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Brophy SA, Minor S, French DG. Abdominal Compartment Syndrome Following Paraesophageal and Diaphragmatic Hernia Repair. ACG Case Rep J 2024; 11:e01344. [PMID: 38682075 PMCID: PMC11049705 DOI: 10.14309/crj.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
Abdominal compartment syndrome (ACS) is defined as a sustained intra-abdominal pressure ≥ 20 mm Hg, associated with new organ dysfunction. Postoperative ACS can occur following repair of hernias with loss-of-domain. Such loss-of-domain hernias are well described involving incisional hernias, less described involving Bochdalek congenital diaphragmatic hernias (CDHs), but not yet described involving paraesophageal hernias (PEHs) or Morgagni CDHs. We describe a case of postoperative ACS following laparoscopic repair of a PEH and Morgagni CDH. This case demonstrates that prophylactic omentectomy should be considered in select patients undergoing repair of large PEHs or CDHs, as ACS is a rare but potential complication.
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Affiliation(s)
- Shawn A. Brophy
- Division of Thoracic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Minor
- Divisions of General Surgery and Critical Care Medicine, Dalhousie University, Queen Elizabeth II Hospital Halifax, Nova Scotia, Canada
| | - Daniel G. French
- Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital Halifax, Nova Scotia, Canada
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Ryan JF, Engels PT, Vogt KN, Minor S, Mador BD. Redefining Trauma Training in Canada: A National Delphi Study on Curriculum, Educational Resources, and Training Initiatives. J Surg Educ 2024; 81:431-437. [PMID: 38281862 DOI: 10.1016/j.jsurg.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 11/14/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE This study aims to develop a set of curriculum recommendations to support trauma training in Canadian general surgery residency programs. DESIGN A modified Delphi study was conducted with a panel of trauma and surgical education experts. Proposed curriculum components were developed from Canadian trauma surgery exposure and educational needs assessment data. Panelists were asked to rate each potential curriculum component for inclusion (mandatory or exemplary) or exclusion in the ideal and feasible trauma training curriculum. SETTING This national Delphi study was conducted in the Canadian trauma education context. PARTICIPANTS A panel of trauma experts and surgeons holding leadership positions in training programs and professional societies across Canada were invited to participate. RESULTS Nineteen panelists representing all geographic regions of Canada achieved consensus on a set of curriculum components. The panel was largely in agreement with the RCPSC trauma competencies. At the end of the study, 71 items were considered mandatory for all programs (such as dedicated trauma rotations, trauma resuscitation and operative skills courses, structured trauma teaching within academic half day, and simulation experiences), and 21 items were considered exemplary (such as program funding for trauma courses, and opportunities to participate in trauma research and quality improvement projects). CONCLUSIONS This study suggests a framework of education components for curricular reform for trauma training in Canadian general surgery residency programs. Such recommendations include rotations, formal courses and certifications, education resources, and simulation experiences to supplement limited clinical exposure.
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Affiliation(s)
- Joanna F Ryan
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Paul T Engels
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kelly N Vogt
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Samuel Minor
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brett D Mador
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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Engels PT, Shi Q, Coates A, Allen L, Priestap F, Moffat BS, Vogt KN, Joos E, Minor S, Marchand M, Williams E, Evans C, Mador B, Widder S, Ziessman M, Lampron J, Ball CG, Rice TJ. Trauma resident exposure in Canada and operative numbers (TraumaRECON): a national multicentre retrospective review of operative and nonoperative trauma teaching. Can J Surg 2024; 67:E99-E107. [PMID: 38453348 PMCID: PMC10927282 DOI: 10.1503/cjs.000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND General surgeons play an important role in the provision of trauma care in Canada and the current extent of their trauma experience during training is unknown. We sought to quantify the operative and nonoperative educational experiences among Canadian general surgery trainees. METHODS We conducted a multicentre retrospective study of major operative exposures experienced by general surgery residents, as identified using institutional trauma registries and subsequent chart-level review, for 2008-2018. We also conducted a site survey on trauma education and structure. RESULTS We collected data on operative exposure for general surgery residents from 7 programs and survey data from 10 programs. Operations predominantly occurred after hours (73% after 1700 or on weekends) and general surgery residents were absent from a substantial proportion (25%) of relevant trauma operations. The structure of trauma education was heterogeneous among programs, with considerable site-specific variability in the involvement of surgical specialties in trauma care. During their training, graduating general surgery residents each experienced around 4 index trauma laparotomies, 1 splenectomy, 1 thoracotomy, and 0 neck explorations for trauma. CONCLUSION General surgery residents who train in Canada receive variable and limited exposure to operative and nonoperative trauma care. These data can be used as a baseline to inform the application of competency-based medical education in trauma care for general surgery training in Canada.
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Affiliation(s)
- Paul T Engels
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Qian Shi
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Angela Coates
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Laura Allen
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Fran Priestap
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Bradley S Moffat
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Kelly N Vogt
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Emily Joos
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Samuel Minor
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Mylene Marchand
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Erin Williams
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Chris Evans
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Brett Mador
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Sandy Widder
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Markus Ziessman
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Jacinthe Lampron
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Chad G Ball
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Timothy J Rice
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Shi, Coates, Rice); the Department of Surgery, Western University, London, Ont. (Allen, Priestap, Moffat, Vogt); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Joos); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Sherbrooke, Sherbrooke, Que. (Marchand); the Department of Emergency Medicine, Queen's University, Kingston, Ont. (Williams, Evan); the Department of Surgery, University of Alberta, Edmonton, Alta. (Mador, Widder); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Ziessman); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Lampron); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
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Kirkpatrick AW, Coccolini F, Minor S. Why are there no data? Critically ill patients deserve better protection from both regulatory authorities and surgeons. J Trauma Acute Care Surg 2023; 95:e61-e62. [PMID: 37563752 DOI: 10.1097/ta.0000000000004033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
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Kirkpatrick AW, Coccolini F, Tolonen M, Minor S, Catena F, Gois E, Doig CJ, Hill MD, Ansaloni L, Chiarugi M, Tartaglia D, Ioannidis O, Sugrue M, Colak E, Hameed SM, Lampela H, Agnoletti V, McKee JL, Garraway N, Sartelli M, Ball CG, Parry NG, Voght K, Julien L, Kroeker J, Roberts DJ, Faris P, Tiruta C, Moore EE, Ammons LA, Anestiadou E, Bendinelli C, Bouliaris K, Carroll R, Ceresoli M, Favi F, Gurrado A, Rezende-Neto J, Isik A, Cremonini C, Strambi S, Koukoulis G, Testini M, Trpcic S, Pasculli A, Picariello E, Abu-Zidan F, Adeyeye A, Augustin G, Alconchel F, Altinel Y, Hernandez Amin LA, Aranda-Narváez JM, Baraket O, Biffl WL, Baiocchi GL, Bonavina L, Brisinda G, Cardinali L, Celotti A, Chaouch M, Chiarello M, Costa G, de'Angelis N, De Manzini N, Delibegovic S, Di Saverio S, De Simone B, Dubuisson V, Fransvea P, Garulli G, Giordano A, Gomes C, Hayati F, Huang J, Ibrahim AF, Huei TJ, Jailani RF, Khan M, Luna AP, Malbrain MLNG, Marwah S, McBeth P, Mihailescu A, Morello A, Mulita F, Murzi V, Mohammad AT, Parmar S, Pak A, Wong MPK, Pantalone D, Podda M, Puccioni C, Rasa K, Ren J, Roscio F, Gonzalez-Sanchez A, Sganga G, Scheiterle M, Slavchev M, Smirnov D, Tosi L, Trivedi A, Vega JAG, Waledziak M, Xenaki S, Winter D, Wu X, Zakaria AD, Zakaria Z. The unrestricted global effort to complete the COOL trial. World J Emerg Surg 2023; 18:33. [PMID: 37170123 PMCID: PMC10173926 DOI: 10.1186/s13017-023-00500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) ( https://clinicaltrials.gov/ct2/show/NCT03163095 ). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study. METHODS The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer. DISCUSSION OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of "damage control"; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention. TRIAL REGISTRATION National Institutes of Health ( https://clinicaltrials.gov/ct2/show/NCT03163095 ).
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Affiliation(s)
- Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, EG23T2N 2T9, Canada.
