Canadian Journal of Surgery

Journal Information
ISSN / EISSN : 0008-428X / 1488-2310
Published by: Joule Inc. (10.1503)
Total articles ≅ 5,953
Current Coverage
SCOPUS
SCIE
MEDICUS
MEDLINE
PUBMED
PMC
Archived in
EBSCO
SHERPA/ROMEO
Filter:

Latest articles in this journal

Trauma 2021Perceptions of a trauma team regarding in situ simulationEpidemiology of submersion injuries in Canadian children and adolescents: 1990–2018A survey of medical and administrative directors on REBOA use in Canadian trauma centresCut to the chase: comparing cutting tools in the exposure of simulated trauma patientsPediatric major trauma. Anaesthesia education: airway, breathing, coffee and cases 2020–2021Geriatric trauma care at a level 1 trauma centre: Are we following best practice?Was the introduction of a provincially standardized consensus statement for postintubation analgesia and sedation associated with increased use of associated pharmacological therapies in New Brunswick?Are there important variations in the care of adult trauma patients with isolated, nonoperative subdural hematomas between those admitted to a neurosurgical centre and those admitted to a non-neurosurgical centre for their entire inpatient stay?Flattening the curve on the negative psychosocial impact of trauma on the family of acute care trauma survivors: a quantitative studyDoes ACLS belong in ATLS? Seeking evidence during resuscitative thoracotomyAutologous omental harvest for microvascular free flap reconstruction of a severe traumatic scalp degloving injury: a case reportDerivation and validation of actionable quality indicators targeting reductions in complications for injury admissionsASA dosing practices in the management of blunt cerebrovascular injury: a retrospective reviewA retrospective analysis of bicycle lane collisions in Vancouver, British Columbia, from 2012 to 2017Evaluating the Screening, Brief Intervention and Referral to Treatment (SBIRT) process at Vancouver General HospitalAlcohol use and trauma in Alberta after COVID-19 lockdown: overrepresentation and undertreatment are opportunities for improvementMental health and addiction diagnoses are linked to increased violent injuries and gaps in provision of resources during the COVID-19 pandemicPain management strategies after orthopedic trauma in a level 1 trauma centre: a descriptive study with a view of optimizing practicesStudy to Actively Warm Trauma Patients (STAY WARM): a feasibility pilot evaluationPrehospital trauma care in civilian and military settings including cold environments: a systematic review and knowledge gap analysisAntibiotic administration in open fractures: adherence to guidelines at a Canadian trauma centreAre we meeting massive transfusion protocol activation and blood product delivery times in trauma patients? A retrospective review from 2014 to 2018Unplanned returns to the operating room: a quality improvement initiative at a level 1 trauma centreStopping the bleed: the history and rebirth of Canadian freeze-dried plasmaThe state of the evidence for emergency medical services (EMS) care of prehospital severe traumatic brain injury: an analysis of appraised research from the Prehospital Evidence-based Practice programA mixed methods study of a...
Olga Bednarek, Mike O’Leary, Sean Hurley, Caleb Cummings, Ruth Bird, Sidney Frattini, Stacey McEachern, Susan Benjamin, Asha Pereira, William Brigode, et al.
Published: 4 October 2021
Canadian Journal of Surgery, Volume 64; https://doi.org/10.1503/cjs.014121

Katie Oxford, Greg Walsh, Jonathan Bungay, Stephen Quigley, Adam Dubrowski
Published: 27 September 2021
Canadian Journal of Surgery, Volume 64; https://doi.org/10.1503/cjs.018719

