Surgery In Canada Research Articles

Commentary: Accessibility and Insurance Coverage for Gender-Affirming Surgery in Canada: A Cross-Sectional Analysis.

Commentary: Accessibility and Insurance Coverage for Gender-Affirming Surgery in Canada: A Cross-Sectional Analysis.

Contemporary Outcomes of a National Fetal Spina Bifida Surgery Service.

To assess contemporary outcomes of fetuses who underwent open fetal spina bifida surgery in Canada. Our clinical program prospectively collected outcomes of all consecutive fetuses who underwent open fetal spina bifida closure at the Ontario Fetal Center in Toronto and who were at least 1year of age at the time of postnatal follow-up. We gathered information on the need for hydrocephalus treatment, motor function, bladder function, as well as neurodevelopment (Ages and Stages Questionnaire and Bayley's scales of infant development). Developmental outcomes were categorized as "Typical Development," "Possible Delay," or "Significantly Delayed." Between 2017 and 2022, 41 fetuses underwent open fetal spina bifida closure. Twenty-four patients (58.5%) responded to the questionnaire at a median age of 46.5months. Eight children (33.3%) required CSF diversion procedures. Bladder management included clean intermittent catheterization (43.5%), spontaneous voiding (34.8%), or both (21.7%), with 43.5% needing medication for overactive bladder. All patients could sit independently, with 50% walking outside and 50% crawling indoors. Among those walking outdoors (50%), 25% did so without orthotics or aid, 58.3% with orthotics, and 16.7% required additional walking aids. Most children demonstrated typical communication and problem-solving skills (79.2%), while gross motor development was significantly delayed in 91.7% of cases. Fine motor skills varied, with 56.5% showing typical development and 34.8% possibly experiencing delays. This study showed a mixed developmental profile among patients who underwent open fetal spina bifida repair, consistent with the MOMs trial findings.

The landscape of Medicare policies for gender-affirming surgeries in Canada: an environmental scan

BackgroundMany studies have described barriers to gender-affirming surgery (GAS) in Canada; however, few have explored why these barriers persist. To address this knowledge gap, we sought to describe documents related to public health insurance (Medicare) for GAS to identify the types of procedures covered, variations in coverage across provinces and territories, and changes in policy over time.MethodsWe conducted a descriptive cross-sectional study using an environmental scan approach. We queried 23 government websites, the Google search engine, and an online legal database between July 2022 and April 2024 to gather gray literature documents related to GAS and Medicare. Variables from relevant documents were compiled to create a present, at-glance overview of GAS Medicare coverage for all provinces and territories and a timeline of policy changes across Canada. ResultsEight provinces and three territories had documents or websites related to GAS Medicare coverage (85%). We identified 15 GAS procedures that were covered variably across Canada. Yukon (n = 14) covered the most types of GAS, while Quebec and Saskatchewan covered the least (n = 6). Mastectomy and genital surgeries were covered across Canada, but other GAS were rarely covered. Five provinces and territories provided coverage for travel-related costs. Our GAS Medicare timeline showed differential expansion of GAS coverage in Canada over the last 25 years.Conclusions We provide previously unreported information regarding GAS Medicare coverage in Canada. We hope our findings will help patients and healthcare providers navigate a complicated public healthcare system. We also highlight barriers within GAS Medicare documents and make recommendations to alleviate those barriers.

Self-defined former smokers consume the highest opioid quantities following knee and shoulder arthroscopy.

To identify risk factors associated with increased postoperative opioid consumption and inferior pain outcomes following knee and shoulder arthroscopy. Using the data set from the NonOpioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) trial, eight prognostic factors were chosen a priori to evaluate their effect on opioid consumption and patient-reported pain following arthroscopic knee and shoulder surgery. The primary outcome was the number of oral morphine equivalents (OMEs) consumed at 2 and 6 weeks postoperatively. The secondary outcome was patient-reported postoperative pain using the Visual Analogue Scale (VAS) at 2 and 6 weeks postoperatively. A multivariable linear regression was used to analyse these outcomes with eight prognostic factors as independent variables. Tobacco usage was significantly associated with higher opioid usage at 2 (p < 0.001) and 6 weeks (p = 0.02) postoperatively. Former tobacco users had a higher 2-week (p = 0.002) and cumulative OME (p = 0.002) consumption compared to current and nonsmokers. Patients with a higher number of comorbidities (p = 0.006) and those who were employed (p = 0.006) reported higher pain scores at 6 weeks. Patients in the 'not employed/other' category had significantly lower pain scores at 6 weeks postoperatively (p = 0.046). Former smoking status was significantly associated with increased post-operative opioid consumption following knee and shoulder arthroscopy at 2 and 6 weeks postoperatively. Increased pain was found to be significantly associated with employment status and an increasing number of comorbidities at 6 weeks postoperatively. These findings can aid clinicians in identifying and mitigating increased opioid utilization as well as worse pain outcomes in high-risk patient populations. Level III, cohort study.