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Matti Tolonen
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Samuel Minor
- Departments of Critical Care Medicine and Surgery, Dalhousie University, Halifax, NS, Canada
| | - Fausto Catena
- Department of Surgery, Bufalini Hospital, Cesena, Italy
| | - Emanuel Gois
- Department of Surgery, Londrina State University, and National COOL Coordinator for Brazil, Londrina, Brazil
| | - Christopher J Doig
- Departments of Critical Care Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael D Hill
- Department of Clinical Neuroscience and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada
| | - Luca Ansaloni
- General Surgery I, San Matteo Hospital Pavia, University of Pavia, Pavia, Italy
| | - Massimo Chiarugi
- Emergency Surgery and Trauma Center, University of Pisa, Pisa, Italy
| | - Dario Tartaglia
- Emergency Surgery and Trauma Center, University of Pisa, Pisa, Italy
| | - Orestis Ioannidis
- 4th Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | | | - Elif Colak
- University of Samsun, Samsun Training and Research Hospital, Samsun, Turkey
| | - S Morad Hameed
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Hanna Lampela
- Department of Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Espoo, Finland
| | | | - Jessica L McKee
- Global Project Manager, COOL Trial and the TeleMentored Ultrasound Supported Medical Interventions Research Group, Calgary, AB, Canada
| | - Naisan Garraway
- Departments of Surgery and Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, Global Alliance for Infections in Surgery, Macerata, Italy
| | - Chad G Ball
- Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB, Canada
| | - Neil G Parry
- Departments of Surgery and Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kelly Voght
- Departments of Surgery and Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lisa Julien
- Department of Surgery, NSHA-Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Jenna Kroeker
- Departments of Surgery and Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Derek J Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center, University of Colorado, Denver, CO, USA
| | | | - Elissavet Anestiadou
- 4th Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | | | - Konstantinos Bouliaris
- General Surgery Department of Koutlimbaneio, Triantafylleio General Hospital of Larissa, Larissa, Thessaly, Greece
| | | | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Francesco Favi
- Chirurgia Generale E d'Urgenza, Ospedale M. Bufalini - Cesena, AUSL Della Romagna, Cesena, Italy
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | - Joao Rezende-Neto
- Trauma and Acute Care Surgery, General Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Arda Isik
- General Surgery Department, Istanbul Medeniyet University School of Medicine Istanbul, Istanbul, Turkey
| | - Camilla Cremonini
- Emergency Surgery and Trauma Center, University of Pisa, Pisa, Italy
| | - Silivia Strambi
- Emergency Surgery and Trauma Center, University of Pisa, Pisa, Italy
| | - Georgios Koukoulis
- General Surgery Department of Koutlimbaneio, Triantafylleio General Hospital of Larissa, Larissa, Thessaly, Greece
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | - Sandy Trpcic
- Trauma and Acute Care Surgery, General Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Alessandro Pasculli
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | - Erika Picariello
- General Surgery Unit, Ospedale M. Buffalini Di Cesena, Cesena, Italy
| | - Fikri Abu-Zidan
- College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Ademola Adeyeye
- Division of Surgical Oncology, Afe Babalola University Multisystem Hospital, Ado-Ekiti, Nigeria
| | - Goran Augustin
- University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Felipe Alconchel
- Virgen de la Arrixaca University Hospital IMIB-Arrixaca, Ctra. Madrid-Cartagena, S/N, Murcia, Spain
| | - Yuksel Altinel
- Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Luz Adriana Hernandez Amin
- Nurse Master of Nursing, Professor and Coordinator of the teaching-service relationship, Faculty of Health Sciences, University of Sucre, Sincelejo, Colombia
| | - José Manuel Aranda-Narváez
- Trauma and Emergency Surgery Unit. General, Digestive and Transplantation Surgery Department, University Regional Hospital of Málaga, Malaga, Spain
| | | | | | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Bonavina
- Department of Surgery, University of Milan Medical School, Milan, Italy
| | - Giuseppe Brisinda
- Department of Surgery, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Luca Cardinali
- Department of Surgery, General Hospital Madonna del Soccorso, San Benedetto del Tronto, Italy
| | - Andrea Celotti
- General Surgery Unit, UO Chirurgia Generale - Ospedale Maggiore Di Cremona, Cremona, Italy
| | - Mohamed Chaouch
- Department of Visceral and Digestive Surgery, Monastir University, Monastir, Tunisia
| | - Maria Chiarello
- Department of Surgery, Azienda Sanitaria Provinciale Di Cosenza, Cosenza, Italy
| | - Gianluca Costa
- Fondazione Policlinico Campus Bio-Medico, University Campus Bio-Medico of Rome, Rome, Italy
| | - Nicola de'Angelis
- Colorectal and Digestive Surgery Unit-DIGEST Department, Beaujon University Hospital AP-HP, University Paris Cité, Clichy, France
| | - Nicolo De Manzini
- Department of General Surgery, Cattinara University Hospital, Trieste, Italy
| | - Samir Delibegovic
- Department of Proctology, Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Italy
| | - Belinda De Simone
- Unit of Digestive and Metabolic Minimally Invasive Surgery, Clinique Saint Louis, Poissy, Poissy, Ile de France, France
- Unit of Emergency and General Surgery, Guastalla Hospital, AUSL Reggio Emilia, Guastalla, Italy
| | - Vincent Dubuisson
- Chirurgie Digestive, Service de Chirurgie Vasculaire Et, Générale University Hospital of Bordeaux FR, Bordeaux, France
| | | | | | - Alessio Giordano
- Emergency and General Consultant Surgeon, Nuovo Ospedale "S. Stefano", Azienda ASL Toscana Centro, Prato, Italy
| | - Carlos Gomes
- Surgery Unit, Hospital Universitário Terezinha de Jesus, SUPREMA, Juiz de Fora, Brazil
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Jinjian Huang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | | | | | | | - Mansoor Khan
- General Surgery, University Hospitals, Sussex, UK
| | | | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- International Fluid Academy, Lovenjoel, Belgium
| | - Sanjay Marwah
- Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | | | | | - Alessia Morello
- Department of General Surgery, Madonna del Soccorso Hospital - San Benedetto del Tronto, Italy, Italy
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Rio, Greece
| | - Valentina Murzi
- Department of Surgical Science, Cagliari State University, Cagliari, Italy
| | | | | | - Ajay Pak
- Department of General Surgery, King George's Medical University, Lucknow, UP, India
| | - Michael Pak-Kai Wong
- School of Medical Sciences & Hospital, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Caterina Puccioni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Kemal Rasa
- Department of General Surgery, Hüseyin Kemal Raşa, Anadolu Medical Center, Kocaeli, Turkey
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Francesco Roscio
- Division of General and Minimally Invasive Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Antonio Gonzalez-Sanchez
- Trauma and Emergency Surgery Unit. General, Digestive and Transplantation Surgery Department, University Regional Hospital of Málaga, Malaga, Spain
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Maximilian Scheiterle
- Emergency Surgery Unit and Trauma Team, Careggi University Hospital, Florence, Italy
| | | | - Dmitry Smirnov
- Department of Surgery, South Ural State Medical University, Chelyabinsk City, Russia
| | - Lorenzo Tosi
- Department of General Surgery, University of Bologna, Bologna, Italy
| | | | | | | | - Sofia Xenaki
- Department of General Surgery, University Hospital of Heraklion, Crete, Greece
| | | | - Xiuwen Wu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Andee Dzulkarnean Zakaria
- Department of Surgery, School of Medical Sciences and Hospital USM, Universiti Sains Malaysia, Georgetown, Malaysia
| | - Zaidi Zakaria
- Department of Surgery, School of Medical Sciences and Hospital USM, Universiti Sains Malaysia, Georgetown, Malaysia
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Engels PT, Lee J, Rice TR, Nenshi R, Ball CG, Hameed M, Widder S, Minor S, Ahmed N, Parry N, Vogt K. The next frontier of acute care general surgery: fellowship training. Can J Surg 2023; 66:E42-E44. [PMID: 36731912 PMCID: PMC9904803 DOI: 10.1503/cjs.020821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 02/04/2023] Open
Abstract
Acute care surgery (ACS) is an area of surgical specialization within general surgery and a model for clinical care delivery that has proliferated over the last 2 decades. Models of ACS in Canada exist in both academic and community settings and are used to manage patients in need of emergency general surgery (EGS) care, with or without the provision of trauma care. The implementation of the ACS model has changed the landscape of patient care, surgical education and the workforce, providing an option for some general surgeons to exclude EGS care from their regular practice. The rise of ACS as a concentration of surgical skill and content expertise has resulted in the establishment of dedicated ACS fellowship training programs. This is a landmark in the evolution of general surgery, as well as a stepping stone on the path to improving patient care, surgical education and scholarly endeavour in this field.
