Canadian Journal of Surgery最新文献

Background: The Surgical Safety Checklist (SSC) is a communication tool used to improve patient safety and teamwork within operating rooms. Unlike the sign-in and timeout phases, the timing for completion of the sign-out phase is ambiguous, lacks a clear and definitive clinical anchor on when to be performed, and fails to capture important safety data related to the patient's emergence from anesthesia, wherein the risks of complications are greatest. We sought to assess perceptions of operating room team members on whether emergence from anesthesia is an appropriate clinical anchor to conduct the SSC sign-out phase.

Methods: In this single-centre proof-of-concept quality-improvement study, the sign-out phase of the SSC was performed following patient emergence from anesthesia. Operating room team members from surgery, anesthesiology, and nursing were approached to complete a self-administered questionnaire. Participants were asked whether, compared with routine sign-out performance, performing the sign-out phase following emergence from anesthesia maximized patient safety, compliance, communication, team member availability, and quality improvement. Responses were graded on a 5-point Likert scale.

Results: Eighty-two operating room team members participated in our study. After experiencing the intervention, most participants agreed or strongly agreed that performing the sign-out phase following emergence from anesthesia maximized patient safety (70.7%), compliance (67.1%), communication (75.6%), and quality improvement (67.0%). More than half agreed that performing the sign-out following emergence from anesthesia maximized team member availability (59.8%).

Conclusion: This proof-of-concept quality-improvement study suggests that emergence from anesthesia is an appropriate clinical anchor for the time to perform the SSC sign-out phase.

Background: The introduction of rentable electric scooters (e-scooters) has been associated with injury presentations to emergency departments (EDs). Our objective was to determine the incidence and severity of injuries from rentable e-scooters among adults presenting to EDs in a northern urban region.

Methods: Adults presenting to all Edmonton EDs with injuries related to rentable e-scooters during 3 summers (2019-2021) were eligible for inclusion. We identified e-scooter charts using multiple sources: administrative data, trauma registry, and text-based triage searching. Two independent reviewers assessed each patient for study inclusion; disagreements were resolved by content experts. Trained researchers performed data extraction and descriptive statistical analysis.

Results: We included 759 e-scooter-related injury presentations. The median age was 28 years, males and females were almost equally represented, 20% presented by ambulance, and 14% were triaged as urgent. Most patients had multiple injuries (62%), with fractures (32%) and head injuries (17%) being common. Helmet use was infrequent (2%) and concurrent substance use was prevalent (26%). Admission to hospital was uncommon (5.5%); however, 30% of patients presenting to an ED with an e-scooter injury required further follow-up, with 9% undergoing surgery within 30 days of their index visit.

Conclusion: Injuries related to rentable e-scooters are increasingly common. Most injured patients have multiple injuries and require investigations, and a third require further management. These injuries represent substantial burdens to patients and the health care system in Canada. Injury prevention strategies should be considered to reduce injuries.

Background: Gender diversity is lacking in the orthopedic workforce, and patient outcomes are known to be negatively affected when gender inequity exists. Following an unpublished needs assessment, we sought to evaluate participants' proposed solutions to gender inequity faced by female orthopedic surgeons in Canada and to translate the range of solutions into a medical education model.

Methods: Open-text responses from a gender-bias survey of Canadian orthopedic surgeons who identified as women were analyzed qualitatively by 2 experts. The questions covered the domain of changes required to improve the work environment. We used the latter 2 steps of Kern's educational framework as a lens to interpret the data and generate solutions.

Results: A total of 330 eligible surgeons were approached, and 220 (67.0%) completed the survey. Respondents provided more than 14 000 words of text for analysis. Using the themes of the unpublished needs assessment, we defined broad goals and specific objectives, including raising awareness, establishing an equitable playing field, drawing attention to male privilege, developing effective mentorship, eliminating harassment, and unburdening the second shift. We present solutions via educational strategies and evaluative methods based on Kern's framework.

Conclusion: We offer a road map for improving gender diversity in orthopedic surgery, based on survey results from Canadian women in orthopedic surgery, analyzed using a gender bias framework and an educational conceptual framework. We hope that this work will improve the surgical profession and patient care.

Background: High rates of hospital revisits after pediatric appendectomy are costly to the health care system, patients, and families. We sought to trial a bundle of interventions targeted at reducing the rate of unnecessary revisits to hospital in this population.

Methods: In February 2021, a working group of relevant stakeholders was created. In June 2021, the group developed and implemented interventions to reduce revisits in a staggered fashion. Interventions included increased education provided to patients and their families, as well as nursing staff, revised discharge pamphlets, and a post-discharge phone call from our nurse practitioner. We tracked revisit rates prospectively using run charts with comparison to historical controls.

Results: We tracked revisit rates from July 2018 to October 2022. A total of 793 appendectomies were performed. There was a downward trend in revisit rates, from 16.7% before interventions to 13.4% after intervention implementation, for a relative reduction of 20%. In the postintervention period, 193 appendectomies were performed, with 78.0% contacted by our nurse practitioner in the early postoperative period. Of those contacted, 74% received the discharge pamphlet and 98.7% of respondents expressed that the phone call was useful. Almost all respondents stated they would want the follow-up phone call if they were to have another child with appendicitis.

