upfront surgery. We aimed to provide an overview of polyp classification techniques to help surgeons select the correct treatment algorithm for advanced colorectal lesions based on their visual characteristics at index endoscopy.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b4/22/066E491.PMC10521811.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41107951","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":"Examining the equity and diversity characteristics of academic general surgeons hired in Canada.","authors":"Nada Gawad,&nbsp;Kieran Purich,&nbsp;Kevin Verhoeff,&nbsp;Blaire Anderson","doi":"10.1503/cjs.006122","DOIUrl":"https://doi.org/10.1503/cjs.006122","url":null,"abstract":"<p><strong>Background: </strong>Job competition and underemployment among surgeons emphasize the importance of equitable hiring practices. The purpose of this study was to describe some of the demographic characteristics of academic general surgeons and to evaluate the gender and visible minority (VM) status of those recently hired.</p><p><strong>Methods: </strong>Demographic information about academic general surgeons across Canada including gender, VM status, practice location and graduate degree status was collected. Location of residency was collected for recently hired general surgeons (hired between 2013 and 2020). Descriptive statistics were performed on the demographic characteristics at each institution. Pearson correlation coefficients and hypothesis testing were used to determine the correlation between various metrics and gender and VM status.</p><p><strong>Results: </strong>A total of 393 general surgeons from 30 academic hospitals affiliated with 14 universities were included. The percentage of female general surgeons ranged from 0% to 47.4% and the percentage of VM general surgeons ranged from 0% to 66.7% at the hospitals. This heterogeneity did not correlate with city population (gender: <i>r</i> = 0.06, <i>p</i> = 0.77; VM: <i>r</i> = 0.04, <i>p</i> = 0.83). The percentage of VM general surgeons at each hospital did not correlate with the percentage of VM population in the city (<i>r</i> = 0.13, <i>p</i> = 0.49). Only 34 of 120 recently hired academic general surgeons (28.3%) did not have a graduate degree. The percentage of recently hired academic general surgeons who did not have a graduate degree was approximately 1.5 times higher among male hirees than female hirees. With respect to academic promotion, the percentage of female full professors ranged from 0% to 40.0% and did not correlate with the percentage of female general surgeons at each institution (<i>r</i> = 0.11, <i>p</i> = 0.70). The percentage of VM full professors ranged from 0% to 44.4% and was moderately correlated with the percentage of VM surgeons at each institution (<i>r</i> = 0.40, <i>p</i> = 0.16).</p><p><strong>Conclusion: </strong>The academic general surgery workforce appears to be somewhat diverse. However, there was substantial heterogeneity in diversity between hospitals, leaving room for improvement. We must be willing to examine our hiring processes and be transparent about them to build an equitable surgical workforce.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/aa/49/066E458.PMC10495166.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10587149","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":"Utility of routine postoperative chest radiography in patients undergoing clavicle fixation: a retrospective chart review.","authors":"Joshua Del Papa,&nbsp;Josh Hobson,&nbsp;Steve Mann","doi":"10.1503/cjs.013421","DOIUrl":"https://doi.org/10.1503/cjs.013421","url":null,"abstract":"<p><strong>Background: </strong>Although uncommon, pneumothorax is a potentially serious complication following open reduction and internal fixation (ORIF) of clavicle fractures. In many centres it is routine practice to obtain postoperative chest radiographs following ORIF of clavicle fractures to assess for iatrogenic pneumothorax. Given the need to contain health care costs, the low sensitivity for detecting small pneumothorax and a desire to decrease patient radiation exposure, the practice of ordering chest radiographs following ORIF of clavicle fractures may be unnecessary.</p><p><strong>Methods: </strong>All patients undergoing ORIF of clavicle fractures with plate and screw fixation at Kingston Health Sciences Centre between April 2009 and June 2020 were identified from the Discharge Abstract Database (inpatient) and National Ambulatory Care Reporting System (outpatient) using relevant Canadian Classification of Health Intervention procedure codes. Charts were manually reviewed to confirm diagnosis and procedure, and patients with preoperative pneumothorax were excluded. The frequency of postoperative chest radiograph and pneumothorax detection were calculated.</p><p><strong>Results: </strong>Among the 292 patients who underwent ORIF of clavicle fractures during the study period, 17 were excluded for having a pneumothorax on preoperative chest radiograph. Of the remaining 275 patients, 101 (36.7%) had postoperative chest radiographs, of whom none were found to have postoperative iatrogenic pneumothorax.</p><p><strong>Conclusion: </strong>Since 2009, the rate of routine postoperative chest radiography following ORIF of clavicle fractures is 36.7% at our centre. During this time period, none of the 101 patients who had postoperative chest radiographs had a postoperative iatrogenic pneumothorax. To our knowledge, this is the largest series of patients available, and our findings confirm those of several smaller studies. Owing to the low rate of postoperative iatrogenic pneumothorax, we conclude that postoperative chest radiography is unnecessary following ORIF of clavicle fractures.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/61/9e/066E467.PMC10495164.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10569461","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}