Canadian Journal of Surgery最新文献

Background: Surgical wait times affect patient outcomes, access to care, and surgeon well-being. The single-entry model (SEM) has been proposed to address these issues, but its implementation raises concerns among surgeons. We sought to explore surgeons' perspectives on surgical wait times, referral processes, and the potential effect of the SEM on improving access to surgical care in a major metropolitan Canadian city.

Methods: We conducted a qualitative descriptive study to explore the perspectives of surgeons at a large community hospital using semi-structured interviews. We used thematic analysis to identify key themes regarding surgical wait times, referral processes, and the SEM.

Results: We interviewed 10 surgeons with different specialties and administrative roles, and a median 16.5 years of experience. Participants expressed frustration with systemic inefficiencies, particularly regarding long wait times for consultations and surgeries. Key issues included overwhelming workloads, limited operating room availability, and nonspecific referrals, which often led to delayed patient care. Surgeons reported burnout from managing these delays. Although many participants viewed the SEM as a promising strategy to improve equitable access to care, others raised concerns about depersonalization of care and reduced surgeon autonomy. Some participants emphasized that, without concurrent reforms to funding models, the SEM could inadvertently reinforce existing disparities, particularly gender-based pay inequities.

Conclusion: Surgical wait times pose substantial challenges for both patient outcomes and surgeon well-being. The SEM holds promise for reducing delays and improving equity in patient access, but its successful implementation requires addressing concerns related to surgeon autonomy and workforce equity.

Background: Thoracic surgeons in Canada responded to the COVID-19 pandemic without existing precedence. The primary aim of this study was to understand how thoracic surgery care in Canada was affected by the pandemic in terms of volume, perioperative management, and patterns of practice.

Methods: Data were obtained using 2 questionnaires (18-item surgeon-specific and 13-item institution-specific questionnaires) in addition to the Canadian Association of Thoracic Surgery (CATS) national database. Outcomes included qualitative surgeon experiences and thoracic surgery volume from March 2020 to December 2022. Centres were separated into 3 levels of COVID-19 burden based on community prevalence.

Results: We received survey responses from 63 surgeons and 6 institutions. In-person consultation dropped by 57% during the pandemic. Preoperative cancer workups experienced minor (≤ 4 wk, 39%) and major (≥ 8 wk, 27%) delays. Operable lung and esophageal cancer experienced minor delays in treatment, while pure ground-glass opacities and benign esophageal pathology experienced major delays (25%) or cancellations (21%). Medical education shifted to virtual platforms, decreasing student involvement by 81%. Perceived factors affecting operating room availability included lack of staff, beds, and personal protective equipment.

Conclusion: There was a pan-Canadian reduction in thoracic surgery volume, regardless of regional COVID-19 caseload. Prioritization of thoracic oncology was observed, with a delay in care for minimally invasive and benign illness. Our findings illustrate how surgeons and institutions responded to the pandemic and inform strategies for Canadian thoracic practice in the event of future analogous events.

Background: Simultaneous bilateral total hip arthroplasty (SBTHA) has been associated with high blood loss and transfusion risk. We sought to analyze the effectiveness of a single intravenous dose of tranexamic acid (TXA) on blood loss and transfusion rates in SBTHA.

Methods: We retrospectively reviewed data from patients who underwent SBTHA with a single dose of TXA (20 mg/kg) before incision. We analyzed hematological parameters and transfusion rates. We performed a multivariate logistic regression analysis to identify independent risk factors for blood transfusion.

Results: We included 92 patients with a median age of 60 (interquartile range [IQR] 52 to 68) years. Of these, 48 (52.2%) were male. The median follow-up time was 4.6 (IQR 3.2 to 7.0) years. Six patients had transfusions, for a transfusion rate of 6.5%. The median hemoglobin levels before surgery, on postoperative day 1, and on the day of discharge were 144 (IQR 135 to 154) g/L, 107 (IQR 93 to 118) g/L, and 101.5 (IQR 90 to 111) g/L, respectively. Longer surgical time (adjusted odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01 to 1.07) and lower preoperative platelet count (adjusted OR 1.01, 95% CI 1.00 to 1.03) were significant risk factors for transfusion. Male sex (adjusted OR 0.04, 95% CI 0.004 to 0.40) and younger age (adjusted OR 0.92, 95% CI 0.86 to 0.99) were protective factors.

Conclusion: We found a low transfusion rate (6.5%) after SBTHA among patients administered a single dose of 20 mg/kg of TXA, with young patients and male patients at lower risk of requiring transfusions. Our results suggest that performing SBTHA with current blood management protocols is effective in patients with bilateral hip disease.

Background: Wellness research has expanded in surgery owing to the high prevalence of burnout. In this scoping review, we aim to identify trends of wellness interventions for surgeons and surgical trainees.

Methods: We identified studies on wellness interventions across surgical specialties. We categorized interventions based on the targeted wellness domain, including physical, social, emotional, intellectual, and occupational domains.

