Canadian Journal of Surgery最新文献

The incidence of early-onset colorectal cancer (CRC), defined as CRC occurring in individuals younger than 50 years, is increasing globally. Emerging evidence suggests that the incidence and prevalence of CRC in individuals aged 45-49 years approach those in individuals aged 50-59 years. To address this concerning trend, many health care systems and clinical specialist societies are advocating for lowering the age of initiation for CRC screening in individuals at average risk to 45 years. The present review, provided by the Canadian Association of General Surgeons Clinical Practice Committee, gives an overview of the current CRC screening guidelines in Canada, the rationale for earlier screening, and the challenges and impact of lowering the screening age to 45 years to health care systems in Canada.

Background: Sex differences in chronic postsurgical pain have been reported, with the main findings indicating that females experience a greater incidence and severity of pain than males; however, it remains unclear to what these sex differences are attributable. We sought to compare pain and related psychological factors between a matched sample of male and female patients 3 months and 1 year after Shouldice repair.

Methods: Male and female participants who underwent Shouldice repair were manually matched 1:1 and compared on 10 variables: age, body mass index, smoking status, preoperative depression and anxiety scores, living status (alone or with others), American Society of Anesthesiologists physical status health classification, preoperative chronic pain, preoperative hernia pain, preoperative pain catastrophizing scores, and nerve handling during surgery. Data on pain were collected from questionnaires administered 3 months and 1 year postoperatively, and data on participant clinical characteristics were collected from operative notes and patient charts.

Results: There were 28 matched male-female pairs at 3 months and 21 at 1 year. The average age preoperatively was 56.18 ± 12.48 years. At 3 months postoperative, 18 females and 6 males had pain (p = 0.001), with females reporting more frequent (p = 0.004) and longer durations (p = 0.005) of pain. The 3-month postoperative Brief Pain Inventory Numeric Rating Scale scores (0-10) showed that in terms of pain severity, females had higher "worst pain" (1.61 ± 1.85 v. 0.32 ± 0.77, p = 0.002), "average pain" (0.86 ± 1.08 v. 0.14 ± 0.45, p = 0.002), and "pain now" (0.43 ± 1.20 v. 0 ± 0, p = 0.010) scores than males. Significant differences were not found in the incidence, severity, frequency, or duration of pain between females and males at 1 year.

Conclusion: After matching on important confounders, sex differences were found in pain frequency, duration, incidence, and severity at 3 months after Shouldice repair. However, by 1 year after surgery the differences were no longer significant.

Trial registration: Clinicaltrials.gov # NCT03986060.

Background: Bibliometric analysis is a research tool for evaluating and analyzing scholarly output and impact within a specific domain. This study aimed to assess the quantity and quality of plastic surgery research conducted by Canadian-affiliated authors from 1999 to 2023.

Methods: We conducted a comprehensive bibliometric analysis using the Web of Science Core Collection to retrieve data from 60 leading plastic surgery journals, focusing on original articles and reviews published between 1999 and 2023. The InCites Benchmarking & Analytics platform evaluated the publications' quantity and quality. Quality assessment employed 2 key metrics:: category-normalized citation impact (CNCI) and the percentage of publications in the top quartile of journals (%Q1) based on impact factors. We used VOSviewer to map collaborative relationships among universities over various periods.

Results: Canada ranked as the 11th leading contributor globally, with 4446 publications. Nationally, the University of Toronto accounted for more than 30% of Canadian contributions. In terms of quality, Canada led with a CNCI of 1.09 and 21% of publications in the %Q1. Within Canada, McMaster University had the highest CNCI at 1.33, while Dalhousie University ranked highest in %Q1 at 32.3%. Our VOSviewer map of institutional collaborations revealed increased cooperation between Canadian universities and international institutions over the last 25 years.

Conclusion: Over the last 25 years, the trajectory of Canadian plastic surgery literature has been characterized by continuous expansion while maintaining high quality. Efforts should be made to continue to increase the quality and quantity of Canadian research while sustaining international collaborations.