Abstract:
Background It is critical that junior residents be given opportunities to practise bowel anastomosis before performing the procedure in patients. Three-dimensional (3D) printing is an affordable way to provide realistic, reusable intestinal simulators. The aim of this study was to test the face and content validity of a 3D-printed simulator for bowel anastomosis. Methods The bowel anastomosis simulator was designed and assembled with the use of desktop 3D printers and silicone solutions. The production cost ranges from $2.67 to $131, depending on which aspects of the model one prefers to include. We incorporated input from a general surgeon regarding design modifications to improve the realism of the model. Nine experts in general surgery (6 staff surgeons and 3 senior residents) were asked to perform an anastomosis with the model and then complete 2 surveys regarding face and content validity. Items were rated on a 5-point Likert scale ranging from 1 (“strongly disagree”) to 5 (“strongly agree”). Results The overall average score for product quality was 3.58, indicating good face validity. The average score for realism (e.g., flexibility and texture of the model) was 3.77. The simulator was rated as being useful for training, with an overall average score of 3.98. In general, the participants agreed that the simulator would be a valuable addition to current simulation-based medical education (average score 4.11). They commented that the model would be improved by adding extra layers to simulate mucosa. Conclusion Experts found the 3D-printed bowel anastomosis simulator to be an appropriate tool for the education of surgical residents, based on the model’s texture, appearance and ability to undergo an anastomosis. This model provides an affordable way for surgical residents to learn bowel anastomosis. Future research will focus on proving educational efficacy, effectiveness and transfer that can be adapted for laparoscopic anastomosis training, hand-sewing and stapling procedures. Contexte Il est crucial que les résidents juniors aient l’occasion de s’exercer à l’anastomose intestinale avant d’intervenir sur des patients. L’impression en 3 dimensions (3D) est une façon abordable de produire des simulateurs intestinaux réalistes et réutilisables. Le but de cette étude était de vérifier la validité apparente et de contenu des simulateurs obtenus par impression 3D pour l’anastomose intestinale. Méthodes Le simulateur d’anastomose intestinale est conçu et assemblé avec des imprimantes de bureau 3D et des solutions de silicone. Le coût de fabrication varie de 2,67 $ à 131 $, selon le nombre de composants désiré. Suite aux commentaires d’un chirurgien général nous avons modifié le modèle afin de le rendre plus réaliste. Nous avons demandé à 9 experts en chirurgie générale (6 chirurgiens en poste et 3 résidents séniors) d’effectuer une anastomose sur le modèle, puis de répondre à 2 questionnaires sur sa validité apparente et de contenu. Les questions étaient notées sur une échelle de Likert en 5 points, allant de 1 (« en désaccord total ») à 5 (« tout à fait d’accord »). Résultats Le score moyen global pour la qualité du produit a été de 3,58, soit une bonne validité apparente. Le score moyen pour le réalisme (p. ex., flexibilité et texture du modèle) a été de 3,77. Le simulateur a été jugé utile pour la formation, avec un score moyen global de 3,98. En général, les participants ont convenu que le simulateur serait un ajout précieux à la formation actuelle par simulation (score moyen 4,11). Ils ont formulé un commentaire à l’effet que le modèle gagnerait à comporter des couches supplémentaires pour simuler la muqueuse. Conclusion Les experts ont jugé que le simulateur d’anastomose intestinale 3D constitue un outil approprié pour la formation des résidents en chirurgie, du point de vue de la texture et de l’aspect du modèle et de la capacité de pratiquer l’anastomose. Ce modèle constitue une façon abordable d’apprendre comment effectuer une anastomose intestinale pour les résidents en chirurgie. La recherche à venir portera sur la détermination de son efficacité didactique, son efficacité et de son applicabilité à l’enseignement de la technique d’anastomose laparoscopique, de la suture à la main et des techniques d’agrafage.
David Isa, David Pace
Published: 27 September 2021
Canadian Journal of Surgery, Volume 64; https://doi.org/10.1503/cjs.004619

