.............Collins Day 2025.............

         SUBMIT REVIEW

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 Session Podium 1: 0800–0815 - Dr. Ishita Aggarwal (PGY2): Feasibility of Same-Day-Discharge Hepatectomy Program - A Pilot Quality Improvement Program

Presenter: Ishita Aggarwal

Aggarwal I, Mallette K, Gilbert R, Bertens K, Martel G, Balaa F, Abou-Khalil J

Division of General Surgery

Quality Improvement

ABSTRACT  

Background: Minimally invasive techniques and enhanced recovery pathways have transformed the convalescent experience of many surgeries.  Many procedures previously requiring hospitalization can now be performed on an outpatient basis. Liver surgery, however, has lagged in these developments. We aim to demonstrate the feasibility of a Same-Day-Discharge Hepatectomy Program (SDDHep) and describe the early experience of our SDDHep series. Methods: To be a candidate for SDDHep, patients had to meet certain predefined preoperative, intraoperative and postoperative inclusion criteria. Patients meeting inclusion criteria were discharged home with 5 days of virtual care follow ups, including twice daily vital signs measurement, video interviews with a nurse specialist and physician, and escalation protocols to the operating surgeon if needed. The primary outcome is the proportion of enrolled patients who are discharged the same day. Secondary outcomes include pain and satisfaction scores and readmission rates. Results: Over a 5 month pilot period from October 2024 to January 2025, 10 patients were evaluated for SDDHep. 8 patients were enrolled, 2 were excluded for failing to meet preoperative inclusion criteria. 3/8 patients were female. Patients ranged in age from 52 to 72 years. 3/8 patients underwent radical cholecystectomy, 2/8 patients underwent segment 3 resection, and 1/8 patients underwent each non-anatomical segment 6/7 resection, segment 8 resection, and left lateral resection. Of the 8 patients eligible for SDDHep to date, 4 were discharged on the day of their surgery, 3 were discharged on postoperative day 1, and 1 required a longer admission for conversion to an open procedure for extensive intra-abdominal adhesions. Of those discharged immediately, 0 were readmitted to hospital for post-operative reasons. Conclusion: Preliminary findings from TOH’s SDDHep suggest that, for selected patients, outpatient liver resection is feasible and safe. Geographic, linguistic, and socioeconomic barriers were the main factors excluding patients from the program.  

SUBMIT REVIEW

 Session Podium 1: 0815–0830 - Dr. George Elzawy (PGY1): Optimal Duration of Post-Operative Antibiotic Prophylaxis following Open Vascular Reconstruction

Presenter: Dr. George Elzawy

Elzawy G, Kubelik D, Tran A

Division of Vascular Surgery

Clinical Research

Background: The optimal duration of post-operative antibiotic prophylaxis following open vascular reconstruction remains unclear. This systematic review and meta-analysis aimed to investigate surgical site infection (SSI) rates and antibiotic safety after short term (< 24 hrs) or long-term (> 24 hrs) antibiotic prophylaxis.  

Methods: We searched the MEDLINE and EMBASE databases from inception to March 2025 for observational or randomized controlled trials (RCTs) comparing short-term (< 24 hrs) to long-term (> 24 hrs) post-operative antibiotic prophylaxis following open vascular reconstructions. The primary outcome was SSI rate. Secondary outcomes included rates of acute kidney injury (AKI) and c. difficile infection. Pooling was performed with a random-effects model.  

Results: We screened 981 abstracts, of which 17 studies were included for full-text review. 3 RCTs comparing short term (< 24 hrs) to long term (> 24 hrs) postoperative antibiotic prophylaxis were included, for a total of 613 patients currently. Postoperative antibiotic prophylaxis durations that were compared included 24 hours, 3 days, and 5 days. Following the inclusion of observational cohort studies beyond the 3 established RCT’s that compared short term to long term antibiotics, the rates of SSI will be calculated and reported as relative risks with associated 95% confidence intervals. Secondary outcomes of AKI and c. difficile infection will be investigated and reported prior to presentation.  

Conclusion: Our analysis of the available literature currently suggests that prolonging postoperative antibiotic prophylaxis does not confer a benefit to reducing SSI rates and may have deleterious consequences including increased rates of AKI and c. difficile secondary to prolonged antibiotic exposure. This will be updated with the addition of observational cohort studies. The included studies were of low quality given (underpowered) and had high risk of biases (lack of blinding). There remains a need for high quality, updated, and adequately powered studies in order to adequately address the optimal duration of postoperative antibiotic prophylaxis.  

SUBMIT REVIEW

 Session Podium 1: 0815–0830 - Dr. Kenza Rahmouni (PGY4): Sex-Based Outcomes of Mitral Surgery for Ischemic Mitral Regurgitation: A Multi-Center Retrospective Cohort Study

Presenter: Dr. Kenza Rahmouni

Rahmouni K, Voisine P, Edwards J, Nantsios A, Tubin J, Dinh V , Rubens F, Dagenais F, Ramsay T, Chan V

Division of Cardiac Surgery

Clinical Research

BACKGROUND: Surgical outcomes for ischemic mitral regurgitation (IMR) in females compared to males remain unclear. The goal of this cohort study is to assess sex-based all-cause mortality following surgery for chronic IMR. METHODS: All consecutive patients who underwent mitral valve repair or replacement for chronic IMR between January 1, 2000 and December 31, 2022 at the Ottawa Heart or the Quebec Heart and Lung Institutes were included. Inverse probability of treatment weighting (IPTW) was performed to account for differences in baseline characteristics between sexes. The two co-primary outcomes were sex-based 30-day and long-term mortality, and were assessed with weighted logistic and Cox regression models, respectively. RESULTS: A total of 1086 patients (330 [30.4%] females) were included. Median follow-up was 6.2 ± 5.3 years. Age, baseline left ventricular ejection function, NYHA class and rate of atrial fibrillation were higher in females while hypertension and congestive heart failure were more common in males. IPTW resulted in a good balance of baseline characteristics between sexes (standardized mean difference <0.10). Mitral valve replacement was performed in 658 (60.6%), of which 256 (38.9%) were mechanical prostheses. Thirty-six (10.9%) females and 42 (5.9%) males died at 30 days. After IPTW adjustment, 30-day mortality remained higher in females (Odds ratio [95% confidence interval (CI)]: 1.77 [1.01-3.10]). Other procedural predictors for 30-day mortality included longer cardiopulmonary bypass times and emergency surgery. Median survival was 9.7 and 10.7 years for females and males, respectively (p-value = 0.03). After IPTW adjustment, long-term mortality was similar between sexes (Hazard ratio [95% CI]: 0.94 [0.77-1.15], p-value = 0.545). However, mitral valve replacement was an independent predictor for long-term mortality (Hazard ratio [95% CI]: 1.45 [1.20-1.75], p-value < 0.001). CONCLUSION: In this cohort, females with IMR presented at an older age and with a higher NYHA class than males. After IPTW adjustment, all-cause 30-day mortality remained higher in females, but long-term mortality was similar between sexes.  

SUBMIT REVIEW

Session Podium 1: 0845–0900 - Dr. Alick Wang (PGY6): Does the degree of endplate preparation during anterior cervical discectomy and fusion affect cage subsidence risk?

Presenter: Dr. Alick Wang

Wang A, Slater T, Raftery K, Masouros S, Levy HA, Freedman BA, Newell N  

Division of Neurosurgery

Translational Research

Introduction: Subsidence after anterior cervical discectomy and fusion (ACDF) is a common complication that may be influenced by the degree of endplate removal prior to cage insertion. The optimal degree of endplate removal remains unclear; therefore, we performed a series of ex vivo experiments to elucidate the relationship between the aggressiveness of endplate preparation and subsidence risk. Methods: Human cadaveric subaxial cervical endplates were partially decorticated either conservatively (n = 10) or aggressively (n = 9). The degree of endplate removal was quantified using microCT. Subsidence was modelled by measuring the strength and stiffness of each specimen when an interbody cage was axially compressed into the endplate. Results: Conservative endplate preparation resulted in less endplate removal than aggressive endplate preparation (mass: 150 vs 301mg, p < 0.001; volume: 47 vs 88mm3, p = 0.01; thickness: 0.02 vs 0.16mm, p < 0.001). There was no significant difference between the two groups with respect to endplate strength (2.04 vs 2.04kN, p = 0.99) or stiffness (2.38 vs 2.41kN/mm, p = 0.89). Bone mineral density (BMD) was similar between the two groups (271.6 vs 271.9mg/cm3, p = 0.98) but positively correlated with endplate strength (p = 0.001). Conclusions: When performing partial cervical endplate decortication, the degree of bony endplate removal did not significantly predict endplate integrity during ex vivo compression testing, but greater BMD was associated with increased strength. The degree of endplate removal should be based on individual patient factors and intraoperative findings to achieve the ideal cage-endplate interface.