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Affiliation(s)
- Paul T Engels
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); the Department of Surgery, Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Lee); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Hameed); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Toronto, Toronto, Ont. (Ahmed); the Department of Surgery, Western University, London, Ont. (Parry, Vogt)
| | - Jennie Lee
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); the Department of Surgery, Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Lee); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Hameed); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Toronto, Toronto, Ont. (Ahmed); the Department of Surgery, Western University, London, Ont. (Parry, Vogt)
| | - Timothy R Rice
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); the Department of Surgery, Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Lee); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Hameed); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Toronto, Toronto, Ont. (Ahmed); the Department of Surgery, Western University, London, Ont. (Parry, Vogt)
| | - Rahima Nenshi
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); the Department of Surgery, Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Lee); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Hameed); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Toronto, Toronto, Ont. (Ahmed); the Department of Surgery, Western University, London, Ont. (Parry, Vogt)
| | - Chad G Ball
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); the Department of Surgery, Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Lee); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Hameed); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Toronto, Toronto, Ont. (Ahmed); the Department of Surgery, Western University, London, Ont. (Parry, Vogt)
| | - Morad Hameed
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); the Department of Surgery, Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Lee); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Hameed); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Toronto, Toronto, Ont. (Ahmed); the Department of Surgery, Western University, London, Ont. (Parry, Vogt)
| | - Sandy Widder
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); the Department of Surgery, Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Lee); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Hameed); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Toronto, Toronto, Ont. (Ahmed); the Department of Surgery, Western University, London, Ont. (Parry, Vogt)
| | - Samuel Minor
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); the Department of Surgery, Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Lee); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Hameed); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Toronto, Toronto, Ont. (Ahmed); the Department of Surgery, Western University, London, Ont. (Parry, Vogt)
| | - Najma Ahmed
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); the Department of Surgery, Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Lee); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Hameed); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Toronto, Toronto, Ont. (Ahmed); the Department of Surgery, Western University, London, Ont. (Parry, Vogt)
| | - Neil Parry
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); the Department of Surgery, Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Lee); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Hameed); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Toronto, Toronto, Ont. (Ahmed); the Department of Surgery, Western University, London, Ont. (Parry, Vogt)
| | - Kelly Vogt
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); the Department of Surgery, Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Lee); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Hameed); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, N.S. (Minor); the Department of Surgery, University of Toronto, Toronto, Ont. (Ahmed); the Department of Surgery, Western University, London, Ont. (Parry, Vogt)
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Meschino MT, Vogt KN, Allen L, Saddik M, Nenshi R, Van Heest R, Saleh F, Widder S, Minor S, Joos E, Parry NG, Murphy PB, Ball CG, Hameed M, Engels PT. Operating room use for emergency general surgery cases: analysis of the Patterns of Complex Emergency General Surgery in Canada study. Can J Surg 2023; 66:E13-E20. [PMID: 36596587 PMCID: PMC9829034 DOI: 10.1503/cjs.008120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Access to the operating room (OR) is variable among emergency general surgery (EGS) services, with some having dedicated EGS ORs, and others only a shared queue. Currently in Canada, only a limited number of acute care surgery services have dedicated daytime operating room (OR) access; hence, we aimed to describe the burden of after-hours EGS operating in Canada and differences associated with OR access. METHODS In this multicentre retrospective cohort study, we used data from a previously conducted study designed to evaluate nonappendiceal, nonbiliary disease across 8 Canadian hospitals. We performed a secondary analysis to describe booking priorities and timing of operative interventions, compare sites with and without access to a dedicated EGS daytime OR, and identify differences in morbidity and mortality based on timing of operative intervention. RESULTS Among 1244 patients, operations were performed during weekday daytime in 521 cases (41.9%), in the evening in 279 (22.4%), on the weekend in 293 (23.6%) and overnight in 151 (12.1%). Operating room booking priority was more than 2 hours to 8 hours in 657 cases (52.8%), more than 8 hours to 24 hours in 334 (26.9%) and more than 24 hours to 48 hours in 253 (20.3%). Substantial variation in booking priority was observed for the same preoperative diagnoses. Sites with dedicated EGS ORs performed a greater proportion of cases during daytime versus overnight compared to sites without dedicated EGS ORs (198/237 [83.5%] v. 323/435 [74.2%], p = 0.006). No significant differences in outcome were found between cases performed during the daytime, evening and overnight. CONCLUSION We found considerable variation in OR booking priority within the same preoperative diagnoses among EGS patients in Canada. Sites with dedicated EGS ORs performed more cases during weekday daytime compared to sites without dedicated EGS ORs; however, this study showed no evidence of compromised outcomes based on OR timing.
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Affiliation(s)
- Michael T Meschino
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Kelly N Vogt
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Laura Allen
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Maisa Saddik
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Rahima Nenshi
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Rardi Van Heest
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Fady Saleh
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Sandy Widder
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Samuel Minor
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Emilie Joos
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Neil G Parry
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Patrick B Murphy
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Chad G Ball
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Morad Hameed
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
| | - Paul T Engels
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
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Minor S, Rowe J, Hoogerboord M. Dystrophic calcification within biologic graft occurring with use of calcium sulfate antibiotic beads masquerading as an enteric fistula. J Surg Case Rep 2022; 2022:rjac270. [PMID: 35721267 PMCID: PMC9202568 DOI: 10.1093/jscr/rjac270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
The rare (<2%) development of calcium deposits in soft tissue, known as dystrophic calcification (DC) with the use of Stimulan® (Biocomposites Ltd, Wilmington, NC) absorbable, calcium sulfate antibiotic beads (CSABs) in the setting of orthopedic surgery has previously been described. However, the use of CSAB in hernia repair is relatively novel and its association with the development of DC in this setting has not been previously reported. We describe a case where DC following abdominal wall reconstruction with CSAB was misinterpreted on CT imaging as an enteric fistula and almost resulted in an unnecessary emergency surgical procedure.
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Affiliation(s)
- Samuel Minor
- Department of Surgery and Critical Care Medicine, Dalhousie University , Halifax, Nova Scotia , Canada
| | - Judy Rowe
- Department of Radiology, Dalhousie University , Halifax, Nova Scotia , Canada
| | - Marius Hoogerboord
- Department of Surgery, Dalhousie University , Halifax, Nova Scotia , Canada
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Minor S, Allen L, Meschino MT, Nenshi R, van Heest R, Saleh F, Widder S, Engels PT, Joos E, Parry NG, Murphy PB, Ball CG, Hameed M, Vogt KN. Failure to rescue in emergency general surgery in Canada. Can J Surg 2022; 65:E215-E220. [PMID: 35318241 PMCID: PMC9259385 DOI: 10.1503/cjs.008820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The risk of death after a postoperative complication — known as failure to rescue (FTR) — has been proposed to be superior to traditional benchmarking outcomes, such as complication and mortality rates, as a measure of system quality. The purpose of this study was to identify the current FTR rate in emergency general surgery (EGS) centres across Canada. We hypothesized that substantial variability exists in FTR rates across centres. Methods: In this multicentre retrospective cohort study, we performed a secondary analysis of data from a previous study designed to evaluate operative intervention for nonappendiceal, nonbiliary disease by 6 EGS services across Canada (1 in British Columbia, 1 in Alberta, 3 in Ontario and 1 in Nova Scotia). Patients underwent surgery between Jan. 1 and Dec. 31, 2014. We conducted univariate analyses to compare patients with and without complications. We performed a sensitivity analysis examining the mortality rate after serious complications (Clavien–Dindo score 3 or 4) that required a surgical intervention or specialized care (e.g., admission to intensive care unit). Results: A total of 2595 patients were included in the study cohort. Of the 206 patients who died within 30 days, 145 (70.4%) experienced a complication before their death. Overall, the mortality rate after any surgical complication (i.e., FTR) was 16.0%. Ranking of sites by the traditional outcomes of complication and mortality rates differed from the ranking when FTR rate was included in the assessment. Conclusion: There was variability in FTR rates across EGS services in Canada, which suggests that there is opportunity for ongoing quality-improvement efforts. This study provides FTR benchmarking data for Canadian EGS services.
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Affiliation(s)
- Samuel Minor
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Laura Allen
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Michael T Meschino
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Rahima Nenshi
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Rardi van Heest
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Fady Saleh
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Sandy Widder
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Paul T Engels
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Emilie Joos
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Neil G Parry
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Patrick B Murphy
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Chad G Ball
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Morad Hameed
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
| | - Kelly N Vogt
- From the Department of Surgery, Dalhousie University, Halifax, NS (Minor, Meschino, Nenshi); the Department of Surgery, Western University, London, Ont. (Allen, Parry, Vogt); the Department of Surgery, William Osler Health System, Brampton, Ont. (van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, McMaster University, Hamilton, Ont. (Engels); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball)
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Brennan K, Patel P, Drohan A, Minor S. Biologic mesh infection with Candida albicans after abdominal wall reconstruction with calcium sulphate antibiotic beads: A case report. IDCases 2021; 26:e01351. [PMID: 34877259 PMCID: PMC8633862 DOI: 10.1016/j.idcr.2021.e01351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/20/2022] Open
Abstract
Mesh infection after abdominal wall reconstruction is a rare and usually devastating complication. Herein, we describe a unique case of a delayed and non-lethal Candida albicans mesh infection after abdominal wall reconstruction with placement of a biologic graft impregnated with antibiotics. Mesh explantation was not required, and the wound healed by secondary intention. This work suggests that locally delivered antibiotics may change the culprit microbes of skin infections to more unusual species such as Candida spp. Future research is required to study the effect of including antifungal agents in the locally delivered antimicrobials for abdominal wall reconstructions with biological meshes.
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Affiliation(s)
- Kelly Brennan
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pooja Patel
- Department of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashley Drohan
- Department of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samuel Minor
- Department of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
Implication Statement
The Department of Critical Care at Dalhousie University developed a smartphone app to improve the quality of learner orientation to the intensive care unit (ICU). The app increased satisfaction with orientation and was perceived as useful. It was ranked as the second most valued resource for orientation after other residents. There is potential to improve the experience of learners with this popular technology.