Abstract:
Background Aboriginal people have higher prevalence rates of diabetes than non-Aboriginal people in the same geographic locations, and diabetic foot ulcer (DFU) complication rates are also presumed to be higher. The aim of this systematic review and meta-analysis was to compare DFU outcomes in Aboriginal and non-Aboriginal populations. Methods We searched PubMed, Embase, CINAHL and the Cochrane Library from inception to October 2018. Inclusion criteria were all types of studies comparing the outcomes of Aboriginal and non-Aboriginal patients with DFU, and studies from Canada, the United States, Australia and New Zealand. Exclusion criteria were patient age younger than 18 years, and studies in any language other than English. The primary outcome was the major amputation rate. We assessed the risk of bias using the ROBINS-I (Risk Of Bias In Non-randomized Studies – of Interventions) tool. Effect measures were reported as odds ratio (OR) with 95% confidence interval (CI). Results Six cohort studies with a total of 244 792 patients (2609 Aboriginal, 242 183 non-Aboriginal) with DFUs were included. The Aboriginal population was found to have a higher rate of major amputation than the non-Aboriginal population (OR 1.85, 95% CI 1.04–3.31). Four studies were deemed to have moderate risk of bias, and 2 were deemed to have serious risk of bias. Conclusion Our analysis of the available studies supports the conclusion that DFU outcomes, particularly the major amputation rate, are worse in Aboriginal populations than in non-Aboriginal populations in the same geographic locations. Rurality was not uniformly accounted for in all included studies, which may affect how these outcome differences are interpreted. The effect of rurality may be closely intertwined with ethnicity, resulting in worse outcomes. Contexte Le taux de prévalence du diabète chez les Autochtones dépasse celui chez les Allochtones des mêmes régions géographiques. On présume qu’il en va de même pour le taux de complications d’un ulcère du pied diabétique (UPD). Le but de cette revue systématique et de cette méta-analyse était de comparer les issues d’UPD dans les populations autochtones et allochtones. Méthodes Nous avons interrogé PubMed, Embase, CINAHL et la Bibliothèque Cochrane, de leur création jusqu’à octobre 2018. Les critères d’inclusion étaient tous les types d’études comparant les résultats de patients autochtones et allochtones atteints d’UPD, et la réalisation au Canada, aux États-Unis, en Australie ou en Nouvelle-Zélande. Les patients de moins de 18 ans et les études dans une langue autre que l’anglais ont été exclus. L’issue primaire était le taux d’amputation majeure. Nous avons évalué le risque de biais à l’aide de l’outil ROBINS-I (Risk Of Bias In Non-randomized Studies – of Interventions). Les mesures de l’effet sont données sous forme de rapport de cotes (RC) avec intervalle de confiance (IC) de 95 %. Résultats Nous avons inclus 6 études de cohortes totalisant 244 792 patients atteints d’UPD (2609 Autochtones et 242 183 Allochtones). La population autochtone présentait un taux d’amputation majeure plus élevé que celle allochtone (RC 1,85; IC de 95 % 1,04–3,31). Le risque de biais était jugé modéré pour 4 études et important pour les 2 autres. Conclusion Notre analyse des études disponibles confirme l’hypothèse voulant que les issues d’UPD, en particulier le taux d’amputation majeure, soient pires chez les Autochtones que chez les Allochtones d’une même région. La prise en compte de la ruralité variait entre les études, ce qui pourrait fausser l’interprétation des disparités. Il est possible que l’incidence de la ruralité soit plus étroitement liée à l’ethnicité, causant ainsi une hausse des issues défavorables.
Gabrielle Gauvin, Kathryn Hay, Wilma Hopman, Scott Hurton, Stephanie Lim, Boris Zevin, Diederick Jalink,
Published: 1 September 2021
Canadian Journal of Surgery, Volume 64; https://doi.org/10.1503/cjs.011520

Sahil Prabhnoor Sidhu, Lyndsay E. Somerville, Aamir Sohail Sidhu, Ryan T. Willing, Matthew G. Teeter, Brent A. Lanting
Published: 1 September 2021
Canadian Journal of Surgery, Volume 64; https://doi.org/10.1503/cjs.010920