 SUBMIT REVIEW

Session Podium 1: 0900–0915 - Dr. Nikita Arora (PGY6): Robotic vs Video-Assisted Thoracoscopic Lung Resections: A Retrospective Analysis

Presenter: Dr. Nikita Arora

Arora N, Seeger R, Anstee C, Stackhouse A, Jones D, Gilbert S, Villeneuve P

Division of Thoracic Surgery

Clinical Research

Background: As the robotic assisted (RATS) approach to lung resection is introduced into the Canadian environment, it is imperative to evaluate the outcomes of this approach in comparison to the standard of care: video assisted thoracoscopic surgery (VATS).  In 2022, RATS was adopted at our Canadian tertiary care thoracic centre. We have previously published a safety and learning curve analysis on our initial experience. The objective of this study was to evaluate whether the robotic approach impacted length of hospital stay (LOS) at our tertiary care centre between 2022 -2024. Methods: Data was identified and collected from the institution’s electronic medical record. Median and interquartile ranges (IQR) were calculated for continuous variables and proportions were calculated for categorical variables. Given that the LOS variable was highly skewed, it was log-transformed, and a multiple linear regression was performed to control for covariates (age, sex, Charlson Comorbidity Index, lung cancer stage, ECOG, DLCO, FEV1, conversion to VATS/open, surgeon). Results: 115 RATS and 326 VATS lung resections were identified. The median age of the cohort was 68 (IQR:62-74) years. The median LOS was 3 days (IQR: 1-5) in the RATS groups and 2 days (IQR: 1-5) in the VATS group, with no significant difference found in the regression. Female sex, no conversion and higher FEV1 significantly predicted shorter length of stay (p<0.05). 11% (8% to VATS and 3% to open) of cases were converted, all for oncologic reasons. Conclusion: This study demonstrates that both RATS and VATS approaches to lung resection yield equivalent LOS at a Canadian tertiary care thoracic centre, during the initial adoption process of RATS. Further work is required to compare quality of surgery and patient-important outcome data between the two groups in the Canadian context.

 SUBMIT REVIEW

Session Podium 1: 0915–0930 - Dr. Jeremy Lee (PGY3): Understanding Delays and Overtime in Thoracic Surgery: A Descriptive Analytics Approach for Lung Resection Procedures 

Presenter: Dr. Jeremy King Hei Lee

Lee JKH, Amro Habash, Al-Zoubi F, Gilbert S, Fallavollita P

Division of General Surgery

Quality Improvement

Introduction: Increasing demand and rising healthcare costs pose challenges for managing healthcare spending. A critical area for improvement is the operating room (OR), where inefficiencies contribute to up to 30% of surgical costs. To enhance surgical efficiency, it is crucial to understand the impact of factors affecting timely completion of surgical cases. This study aims to identify factors causing OR delays and influencing efficiency in thoracic surgery. Methods: Retrospective data were collected from 3738 lung resection procedures at a single institution performed between April 2008 to April 2024, containing information on patient demographics, perioperative time intervals, and surgical team composition. Data were analyzed using descriptive statistics and correlation analyses to examine relationships between individual factors and the surgical success rate (SSR) – defined as the ratio of successful on-time case completions to total cases – and interactions among various factors. Results: The overall SSR at our institution was 43%. SSR varied among the 7 surgeons (34-47%) and among anesthesiologists (23-60%), however this did not correlate with the number of cases they participated in. Patient factors including male sex, elevated body mass index (BMI), and increasing ASA class were associated with lower SSR. Anesthesia Prep Time (APT), Procedure length, and Surgical Finish Time (SFT) intervals had notable influence on SSR. Prolonged APT was correlated with increasing patient age, elevated BMI, and female sex. Male patients were observed to have longer mean procedure times than female patients (152.9 vs 140.6 minutes, p < 0.001). Conclusions: There is significant room for improvement in the utilization of limited OR resources to improve access to surgical care. This study identifies several trends in patient characteristics and time intervals which correlate with surgical success. Insights from this study will inform the development of a machine-learning model designed to predict OR success based on established benchmarks of key factors and provide recommendations for case scheduling to enhance OR efficiency.  

 SUBMIT REVIEW

Session Lightning Oral 1A: 0940–0946 - Dr. Marie-Pier Lefrancois (PGY4): Video-Based Assessment in Surgical Education: a prospective study on scoring and feedback on complete video versus video edited versions of specific surgical tasks for surgical trainees

Presenter: Dr. Marie-Pier Lefrançois

Lefrançois MP, Raiche I, Gawad N, Dudek N, Wood TJ, Lacaille-Ranger A

Division of General Surgery

Educational Research

Introduction: The number of hours residents spend in the operating room receiving teaching and feedback from surgeons has decreased over time. Optimizing every opportunity for formative feedback on surgical skills is essential. Numerous methods have been used to provide feedback, including assessing video recordings of specific surgeries. Reviewing entire procedures can be time consuming, so video-editing has been used to expedite the process. There are limited studies regarding what type of edited videos can provide reliable assessments. Beyond reliability, the impact of reviewing edited versions of procedures on the quality of written comments needs to be assessed. Methods: This study used a multicentre retrospective library of videos of surgical residents performing closure of a laparotomy incision and laparoscopic suturing in a simulation setting. The modified OSATS (for laparotomy closure) and GOALS (for laparoscopic suturing) assessment tools were used to compare three video conditions: (1) unedited full-length videos, (2) videos at 1.25x speed, and (3) videos where raters could fast forward at their discretion. 10 videos were scored by a total of 9 raters (general surgeons) and the comments were rated by 3 senior surgical residents. Results: For the OSATS assessments, the unedited videos had an average score of 17.07 (SD = 1.38), the 1.25x speed videos 14.07 (SD = 4.20), and the fast-forwardable videos 17.27 (SD = 2.85). For the GOALS assessments, the unedited videos averaged 10.60 (SD = 4.58), the 1.25x speed videos 9.73 (SD = 1.96), and the fast-forwardable videos 9.40 (SD = 3.48). There were no statistically significant differences between any of the video conditions (p>0.05). Conclusion: The results suggest that any version of a video could be used to assess a resident's surgical performance. Further analysis is needed to determine whether video editing influences the quality of qualitative comments provided by raters. This will be examined using the QuAL score and will be included in the final analysis.  

SUBMIT REVIEW

Session Lightning Oral 1A: 0946–0952 - Sierra Land (Medical Student): Exploring Applications of and Perspectives on Artificial Intelligence in Canadian Medical Education: A Scoping Review

Presenter: Sierra Land

Land S, Liang E, Lee JKH, Fallavollita P, Seely A

Division of Thoracic Surgery

Educational Research

Introduction: Artificial intelligence (AI) has demonstrated promise in transforming medical education through simulated clinical encounters and procedural skills teaching. While several reviews have explored uses of AI in medical education globally, little is known about its acceptance and integration among Canadian medical schools. This study evaluates current perspectives on and the scope of AI curricula in Canadian medical education. Methods: MEDLINE, Web of Science, ERIC, and Education Source were searched for studies discussing AI education in Canadian undergraduate medical programs. Primary studies describing student perspectives on AI or AI teaching in medical school were included. Data were qualitatively analyzed and synthesized following PRISMA-ScR guidelines. Results: 310 abstracts were identified, and 14 articles were included for final analysis. Three primary themes emerged: medical student perspectives on AI, AI-enhanced curriculum delivery, and formal AI literacy programs. Despite strong interest in AI and agreement that AI would positively influence the future of medicine, most medical students reported limited exposure and lack of structured AI curricula in medical school. AI-based tools were effectively used to enhance clinical reasoning and teach surgical skills through simulations featuring real-time AI feedback, skill assessments, and adaptive learning for procedures. AI-enhanced surgical simulations improved technical precision but also reduced movement efficiency among novice trainees, emphasizing the need for expert supervision. Only two pilot curricular programs teaching AI literacy were identified and received positive feedback from medical student participants. Conclusion: AI has the potential to enhance Canadian medical education, however a lack of standardized curricula limits students’ ability to engage with these technologies. Integrating AI education into Canadian medical programs is crucial to ensure future physicians and surgeons are equipped to navigate AI-driven clinical environments. Further research is needed to develop competency-based AI curricula and evaluate their impact on clinical performance and surgical education.

 SUBMIT REVIEW

Session Lightning Oral 1A: 0952–0958 - Dr. Catherine Binda (PGY1): How are Task Shifting and Task Sharing practitioners evaluated? A scoping review

Presenter: Dr. Catherine Binda

Binda C, Blackman C. Jami Z, Joharifard S, Joos E, Livergant R, Tersago J, Wild H

Division of General Surgery

Educational Research

Background: Task Shifting/Sharing (TS) are methods of surgical training that increase local surgical capacity in underserved areas. While much is known about the geographical distribution and scope of these TS programs, there is a knowledge gap surrounding the monitoring and evaluation of trainees in such programs. The objective of this project was to 1) describe how trainees in TS programs are evaluated, and 2) propose a framework for monitoring and evaluating current and future TS trainees. Methods: In consultation with a research librarian, we searched nine electronic databases using MeSH terms and keywords relating to “Task Sharing” AND “Surgery” on 31/01/024 and 12/03/2025. We included all patient populations, practice settings, surgical skills, and study types. We excluded records if they didn’t describe the evaluation of surgical skills or records that described the evaluation of skills within practitioners’ typical scopes of practice. Results: We removed 874 duplicates and abstract-screened 1609 unique reports, full-text screened 452 reports, and extracted data from 245 reports. Articles evaluated had a mean MINORs score of 12/18 on the first 8 quality criteria. Records most often discussed TS trainees practicing in Low-Income Countries (n=128; 36%). The most commonly taught procedures were OB GYN procedures (n=150; 61%). Most records reported using a set number of evaluations (n=220; 89%). Records used quantitative (n=220, 90%) and qualitative (n=139, 57%) methods. Evaluation sources included logbooks (n=146, 60%), patient outcomes data (n=55%), and Entrustable Professional Activities (n=26, 11%). Common outcomes evaluated included the productivity, safety, efficacy, and acceptability of TS programs. Conclusion: By identifying how trainees are evaluated within TS programs, we will build an evaluation framework adaptable to these programs globally.  