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Affiliation(s)
- Olga Bednarek
- Division of General Surgery, Dalhousie University, Nova Scotia, Canada
| | - Osama Loubani
- Division of General Surgery, Dalhousie University, Nova Scotia, Canada
| | - Samuel Jessula
- Division of General Surgery, Dalhousie University, Nova Scotia, Canada
| | - Samuel Minor
- Division of General Surgery, Dalhousie University, Nova Scotia, Canada
- Department of Critical Care, Dalhousie University, Nova Scotia, Canada
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Minor S, Brown CJ, Rooney PS, Hodde JP, Julien L, Scott TM, Karimuddin AA, Raval MJ, Phang PT. Single-stage repair of contaminated hernias using a novel antibiotic-impregnated biologic porcine submucosa tissue matrix. BMC Surg 2020; 20:58. [PMID: 32228664 PMCID: PMC7106678 DOI: 10.1186/s12893-020-00715-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 03/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background Single-stage repair of incisional hernias in contaminated fields has a high rate of surgical site infection (30–42%) when biologic grafts are used for repair. In an attempt to decrease this risk, a novel graft incorporating gentamicin into a biologic extracellular matrix derived from porcine small intestine submucosa was developed. Methods This prospective, multicenter, single-arm observational study was designed to determine the incidence of surgical site infection following implantation of the device into surgical fields characterized as CDC Class II, III, or IV. Results Twenty-four patients were enrolled, with 42% contaminated and 25% dirty surgical fields. After 12 months, 5 patients experienced 6 surgical site infections (21%) with infection involving the graft in 2 patients (8%). No grafts were explanted. Conclusions The incorporation of gentamicin into a porcine-derived biologic graft can be achieved with no noted gentamicin toxicity and a low rate of device infection for patients undergoing single-stage repair of ventral hernia in contaminated settings. Trial registration The study was registered March 27, 2015 at www.clinicaltrials.gov as NCT02401334.
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Affiliation(s)
- Samuel Minor
- QE2 Hospital, QEII Health Sciences Centre Dalhousie University, 1278 Tower Road, Halifax, NS, B3H 2Y9, Canada.
| | - Carl J Brown
- St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Paul S Rooney
- Royal Liverpool Hospital, Prescot Street, Merseyside, Liverpool, L7 8XP, UK
| | - Jason P Hodde
- Cook Biotech Incorporated, 1425 Innovation Place, West Lafayette, IN, 47906, USA
| | - Lisa Julien
- QE2 Hospital, QEII Health Sciences Centre Dalhousie University, 1278 Tower Road, Halifax, NS, B3H 2Y9, Canada
| | - Tracy M Scott
- St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Ahmer A Karimuddin
- St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Manoj J Raval
- St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - P Terry Phang
- St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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13
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Ball CG, Murphy P, Verhoeff K, Albusadi O, Patterson M, Widder S, Hameed SM, Parry N, Vogt K, Kortbeek JB, MacLean AR, Engels PT, Rice T, Nenshi R, Khwaja K, Minor S. A 30-day prospective audit of all inpatient complications following acute care surgery: How well do we really perform? Can J Surg 2020; 63:E150-E154. [PMID: 32216251 DOI: 10.1503/cjs.019118] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Acute care surgery (ACS) and emergency general surgery (EGS) services must provide timely care and intervention for patients who have some of the most challenging needs. Patients treated by ACS services are often critically ill and have both substantial comorbidities and poor physiologic reserve. Despite the widespread implemention of ACS/EGS services across North America, the true postoperative morbidity rates remain largely unknown. Methods In this prospective study, inpatients at 8 high-volume ACS/EGS centres in geographically diverse locations in Canada who underwent operative interventions were followed for 30 days or until they were discharged. Readmissions during the 30-day window were also captured. Preoperative, intraoperative and postoperative variables were tracked. Standard statistical methodology was employed. Results A total of 601 ACS/EGS patients were followed for up to 30 inpatient or readmission days after their index emergent operation. Fifty-one percent of patients were female, and the median age was 51 years. They frequently had substantial medical comorbidities (42%) and morbid obesity (15%). The majority of procedures were minimally invasive (66% laparoscopic). Median length of stay was 3.3 days and the early readmission (< 30 d) rate was 6%. Six percent of patients were admitted to the critical care unit. The overall complication and mortality rates were 34% and 2%, respectively. Cholecystitis (31%), appendicitis (21%), bowel obstruction (18%), incarcerated hernia (12%), gastrointestinal hemorrhage (7%) and soft tissue infections (7%) were the most common diagnoses. The morbidity and mortality rates for open surgical procedures were 73% and 5%, respectively. Conclusion Nontrauma ACS/EGS procedures are associated with a high postoperative morbidity rate. This study will serve as a prospective benchmark for postoperative complications among ACS/EGS patients and subsequent quality improvement across Canada.
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Affiliation(s)
- Chad G. Ball
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Patrick Murphy
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Kevin Verhoeff
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Omar Albusadi
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Matthew Patterson
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Sandy Widder
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - S. Morad Hameed
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Neil Parry
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Kelly Vogt
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - John B. Kortbeek
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Anthony R. MacLean
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Paul T. Engels
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Timothy Rice
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Rahima Nenshi
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Kosar Khwaja
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
| | - Samuel Minor
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor)
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Abstract
Background In situ trauma simulations allow for the trauma team and emergency department to practise team dynamics, resuscitation and logistics in a safe environment. The goal of this investigation was to show the feasibility of an in situ trauma simulation program at a Canadian level 1 trauma centre. Methods We performed a retrospective review of in situ simulations (maximum 20 min, followed by a 10-min debriefing session) at a level 1 trauma centre from 2015 to 2017. Errors were categorized according to the National Patient Safety Agency risk assessment matrix by 3 independent raters and assigned consequence scores (assessing potential harm) and likelihood scores (assessing the likelihood of potential harm). A risk score was calculated as the product of the mean consequence and likelihood scores. Errors per simulation and the number of simulations required for error resolution were recorded. Results We reviewed 8 in situ simulations and identified 54 errors, of which 7 were related to medications, 20 to equipment, 21 to environment/staffing and 6 to training. The mean consequence score was 2.85/5 (standard deviation [SD] 0.75, intraclass correlation coefficient [ICC] 28%), indicating minor to moderate harm. The mean likelihood score was 2.82/5 (SD 0.55, ICC 41%), indicating unlikely to possible. The mean risk score was 8.42/25 (SD 3.19, ICC 43%). One error (2%) was low risk, 23 (43%) were moderate risk, 26 (48%) were high risk, and 4 (7%) were extreme risk. Conclusion In situ trauma simulations are feasible in a Canadian centre and provide a safe environment to identify and rectify errors.
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Affiliation(s)
- Samuel Minor
- From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS (Minor, Jessula); the Department of Critical Care, Dalhousie University, Halifax, NS (Minor, Green); Trauma Nova Scotia, Halifax, NS (Minor, Green); the Department of Surgery, Dalhousie University, Halifax, NS (Green); and the Department of Emergency Medicine, Dalhousie University, Halifax, NS (Green)
| | - Robert Green
- From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS (Minor, Jessula); the Department of Critical Care, Dalhousie University, Halifax, NS (Minor, Green); Trauma Nova Scotia, Halifax, NS (Minor, Green); the Department of Surgery, Dalhousie University, Halifax, NS (Green); and the Department of Emergency Medicine, Dalhousie University, Halifax, NS (Green)
| | - Samuel Jessula
- From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS (Minor, Jessula); the Department of Critical Care, Dalhousie University, Halifax, NS (Minor, Green); Trauma Nova Scotia, Halifax, NS (Minor, Green); the Department of Surgery, Dalhousie University, Halifax, NS (Green); and the Department of Emergency Medicine, Dalhousie University, Halifax, NS (Green)
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DeGirolamo K, D'Souza K, Apte S, Ball CG, Armstrong C, Reso A, Widder S, Mueller S, Gillman LM, Singh R, Nenshi R, Khwaja K, Minor S, de Gara C, Hameed SM. A day in the life of emergency general surgery in Canada: a multicentre observational study. Can J Surg 2018; 61:237-243. [PMID: 30067181 PMCID: PMC6066383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Emergency general surgery (EGS) services are gaining popularity in Canada as systems-based approaches to surgical emergencies. Despite the high volume, acuity and complexity of the patient populations served by EGS services, little has been reported about the services' structure, processes, case mix or outcomes. This study begins a national surveillance effort to define and advance surgical quality in an important and diverse surgical population. METHODS A national cross-sectional study of EGS services was conducted during a 24-hour period in January 2017 at 14 hospitals across 7 Canadian provinces recruited through the Canadian Association of General Surgeons Acute Care Committee. Patients admitted to the EGS service, new consultations and off-service patients being followed by the EGS service during the study period were included. Patient demographic information and data on operations, procedures and complications were collected. RESULTS Twelve sites reported resident coverage. Most services did not include trauma. Ten sites had protected operating room time. Overall, 393 patient encounters occurred during the study period (195/386 [50.5%] operative and 191/386 [49.5%] nonoperative), with a mean of 3.8 operations per service. The patient population was complex, with 136 patients (34.6%) having more than 3 comorbidities. There was a wide case mix, including gallbladder disease (69 cases [17.8%]) and appendiceal disease (31 [8.0%]) as well as complex emergencies, such as obstruction (56 [14.5%]) and perforation (23 [5.9%]). CONCLUSION The characteristics and case mix of these Canadian EGS services are heterogeneous, but all services are busy and provide comprehensive operative and nonoperative care to acutely ill patients with high levels of comorbidity.