Abstract:
Background: Surgical approaches for total knee arthroplasty (TKA) include the medial parapatellar (MPA), subvastus (SV), midvastus (MV), and lateral parapatellar approach (LPA); it remains unclear which approach is superior. Methods: Patients having undergone TKA at our institution were retrospectively organized into matched groups according to surgical approach (MPA, MV, SV, or LPA). Outcomes between the groups were compared using the Short-Form 12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and range of motion (ROM) up to 2 years postoperative. Results: Sixty-eight MV patients, 8 SV patients, and 4 LPA patients were matched with groups of MPA patients. There was no difference in outcomes between the MPA and MV groups up to 2 years. The SV group had significantly higher SF-12 Physical Composite Score (PCS; p = 0.036) and WOMAC stiffness score (p = 0.014) at 2 years, but significantly lower flexion at 1 year (p = 0.022) than the MPA group. The LPA group had significantly lower SF-12 PCS (p = 0.011) and WOMAC function scores (p = 0.022) at 1 year than the MPA group. Conclusion: There was no significant difference between the MPA and MV approach. The SV approach had some improved long-term outcomes over the MPA aproach (SF-12 and WOMAC), but had significantly lower flexion at 1 year. The LPA group showed inferior outcomes than the MPA group but had more severe valgus preoperative deformity (p = 0.024). Further studies are required to investigate the potential benefit of quadriceps-sparing approaches. Contexte: Les voies chirurgicales d’arthroplastie totale du genou (ATG) sont les suivantes : parapatellaire interne (PI), subvastus (SV), midvastus (MV), et parapatellaire externe (PE); il n’est pas clair quelle voie est supérieure. Méthodes: Les patients qui ont subi une ATG dans notre établissement ont été classés rétrospectivement en groupes appariés selon la voie chirurgicale (PI, MV, SV ou PE). Les résultats des différents groupes ont été comparés au moyen du Short-Form 12 (SF-12), de l’indice Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), du score de la Knee Society (KSS) et de l’amplitude du mouvement jusqu’à 2 ans après l’opération. Résultats: Au total, 68 patients traités par voie MV, 8 par voie SV et 4 par voie PE ont été appariés avec des groupes de patients traités par voie PI. Il n’y avait aucune différence dans les résultats entre les groupes PI et MV jusqu’à 2 ans. Comparativement au groupe PI, le groupe SV avait des résultats significativement plus élevés pour le score physique fonctionnel (PCS) du SF-12 (p = 0,036) et le score de raideur de l’indice WOMAC (p = 0,014) après 2 ans, mais une flexion significativement plus faible après 1 an (p = 0,022). Encore comparativement au groupe PI, le groupe PE avait des résultats significativement plus faibles pour le PCS du SF-12 (p = 0,011) et les scores fonctionnels de l’indice WOMAC (p = 0,022) après 1 an. Conclusion: Il n’y avait pas de différence significative entre les voies PI et MV. La voie SV offrait de meilleures issues à long terme que la voie PI (SF-12 et WOMAC), mais une flexion significativement plus faible après 1 an. Le groupe PE a eu des issues moins bonnes que le groupe PI, mais présentait plus souvent une déformation valgus préopératoire grave (p = 0,024). D’autres études seront requises pour établir les bienfaits potentiels de voies évitant le quadriceps.
Amandeep Ghuman, Ahmer A. Karimuddin, Carl J. Brown, Manoj J. Raval, P. Terry Phang
Published: 1 September 2021
Canadian Journal of Surgery, Volume 64; https://doi.org/10.1503/cjs.007220

Abstract:
Summary Surgical site infections (SSI) pose significant morbidity after colorectal surgery. We sought to document current practices in colorectal surgery SSI prevention in British Columbia (BC). Reporting the current provincial landscape on SSI prevention helps to understand the foundation upon which improvements can take place. We surveyed all BC surgeons performing elective colon and rectal resections, and 97 surveys were completed (60% response rate). Eighty-six per cent of respondent hospitals tracked SSI rates. The reported superficial SSI was less than 5% and the anastomotic leak/organ space rate was less than 10%. All respondents gave preoperative prophylactic antibiotics, with 24% continuing antibiotics postoperatively; 62% are using oral antibiotics (OAB) and mechanical bowel preparation (MBP) and 29% use MBP without OAB. Areas for improvement include OAB with MBP and discontinuing prophylactic antibiotics postoperatively, as recommended by the World Health Organization.
Jans van der Merwe
Published: 1 September 2021
Canadian Journal of Surgery, Volume 64; https://doi.org/10.1503/cjs.013420

Abstract:
Summary Metal hypersensitivity (MHS) and trunnionosis are being looked at more frequently. Both entities pose a difficult concern for surgeons and patients alike. This commentary highlights the similarities and differences between the 2 conditions. When a surgeon suspects either MHS or trunnionosis, both should be considered in the differential diagnosis. Both conditions are rare and should be considered a diagnosis of exclusion. The commentary proposes an outline on how to diagnose and treat the 2 entities.
Andrew W. Kirkpatrick, Thomas West Clements, Jessica L. McKee, Chad G. Ball
Published: 1 September 2021
Canadian Journal of Surgery, Volume 64; https://doi.org/10.1503/cjs.017619

Abstract:
Summary Traumatic pneumothoraces remain a life-threatening problem that may be resolved quickly with timely diagnosis. Unfortunately, they are still not optimally managed. The most critically injured patients with hemodynamic instability require immediate diagnoses of potentially correctible conditions in the primary survey. Point-of-care ultrasonography (POCUS) performed by the responsible physician can be a tremendous adjunct to expediting diagnoses in the primary surgery and can typically be done in seconds rather than minutes. If more detailed sonographic examination is required, the secondary survey of the hemodynamically unstable patient is more appropriate. All involved in bedside care need to be conscious to efficiently integrate POCUS into resuscitation with the right intentions and goals to avoid sono-paralysis of the resuscitation sequence. Sono-paralysis has recently been described as critical situations wherein action is delayed through unnecessary imaging after a critical diagnosis has been made or unnecessary imaging details are sought despite an urgent diagnosis being made.
Back to Top Top