Background: Use of poton pump inhibitors (PPIs) is associated with increased risk of Clostridioides difficile-associated colitis, pneumonia, and acute kidney injury. Their effect on postoperative complications is unknown. The objective of this study was to investigate the association between PPIs and the risk of C. difficile-associated colitis, pneumonia, and acute kidney injury following elective surgery.

Methods: In this population-based, matched cohort study, we identified patients who had filled a PPI prescription within 90 days before major elective surgery (2010-2019). Study outcomes included C. difficile-associated colitis, pneumonia, acute kidney injury, gastrointestinal bleeding, and death within 90 days of surgery. We matched patients 1-to-1 on the basis of age, sex, procedure, date of surgery, and a propensity score predicting PPI exposure. We used logistic regression to evaluate between-group differences.

Results: Of 313 163 patients, 89 047 (28.4%) used PPIs; of those, 79 681 were successfully matched to patients who did not use PPIs. The risk of the composite outcome (acute kidney injury, pneumonia, C. difficile-associated colitis, and death) among the patients who used PPIs was slightly higher than among the patients who did not use PPIs (10.6% v. 10.2 4%), and was driven primarily by a higher rate of pneumonia among those who used PPIs (4.0% v. 3.7%). There was a lower rate of gastrointestinal bleeding among the patients who used PPIs (1.6% v. 1.8%). The risk of pneumonia was most pronounced in the subgroup undergoing hip and knee replacement (odds ratio 1.21, 95% confidence interval 1.08-1.36; p = 0.001). There were no significant differences between groups with regard to rates of C. difficile-associated colitis or acute kidney injury.

Conclusion: We found that preoperative PPI use was associated with higher rates of pneumonia, particularly among patients undergoing hip and knee replacement surgery, and lower rates of gastrointestinal bleeding. Patients taking a PPI before surgery should be targeted for therapies aimed at reducing pneumonia risk, such as aggressive chest physiotherapy, following their operation.

Background: Traditionally, pulmonary thrombi following trauma were believed to occur secondary to embolization from deep vein thrombosis (DVT). However, computed tomography (CT) during initial trauma resuscitation has identified pulmonary thrombi, which raises the possibility of primary pulmonary thrombosis as a distinct clinical entity. This study identifies cases of pulmonary thrombosis identified immediately after trauma and describes associated injury patterns and treatments.

Methods: We conducted a retrospective review of the trauma and radiology registries at a Canadian level-1 trauma centre from January 2010 to April 2021. A chart review identified patients with pulmonary thrombi on initial CT. We extracted and analyzed patient demographic characteristics, mechanism of injury, summary of injuries, treatments, and outcomes.

Results: A total of 24 patients (15 male, 9 female; mean age 54, standard deviation [SD] 18.6, yr) met the inclusion criteria. All patients experienced blunt trauma (mean Injury Severity Score 23.5, SD 9.5). Rib fractures (n = 11, 46%), pneumohemothorax (n = 7, 29%), and spinal fractures (n = 8, 33%) were common. Four patients had a concomitant DVT, and 10 patients did not undergo assessment for DVT; 10 patients were identified as having primary pulmonary thrombosis. Treatment was started in 18 patients (75%): 9 patients were treated with dalteparin, 2 with dalteparin and inferior vena cava (IVC) filter, 6 with IVC filter in isolation, and 1 with IVC filter and intravenous heparin. Five patients (21%) died from their injuries.

Conclusion: Early pulmonary thrombosis was associated with chest injuries, often without DVT. These findings challenge the traditionally held view of DVT embolization as the cause of pulmonary thrombosis immediately following trauma and suggest that primary pulmonary thrombosis is a distinct clinical entity.

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common bariatric procedure, but patients often experience extended inpatient stays. Given that Enhanced Recovery After Surgery (ERAS) protocols aim to expedite recovery and discharge, we sought to evaluate the impact of introducing an overnight short-stay unit with ERAS protocols, along with transfer protocols for patients requiring prolonged care.

Methods: We retrospectively reviewed prospectively collected data on LRYGBs performed between November 2017 and December 2020. Postoperative evaluations were conducted 16-21 hours after surgery. Patients were educated about potential complications and required to stay within 1 hour of a tertiary centre for 7 days. We analyzed descriptive outcomes including length of stay (LOS), 30-day emergency department (ED) presentations, and 7-day and 30-day readmissions.