Conclusion: Simple, low-cost interventions aimed at improving education at time of discharge after pediatric appendectomy were associated with a reduction in unnecessary hospital revisits. Ongoing efforts are required to sustain results and assess efficacy of bundle elements to determine if additional initiatives may be beneficial in further reductions of revisits.

SummaryThe Canadian Undergraduate Surgical Education Committee (CUSEC) undertook a project to address variance in undergraduate surgical learning objectives among Canada's medical schools. Its aim was to compile a reasonable set of national undergraduate surgical learning objectives (NUSLOs) for all medical undergraduates and map them to the Medical Council of Canada (MCC) objectives. In phase 1, CUSEC invited Canada's 10 surgical specialty societies or associations to identify discipline-specific lists of undergraduate surgical learning objectives deemed essential for all Canada's medical students to achieve by the time of graduation. In phase 2, 8 medical students and 7 CUSEC faculty from 6 Canadian universities mapped each individual NUSLO to the corresponding MCC objectives, then to primary and secondary MCC objectives. By 2023, all 10 surgical specialty societies had derived, ratified, and submitted their discipline-specific NUSLOs, for a total of 72 major objectives, some of which had sub-objectives. All phase 1 NUSLOs were mapped to corresponding MCC objectives, with each NUSLO mapping to an average of 18 MCC objectives. Each NUSLO was then tiered to 1-2 primary MCC objectives. The NUSLOs and the NUSLO-MCC maps, now publicly posted on the CUSEC website, may serve as a foundational reference for students and teachers. They are a means by which Canada's medical schools can customize, standardize, and revise their undergraduate surgical curricula.

Background: Timing to surgery for acute cholecystitis remains variable, ranging from early (< 7 d) to delayed surgery (> 7 d). Accelerated surgery may result in better outcomes owing to reduced exposure to hypercoagulable and inflammatory states. We sought to determine the feasibility of a trial comparing accelerated surgery with standard care among patients with calculous acute cholecystitis.

Methods: We conducted a multicentre pilot randomized controlled trial. We randomly assigned adult patients with acute cholecystitis to receive accelerated surgery (i.e., goal of surgery within 6 hours of diagnosis) or standard care. The primary feasibility outcome included recruitment of 60 patients, randomly assigning the equivalent of 1 patient per site per month, and 95% follow-up at 90 days.

Results: Sixty patients (mean age 61.7, standard deviation [SD] 13.5, yr; 27 [45%] female) were randomly assigned to accelerated surgery (n = 31) or standard care (n = 29) from December 2019 to December 2021, with 2 recruitment pauses due to the COVID-19 pandemic. The median time from diagnosis to surgery was 5.8 (interquartile range [IQR] 4.4-11.1) hours in the accelerated care arm and 20.3 (IQR 6.8-26.8) hours in the standard care arm. Across 4 sites, 4.6 patients per month were randomly assigned. All patients completed the 90-day follow up.

Conclusion: In our pilot trial, we found that accelerated cholecystectomy was achievable. These results show the feasibility of a trial comparing accelerated and standard care among patients requiring surgery for acute cholecystitis and support a definitive trial.

Trial registration: ClinicalTrials.gov, no. NCT04033822.

Background: Trauma educational opportunities for general surgery residents in Canada are uncharacterized. We aimed to characterize these opportunities for and identify factors associated with such opportunities.

Methods: We performed a prospective cross-sectional study characterizing trauma educational opportunities within Canadian trauma programs. Data were collected during 1 summer week and 1 winter week. We summarized educational opportunities by trauma site and season and used multivariable modelling to evaluate factors associated with increased likelihood of procedure opportunities.

Results: Nine academic trauma centres participated. Most consults (93.9%) and trauma team activations (TTAs) (72.3%) were for blunt injuries, and most presentations were during the summer (67.2% TTAs + consults, 69.3% TTAs). Trauma services cared for a median of 14 (interquartile range [IQR] 10-20) inpatients, 4 (IQR 1-6) patients in the intensive care unit, and 0 (IQR 0-2) patients admitted to another service but subsequently followed by a trauma physician (i.e., consulting patients), which varied across hospitals (p < 0.001). Consult, TTA, nonoperative, and operative procedure volumes varied across sites. The most common operative procedures were laparotomies (36.4%), with 1.33 laparotomies per week per site. For nonlaparotomy operations, the maximum volume was 6 over 2 weeks. More operations occurred during summer (74.2%) than winter. Multivariable modelling determined that penetrating mechanisms (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.11-3.15) and TTAs with a trauma surgeon present (OR 2.37, 95% CI 1.59-3.54) were associated with increased likelihood of procedures.

Conclusion: Trauma educational opportunities remain heterogeneous across Canada. Higher volumes of patients with trauma were seen during the summer. Penetrating mechanism and TTAs with a trauma surgeon present appear to increase opportunities to perform procedures. Our results can inform general surgery training programs to optimize resident trauma training in Canada.