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Affiliation(s)
- Kristin DeGirolamo
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Karan D'Souza
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Sameer Apte
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Chad G Ball
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Christopher Armstrong
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Artan Reso
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Sandy Widder
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Sarah Mueller
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Lawrence M Gillman
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Ravinder Singh
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Rahima Nenshi
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Kosar Khwaja
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Samuel Minor
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Chris de Gara
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - S Morad Hameed
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
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16
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DeGirolamo K, D'Souza K, Apte S, Ball CG, Armstrong C, Reso A, Widder S, Mueller S, Gillman LM, Singh R, Nenshi R, Khwaja K, Minor S, de Gara C, Hameed SM. A day in the life of emergency general surgery in Canada: a multicentre observational study. Can J Surg 2018; 61:13517. [PMID: 29806805 DOI: 10.1503/cjs.013517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Emergency general surgery (EGS) services are gaining popularity in Canada as systems-based approaches to surgical emergencies. Despite the high volume, acuity and complexity of the patient populations served by EGS services, little has been reported about the services' structure, processes, case-mix or outcomes. This study begins a national surveillance effort to define and advance surgical quality in an important and diverse surgical population. METHODS A national cross-sectional study of EGS services was conducted during a 24-hour period in January 2017 at 14 hospitals across 7 Canadian provinces recruited through the Canadian Association of General Surgeons Acute Care Committee. Patients admitted to the EGS service, new consultations and off-service patients being followed by the EGS service during the study period were included. Patient demographic information and data on operations, procedures and complications were collected. RESULTS Twelve sites reported resident coverage. Most services did not include trauma. Ten sites had protected operating room time. Overall, 393 patient encounters occurred during the study period (195/386 [50.5%] operative and 191/386 [49.5%] nonoperative), with a mean of 3.8 operations per service. The patient population was complex, with 136 patients (34.6%) having more than 3 comorbidities. There was a wide case-mix, including gallbladder disease (69 cases [17.8%]) and appendiceal disease (31 [8.0%]) as well as complex emergencies, such as obstruction (56 [14.5%]) and perforation (23 [5.9%]). CONCLUSION The characteristics and case-mix of these Canadian EGS services are heterogeneous, but all services are busy and provide comprehensive operative and nonoperative care to acutely ill patients with high levels of comorbidity.
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Affiliation(s)
- Kristin DeGirolamo
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Karan D'Souza
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Sameer Apte
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Chad G Ball
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Christopher Armstrong
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Artan Reso
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Sandy Widder
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Sarah Mueller
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Lawrence M Gillman
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Ravinder Singh
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Rahima Nenshi
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Kosar Khwaja
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Samuel Minor
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Chris de Gara
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - S Morad Hameed
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
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Avery P, Salm L, Bird F, Hutchinson A, Matthies A, Hudson A, Jarman H, Nilsson MB, Konig T, Tai N, Fevang E, Hognestad B, Abrahamsen HB, Cheetham OV, Thomas MJC, Rooney KD, Murray J, Tunnicliff M, Collinson JW, Brown T, Pritchett C, Pritchett CSA, Jadav M, Meredith G, Plumb J, Harris S, Langford R, Hunter JG, Sage A, Madden R, Flamank O, Broadbent B, Marsh S, Lewis H, Daniels E, Roberts N, Hunter JG, Sage A, Madden R, Flamank O, Broadbent B, Marsh S, Lewis H, Daniels E, Lin N, Roberts N, Bulford S, Houghton-Budd S, Pearson S, Clear-Hill M, Menzies DJ, Leonard JP, Keogh C, Quinn R, Hinds JD, Roberts N, Ashton-Cleary D, Jadav M, Mahmood I, El-Menyar A, Younis B, Khalid A, Nabir S, Ahmed MN, Al-Yahri O, Al-Thani H, Young K, Hendrickson SA, Phillips G, Gardiner MD, Hettiaratchy S, Crossland AA, Hudson A, Brassington NC, Hudson A, McWhirter E, Reid BO, Rehn M, Uleberg O, Krüger AJ, Jennings C, Kapadia Y, Bew D, Townsend J, Hurst TP, Foster EA, Brown TB, Collinson J, Pritchett C, Slade T, Tønsager K, Rehn M, G.Ringdal K, J.Krüger A, Hesselfeldt R, Wulffeld S, Sonne A, Rasmussen LS, Steinmetz J, Renninson TJ, Thomson N, Pynn H, Hooper TJ, Hudson A, Dawson J, Matthies A, Friberg ML, Rognås L, Wills JFG, Hudson A, Turner CDA, Rehn M, Nunn J, Erdogan M, Green RS, Minor S, Erdogan M, Hartlen K, Green RS, Bird R, Grupping RL, Stacey AM, Rehn M, Lockey DJ, Abiks S, Cutler L, Monaghan K, Al-Rais A, Hymers C, Bloomer R, Kapadia Y, Seidenfaden SC, Riddervold IS, Kirkegaard H, Juul N, Bøtker MT, Gao A, Perkins Z, Grier G, Tzannes A, Hudson-Peacock NJ, Otto Q, Phillipson L, Thomas R, Heyworth A, Otto Q, Hudson-Peacock NJ, Phillipson L, Heyworth A, Ley E, Banner D, Heyworth A, Ley E, Benson M, Hudson-Peacock N, Stone T, Ley E, Rousson L, Heyworth A, Lineham BA, Lee MJ, Gough M, Seligman WH, Thould HE, Dinsmore A, Tan C, Thompson J, Eynon CA, Lockey DJ, Wahlin RMR, Lindström V, Ponzer S, Vicente V, Eligio P, Hudson A, Young R, Amiras D, Sinha I. London Trauma Conference 2015. Scand J Trauma Resusc Emerg Med 2016; 24 Suppl 1:78. [PMID: 27357386 PMCID: PMC4928155 DOI: 10.1186/s13049-016-0248-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
I1: Trauma, Pre-hospital and Cardiac Arrest Care 2015 Pascale Avery, Leopold Salm, Flora Bird A1: Retrospective evaluation of HEMS ‘Direct to CT’ protocol Anja Hutchinson, Ashley Matthies, Anthony Hudson, Heather Jarman A2 Rush hour – Crush hour: temporal relationship of cyclist vs. HGV trauma admissions. A single site observational study Maria Bergman Nilsson, Tom Konig, Nigel Tai A3 Semiprone position endotracheal intubation during continuous cardiopulmonary resuscitation in drowned children with regurgitation: a case report and experimental manikin study Espen Fevang, Børge Hognestad, Håkon B. Abrahamsen A4 An audit of CO2 A-a gradient in non-trauma patients receiving pre-hospital anaesthesia Olivia V Cheetham, Matthew JC Thomas, Kieron D Rooney A5 Can the use of c-spine immobilisation collars be avoided in non-trauma patients presenting to the Emergency Department? Josephine Murray, Malcolm Tunnicliff A6 Curriculum mapping in ED point of care simulation Joseph W Collinson, Thomas Brown, Christopher Pritchett A7 Point of care multidisciplinary trauma team simulation & participant satisfaction in a geographically remote trauma unit in Cornwall Christopher SA Pritchett, Mark Jadav, Gareth Meredith, Jamie Plumb, Steve Harris, Roger Langford A8 Conservative management of head injury inpatients - the challenge of simplifying injury management in a non-neurosurgical hospital JG Hunter, A Sage, R Madden, O Flamank, B Broadbent, S Marsh, H Lewis, E Daniels, N Roberts A9 Improving the care of traumatic brain injury at non-neurosurgical hospitals: Introducing a head injury pathway and single place of care is associated with significant improvements in neurological observation JG Hunter, A Sage, R Madden, O Flamank, B Broadbent, S Marsh, H Lewis, E Daniels, N Lin, N Roberts A10 The experience of inter-disciplinary students undertaking cardiac arrest moulage training Samuel Bulford, Silas Houghton-Budd, Sam Pearson, Megan Clear-Hill A11 Impact brain apnoea – nine cases David J Menzies, James P Leonard, Conor Keogh, Ray Quinn, John D Hinds A12 Time well spent? Improving the performance improvement programme in a busy Trauma Unit N Roberts, D Ashton-Cleary, M Jadav A14 Clinical significant and outcome of pulmonary contusions in patients with blunt chest trauma Ismail Mahmood, Ayman El-Menyar, Basil Younis, Ahmed Khalid, Syed Nabir, Mohamed Nadeem Ahmed, Omer Al-Yahri, Hassan Al-Thani A15 Plastics operative workload in major trauma centres: a national prospective survey Katie Young, Susan A. Hendrickson, Georgina Phillips, Matthew D. Gardiner, Shehan Hettiaratchy A16 A survey to assess the accuracy of estimating height by pre-hospital clinicians: can we reliably predict those most at risk of serious injury? Alexandra Alice Crossland, Anthony Hudson A17 An audit of the cause, outcome and adherence to treatment Standard Operating Procedure (SOP) for all traumatic cardiac arrests at a Helicopter Emergency Medical Service over a 12-month period Nicholas C Brassington, Anthony Hudson, Emily McWhirter A18 Should we “stay-and-play? A study of patient physiology in Norwegian Helicopter Emergency Services Bjørn O Reid, Marius Rehn, Oddvar Uleberg, Andreas J Krüger A19 Training in resuscitative thoracotomy: have we cracked it? A survey of higher Emergency Medicine trainees in London Cara Jennings, Yasmin Kapadia, Duncan Bew A20 London’s Air Ambulance (LAA): 25-years of drownings in an urban environment Jenny Townsend, Tom P Hurst, Elizabeth A Foster A21 Live patients in trauma simulation – more than just simulation on a shoestring? Thomas B Brown, Joseph Collinson, Christopher Pritchett, Toby Slade A22 Collecting core data in pre-hospital critical care using a consensus based template Kristin Tønsager, Marius Rehn, Kjetil G.Ringdal, Andreas J.Krüger A23 Prehospital interventions before and after implementation of a physician staffed helicopter Rasmus Hesselfeldt, Sandra Wulffeld, Asger Sonne, Lars S. Rasmussen, Jacob Steinmetz A24 Duration of ventilation following prehospital drug assisted intubation; a retrospective review Thomas J Renninson, Nadine Thomson, Harvey Pynn, Timothy J Hooper A25 Non-haemorrhagic shock in trauma: a novel guideline for management in ED Anthony Hudson, Jacinta Dawson, Ashley Matthies A26 Patient-tailored triage decisions by anaesthetist-staffed pre-hospital critical care teams Morten Langfeldt Friberg, Leif Rognås A27 Anatomical accuracy and appropriate sizing of pre-hospital thoracostomies Jessica FG Wills, Anthony Hudson A28 Pre-hospital management of mass casualty civilian shootings Conor DA Turner, Marius Rehn A30 The prevalence of alcohol-related trauma recidivism: a systematic review James Nunn, Mete Erdogan, Robert S. Green A31 Development of a hospital-wide program for simulation-based training in trauma care and management Samuel Minor, Mete Erdogan, Kathy Hartlen, Robert S. Green A32 Out of Hospital Cardiac Arrests (OOHCA); lessons from Hollywood Ruth Bird, Rachael L. Grupping A33 Mechanism of injury as a predictor of severity of injury in road traffic collisions: a literature review Amelia M. Stacey, Marius Rehn, David J. Lockey A34 Lessons to be learned from prehospital airway intervention documentation? Are airway intervention documentation templates as successful in-hospital as prehospitally? S. Abiks, L. Cutler, K. Monaghan, A. Al-Rais, C. Hymers, R. Bloomer, Y. Kapadia A35 Novel biomarkers in prehospital management of traumatic brain injury (the PreTBI study protocol) Sophie-Charlott Seidenfaden, Ingunn S. Riddervold, Hans Kirkegaard, Niels Juul, Morten T. Bøtker A36 Hospital outcomes of traumatic railway incidents: a seven-year observational retrospective study of a major trauma centre Alice Gao, Zane Perkins; Gareth Grier, Alex Tzannes A37 Does taking a third crew member affect the on-scene time of HEMS jobs? Nathan Hudson-Peacock, Quentin Otto, Laurie Phillipson, Rik Thomas, Ainsley Heyworth A38 Does pre-hospital rapid sequence induction affect on-scene time of HEMS jobs? Quentin Otto, Nathan Hudson-Peacock, Laurie Phillipson, Ainsley Heyworth, Erica Ley A39 Code red: shock index as a prehospital indicator of massive haemorrhage Daniel Banner, Ainsley Heyworth, Erica Ley A40 Air ambulance tasking: how accurate are our current methods? Madeleine Benson, Nathan Hudson-Peacock, Tony Stone, Erica Ley, Louise Rousson, Ainsley Heyworth A41 Modern trauma burden in a district general hospital Beth A Lineham, Matthew J Lee, Martin Gough A42 Establishing a legal service for major trauma patients in two UK major trauma centres William H Seligman, Hannah E Thould, Andrew Dinsmore, Charlotte Tan, Julian Thompson, C Andy Eynon, David J Lockey A43 Prehospital assessment and care of patients – a study of the use of guidelines when assessing head trauma Rebecka M Rubenson Wahlin, Veronica Lindström, Sari Ponzer, Veronica Vicente A44 An audit of pre-hospital blood pressure management resulting from head injury Pamela Eligio, Anthony Hudson A45 The surgical contribution of surface shading volumetric rendering techniques in rib fracture management Robert Young, Dimitri Amiras, Ian Sinha
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Nantais J, Dumbarton TC, Farah N, Maxan A, Zhou J, Minor S, Lehmann C. Impact of methylene blue in addition to norepinephrine on the intestinal microcirculation in experimental septic shock. Clin Hemorheol Microcirc 2015; 58:97-105. [PMID: 25227191 DOI: 10.3233/ch-141874] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Methylene blue (MB) has been used with some success as a treatment for the vasoplegia of vasopressor-refractory septic shock. The putative mechanism of action of MB is the inhibition of endothelial nitric oxide within the microvasculature and improved responsiveness to endogenous catecholamines (norepinephrine (NE)). However, to date, no study has demonstrated the microcirculatory effect of methylene blue in septic shock. The objective of this randomized, controlled, animal study was to show, in an experimentally-induced, septic shock model in rats, the effects of MB and NE on global hemodynamics and the microcirculation. Mean arterial pressure (MAP) was drastically reduced following bacterial endotoxin (lipopolysaccharide, LPS) administration in animals not receiving vasopressors. Only the combination of NE + MB restored MAP to control levels by the end of the three hour experiment. Intravital microscopy of the microcirculation was performed in the terminal ileum in order to examine functional capillary density in intestinal muscle layers and the mucosa, as well as leukocyte activation in venules (rolling, adhesion to the endothelium). Untreated LPS animals showed a significant increase in leukocyte adhesion and a decrease in capillary perfusion in the intestinal microcirculation. In groups receiving NE or NE+MB, we observed a significant decrease in leukocyte adhesion and improved functional capillary density, indicating that microvasculature function was improved. This study suggests that methylene blue may be able to improve hemodynamics while preserving microvascular function in septic shock.
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Affiliation(s)
- Jordan Nantais
- Department of General Surgery, Dalhousie University, Halifax, Canada
| | - Tristan C Dumbarton
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
| | - Nizam Farah
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada Department of Microbiology and Immunology, Dalhousie University, Halifax, Canada
| | - Alexander Maxan
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada Department of Microbiology and Immunology, Dalhousie University, Halifax, Canada
| | - Juan Zhou
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada Department of Microbiology and Immunology, Dalhousie University, Halifax, Canada
| | - Samuel Minor
- Department of General Surgery, Dalhousie University, Halifax, Canada
| | - Christian Lehmann
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada Department of Microbiology and Immunology, Dalhousie University, Halifax, Canada Deparment of Pharmacology, Dalhousie University, Halifax, Canada
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Abstract
BACKGROUND The open abdomen is an increasingly used technique that is applied in a wide variety of clinical situations. The ABThera Open Abdomen Negative Pressure Therapy System is one of the most common and successful temporary closure systems, but it has limited ability to close the fascia in approximately 30% of patients. The abdominal reapproximation anchor system (ABRA) is a dynamic closure system that seems ideal to manage patients who may not achieve primary fascial closure with ABThera alone. We report on the use of the ABRA in conjunction with the ABThera in patients with an open abdomen. METHODS We retrospectively analyzed patients with an open abdomen managed with the ABThera and ABRA between January 2007 and December 2012 at the Halifax Infirmary, QEII Health Science Centre, Halifax, Nova Scotia. RESULTS Sixteen patients had combination therapy using the ABRA and ABThera systems for treatment of the open abdomen. After removing patients who died prior to closure, primary fascial closure was achieved in 12 of 13 patients (92%). CONCLUSION We observed a high rate of primary fascial closure in patients with an open abdomen managed with the ABThera system in conjuction with the ABRA. Applying mechanical traction in addition to the ABThera should be considered in patients predicted to be at high risk for failure to achieve primary fascial closure.