Results: Among the 439 patients, the postoperative day 1 discharge rate was 94.8%, and the day 2 discharge rate was 1.8%. A small proportion of patients (2.7%) required transfer for anticipated prolonged LOS, primarily for delayed intra-abdominal hemorrhage requiring reoperation (66.7%) and as a precautionary measure for technically challenging procedures (16.7%). Two brief admissions to the intensive care unit occurred, with no deaths. Overall, 45 (10.3%) patients presented to the ED within 30 days, 12 (2.7%) patients were readmitted within 7 days, and 18 (4.1%) patients were readmitted within 30 days. Gastrointestinal intolerance was the most common reason for readmission.

Conclusion: An ERAS protocol for LRYGB enabled safe next-day discharge for 94.8% of patients. Rates of ED presentation and readmission aligned with existing literature, supporting the feasibility of next-day discharge for appropriately selected patients. These findings contribute to the evidence base for optimizing postoperative care and enhancing patient outcomes in bariatric surgery.

Background: Most guidelines recommend use of sterile water in single-use plastic bottles for irrigation in colonoscopy, a recommendation extrapolated from case reports of infection linked to endoscopic retrograde cholangiopancreatography. Our objective was to identify evidence exploring the impact of tap versus sterile water in colonoscopy on patient, health care resource, and environmental outcomes.

Methods: We performed a scoping review and included any study examining the effects of irrigation source during colonoscopy. A health information specialist searched Embase, MEDLINE, CINAHL, and Web of Science from inception to March 2024 using Peer Review of Electronic Search Strategies standards. Two reviewers performed screening and data extraction using a standardized form. We conducted a quantitative analysis of patient outcomes.

Results: Of 335 identified articles, we included 3. All were prospective studies published between 1996 and 2002. Overall, 137 colonoscopies and 38 flexible sigmoidoscopies were reported. Two studies compared sterile versus tap water, with 7 of 118 (6%) and 35 of 327 (11%) positive water cultures, respectively. There were no clinical adverse events. One study compared tap water at warm versus room temperature and measured patient pain scores (2/10 and 4/10, respectively). Infectious complications were not reported.

Conclusion: There is limited evidence to support either tap or sterile water in irrigation for colonoscopy, but potable tap water may be a safe choice and is environmentally and economically more beneficial than sterile water. In the context of the climate crisis and increasing economic health care burden, tap water in reusable bottles should be strongly considered for irrigation in colonoscopy. Registration: Open Science Framework Registry, https://osf.io/8dgck.

Background: Disparate gender representation among Canadian academic surgeons is documented; however, the association of academic rank with research productivity across all surgical specialties is not well understood. Our objective was to assess differences in gender representation by academic rank and research productivity metrics for surgical specialties in Canadian academic centres.

Methods: This retrospective, cross-sectional, comparative study used online public databases in 2021. Data sources included the Canadian Resident Matching Service program descriptions, College of Physicians and Surgeons databases, the Scopus platform, and professional websites. Gender distribution by academic rank, research productivity metrics, institution, and surgical specialty were tested for a 0.5 proportion rate. We used a generalized logistic regression model adjusting for confounders to assess gender association with ordinally ranked academic rank. We defined significance by p < 0.05 with reported 95% confidence intervals.

Results: We assessed 10 surgical specialties across 17 Canadian academic institutions. Women surgeons were underrepresented in 16 out of 17 centres (p < 0.001), comprising the majority in only obstetrics-gynecology (p < 0.001). Women were also less represented as assistant (37%), associate (27%), and full professors (18%) (p < 0.001), with lower mean h-index (6.4, p < 0.001), years active in research (11.5, p < 0.001), number of publications (18, p < 0.001), and m-quotient (0.42, p < 0.001). Multivariate analysis showed that men were more likely to be represented in senior professorship regardless of research productivity, institution, and specialty determinants (odds ratio 1.30-1.33, p = 0.001-0.024).

Conclusion: Women surgeons were underrepresented across all academic ranks, were less likely to achieve senior professorship, and had lower research productivity metrics.