Lived experiences of transgender and nonbinary people in the perioperative context: a qualitative study.

Transgender and nonbinary (TNB) people experience obstacles that create barriers to accessing health care, including stigmatization and health inequities. Our intention was to describe the lived experiences of TNB patients and identify potential gaps in the education of health care professionals. We conducted a qualitative descriptive study influenced by phenomenology by interviewing with TNB adults who underwent surgery in Canada within the previous 5 years. We recruited participants using purposeful and snowball sampling via online social networking sites. Audio recordings were transcribed. Two authors coded the transcripts and derived the themes. We interviewed 21 participants, with a median interview duration of 49 minutes. Participants described positive and negative health care encounters that led to stress, confusion, and feelings of vulnerability. Major themes included having to justify their need for health care in the face of structural discrimination; fear and previous traumatic experiences; community as a source of support and information; and the impact of interactions with health care professionals. Participants detailed barriers to accessing care, struggled to participate in shared decision-making, and desired trauma-informed care principles; they described strength in community and positive interactions with health care professionals, although barriers to accessing gender-affirming care often overshadowed other aspects of the perioperative experience. Additional research, increased education for health care professionals, and policy changes are necessary to improve access to competent care for TNB people.

Damage-control vascular surgery in Canada: supporting surgeons and teams

Damage-control vascular surgery in Canada: supporting surgeons and teams

Experiences and Outcomes of Indigenous Patients Undergoing Bariatric Surgery: a Mixed-Method Scoping Review.

Obesity and type 2 diabetes (T2D) are growing global health concerns. Evidence suggests that Indigenous peoples are at higher lifetime risk of obesity and its associated conditions. Obesity increases the risk of T2D, cardiovascular disease, and all-cause mortality. Bariatric surgery is the most sustained and effective intervention for treating obesity-associated medical problems. This review aims to explore the experiences and outcomes of Indigenous peoples undergoing bariatric surgery in Canada, the USA, Australia, and New Zealand (CANZUS). Analysis of quantitative data revealed that Indigenous patients had fewer bariatric procedures, poorer clinic attendance, similar weight loss outcomes and slightly higher post-operative complication rates. Qualitative data analysis revealed that Indigenous patients living with obesity have a desire to improve their health and quality of life.

Patient’s Perception Regarding Vision Related Quality of Life in Immediate Sequential and Delayed Sequential Bilateral Cataract Surgery

Cataract is the main cause of visual impairment and treatable blindness in the world and surgery can restore normal sight to the patients. In bilateral cataract patient, surgery in the second eye is as important and meaningful as surgery in the first eye and it can be performed by immediate sequential (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS). There is no statistically significant difference in surgical complications, visual acuity or long term self-perceived visual function between these two methods. To adopt surgical procedure, to improve the patient’s satisfaction and to improve the quality of services, patient opinion should be a great concern. This evaluative study was done to find out various recommendations and suggestions from patients regarding merits &amp; demerits of both types of cataract surgery that will be helpful for the decision-maker and administrator for future practice of cataract surgery in Canada. In this study, vision related quality of life improved in both groups. Participants in DSBCS group experienced different types of difficulties during the gap period between first eye and second eye cataract surgery i.e. visual imbalance between the two eyes and difficulty in driving. They recommended and suggested that cataract surgery wait time should be reduced and the difficulties experienced during the gap period can be eliminated by adopting ISBCS procedure. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 07-13

A 20-Year Update on the Practice of Thoracic Surgery in Canada: A Survey of the Canadian Association of Thoracic Surgeons.