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Dumbarton TC, Gorman SK, Minor S, Loubani O, White F, Green R. Local cutaneous necrosis secondary to a prolonged peripheral infusion of methylene blue in vasodilatory shock. Ann Pharmacother 2012; 46:e6. [PMID: 22388329 DOI: 10.1345/aph.1q560] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To report a case of methylene blue extravasation and subsequent tissue necrosis in a patient with refractory septic shock. CASE SUMMARY A 47-year-old female presented with febrile neutropenia secondary to chemotherapy. The patient quickly decompensated to refractory septic shock in the critical care unit despite implementation of early goal-directed therapy as well as intravenous norepinephrine and vasopressin to stabilize her hemodynamic status. She received a 16-hour infusion of 1% methylene blue 0.25 mg•kg(-1)•h(-1), titrated up to 0.5 mg•kg(-1)•h(-1), via a peripheral intravenous catheter. Ten hours after the start of the methylene blue infusion, she experienced a local extravasation injury, which led to distal digital necrosis. While her hemodynamic status improved dramatically, allowing discharge from the intensive care unit and eventually to home, the extravasation site became necrotic and required debridement and skin graft. DISCUSSION Methylene blue is a vasoactive chemical that has been shown to provide hemodynamic stability in the treatment of refractory septic shock. Methylene blue administration is not considered standard of practice in the treatment of refractory septic shock and many aspects of its dosing, route, duration, and adverse effects are poorly described. As such, there is little guidance for its administration. We postulate that, in our patient, in the presence of systemic vasopressin and norepinephrine, methylene blue caused extensive vasoconstriction at the site of extravasation, resulting in tissue ischemia and necrosis. Tissue necrosis secondary to peripheral intravenous extravasation has not been previously described and is not listed as an adverse outcome on the drug monograph. The Naranjo probability scale indicates that the tissue necrosis was probably caused by the methylene blue extravasation. CONCLUSIONS To mitigate future risk to limb and skin, we recommend that methylene blue infusions be delivered via central venous catheter. Extra care should be given to patients with risk factors for extravasation, such as sedation, presence of systemic disease, proximal intravenous puncture sites, and improperly placed catheters.
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Dumbarton TC, Minor S, Yeung CK, Green R. Prolonged methylene blue infusion in refractory septic shock: a case report. Can J Anaesth 2011; 58:401-5. [PMID: 21246318 DOI: 10.1007/s12630-011-9458-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Methylene blue (MB) has been advocated for the treatment of refractory hemodynamic instability in patients with septic shock. However, the use of MB infusions in septic shock is not considered standard treatment, and the available literature describes infusions of short duration, typically less than six hours. CLINICAL FEATURES We report a case of septic shock in a 67-yr-old male who required maximal vasopressor support with norepinephrine, epinephrine, and vasopressin. Despite standard protocols for the treatment of septic shock, the patient's hemodynamic status was refractory 80 hr post admission. However, initiation of a MB infusion resulted in the rapid restoration of hemodynamic stability and a subsequent decrease in vasopressor requirements. Multiple attempts to discontinue the MB infusion resulted in immediate and repeated increases in vasopressor requirements, necessitating a continuous infusion with a slow taper of MB for 120 hr. Ultimately, the patient survived the illness and was discharged home. We observed no adverse events that could be attributed to the use of MB. CONCLUSION In our patient, the use of MB resulted in hemodynamic stability unattained with standard vasopressor support. Further research is warranted on the use of MB in patients with septic shock.
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Affiliation(s)
- Tristan C Dumbarton
- Department of Undergraduate Medicine, Dalhousie University, Halifax, NS, Canada
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Gillman LM, Vergis A, Park J, Minor S, Taylor M. 58. Stories - Structured operative reporting in enteric surgerys. CLIN INVEST MED 2007. [DOI: 10.25011/cim.v30i4.2819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The purpose of this study was to determine whether the introduction of a Standardized Operative Dictation Template improved the quality of resident dictation.
General surgery residents (N = 20) from the University of Manitoba participated in the study. All residents were shown a standardized surgical procedure video and then asked to dictate an operative report. Residents were randomized with the intervention group receiving the Operative Dictation Template. Three months later, all residents were retested. Resident comfort level with dictation and satisfaction with the template was evaluated with a questionnaire. Dictations were evaluated by two blinded independent reviewers using the previously validated SAFE-OR assessment tool. This tool consists of a Structured Assessment Form (SAF) scored out of 45 and a Global Quality Ratings Scale (GQRS) out of 36. Pre and post scores were analyzed using a two-tailed Wilcoxon signed rank test.
Subjective comfort level with dictation, as measured by responses on a five point Likert scale, improved significantly in the intervention group (p=0.02). In addition, 90% of residents in the intervention group subjectively reported their dictations improved because of the template. There was no overall difference in the quality of dictation in the intervention group pre and post intervention as measured by the SAF (28.6 vs. 30.0; p=0.36) and GQRS (21.7 vs. 21.8, p=0.96). However, junior resident subgroup analysis revealed statistically significant improvement in the intervention on both the SAF (23.2 vs. 28.3; p=0.02) and GQRS (17.1 vs. 20.4; p=0.02). Senior resident subgroup analysis showed no difference in the intervention group on either the SAF (36.8 vs. 32.4; p=0.07) and GQRS (28.5 vs. 23.9; p=0.07).
The Operative Dictation Template can result in a significant improvement in resident comfort level with dictation and has the potential to improve the quality of junior resident dictations.
Eichholz AC, Van Voorhis BJ, Sorosky JI, Smith BJ, Sood AK. Operative note dictation: should it be taught routinely in residency programs? Obstetrics and Gynecology 2004; 103:342-6.
Menzin AW, Spitzer M. Teaching operative dictation. A survey of obstetrics/gynecology residency program directors. Journal of Reproductive Medicine 2003; 48:850-2.
Moore RA. The dictated operative note: important but is it being taught? Journal of the American College of Surgeons 2000; 190:639-40.
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Vergis A, Gillman L, Taylor M, Minor S, Park J. 51. Structured assessment format for evaluating operative reports (SAFE-OR) in general surgery. CLIN INVEST MED 2007. [DOI: 10.25011/cim.v30i4.2812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study determined the construct validity, inter-rater reliability and internal consistency of a “Structured Assessment Format for Evaluating Operative Reports” (SAFE-OR) in general surgery. The assessment instrument was developed using consensus criteria set forth by the Canadian Association of General Surgeons. It includes a structured assessment and a global quality rating scale. Residents divided into novice and experienced groups viewed and dictated a video-taped laparoscopic sigmoid colectomy. Transcriptions were then graded by blinded, independent faculty evaluators using SAFE-OR.
Twenty-one residents participated in the study. Mean structured assessment scores (out of 44) were significantly lower for novice versus experienced residents (23.3 ± 5.2 vs 34.1 ± 6.0, t=0.001). Mean global quality scores (out of 45) were similarly lower for novice residents (25.6 ± 4.7 vs 35.9 ± 7.6, t=0.006). Inter-class correlation coefficients were 0.98 (95% CI 0.96-0.99) for structured assessment and 0.93 (95% CI 0.83-0.97) for global quality scales. Cronbach’s alpha coefficients for internal consistency were 0.85 for structured assessment and 0.96 for global quality assessment scales.
SAFE-OR demonstrates significant construct validity, excellent inter-rater reliability and high internal consistency. This tool will allow educators to objectively evaluate the quality of trainee operative reports and ultimately provide a mechanism for implementing, monitoring, and refining curriculum for operative dictation communication skills.
Moore R. The dictated operative note: important but is it being taught? Journal of the American College of Surgeons 2000; 190(5):639-40.
Novitsky Y, Sing R, et al. Prospective, blinded evaluation of accuracy of operative reports dictated by surgical residents. The American Surgeon 2005; 71(8):627-31.
Wanzel K, Ward R, et al. Teaching the surgical craft: From selection to certification. Current Problems in Surgery 2002; 39(6):573-659.
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Minor S, Park J, Belliveau P, Walker R. A better lifestyle during surgical clerkship may not increase application rates to general surgery. World J Surg 2007; 31:607-11; discussion 612. [PMID: 17322971 DOI: 10.1007/s00268-006-0267-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lifestyle has been identified by numerous studies as the number one deterrent to pursuing a career in general surgery. This study tests the hypothesis that a better lifestyle during general surgery clerkship correlates with a higher application rate to general surgery. METHODS Canadian Residency Matching Service data from the past 10 years were used to identify institution-specific application rates to general surgery. Through a survey of all fourth-year medical students applying to general surgery in Canada and Canadian undergraduate surgery program directors, the lifestyle of each general surgery clerkship was described and given a score. RESULTS Multiple descriptions of the clerkship structure were obtained for every school in Canada to reduce recall bias, with an average of 4 sources per program. One school stood out as the most prolific producer of general surgery applicants, with an average of 7.9% of the total class applying to general surgery each year. This represented 80% more general surgery applicants relative to the national average (p < 0.05). Surprisingly, however, this institution also had the worst clerkship lifestyle score, having a higher call requirement, not sending their clerks home at noon post call, and placing a higher burden of responsibility on their clerks. CONCLUSIONS This study suggests that a lifestyle-friendly surgical clerkship may not be necessary to increase recruitment into general surgery.
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Affiliation(s)
- Samuel Minor
- Department of Surgery, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, K7L 2V7, Canada.