SUBMIT REVIEW

Session Lightning Oral 1A: 0958–1004 - Dr. Alveena Ahmed (PGY1): Outcomes Following Aortic Reconstruction with Physician-Made Bovine Pericardial Tubes for Aortic Infection: A Systematic Review and Meta-Analysis 

Presenter: Dr. Alveena Ahmed

Ahmed A, Pandya R, Nagpal S

Division of Vascular Surgery

Clinical Research

Objective: Native aortic infections and vascular graft and endograft infections (VGEI) pose complex challenges for vascular surgeons. Treatment has progressed from extra-anatomical bypass to in situ reconstruction, however, ideal material for aortic reconstruction remains unclear. Bovine pericardium reconstruction (BPR) is promising due to accessibility and reduced lower limb morbidity, however, there is limited evidence for its use. This study aims to synthesize the current literature and estimate short-term and mid-term outcomes following BPR of mycotic aneurysms and VGEI. Methods: The electronic database including PubMed, EMBASE and Google Scholar was extensively searched with predetermined search terms for original articles published in the last 20 years. Observational studies on BPR were screened against predefined inclusion and exclusion criteria. Data was extracted in duplicate and systematically reviewed. A random effects meta-analysis is planned to calculate overall pooled incidence of primary outcomes i.e. mortality, re-infection, graft degeneration and graft thrombosis, as well as secondary outcomes, i.e. causative organisms, perioperative complications and follow-up length. Subgroup-analysis and meta-regression will subsequently be performed to assess heterogeneity of these parameters across studies. Results: 890 unique articles were identified meeting our search criteria, 21 underwent full-text screening and 9 studies were included involving a total 301 patients: 74% native aortic infections and 26% VGEI. Median 30-day mortality, late mortality and overall mortality following BPR were 16.7% (IQR 14.5), 17% (IQR 23) and 39% (IQR 18), respectively. Notably, mortality was highest in 4/9 studies wherein thoracoabdominal or aortic arch BPR was performed. 201 patients suffered in-hospital complications, most commonly acute renal failure (21%), pneumonia (11%) and respiratory insufficiency (8%). Median length of follow-up was 420 days (IQR 600). During this period, median graft thrombosis, graft degeneration and re-infection rates were 5% (IQR 5), 10% (IQR 10) and 0% (IQR 0), respectively, necessitating re-intervention in 94% of cases. Quantitative data synthesis to estimate summary incidence of the aforementioned outcomes, subgroup analysis and heterogeneity analysis are currently pending.  Conclusion: Expectedly, morbidity and mortality following BPR for native aortic infection and VGEI is high given the medical complexity of the population. However, based on our preliminary analysis, BPR has low reinfection rate, high graft patency and freedom from degeneration making it an attractive option for aortic reconstruction. Meta Analysis results including pooled incidence of primary outcomes will follow to support preliminary findings. 

SUBMIT REVIEW

Session Lightning Oral 1A: 1004–1010 - Dr. Malavan Ragulojan (PGY3): Red blood cell transfusion and outcomes in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

Presenter: Dr. Malavan Ragulojan

Ragulojan M, Trivedi A, English S  

Division of Neurosurgery

Clinical Research

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with considerable morbidity and mortality. There is a lack of consensus in this unique population around red blood cell transfusion (RBCT) thresholds to optimize oxygen delivery while minimizing transfusion-related adverse events. We present a comprehensive systematic review and meta-analysis to address the optimal RBCT threshold in aSAH.  Methods: We conducted a literature search including studies of adult aSAH patients that report a comparative analysis of either hemoglobin levels or transfusion strategies. Our primary and secondary outcomes were all-cause mortality and functional neurologic recovery, respectively. Quality assessment was performed using the Cochrane and Downs and Black tools. Only studies rated as ‘good’ by Downs and Black (score > 20) or ‘low to some risk’ as per Cochrane were included in the pre-planned meta-analyses. We report our results in accordance with the PRISMA guidelines. Results: 2856 papers were screened, of which 41 (N=18733) were included. Of these, 26 examined transfusion effects or strategies, while the remainder focused on hemoglobin level and anemia. The 26 transfusion studies consisted of 3 randomized controlled trials, 1 non-randomized interventional study, and 22 observational studies. Of the 14 studies that met the quality threshold, only the 3 RCTs compared different transfusion thresholds, with 2 of these focused on an anemic patient population. Only one study (N=742) reported sufficiently granular mortality data, demonstrating no significant association between liberal transfusion strategy and 12-month mortality (OR: 1.00 (0.72 - 1.39)). Meta-analysis using a random-effects model of the two RCTs (N=913) demonstrated no significant association between liberal transfusion strategy and long-term functional outcome (OR 0.79 (0.59 - 1.03)).  Conclusion: Prior to the publication of recent large, randomized control trials, results in the literature have been heterogenous, and at high risk for confounding. This meta-analysis collates this data, demonstrating no difference in outcome between liberal and conservative transfusion strategies. 

 SUBMIT REVIEW

Session Lightning Oral 1A: 1010–1016 - Justin Phung (Medical Student): Artificial Intelligence Applications in Laparoscopic Skill Acquisition and Assessment: A Scoping Review

Presenter: Justin Phung

Phung J, Gnanaseelan C, Lee JKH, Fallavollita P

Division of General Surgery

Educational Research

Background: Laparoscopic surgery requires dexterity, coordination, and fine motor skills. Traditional laparoscopic skill assessment has relied on human evaluators, which is both labor-intensive and subject to bias. Artificial intelligence (AI) offers objective, automated feedback for laparoscopic training, however its reliability and integration into surgical education remains unclear. This study aims to review recent developments in AI applications for laparoscopic skill assessment in surgical education and identifies areas for future research. Methods: MEDLINE, EMBASE, and Web of Science databases were searched for studies evaluating AI-based laparoscopic skill assessment involving medical students, surgical residents, and/or fellows published from 2015 to 2024. All original research referencing “artificial intelligence” or “virtual reality” or “computer simulation” and “laparoscopy” and “medical education” or “assessment” were included. Data were qualitatively analyzed and synthesized according to the PRISMA scoping review guidelines. Results: 1973 abstracts were reviewed, and 30 studies were included. Studies were classified as comparing AI systems against validated scoring methods by human raters (n = 12) and AI tools for distinguishing operator skill level (n = 18). The most common skills assessed by AI platforms were laparoscopic peg transfer (n = 9), suturing (n = 7), knot tying (n = 6), or pattern cutting (n = 6). AI models demonstrated strong correlation and agreement with manual scoring by human assessors on standardized assessment tools. AI skill assessment via real-time data capture and video analysis demonstrated moderate-to-high accuracy in distinguishing between novice and expert surgeons. Conclusion: AI-based technologies offer an objective alternative to manual assessment by accurately classifying operator skill level and providing reliable automated scoring for various laparoscopic tasks. Real-time AI feedback may accelerate skill acquisition, reduce human bias, and improve training efficiency. Further research with standardized AI assessment metrics and randomized trials is needed for validation prior to implementation in surgical education.  

SUBMIT REVIEW

Session Lightning Oral 1B: 0940–0946 - Dr. Tyler Lamb (PGY5): The Revised Canadian Bleeding (CAN-BLEED) Score for Risk Stratification of Bleeding Trauma Patients: A Mixed Retrospective-Prospective Cohort Study

Presenter: Dr. Tyler Lamb

Tran A, Lamb T, Fernanado SM, Charette M, Nemnom MJ, Matar M, Lampron J, Vaillancourt C

Division of General Surgery

Clinical Research

Background: Traumatic hemorrhage is a significant cause of morbidity and mortality. There is considerable interest in risk stratification tools to aid with early activation of intervention pathways for bleeding patients. In this study, we refine the Canadian Bleeding (CAN-BLEED) score for the prediction of major interventions in bleeding trauma patients. Methods: We conducted a mixed retrospective-prospective cohort study. We included a retrospective cohort from the CAN-BLEED derivation study, from September 2014 to September 2017. We also conducted a prospective cohort from May 2019 to August 2021 and included both datasets for refinement of the CAN-BLEED score. The primary outcome was major intervention, defined by a composite of massive transfusion, embolization, or surgery for hemostasis. Predictors were pre-specified based on previous validation work. We used a step down procedure and regression coefficients to create a clinical risk stratification score. We used bootstrap internal validation to assess optimism-corrected performance. Results: We included 1368 patients in the overall cohort. Incidence of penetrating injury was 23% and median injury severity score was 17. The overall incidence of the need for major intervention was 17%. The revised score included 8 variables: systolic blood pressure, heart rate, lactate, penetrating mechanism, pelvic instability, Focused Abdominal Sonography for Trauma positive for free fluid, computed tomography positive for free fluid, or contrast extravasation. The C-statistic for the simplified score is 0.89. A score cut-off of less than 2 points yielded a 97% (94–98%) sensitivity in ruling out the need for major intervention. Conclusion: The revised CAN-BLEED score offers a clinically intuitive and internally validated tool with excellent performance in identifying patients requiring major intervention for traumatic bleeding. Further efforts are required to evaluate its performance with an external validation.  