Results: We included 49 studies in the final analysis. Most focused on resident wellness (n = 40) and were categorized as an individual-level intervention (n = 21). General surgery was represented in most studies (n = 24). Interventions focused on ergonomics, mindfulness, stress reduction, work hours, and wellness programs. Since 2015, there has been a shift in the wellness domains addressed from physical and occupational, to mostly emotional.

Conclusion: The prevalence of individual-level interventions targeting emotional wellness reflects a belief that surgeons are responsible for their own wellness. Studies to date have largely focused on surgical trainees, with a dearth of research on measures to improve staff surgeon wellness. Methodologically sound intervention studies with objective outcome measures are lacking and needed to facilitate a culture of shared organizational responsibility for surgeon well-being.

Background: Delivering trauma care in Nunavik is challenging. Despite the benefits of trauma registries, no routine data collection captures data from Nunavik patients in Quebec's provincial database. We sought to compare trauma epidemiology from data collected on site in Nunavik with data from a governmental registry at a tertiary centre, hypothesizing sufficient cohort differences to justify a dedicated registry.

Methods: We conducted a retrospective review of 2 cohorts (2015 to 2019). The first cohort included patients at Kuujjuaq's Centre de santé Tulattavik de l'Ungava or Puvirnituq's Centre de santé Inuulitisivik (the Nunavik cohort) and the second cohort included patients admitted to the provincial referral centre for the Nunavimmiut at the Montreal General Hospital (MGH). Nunavik data were collected through chart review, while MGH data were obtained from the McGill University Health Centre Trauma Registry. We analyzed patient demographics, injury mechanisms, transfer characteristics, and modifiable risk factors using descriptive statistics.

Results: We identified 776 patients in the Nunavik cohort, of whom 42.0% were transferred to the MGH. Of all 776 trauma patients in Nunavik, only 14.3% were captured in the trauma registry. Among those transferred to the MGH, 33.9% were recorded in the registry, highlighting a gap in data representation. Patients in the Nunavik cohort were significantly younger (30 yr v. 37 yr, p < 0.001) and more often female (51.0% v. 38.8%, p < 0.001). Mechanisms of injury and vital signs also differed significantly (p < 0.001).

Conclusion: Data from many patients from Nunavik are not captured in the governmental database, with the trauma epidemiology in the region significantly differing from those presenting to the tertiary centre. A dedicated prospective, sustainable registry is needed to improve quality of care and outcomes in Nunavik.

Health equity and the social determinants of health are increasingly prioritized in health care delivery across North America and globally, yet academic medicine remains ill equipped to support equity-focused advocacy. We argue that this stems mainly from a gap in recognizing advocacy as an academic pillar alongside research, education, and administration. Advocacy is undervalued in academic medicine, as reflected in teaching, hiring, and promotion criteria and what is published in academic journals. Health equity is essential for the health of populations, and the current structure of academic medicine should be redesigned to recognize, value, and support equity-based advocacy efforts. Advocacy can be integrated in 2 key areas: medical education and faculty roles and promotion pathways. A new academic role, the surgeon-advocate - whose work focuses on the engagement, knowledge dissemination, and administration of advocacy-based work to affect system change - is vital for a paradigm shift that accepts advocacy into the essential work of academic medicine. The concept of a surgeon-advocate is not new and is vital to our identities as physicians. However, formally embracing advocacy within academic institutions represents the paradigm shift needed to move closer to health equity goals. This analysis proposes a critical revision to academic surgery and, more broadly, academic medicine. We provide practical steps to intentionally weave advocacy and health equity into the fabric of academic medical institutions to improve how we practise and serve our patients.

Background: The rapid evolution of genetic testing and availability of information has necessitated increased surgeon participation in genetics-related tasks. We sought to characterize knowledge, perceptions, attitudes, and barriers pertaining to genetic literacy among Canadian surgeons who manage patients with a hereditary predisposition to or confirmed cancer.

Methods: We distributed a Web-based survey to surgeons across Canada from June to December 2023 through relevant surgical societies. We analyzed quantitative and narrative data from the survey descriptively and thematically.

Results: We included 57 participants from 8 provinces (response rate 10%). Many surgeons (28/45, 62%) reported performing risk assessment, but 16% (7/45) reported counselling and 29% (13/45) reported ordering genetic testing. Surgeons reported low confidence in ordering testing and in interpreting and discussing implications of testing results. Most surgeons (35/39, 90%) expressed a desire for improvement in their knowledge and in their confidence in hereditary cancer genetics. Approval and funding for testing, referral to a genetic counsellor or medical geneticist, and availability of genetics clinics were reported as extreme barriers to providing care.

Conclusion: Practising surgeons in Canada participate in many genetics-related tasks, but they report low confidence and face barriers to genetic literacy. There is a need and desire for interventions targeting genetic literacy among surgeons in Canada.