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Verma A, Kilicaslan F, Martin DO, Minor S, Starling R, Marrouche NF, Almahammed S, Wazni OM, Duggal S, Zuzek R, Yamaji H, Cummings J, Chung MK, Tchou PJ, Natale A. Preimplantation B-type natriuretic peptide concentration is an independent predictor of future appropriate implantable defibrillator therapies. Heart 2005; 92:190-5. [PMID: 15923278 PMCID: PMC1860790 DOI: 10.1136/hrt.2004.058198] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess prospectively whether preimplantation B-type natriuretic peptide (BNP) and C reactive protein (CRP) concentrations predict future appropriate therapies from an implantable cardioverter-defibrillator (ICD). DESIGN AND SETTING Prospective cohort study conducted in a tertiary cardiac care centre. METHODS 345 consecutive patients undergoing first time ICD implantation were prospectively studied. Serum BNP and CRP concentrations were obtained the day before ICD implantation. Patients were followed up with device interrogation to assess for appropriate shocks or antitachycardia pacing. Inappropriate therapies were excluded. Mean (SD) follow up was 13 (5) months. RESULTS Patients had ischaemic (71%), primary dilated (17%), and valvar or other cardiomyopathies (12%). About half (52%) had ICDs implanted for primary prevention. Sixty three (18%) received appropriate ICD therapies. Serum creatinine, beta blocker, statin, and angiotensin converting enzyme inhibitor usage did not differ between therapy and no therapy groups. By univariate comparison, ejection fraction (p = 0.048), not taking amiodarone (p = 0.033), and BNP concentration (p = 0.0003) were risk factors for ICD therapy. However, by Cox regression multivariate analysis, only BNP above the 50th centile was a significant predictor (hazard ratio 2.19, 95% confidence interval 1.07 to 4.71, p = 0.040). Median BNP was 573 ng/l versus 243 ng/l in therapy and no therapy patients, respectively (p = 0.0003). More patients with BNP above the 50th centile (27% v 10%, p = 0.006) received ICD therapies. CONCLUSIONS A single preimplantation BNP concentration determination is independently predictive of ICD therapies in patients with cardiomyopathies undergoing first time ICD implantation. CRP was not independently predictive of ICD therapies when compared with BNP.
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Affiliation(s)
- A Verma
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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McSweeney PA, Niederwieser D, Shizuru JA, Sandmaier BM, Molina AJ, Maloney DG, Chauncey TR, Gooley TA, Hegenbart U, Nash RA, Radich J, Wagner JL, Minor S, Appelbaum FR, Bensinger WI, Bryant E, Flowers ME, Georges GE, Grumet FC, Kiem HP, Torok-Storb B, Yu C, Blume KG, Storb RF. Hematopoietic cell transplantation in older patients with hematologic malignancies: replacing high-dose cytotoxic therapy with graft-versus-tumor effects. Blood 2001; 97:3390-400. [PMID: 11369628 DOI: 10.1182/blood.v97.11.3390] [Citation(s) in RCA: 1041] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Toxicities have limited the use of allogeneic hematopoietic cell transplantation (HCT) to younger, medically fit patients. In a canine HCT model, a combination of postgrafting mycophenolate mofetil (MMF) and cyclosporine (CSP) allowed stable allogeneic engraftment after minimally toxic conditioning with low-dose (200 cGy) total-body irradiation (TBI). These findings, together with the known antitumor effects of donor leukocyte infusions (DLIs), led to the design of this trial. Forty-five patients (median age 56 years) with hematologic malignancies, HLA-identical sibling donors, and relative contraindications to conventional HCT were treated. Immunosuppression involved TBI of 200 cGy before and CSP/MMF after HCT. DLIs were given after HCT for persistent malignancy, mixed chimerism, or both. Regimen toxicities and myelosuppression were mild, allowing 53% of eligible patients to have entirely outpatient transplantations. Nonfatal graft rejection occurred in 20% of patients. Grades II to III acute graft-versus-host disease (GVHD) occurred in 47% of patients with sustained engraftment. With median follow-up of 417 days, survival was 66.7%, nonrelapse mortality 6.7%, and relapse mortality 26.7%. Fifty-three percent of patients with sustained engraftment were in complete remission, including 8 with molecular remissions. This novel allografting approach, based on the use of postgrafting immunosuppression to control graft rejection and GVHD, has dramatically reduced the acute toxicities of allografting. HCT with the induction of potent graft-versus-tumor effects can be performed in previously ineligible patients, largely in an outpatient setting. Future protocol modifications should reduce rejection and GVHD, thereby facilitating studies of allogeneic immunotherapy for a variety of malignancies. (Blood. 2001;97:3390-3400)
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Affiliation(s)
- P A McSweeney
- Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA, USA.
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Abstract
This study investigated the moderating effects of perceived prepubertal social support on the relationship between prepubertal childhood physical abuse and child abuse potential as well as on the relationship between a childhood history of abuse and conflict and depth in adult relationships. Three hundred and sixty-nine undergraduate men and women were classified as abused or nonabused based on their responses to the Childhood History Questionnaire. Multiple regression analyses revealed interactions of social support and a childhood history of physical abuse on both the potential to abuse and the quality of participants' relationships with their parents. Differences between abused and nonabused individuals were obtained only under conditions of low perceived social support. When social support was perceived to be high, abused and nonabused individuals did not differ in the potential to abuse or in the ratings of the depth of their relationships with parents. Implications of these findings for the intergenerational transmission of abuse are discussed.
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Affiliation(s)
- C G Litty
- Department of Psychology, Western Carolina University, Cullowhee, NC 28723, USA
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Faxon DP, Spiro TE, Minor S, Coté G, Douglas J, Gottlieb R, Califf R, Dorosti K, Topol E, Gordon JB. Low molecular weight heparin in prevention of restenosis after angioplasty. Results of Enoxaparin Restenosis (ERA) Trial. Circulation 1994; 90:908-14. [PMID: 8044962 DOI: 10.1161/01.cir.90.2.908] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Heparin, an anticoagulant, possesses antiproliferative effects and has been shown to reduce neointimal proliferation and restenosis following vascular injury in experimental studies. METHODS AND RESULTS The primary aim of this double-blind multicenter study was to determine if 40 mg Enoxaparin, a low molecular weight heparin, administered subcutaneously once daily for 1 month after successful angioplasty would reduce the incidence of restenosis. Four hundred fifty-eight patients were randomized at nine clinical centers (231 to placebo and 227 to Enoxaparin). The primary end point was angiographic or clinical restenosis. Angiographic restenosis was defined as a loss of 50% of the initial gain as measured by quantitative coronary angiography (QCA) at a core laboratory. In the absence of QCA, clinical evidence of restenosis was defined as death, myocardial infarction, repeat revascularization, or worsening angina. Using the intention-to-treat analysis for all patients, restenosis occurred in 51% of the placebo group and 52% of the Enoxaparin group (relative risk, 1.07, P = .625). Likewise, no difference in restenosis was evident when the change in minimal lumen diameter or other angiographic definitions of restenosis were used. Adverse clinical events were infrequent and did not differ between the groups with the exception of minor bleeding complications, which were more common in the Enoxaparin group. CONCLUSIONS Enoxaparin (40 mg/d SC for 1 month) following successful angioplasty did not reduce the incidence of angiographic restenosis or the occurrence of clinical events over 6 months. The treatment was well tolerated, although in-hospital minor bleeding was more common with active treatment.
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Affiliation(s)
- D P Faxon
- Evans Memorial Department of Medicine, Boston University Medical Center, Mass
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Minor S. Hemispheric comprehension of categories and activities in pictures. Arch Clin Neuropsychol 1989. [DOI: 10.1016/0887-6177(89)90118-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Minor S, Taylor K, Knight TF, Senekjian HO, Weinman EJ. The effects of ticrynafen in the rat. Res Commun Chem Pathol Pharmacol 1979; 25:53-63. [PMID: 451359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The effects of ticrynafen, a uricosuric diuretic, were examined utilizing free-flow micropuncture and clearance techniques in the rat. The intravenous infusion of ticrynafen (50 mg/kg body wt/hr) had no effect on glomerular filtration rate, but resulted in significant increases in urine flow from 4.4 +/- 0.7 microliter/min/g kidney wt to 19.2 +/- 2.6 (p less than 0.001); in urinary sodium excretion from 0.14 +/- 0.07 micronEq/min/g kidney wt to 2.35 +/- 0.52 (p less than 0.01); and in urinary urate excretion from 2.8 +/- 0.2 microgram/min/g kidney wt to 4.0 +/- 0.2 (p less than 0.005). There was no change in urinary phosphate excretion. The end-proximal TF/Pinulin ratio was 2.66 +/- 0.18 in control and 2.67 +/- 0.16 in experimental periods (p=NS). In awake animals, ticrynafen administration resulted in a decrease in CH2O from 6.47 +/- 0.12% to 3.50 +/- 0.69 (p less than 0.05), but no change in TCH2O. These studies demonstrate that ticrynafen is a uricosuric and diuretic agent in the rat. The natriuresis appears to derive from an inhibitory action of this agent in the cortical diluting segment of the nephron. In comparison to a related uricosuric diuretic, MK-196, ticrynafen is a less potent agent with respect to both its uricosuric and diuretic properties in the rat.
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