SUBMIT REVIEW

Session Lightning Oral 1B: 0946–0952 - Dr. Omar Salem (Fellow): A single tertiary-care center experience using Vertical Rectus Abdominis Myocutaneous flap in the management of complex Periprosthetic Joint Infections of the Hip

Presenter: Dr. Omar Salem

Salem O, Zhang J, Grammatopoulos, Garceau S, Abdelbary H

Division of Orthopedic Surgery

Clinical Research

Purpose: Prosthetic joint infections (PJIs) present significant challenges in orthopedic surgery, often requiring multiple interventions that result in soft tissue loss, large dead spaces, and extensive fibrosis. Wound breakdown further increases the risk of developing polymicrobial infections, complicating treatment and heightening the likelihood of treatment failure. The vertical rectus abdominis myocutaneous (VRAM) flap is a well-established option for complex wound coverage, but its role in managing persistent hip PJI remains underexplored. This study aims to evaluate the outcomes of VRAM flap reconstruction in the context of polymicrobial PJI, focusing on flap survival, infection control, and wound healing. Methods: We retrospectively reviewed five patients who underwent VRAM flap reconstruction for polymicrobial hip PJI between December 2020 and December 2023. Management was multidisciplinary, involving orthopedic, plastic, and infectious disease specialists. Primary outcomes included flap survival, infection control, and wound healing. Secondary outcomes were implant retention, postoperative complications (Clavien-Dindo classification), and functional status. Results: At a mean follow-up of 28 months (range: 12–47), four patients (80%) achieved complete wound healing and remained infection-free, while one (20%) had persistent sinus drainage but retained the implant. Flap survival was 100%, with no necrosis or failure. No major complications requiring reoperation occurred. Two patients developed deep collections, managed with ultrasound-guided drainage (Clavien-Dindo IIIa). Minor complications in all cases included donor-site wound dehiscence (three), flap site dehiscence (one), edge necrosis (two), and donor-site hernias (two), all managed non-surgically (Clavien-Dindo I or II). All patients retained their implants and remained ambulatory at final follow-up. Conclusions: VRAM flap reconstruction is a reliable option for managing complex polymicrobial hip PJI. Flap survival was excellent, and most patients achieved infection control. However, persistent infection and the need for suppressive antibiotics highlight the ongoing challenges in treating these cases.

SUBMIT REVIEW

Session Lightning Oral 1B: 0952–0958 - Said Ashkar (Medical Student): Natural History of Chronic Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis of 87 Studies Enrolling 9,705,463 Participants

Presenter: Said Ashkar

Ashkar S, Kirkham AM, Abdul SA, Ramsay T, Fergusson DA, Brandys T, Nagpal S, Shorr R, Stelfox HT, Roberts D

Division of Vascular Surgery

Clinical Research

Objective: To describe the occurrence (i.e., natural history) of clinical and health-related-quality-of-life (HRQoL) outcomes in chronic-limb-threatening-ischemia (CLTI) patients, a research area recently prioritized by the Society for Vascular Surgery.  

Methods: We searched MEDLINE and EMBASE (inception-to-June 24-2024) for population-based observational studies describing the cumulative incidence of clinical and HRQoL outcomes among adults (≥18 years-of-age) with CLTI in high-income countries. Two investigators independently screened abstracts/full texts, extracted data, and assessed risk of bias. Data were pooled using random-effects models and GRADE was used to assess certainty.

Results: Among 7,134 unique citations identified, we included 87 studies (n =9,705,463 participants). The pooled cumulative incidence of in-hospital/30-day, 6-12 month, and 5-year mortality was 4% (95% confidence interval [CI]=2-6%; high-certainty), 18% (95% CI=13-24%; moderate-certainty), and 10% (95% CI=1-55%; low-certainty), respectively. The cumulative incidence of in-hospital/30-day, 6-12 month, and 5-year major (i.e., above-ankle) amputation was 8% (95% CI=3-16%; moderate-certainty), 9% (95% CI=4-16%; moderate-certainty), and 5% (95% CI=5-5%; moderate-certainty), respectively. The cumulative incidence in-hospital/30-day and 6-12 month major adverse limb events was 9% (95% CI=8-11%; high-certainty), and 29% (95% CI= 26-32%; moderate-certainty), respectively. The cumulative incidence of in-hospital/30-day and 6-12 month major adverse cardiovascular events was 5% (95% CI=4-6%; high-certainty), and 10% (95% CI=4-18%; moderate-certainty), respectively. The cumulative incidence 30-day and 6-12 month readmission was 17 % (95% CI=13-23%; moderate-certainty) and 41% (95% CI= 41-41%; moderate-certainty), respectively.  

Conclusions: We report the cumulative incidence of 83 clinical and HrQoL outcomes in adults with CTLI living in high-income countries based on population-level data at six clinically important timepoints. The outcome incidences we report may be used by practicing clinicians during patient consultations to provide the CLTI patients that they manage with more accurate estimates of their likelihood of experiencing these outcomes over different time periods.  

SUBMIT REVIEW

Session Lightning Oral 1B: 0958–1004 - Dr. Matthew Cornacchia (PGY5): Does a dedicated daytime operating room improve outcomes for patients admitted with appendicitis and biliary disease: a single institution experience

Presenter: Dr. Matthew Cornacchia

Cornacchia M, Ehlebracht A, Glen P

Division of General Surgery

Quality Improvement Research

Introduction: Timely surgical intervention for biliary disease can be hindered by limited access to operating rooms (OR). A dedicated daytime OR may reduce wait times, improve patient outcomes, and optimize resource use. This study evaluates the impact of a dedicated OR versus a shared OR model on key time-based metrics at a single institution operating under an Acute Care Surgery (ACS) framework. Methods: A retrospective analysis was conducted at a tertiary care center from January 2022 to July 2023. Two cohorts were compared: one campus with a dedicated weekday OR (Civic) and another campus without a dedicated OR (General). Adult patients who presented with biliary pathology and underwent urgent laparoscopic cholecystectomy were included; those managed non-operatively or undergoing scheduled procedures were excluded. Outcomes assessed included time from emergency department (ED) arrival to admission, time from surgical request to OR entry, operative duration (first incision to closure), proportion of surgeries performed during daytime hours and within priority specific target time. Results: Of 861 cases analyzed (Civic n=402; General n=459), the mean ED-to-admission time was significantly shorter at Civic (10.37 vs 12.75 hours, p=0.011). For lower-acuity (Urgent E) cases, Civic showed faster operative times (1.02 vs 1.18 hours, p=0.0019) and a higher proportion of daytime surgeries (82.43% vs 68.71%, p=0.009). Urgent D cases demonstrated no significant difference in daytime versus nighttime surgeries between campuses. Neither site met institutional targets consistently: at Civic, 68.25% of Urgent D cases and 48.65% of Urgent E cases met booking-to-surgery targets, compared to 63.67% and 46.26% at General, respectively. Conclusion: A dedicated ACS OR was associated with reduced ED-to-admission times, shorter operative times for Urgent E cases, and more daytime surgeries. However, both campuses struggled to meet internal surgical timing targets, highlighting broader system challenges in resource allocation and OR capacity. 

SUBMIT REVIEW

Session Lightning Oral 1B: 1004–1010 - Dr. Adolfo Lopez Rios (PGY2): Impact of Age, Body Mass Index, and Resection Weight on Postoperative Complications in Oncoplastic Surgery with Simultaneous Symmetry Procedure: A Canadian Perspective

Presenter: Dr. Adolfo Lopez Rios

Lopez Rios, AA, Dozois A, Zhang J

Division of Plastic Surgery

Clinical Research

INTRODUCTION: Breast cancer is a common cancer and a leading cause of cancer-related deaths among women. Treatment options include partial resection, mastectomy, and oncoplastic surgery, which combines oncologic and plastic surgery to maintain breast appearance while removing cancerous tissue. Our main objective was to assess how age, body mass index (BMI), and comorbidities affect postoperative complications in oncoplastic surgery with symmetry procedures. METHODS: A retrospective chart review was conducted on all patients diagnosed with breast cancer who underwent oncoplastic breast-conserving surgery at the Ottawa Hospital over six years. We collected data on patient demographics, presentation, smoking history, neoadjuvant treatment, radiotherapy, pathology, complications, any delays in adjuvant therapy, local recurrence and distant metastasis, procedural details, treatment, tumour characteristics, complications, follow-up, and outcome data. RESULTS: We include 76 females in our study, averaging 63 years. Fifty percent of the patients had a BMI greater than 30, and the average follow-up period was 744 days—thirty percent presented with comorbidities, the most common being hypertension. Patients received adjuvant chemotherapy in 43.4% of cases, neoadjuvant treatment in 14.5%, and adjuvant radiotherapy in 96.1%. Minor complications, including fat necrosis, dehiscence, or infection managed with oral antibiotics, occurred in 35% of the patients—additionally, 9.2% required surgical debridement. There were no significant medical complications, such as deep vein thrombosis (DVT) or pulmonary embolism (PE). Patients with a BMI greater than 30 (X²=10.97, p=0.02) and those requiring hospitalization after surgery (X²=15.29, p<0.001) had higher rates of both minor and major complications. CONCLUSIONS: Patients undergoing oncoplastic breast-conserving surgery with symmetrizing mastopexy do not experience delays in therapy. However, obese patients and those requiring hospitalization after surgery exhibited increased rates of minor and major complications.