This study provides an update to a landmark 2004 report describing demographics, training, and trends in adherence to thoracic surgery practice standards in Canada. An updated questionnaire was administered to all members of the Canadian Association of Thoracic Surgeons via email (n=142, compared to n=68 in 2004). Our report incorporates internal data from Ontario Health and the Canadian Partnership Against Cancer. Forty-eight surgeons completed the survey (male, 70.8%; mean±standard deviation age, 50.3±9.3 years). This represents a 33.8% response rate, compared to 64.7% in 2004. Most surgeons (69%) served a patient population of over 1 million per center; 32%-34% reported an on-call ratio of 1:4-1:5 days, and the average weekly hours worked was 56.4±11.9. Greater access to dedicated geographic units per center (73% in 2021 vs. 53% in 2004) has improved thoracic-associated services and house staff, notably endoscopy units (100% vs. 91%), with 73% of respondents having access to both endobronchial and endoscopic ultrasound. Access to thoracic radiology has also improved, particularly regarding positron emission tomography scanners per center (76.9% vs. 13%). Annual case volumes for lung (255 vs. 128), esophageal (41 vs. 19), and mediastinal resections (30 vs. 13), along with hiatal hernia repair (45 vs. 20), have increased substantially despite reports of operating room availability and radiology as rate-limiting steps. This survey characterizes compliance with current practice standards, addressing the needs of thoracic surgeons across Canada. Over 85% of respondents were aware of the 2004 compliance paper, and 35% had applied for resources and equipment in response.

Current Practices and Trends of Plastic and Oncoplastic Breast Surgeons in Canada

Background: There is a lack of previous studies investigating oncoplastic practice trends for breast reconstruction in Canada, particularly from the plastic surgeon perspective. Given the rising popularity of oncoplastic techniques, this study aimed to identify current practice trends for breast and plastic surgeons in Canada. Methods: A cross-sectional survey study of breast and plastic surgeons performing oncoplastic surgery across Canada was conducted. Results: Ninety-five surgeons were invited to complete the survey, with 58 respondents (response rate 61%), of which 29 (50.0%) were breast surgeons and 29 (50.0%) were plastic surgeons. Compared to plastic surgeons, breast surgeons performed significantly more level 1 surgeries (27.6 vs 3.45%, P &lt; .001). Plastic surgeons performed more level 2 (37.9% vs 13.8%, P = .0475) and level 3 (31.4% vs 10.3%, P = .00814) surgeries. Breast surgeons identified significant perceived barriers including unfamiliarity with techniques ( P = .00513), adjuvant therapy delays ( P = .00612), lack of plastic surgery support ( P &lt; .001), lack of radiation oncology support ( P = .0485), increased OR time ( P &lt; .001), lack of OHIP billing codes ( P &lt; .001), and post-operative complication management ( P = .0372). Breast surgeon comfort with oncoplastic techniques was not correlated with practice duration (R-square = .037, P-value = .853). Breast surgeon comfort with contralateral surgery was not correlated with practice setting (R-square = .071, P-value = .632). Conclusions: Breast surgeons perceive a lack of training, a lack of support from plastic surgery, concerns regarding appropriate financial remuneration, and worries of increased OR time as barriers in oncoplastic surgery. Collaboration between general breast surgery and plastic surgery is needed for improving training options for oncoplastic surgery in Canada and for providing excellent breast cancer care overall.

Prioritization of patients for surgery in Canada: The case of hip and knee replacement surgeries in Newfoundland

AbstractBackgroundSingle‐entry models (SEM) improve wait times for hip and knee replacement, but little is known whether prioritization implemented in SEM can help meet the benchmarks for consolation/surgery. This study aimed to determine the impact of prioritization on receiving consultation and surgery within the benchmarks.MethodsThis is a retrospective cohort study for which two administration databases were linked. Logistic regression was used to investigate the impact of prioritization on receiving consultations and surgery within the benchmarks of 90 and 182 days, respectively, adjusting for patients’ characteristics and preference for surgeon.Results1,967 patients were included in this study. The odds ratios of having consultation within 90 days for hip replacement patients in priorities 1 and 2 (high priority) were 57.24 (CI: 23.16–141.47) and 14.63 (CI: 6.44–33.25), respectively, compared with those in priority 3. For knee replacement, patients with higher priority were more likely to have consultation within 90 days. Although priority levels were not related to having surgery within 182 days for knee replacement, hip replacement patients with priority 1 (CI: 0.2–0.75) and 2 (CI: 0.16–0.54) were less likely to have surgery within 182 days, compared with those with priority 3.ConclusionPatients with high priority levels were more likely to have consultation within 90 days for hip and knee replacements. SEM may not help have surgery within 182 days. Prioritization has no impact on receiving surgery within 182 days for knee replacement, but hip replacement patients with high priority were less likely to have surgery within 182 days.