 SUBMIT REVIEW

 Session Lightning Oral 1B: 1010–1016 - Arushi Wadhwa (Medical Student): Use of Artificial Intelligence Versus Traditional Statistical Modelling in Predicting Anastomotic Leakage for Patients Undergoing Colorectal Surgery: A Scoping Review

Presenter: Arushi Wadhwa

Anant S, Wadhwa A, Lee JKH, Auer R, Fallavollita P

Division of General Surgery

Clinical Research

Introduction: Anastomotic leak (AL) is a devastating complication of colorectal surgery, causing significant morbidity and mortality. Traditional risk assessment models (e.g. logistic regression and nomograms) have identified various risk factors for AL, however there is no consensus on best models for stratifying AL risk. Recently, artificial intelligence (AI) models have shown promise in accurately predicting AL by analyzing large patient datasets. This study aims to compare the performance of traditional and AI-based predictive models for AL and guide future development of AI-driven surgical decision-making tools for AL. Methods: MEDLINE and EMBASE were searched from database inception to March 2024 for observational cohort studies outlining the development and/or validation of conventional or AI-based risk prediction models for AL following colorectal surgery. Primary outcomes included the model performance through area under the curve (AUC), concordance-index, sensitivity, and specificity, while secondary outcomes focused on the specific risk factors, calibration and power of studies. Data were extracted based on the CHARMS checklist and synthesized according to PRISMA-ScR guidelines. Results: 1882 abstracts were reviewed, and 53 studies were included for analysis. Eight studies (15%) focused on AI-based models, while 45 studies (85%) described traditional predictive models for AL. AI-based models utilized more predictors per model compared to traditional models, but this was not statistically significant. Amongst AI-based models, the highest AUC observed was 0.92 (95%CI 0.91–0.93) attained through an artificial neural network. Frequently assessed variables included patient ASA status, BMI, age, sex, and operative time. Amongst traditional models, the highest observed AUC was 0.95 (95%CI 0.91-0.93) using a logistic regression analysis. Commonly included prognostic variables were male sex, ASA grade, and BMI. Conclusion: AI models have demonstrated promising reliability and accuracy for predicting AL using comprehensive patient cohorts. Further research is needed to externally validate models and establish widespread applicability for AL risk stratification.

 SUBMIT REVIEW

Session Podium 2: 1030–1045 - Dr. Taylor Woolnough (PGY5): The Anterior Approach Does Not Improve Recovery After Hemi-arthroplasty for Femoral Neck Fracture. A Randomized Controlled Trial

Presenter: Dr. Taylor Woolnough

Woolnough T, Horton I, Garceau S, Beaule P, Feibel RJ, Gofton W, Poitras S, Kim P, Grammatopoulos G

Division of Orthopedic Surgery

Clinical Research

Introduction: Evidence supporting the anterior approach (AA) over the lateral approach (LA) in patients undergoing hemiarthroplasty for intracapsular hip fracture, while promising, is inconsistent and largely retrospective. The purpose of this study was to compare the AA to the LA for early function, time to discharge, pain, and complications in patients undergoing hemiarthroplasty for hip fracture.  

Methods: A multi-surgeon, single-center, randomized-controlled-trial (RCT) was performed. One hundred and two patients undergoing hemiarthroplasty for acute femoral neck fractures were randomized to AA (n=50) or LA (n=52). All procedures were performed by fellowship-trained arthroplasty surgeons using cemented- (92/100) or uncemented (10/102) stems. Patients were followed at regular intervals and outcomes were assessed at 2-, 6-, 12-, and 26-weeks. Age (mean: 81±7.6 years-old), BMI, pre-operative mobility, ASA grade, and stem fixation were similar between groups (p>0.05). The primary outcome was patient function assessed using the Barthel-20 Index at 6 weeks. Secondary outcomes included pain (Visual-Analogue-Scale [VAS] Pain), EQ-5D global health assessment, length of stay, and complications.

Results: Barthel-20 Index score did not differ between groups at 6 weeks (AA:15.8±5.3; LA: 15.8±5.2, p=0.976) or at any other time. EuroQoL-5D and VAS pain were not different. Mean length of hospital stay (AA: 11.1±7.7 days; LA: 9.4±6.7 days, p=0.226) and time from surgery to rehabilitation discharge (AA: 31.3±18.6 days; LA: 30.4±28 days, p=0.867) were not different. There was no difference in readmission/ED visit within 90 days (p=0.858) or 90-day mortality (AA, 2/50; LA, 2/52, 4%, p=0.916). There was no difference in re-operations (AA: 2/50; LA, 1/52, p=0.535) or medical (AA:14/50; LA: 21/52, p=0.365) complications.

Conclusion: The AA is not associated with superior recovery or early-term outcomes in hip fracture patients. At present, without proven benefit, widespread adoption of the AA in this population is not recommended, particularly considering the learning-curve and specialized equipment requirements.

SUBMIT REVIEW

Session Podium 2: 1045–1100 - Dr. Sami Khairy (Fellow): New Postoperative Visual Deterioration and Deficit Post Endoscopic Endonasal Pituitary Adenoma Resection: Predictors and Long-Term Outcome

Presenter: Dr. Sami Khairy

Khiary S, Vargas-Moreno A, Mouaz S, Rabski J, Kilty S, Alkherayf F

Division of Neurosurgery

Clinical Research

BACKGROUND: Postoperative visual deterioration following endoscopic endonasal transsphenoidal surgery for pituitary adenoma is very rare yet significant morbidity. Iatrogenic injury, compression, and ischemic insults are the principal mechanisms but timely diagnosis and intervention can potentially improve the outcome; however, the predictors and their correlation with intervention outcome remain poorly elucidated. The aim of this study is to investigate the predictors of visual deterioration in patients who underwent endoscopic endonasal pituitary adenoma resection.

STUDY DESIGN AND METHODS: We reviewed 790 patients in our database for the last 10 years (2014- 2024). We included all the patients with pituitary adenoma who underwent endoscopic endonasal transsphenoidal surgery and had Postoperative visual deterioration. Demographic data, preoperative, intraoperative, postoperative clinical data and patients' outcomes were retrospectively collected and analyzed.

RESULTS: Nine patients (1.13%) experienced early postoperative visual deterioration. None of the patients has an intraoperative report of direct injury to the optic apparatus, ischemic etiology was seen in five patients. Four patients (44%) underwent early reoperation to explore and decompress the optic apparatus. Vision was restored to baseline after reoperation in all 4 compressive cases. In the ischemic group (n = 5), three patients improved with supplemental oxygen and hypervolemic-hypertensive therapy (p = 0.03). mean arterial pressure elevation after surgery were significantly higher (p = 0.04) in those ischemic patients who recovered some vision compared with those with persistent visual deficits.

CONCLUSIONS: Postoperative visual deterioration following endoscopic endonasal surgery for pituitary adenoma is a very rare but serious complication. Visual deterioration can be treated if the underlying cause was identified and intervention was done. Compressive etiology has a favorable prognosis when identified and managed with reoperation and decompression. Ischemic etiology is potentially treatable with supplemental oxygen, hypervolemic-hypertensive and high mean arterial pressure in more than half of cases.

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Session Podium 2: 1100–1115 - Dr. Julian Wang (PGY5): Head-Mounted Laser Pointer Improves Trainees’ Recognition of Surgical Planes

Presenter: Dr. Julian Wang

Wang J, Raiche I, Nyarko K, Gawad N

Division of General Surgery

Educational Research

 
Background: Plane recognition is critical in surgery, and teaching trainees this skill using verbal instruction can be challenging. Various innovations such as augmented reality have improved intraoperative guidance but require sophisticated technology. This study evaluates the effectiveness of a novel head-mounted laser pointer compared to verbal instruction in improving trainees’ ability to identify surgical dissection planes. Methods: General surgery residents were shown 10 second surgical videos on an iPad. At a paused frame, they drew their perceived line of dissection without instruction. They were then randomized to receive instruction from a staff surgeon either using verbal instruction alone or verbal instruction plus the laser pointer before redrawing the line. Accuracy was assessed by comparing each line to a reference line decided a priori by the same surgeons. Using a Euclidean distance-based calculation, a distance score was generated for each line using python3. One-way ANOVA and paired t-tests were used to compare the average distance between lines.  Subjective feedback was collected using a Likert-scale questionnaire afterwards. Results: Twelve participants across five years of residency reviewed 10 videos, generating 240 lines. Compared to the control lines, all participants improved with instruction, and there was significantly greater improvement using the laser relative to verbal instruction alone (distance from reference line: 221, 130 and 170 pixels for control, laser and verbal groups, p<0.001).  PGY1 and 5 residents showed the greatest improvement with the laser (82 and 99 pixels better than verbal, p<0.001). All participants agreed or strongly agreed that the laser pointer was more effective than verbal instruction alone for identifying surgical planes. Conclusion: A head-mounted laser pointer is a simple tool that can significantly improve surgical trainees’ accuracy in identifying dissection planes compared to verbal instruction alone in laparoscopic surgery. Future direction includes evaluating use of the laser pointer in the operating room.  

 SUBMIT REVIEW

Session Podium 2: 1115–1130 - Dr. Ian Malnis (PGY4): The Accessible Support in Surgical Training (ASSIST) Trial: A Randomized Controlled Trial

Presenter: Dr. Ian Malnis

Malnis I, Roberts D, Rockley M, Brandys T

Division of Vascular Surgery

Educational Research

Introduction: To assess the impact of a mobile app-based mindfulness program on surgical trainees’ psychological well-being. Methods: A prospective, randomized, observer-blinded trial. Surgical residents were randomized 1:1 to the intervention group (free access to mobile mindfulness app) versus control group (no free access). The intervention group was directed to use the app 3 times per week for 15 minutes over 12 weeks. The primary outcome was psychological well-being measured by three validated surveys: Perceived Stress Questionnaire (PSQ), Maslach Burnout Inventory (MBI), and DASS-21 (Depression, Anxiety and Stress Scale); performed at baseline, 6 weeks, 12 weeks and 18 weeks. The primary outcome was assessed using linear mixed effects models, adjusted to consider baseline score differences. Secondary outcomes included dose-response (mean min/week), adherence, and app satisfaction. Residents who reported scores greater than two standard deviations from the mean in the negative direction were considered high-risk, and confidentially contacted by the blinded study coordinator. Results: All participants completed at least one baseline survey. 36% were high-risk at baseline and at the end of the study period, 68% had been notified of high-risk scores. There were no statistical differences between the control and intervention groups in their perceived psychological wellbeing, regardless of adjustment. Within the intervention group, dose-response was negative. Adherence, measured by attrition, was low, with only 50% completing all surveys, and 25% of participants completing baseline surveys only. Attrition was similar between the control and intervention groups (57% vs 43%). 55% of participants were satisfied or highly satisfied with the app, with only 5% reporting dissatisfaction. Conclusions: Surgical trainees are at high risk for burnout. Despite high levels of satisfaction with the mobile app, adherence was poor and the intervention did not produce significant improvements in well-being. Further strategies should be explored to facilitate risk reduction in this population.

 SUBMIT REVIEW

Session Podium 2: 1130–1145 - Yoohyun Park (Medical Student): Machine Learning-Based Analysis of Key Factors Influencing Operating Room Efficiency in Thoracic Surgery

Presenter: Yoohyun Park

Hanash A, Lee JKH, Park Y, Gilbert S, Fallavollita P

Division of Thoracic Surgery

Quality Improvement Research

Introduction: Operating room (OR) inefficiencies contribute to increased healthcare costs, prolonged wait times, and poorer patient outcomes. Machine learning (ML) techniques analyze patterns in surgical workflows and case factors better than traditional statistical methods, which fail to account for complex interactions between multiple perioperative factors. This study utilizes ML models to conduct a framework-based analysis of key predictors impacting OR efficiency in thoracic surgery. Methods: Data from 3738 lung resection procedures performed between April 2008-April 2024 were analyzed. Feature selection using Random Forests, Recursive Feature Elimination, and Binary Mask Optimisation identified key predictors from patient demographics, time intervals, and team composition data. Six ML models were tested to analyze the relationship between factors within team, time, or patient metrics and surgical success rate (SSR) - the ratio of successful on-time case completions to total cases. Model performance was evaluated through 5-fold cross-validation (CV), precision, overfitting, sensitivity and specificity. Results: Key predictors of SSR included Anesthesiologist, Anesthesia Prep Time (APT), Procedure time, presence of Scrub person 3, and Surgical Prep Time (SPT). SSR was most correlated with Anesthesiologist (0.329) and Scrub person 3 (0.327), highlighting relative importance of team composition for surgical success. No single feature exhibited strong correlation with SSR, suggesting a multifactorial impact of included metrics on surgical efficiency. Time metrics exhibited the highest predictive power for SSR (CV 5-fold = 73%, Random Forest), followed by team metrics (CV 5-fold = 71%, Support Vector Machine) and patient metrics (CV 5-fold = 64%, Random Forest). Conclusion: This study identifies important factors for surgical success and highlights the predictive power of time, team and patient-metric frameworks, offering data-driven solutions for optimizing OR efficiency in thoracic surgery. Further ML modelling will be performed to establish key benchmarks within frameworks to assist with case scheduling and track OR performance through prescriptive analytics.

 SUBMIT REVIEW

Session Podium 2: 1145–1200 - Dr. Ana Turner (PGY3): Using Generative Artificial Intelligence to Aid in Surgery Resident Selection: Not Ready Yet

Presenter: Dr. Ana Turner

Turner A, Nyarko K, Gawad N, Raiche I

Division of General Surgery

Educational Research

Background: Surgery resident selection is a resource-intensive process. The advent of generative artificial intelligence (GAI) offers a new possibility to aid in resident selection, increasing the efficiency of file review without the burden of creating a customized machine-learning algorithm. Our study aimed to compare file review of general surgery applicants by GAI to file review by our program’s residency selection committee (RSC).

Methods: GPT-4o, an open access GAI software, was used to score deidentified 2023-2024 CaRMS application files to our program based on our RSC’s file review scoresheet. GAI scores were compared to RSC-assigned scores for each application element including CVs, personal letters, and reference letters. Rank lists generated from both sets of scores were compared using Spearman’s rank correlation. GPT-4o was then used to create ten generic application files. These were scored by GAI and compared to GAI scores for the 2023-2024 CaRMS applicants using the Wilcoxon rank-sum test.  

Results: A total of 124 application files were included. Median GAI file review scores were consistently higher than RSC-assigned scores (24.46 vs. 17.54 y, p<0.05) and had less variance between applicants (6.96 vs. 20.80, p<0.05). The interrater reliability between GAI scores and RSC scores was poor across all application elements (0.16). Rank lists generated by GAI and RSC scores demonstrated a weakly positive correlation for each application element (0.25 to 0.37, p<0.05).  Rank lists based on total file review scores demonstrated a moderately positive correlation (0.44, p<0.05). Median scores for GAI-created files compared to CaRMS applicant files were statistically similar for application CVs (6.88, p=0.25), but were significantly higher for other application elements and global scores (27.51 vs. 24.46, p<0.05).

Conclusion: GAI in its current form cannot reliably replicate human file review. Further research is needed to determine the potential role for GAI in residency selection.

SUBMIT REVIEW

Session Lightning Oral 2A: 1410–1416 - Ervis Musa (Medical Student): Exploring the Perceptions of Artificial Intelligence Applications in Surgery: A Review of Clinician and Patient Perspectives

Presenter: Ervis Musa

Musa E, Lee JKH, Tubin J, Saal A, Fallavollita P

Division of General Surgery

Educational Research

Introduction: Artificial intelligence (AI) is rapidly being incorporated within various domains of surgical care, demonstrating promise in enhancing surgical decision-making, increasing efficiency, and improving patient outcomes. However, adoption into clinical practice is highly dependent on clinician and patient attitudes towards AI, which remain poorly characterized in surgery. This review explores surgeon and patient perspectives regarding use of AI technologies in perioperative settings to identify key barriers and facilitators to their integration. Methods: MEDLINE, EMBASE, PubMed, CINAHL, and Web of Science were searched from database inception to June 2024 for studies reporting perspectives of surgeons, allied health professionals, and patients on use of AI technology in surgery. Data were qualitatively analyzed and synthesized according to the PRISMA scoping review guidelines (PRISMA-ScR). Results: 2158 abstracts were reviewed, and 16 studies were included. Four major themes emerged: Confidence and Trust in AI (n=15), Expectations for AI Use (n=11), Familiarity with AI (n=8), and Ethical Concerns (n=5). Surgeons generally trusted AI decision-support tools, but this was dependent on AI’s alignment with their own clinical judgement, while patients had less confidence and preferred human judgment and expertise. Familiarity in AI varied, with surgeons lacking detailed understanding of AI technologies, while patients’ self-reported limited knowledge contributed to their relative discomfort with AI. Both groups expressed greater support for AI’s role in preoperative decision-making over intraoperative guidance or autonomous surgery. Ethical concerns such as liability and potential loss of human interaction with AI use were frequently reported among surgeons and patients. Conclusion: Surgeons and patients recognize the potential benefits of AI in perioperative settings but cite concerns around trust, transparency, and responsible use in surgery. Further validation studies, enhanced AI education for clinician users and support staff, and clear regulatory guidelines are necessary for achieving ethical, patient-centered integration of AI into surgical workflows.

SUBMIT REVIEW

Session Lightning Oral 2A: 1416–1422 - Sami Khairy (Fellow): Improving Outcomes in Giant Olfactory Groove Meningioma: A New Predictive Scale

Presenter: Dr. Sami Khairy

Khairy S, Alkhaibary A, Vargas-Moreno A, Alkherayf A

Division of Neurosurgery

Clinical Research

BACKGROUND: Giant olfactory groove meningiomas (OGMs), while relatively rare, pose significant challenges due to their size. OGMs are slow-growing tumors often going undetected until reaching Giant size. OGMs consider Giant when it reaches more than 6 cm (2.4 in) in diameter. These tumors can cause a variety of symptoms, including headaches, personality changes, insomnia, and visual deterioration. Despite advancements in surgical techniques, understanding the factors influencing long-term outcomes remains crucial.

STUDY DESIGN AND METHODS: This retrospective study includes all the patients with Giant olfactory meningioma (more than 6 cm in diameter) who underwent surgery over a 22-year period (January 2000 to December 2022). Long-term outcomes including visual status, recurrence and functional status were collected. Multivariable logistic regression was used to identify predictors of recurrence and functional outcome.

RESULTS: Thirty-two patients met the criteria and included in this study with mean age of 55.8 years, and the majority (71%) were female. These patients were followed for a mean of 62 months. Most of our Giant OGMs reported as WHO grade 1 (84.4%). The improvement of visual acuity and visual field deficits was observed in 19 patients after surgery. Recurrence was observed radiologically in nine patients (28.1%) at mean of 56 months follow up. Only 3 required reoperations for tumor resection. One patient had brain abscess following rhinorrhea and required surgery. Multivariable analysis identified age, Simpson grade of excision, and WHO grading of tumor were the factors that significantly affected the recurrence rate.