Deep Brain Stimulation Surgery Programs in Canada

&#x0D; Deep brain stimulation involves the surgical insertion of electrodes to stimulate targeted areas of the brain. It is recommended to help control movement-related symptoms of Parkinson disease with certain indications and contraindications to consider.&#x0D; This rapid Environmental Scan describes the landscape of deep brain stimulation surgery across Canada and identifies conditions other than Parkinson disease that can benefit from the therapy. It also provides an overview of cost-effectiveness studies on deep brain stimulation for Parkinson disease.&#x0D; Emerging indications for deep brain stimulation include refractory obsessive-compulsive disorder, refractory epilepsy, treatment-resistant Tourette syndrome, certain types of pain, refractory major depressive disorder, tardive dyskinesia, and essential tremor.&#x0D; In Canada, there are deep brain stimulation surgery programs in Alberta, British Columbia, Manitoba, Nova Scotia, Ontario, Quebec, and Saskatchewan. The number of qualified neurosurgeons for deep brain stimulation surgery ranges from 1 to 5 (at least) across jurisdictions.&#x0D; Overall, deep brain stimulation is considered cost-effective for people living with advanced Parkinson disease. The risk of developing Parkinson disease increases with age, with onset typically occurring in late adulthood. The number of people eligible for deep brain stimulation in Canada is expected to increase with the aging population and emerging indications. Information related to existing surgery programs can help support capacity planning for deep brain stimulation surgery in Canada.&#x0D;

Ambulatory surgery centres: a potential solution to a chronic problem.

SummaryLong wait times for elective surgery in Canada have been a persistent problem for many years and the recent pandemic has made the situation substantially worse. Current evidence suggests that ambulatory surgery centres are more cost-effective and efficient in the delivery of ambulatory surgical services than larger institutions. We explore the merits of a network of publicly funded ambulatory surgery centres.

Bariatric Surgery Should Be Offered to Active-Duty Military Personnel: a Retrospective Study of the Canadian Armed Forces’ Experience

PurposeLike most Western armies, obesity affects Canadian Armed Forces (CAF) personnel. Bariatric surgery is an effective treatment for obesity. However, this is not yet accepted for active-duty soldiers in most countries. The CAF have approved bariatric surgery since 2005. Our aim is to assess weight loss, resolution of obesity-related comorbidities, and impacts of bariatric surgery on military careers.Materials and MethodsWe retrospectively reviewed the perioperative data, long-term bariatric results, and military outcomes of 108 CAF active-duty military personnel who underwent bariatric surgery in Canada over a 61-month period.ResultsThe cohort was predominantly male (66.7%) with a mean preoperative body mass index (BMI) of 43.6 ± 5.8 kg/m2. Roux-Y gastric bypass was performed in 59 patients, sleeve gastrectomy in 29, and gastric banding in 20. All the surgeries were performed laparoscopically. The total body weight loss at the last follow-up visit was 22.5 ± 11.0%. Remission or improvement of hypertension was observed in 91.2%, diabetes in 85.7%, gastroesophageal reflux disorder (GERD) in 43.6%, sleep apnea in 43.1%, and dyslipidemia in 42.9%. One patient (0.9%) was medically released due to postoperative complications. Fifteen patients (13.9%) were deployed postoperatively. The combined deployable and possibly deployable statuses increased from 35.4% preoperatively to 47.9% postoperatively.ConclusionThis is the largest series of bariatric surgeries performed in active-duty military personnel. Bariatric surgery is effective and safe and improves deployability without impairing military careers. These results are relevant to the military of many industrialized countries. Bariatric surgery should be considered for all active-duty military personnel who meet surgical criteria for the treatment of obesity.Graphical

2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing

# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

Robotic thoracic surgery in Canada: Are patients willing to pay out of pocket?