CONCLUSIONS: This study showed that visual deficits and functional outcome will improve in patients with Giant OGMs after the surgery. The post operative outcome was strongly predicted by factors like patient age, extent of resection and histological status. Building a new predictive scale based on these parameters appears to strongly predict the Giant OGMs outcome.

SUBMIT REVIEW

Session Lightning Oral 2A: 1428–1434 - Kwadjo Nyarko (Medical Student): Patient-Reported Outcome Measures in Liver Surgery: A Scoping Review

Presenter: Kwadjo Nyarko

Nyarko K, Lapolice S, Abou-Khalil J

Division of General Surgery

Clinical Research

Background: Patient-reported outcome measures (PROMs) are instruments that assess self-perceived health without clinician modification or interpretation. Liver surgery is associated with quality-of-life impacts that may be unique and not shared with other procedures. This scoping review aims to characterize PROM use in contemporary randomized controlled trials (RCTs) in liver surgery patients and identify whether tools specific to patient-centred evaluation of liver surgery’s convalescent experience are needed. Methods: A comprehensive search of Medline, Embase, Scopus and the Cochrane Central Register of Randomized Controlled Trials (CENTRAL) was conducted with an academic librarian’s guidance to identify liver surgery RCTs published from January 1st,2022 to August 9th, 2024. Title and abstract screening, full-text review, and data extraction were conducted in duplicate with a third reviewer resolving disputes. This scoping review was reported per the PRISMA-ScR Checklist. Results: The electronic database search yielded 1103 studies after removing duplicates. Following title and abstract screening, 291 full texts were assessed for eligibility, and 76 studies were included in the scoping review. There were 33 (43.4%) studies published in 2022, 26 (34.2%) in 2023 and 17 (22.4%) in 2024. PROMs were infrequently used: 47 (61.8%) studies used none, 11 (14.5%) studies used 1, 11 (14.5%) studies used 2, 6 (7.9%) studies used 3 and 1 (1.3%) study used 5. Of the 56 PROMs identified in the study, the Numeric Rating Scale (NRS) pain score, patient satisfaction and the Visual Analog Scale (VAS) pain score were most prevalent (n = 16, 28.6%; n = 9, 16.1%; and n = 5, 8.9% respectively). All PROMs were recorded postoperatively and 7 (12.5%) were also recorded preoperatively. No liver-surgery-specific PROMs were identified. Conclusion: We identified that patient-reported outcomes are infrequently utilized in liver surgery RCTs. There is no widely used liver-surgery-specific PROM capturing the unique experience of liver surgery patients.

SUBMIT REVIEW

Session Lightning Oral 2A: 1434–1440 - Dr. Akshay Sathya (PGY5): Radical Cystectomy versus Trimodal Therapy for the Treatment of Non-Metastatic Muscle Invasive Bladder Cancer: A Novel Patient Decision Aid

Presenter: Dr. Akshay Sathya

Sathya A, Sigurdson S, McAlpine K, Breau R, Stacey D, Yachin D, Cagiannos I, Morash C, Lukka H, Lavalée L

Division of Urology

Clinical Research

Purpose: The standard of care for the treatment of patients with non-metastatic muscle invasive bladder cancer (MIBC) is neoadjuvant chemotherapy followed by radical cystectomy. The use of trimodal therapy (maximal transurethral resection of tumour followed by chemoradiotherapy) as an alternative treatment for patients with MIBC has increased in availability, with increasing evidence supporting its efficacy. To support a shared decision-making approach for patients with MIBC choosing between radical cystectomy and trimodal therapy, we sought to develop a novel patient decision aid (PtDA). Methods: A multidisciplinary committee of urologic-, radiation-, and medical oncologists, as well as methodological experts and patient advocates was created to create an evidence-based decision aid. The International Patient Decision Aid Standards and the Ottawa Decision Support Framework were applied.  The literature was reviewed for the best available evidence on important procedure-specific and cancer-specific outcomes of radical cystectomy with and without neoadjuvant chemotherapy versus trimodal therapy. Patient-centred language was used, and outcomes were included in the PtDA with graphics and figures. Ethics approval was obtained through HREB. Alpha testing was completed with both patients and clinicians to facilitate feedback. Results: The first draft of an evidenced-based PtDA was created. The expected experience for patients receiving trimodal therapy and radical cystectomy were explained. This draft was reviewed with colleagues nationally and outcomes were agreed upon. Alpha testing was then performed using surveys with patients who had been treated for muscle invasive bladder cancer, in addition to urologists, medical oncologists, and radiation oncologists who treat muscle invasive bladder cancer. 15 clinicians responded to the survey. Patients are currently accruing. Feedback from clinicians and patients will be used to improve upon the decision aid before publishing the decision aid for clinical use. Conclusion: The first draft of a novel, evidence-based PtDA was created for patients with non-metastatic MIBC considering treatment with trimodal therapy or radical cystectomy. Acceptability and effectiveness testing was performed prospectively with uro-oncologists, medical and radiation oncologists, and patients. After using this feedback to implement appropriate changes, the final product will then be disseminated for use in clinical practice.  

SUBMIT REVIEW

Session Lightning Oral 2B: 1410–1416 - Jeremy Lee (PGY3): Advances in Artificial Intelligence and Extended Reality for Enhanced Surgical Navigation in Thoracic Surgery: A Scoping Review

Presenter: Dr. Jeremy King Hei Lee

Seeger R, Lee JKH, Patel M, Alkalani SR, Fallavollita P, Gilbert S

Division of General Surgery

Clinical Research

Introduction: Lung cancer remains the leading cause of cancer-related deaths. Emerging technologies like artificial intelligence (AI), virtual (VR) and artificial reality (AR) show promise in improving precision of tumor localization and anatomical mapping for lung resections. This review examines the scope of these technologies for preoperative surgical planning, evaluates safety profiles, and explores potential applications for improving outcomes in thoracic surgery. Methods: A comprehensive literature search was conducted on MEDLINE, Embase, and Web of Science from January 2010 to May 2024 for studies describing AI, AR or VR technologies for thoracic surgery planning. Patients of all ages undergoing elective lung resection were included. A qualitative analysis of included technologies, primary aims for use, oncologic and postoperative patient outcomes was conducted. Results: 2801 abstracts were reviewed, and 13 studies were included. Most studies utilized VR (n = 8), while the remainder used AR (n = 2), AI (n = 2), or mixed reality platforms (n = 1) for surgical planning. Three studies evaluated changes to surgical plans through image assistance platforms, reporting changes to surgical strategy, extent of resection, or selected target segment in up to 40-80% of cases. Eight studies found improvements to accuracy of localizing nodules, vascular structures, and/or detecting anatomical variations using AI/AR/VR technologies compared to conventional imaging. Most studies (n = 10) included intraoperative and postoperative patient outcome data associated with use of AI/AR/VR platforms, reporting acceptable safety profiles without compromising oncologic principles or operative times. Conclusions: AI/AR/VR technologies have the potential to improve thoracic surgery by improving lesion localization, refining surgical plans, and enhancing patient outcomes. Although these technologies have demonstrated positive impacts in other fields, their application in thoracic surgical challenges remains rudimentary. Further research using randomized trials with standardized outcomes and inclusion of feasibility data is needed to optimize their integration within thoracic surgery.

SUBMIT REVIEW

Session Lightning Oral 2B: 1416–1422 - Dr. Datta Debajyoti (Fellow): Low/Negative Pressure Hydrocephalus in Children – Influence of Venous Thrombosis: A Retrospective Case Series

Presenter: Dr. Datta Debajyoti

Datta D, Tu A

Division of Neurosurgery (Pediatric)

Clinical Research

Background: Low/negative pressure hydrocephalus (LPH) is a rare condition characterized by signs and symptoms of hydrocephalus with a low intracranial pressure (ICP). The aim of the present study was to review and analyze the clinical characteristics, management, and outcomes of pediatric patients treated for LPH. Methods: We conducted a retrospective, observational study of pediatric patients (≤18 years) diagnosed with LPH at our institution. Inclusion criteria were change in ventricular size with clinical hydrocephalic symptoms, measured intracranial pressure (ICP) ≤5 cmH2O, and clinical improvement following cerebrospinal fluid (CSF) drainage at low opening pressure. Data on demographics, etiology, type of hydrocephalus, clinical presentation, management strategies and outcomes were collected. Results: Six patients (3 males, 3 females; age range: 5 months–18 years) met inclusion criteria. Four had non-communicating hydrocephalus, two had communicating hydrocephalus. All patients exhibited symptoms of hydrocephalus at ICP ≤5 cmH2O. Management involved ventriculoperitoneal shunts at low-pressure settings (n=3) and placement of shunts into negative pressure cavities (n=3). One illustrative case required multiple shunt revisions before clinical resolution, whereas another needed prolonged external ventricular drainage prior to definitive ventriculoatrial shunting. The presence of prior jugular vein thrombosis and sigmoid sinus thrombosis was an unusual finding. We modeled the role of venous thrombosis and demonstrated that it is theoretically plausible for prior venous thrombosis to contribute to LPH. Conclusions: LPH in children is rare and clinically challenging, with pathogenesis involving altered cerebral viscoelasticity and/or a transmantle pressure gradient. We demonstrate that it is theoretically possible for prior venous thrombosis to contribute to LPH.