SummaryRobotic-assisted thoracoscopic surgery (RTS) is safe and effective, but is associated with high capital and operating costs that are not reimbursed by the Canadian government. Currently, patients have access to RTS only when it is supported by research or philanthropic funds. In a recent study, we assessed the extent of patient-reported satisfaction with RTS, whether patients would have been willing to pay out of pocket for it, and what factors were associated with patients’ willingness to pay. Many patients (290 of 411 [70.56%]) stated that they would have paid the additional $2000 to supplement the government health care coverage to have access to RTS. Factors found to be significantly associated with participants’ willingness to pay were an annual income of $60 000 or more (p = 0.034), private insurance coverage (p = 0.007), overall experience with RTS rated as 8 or higher out of 10 (p < 0.001), and overall postoperative postdischarge experience rated as satisfying or very satisfying (p = 0.004).

Opioid reduction and enhanced recovery in orthopaedic surgery (OREOS): A feasibility randomized controlled trial in knee replacement patients

ABSTRACT Background Total knee arthroplasties are the second most common surgery in Canada. Most patients recover well, but 20% or more still suffer from persistent pain and opioid use. Though opioids are an important part of perioperative pain management, their potential for long-term adverse effects is well recognized. Limiting opioids may be insufficient to overcome the issue of opioid overuse. Pain and opioid use are highly linked, so an effective alternative needs to address both issues. Objectives The principal objective of this pilot trial is to assess the feasibility. The clinical objectives are to determine the effects of a multicomponent care pathway on opioid-free pain control, persisting pain and opioid use, functional knee outcomes, quality of life, and return to function. Methods We will include adult patients scheduled for primary elective total knee arthroplasty. Patients in the intervention group will undergo a multicomponent intervention pathway that will be facilitated by an intervention coordinator linking each patient and their surgical/ perioperative team. The interventional pathway will include (1) preoperative education on pain and opioid use, (2) preoperative risk identification and mitigation using cognitive behavioral skills, (3) personalized postdischarge analgesic prescriptions, and (4) continued support for pain control and recovery up to 8 weeks. Patients in the control group will receive the usual care at their institution. Discussion The overarching goal is to implement and evaluate a coordinated approach to clinical care to improve pain control and reduce harms, with an emphasis on patient-centered care and shared decision making. Trial Registration Number: NCT04968132 (informed consent/ research ethics board statement).

The Burden of Plastic Surgery Related Disease in Canada: A Perspective Based on the 2019 Global Burden of Disease Study.

Purpose: Identifying the burden of disease related to plastic and reconstructive surgery in Canada will provide timely population-based data, inform policy, and generate support for research funding. Methods and Patients: Data on the burden of disease (ie, prevalence, incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years [DALYs]), were extracted from the Global Burden of Disease 2019 results tool for all available and relevant plastic surgery diseases. The economic burden of disease in Canadian dollars was calculated based on prior studies. Data are presented as either rates (per 100 000) or counts with the associated uncertainty interval. Results: In 2019, plastic surgery related conditions in Canada had an overall age-standardized DALY rate of 556 per 100 000 [463-664]. Of these conditions, breast cancer was responsible for approximately 50% of the overall burden of disease, with an age-standardized DALY rate of 268 per 100 000 [244-294] followed by squamous cell carcinoma (66 per 100 000 [45-94]) and thermal burns (61 per 100 000 [46-82]). Age-standardized incidence rates were highest for cellulitis (2654 per 100 000 [2502-2812]). Breast cancer had the highest age-standardized cost of care of all plastic surgery related diseases, at $5.1 billion, approximately half of the total age-standardized cost of $10.6 billion for included plastic surgery diseases. Conclusion: Plastic and reconstructive surgery related diseases, particularly breast cancer, thermal burns, and malignant melanoma, are responsible for a high burden of disease and significant cost to the Canadian healthcare system. These results will help guide national healthcare policy and should provide support to directing funding and research efforts toward impactful diseases facing the Canadian healthcare system.

Cancer surgery in Canada during the COVID-19 pandemic: qualitative analysis of cancer surgeons' perspectives.

Cancer surgery in Canada during the COVID-19 pandemic: qualitative analysis of cancer surgeons' perspectives.

SA48 Patient Impact and Economic Burden of Waiting for Cataract Surgery in Canada: A Targeted Literature Review

SA48 Patient Impact and Economic Burden of Waiting for Cataract Surgery in Canada: A Targeted Literature Review