SUBMIT REVIEW

Session Lightning Oral 2B: 1422–1428 - Angela Li (Medical Student): Rates of Healing and Timing of Repeat Imaging after Blunt Cerebrovascular Injury: A Systematic Review and Meta-Analysis

Presenter: Angela Li

Li A, Durr K, Fernando SM, Rochwerg B, Inaba K, Biffl WL, Glen P, Matar M, Lampron J, Kubelik D, Engels PT, Rosenkrantz L, Dawe P, Garraway N, Joos E, Tran A

Division of General Surgery

Clinical Research

Background & Objective: Blunt cerebrovascular injury (BCVI) is a non-penetrating carotid and/or vertebral artery injury following trauma. Treatment typically involves antiplatelets or anticoagulation followed by repeat imaging. However, little is known regarding the natural history of BCVI on treatment. Therefore, we performed a systematic review and meta-analysis to summarize the healing rates at various intervals of repeat imaging.

Methods: We searched EMBASE and MEDLINE from inception to December 1, 2024. We included studies reporting imaging-based follow-up outcomes of adult patients with BCVI. We organized data based on injury status and summarized overall resolution, progression, stability, and worsening of BCVI at various time points and according to injury grade.  

Results: We included 20 studies involving 2,641 patients. Studies were predominantly retrospective in nature, originating from North America, and follow-up primarily performed using computed tomography angiography (CTA). Median (Q1 to Q3) stroke incidence was 8.5% (5.1% to 13.1%). We demonstrate that lower grade injury is probably associated with BCVI healing at follow-up imaging (pooled unadjusted odds ratio 6.73, 95% CI 4.23 to 10.71, moderate certainty). In addition, we demonstrate that Grade I and II injuries demonstrated higher rates of resolution or improvement at every follow-up imaging period.  

Conclusion: This review demonstrates with moderate certainty that lower grade BCVIs probably heal faster, while higher grade BCVIs persist longer. These findings emphasize the importance of considering injury grade when determining the appropriate follow-up imaging interval.  

SUBMIT REVIEW

Session Lightning Oral 2B: 1428–1434 - Dr. Nardin Farag (PGY2): When Specialties Converge on a Real-Life Crisis: Resident’s Reported Positive and Negative Experiences of Multi-Specialty Emergency Patient Care

Presenter: Dr. Nardin Farag

Farag N, Dube LR, Silver JA, Young M, Bank I, Fisher R, Nguyen LHP

Division of General Surgery

Educational Research

Background: Crisis resource management (CRM) skills are necessary for ensuring the best possible patient outcomes and have become a mainstay in residency education. However, the majority of CRM training occurs within individual residency programs, leading to challenges when multiple specialties must coordinate to deliver patient care during a crisis. The goal of this study was to describe residents’ experiences witnessing or participating in positive or negative inter-specialty emergency care during their residency training. Methods: This manuscript reports on a secondary analysis of survey-generated data. An anonymous online survey was distributed to residents in eight specialties across Canada, and included items asking participants to describe positive and negative experiences of inter-specialty CRM during hospital-based patient care. Free-text responses were deductively coded according to the Stanford CRM framework themes, and responses that did not match pre-determined categories were analyzed using content analysis to identify data categories. Data categories were quantified and frequency of occurrence of categories were compared across positive and negative inter-specialty CRM experiences to identify areas of concordance and discordance. Results: 474 surveys were analyzed, and 1267 positive and 1204 negative free-text responses were coded. 62% of responses aligned with the Stanford framework. Highest frequency categories were “Designate leadership”, “Establish role clarity”, and “Communicate effectively”. “Designate leadership” was more frequently mentioned when describing negative experiences, while other leadership categories were more frequently associated with positive experiences, suggesting establishing a leader may be challenging in multi-specialty crises. Conclusion: This large survey-based study examined the characteristics of CRM experiences as reported by residents in Canada. These findings highlight using lived experiences as important lessons learned about the role of professionalism and systems. This study supports consideration for future CRM training practice amongst an inter-specialty cohort to identify leadership versus other roles.

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Session Lightning Oral 2B: 1434–1440 - Rena Seeger (Medical student): Learning Curve & Safety Analysis After 170 Robotic-Assisted Cases in Thoracic Surgery

Presenter: Rena Seeger

Seeger R, Bhattacharyya U, Gilbert S, Jones D, Stackhouse A, Villeneuve P

Division of Thoracic Surgery

Quality Improvement Research

Background: Robotic technology in thoracic surgery continues to gain popularity, with advancements improving intraoperative and postoperative outcomes. At the Ottawa Hospital, robotic-assisted (RATS) procedures have been conducted since 2022. We sought to evaluate surgeon performance for RATS procedures over time by a) assessing surgical efficiency using learning curves, and b) assessing safety by analyzing conversions and post-operative complications. Methods: Ethics approval was obtained for a prospective quality-improvement registry of all robotics cases. We analyzed 170 consecutive robotic-assisted thoracoscopic surgeries (April 2022–November 2024) and a time-matched dataset of 340 video-assisted thoracoscopic surgeries for comparison. Descriptive statistics were performed in Microsoft Excel (Redmond, WA, USA). Cumulative sum (CUSUM) analysis of lobectomies and anterior mediastinal resections was conducted in R (RStudio Team, Version 8) to assess the learning curve and operative time trends, using console time as a surrogate marker. Safety was evaluated by analyzing adverse events with the Ottawa TM & M Clavien-Dindo schema. Results: RATS at the Ottawa Hospital are safe, with a trend of greater efficiency with more experience. Mean console time for all cases (n=144) was 126 minutes, with a mean docking time of 24 minutes. For both lobectomies and anterior mediastinal resections, we observe increased time efficiency, seeing a steady decrease in operative time after 41 cases and 15 cases, respectively. Our safety outcomes are comparable to those shown in VATS, with majority (n=43, 73%) being a Grade II comprised of prolonged air leak (n=19, 32%). Out of our 170 cases, 14 (8%) were converted to VATS, primarily due to complex anatomy, with only three cases (2%) converted to open. Conclusion: We demonstrate that RATS can be introduced while maintaining surgical efficiency and patient safety. Our collective learning curves for pulmonary and anterior mediastinal resections align with our VATS data and literature reports. The safety profile of our early RATS series is excellent, with comparable LOS and prolonged air leaks to VATS cases.

SUBMIT REVIEW

Session Lightning Oral 2B: 1440–1446 - Dr. Nardin Farag (PGY2): A Scoping Review of Health Disparities in the Canadian Trauma System

Presenter: Dr. Nardin Farag

Farag N, Nyarko K, Raiche I, Alexanian J, Gawad N

Division of General Surgery

Clinical Research

Background: Racial and socioeconomic disparities in healthcare access and health outcomes exist in all patient populations, with the trauma population being particularly vulnerable given the high proportion of visible minority patients. The objective of this scoping review was to explore what disparities exist in Canadian trauma care. Methods: A database search was conducted in MEDLINE, EMBASE, and SCOPUS for studies on health disparities or inequity specific to trauma care in Canada. Data were qualitatively analyzed and synthesized using the PRISMA-ScR. Results: The search yielded 1,893 citations, and fourteen papers were included in the analysis. 71.4% of studies were published in the last 10 years, and 57.1% had Indigenous patients as their population of interest. All studies were conducted in the Canadian context. Six studies highlighted disparity in trauma care access between Indigenous and non-Indigenous patients, mainly attributed to longer travel distances and lack of formal emergency response in remote areas. This lack of formal emergency response results in increased emotional burden among the affected communities. Indigenous patients also have a higher rate of conservative management following traumatic spinal cord injuries and are more likely to be admitted to the intensive care unit. Both Indigenous and lower socioeconomic status (SES) patients are more likely to have a prolonged length of stay (LOS). Lower SES patients also have a higher incidence of adverse events while admitted for traumatic injuries and are more likely to undergo alcohol testing. Conclusion: Health disparities among trauma patients in Canada exist, although there is a general paucity of literature. The results of this scoping review identify those at risk and factors that may contribute to health disparities. This scoping review also highlights the need to build comprehensive Canadian trauma databases that capture data on race and SES to guide future research.  

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Session Podium 3: 1500–1515 - Dr. Victoria Ivankovic (PGY3) - Physiologic outcomes in a randomized controlled trial of hypovolemic phlebotomy in liver resection at higher risk of bleeding (PRICE-2)

Presenter: Dr. Victoria Ivankovic

Ivankovic V, Mallette K, Carrier FM, Wherrett C, Vanterpool Z, Brousseau K, Monette L, Workneh A, Ruel M, Sabri E, Maddison H, Tokessy M, Wong PBY, McGinn R, Vandenbroucke-Menu F, Massicotte L, Chassé M, Collin Y, Perrault MA, Hamel-Perreault E, Park J, Lim S, Maltais V, Leung P, Gilbert RWD, Segedi M, Abou-Khalil J, Bertens K, Balaa F, Ramsay T, Tinmouth A, Fergusson DA, Martel G

Division of General Surgery

Clinical Research

Background: The PRICE-2 trial demonstrated hypovolemic phlebotomy (HP) to decrease red blood cell transfusion and blood loss. We sought to compare secondary intraoperative physiologic outcomes in the same trial. Methods: PRICE-2 was a multi-center randomized controlled trial (2018-2023). Patients undergoing liver resection were randomly assigned to HP or usual care. Surgeons were blinded. HP consisted of removing 7-10 mL/kg of whole blood, without volume replacement, prior to liver transection. Phlebotomized blood was reinfused prior to closure. Unadjusted and adjusted risk ratios, as well as risk and mean differences were calculated for secondary physiologic outcomes, accounting for center effects and important prognostic variables. Results: A total of 486 patients were randomized, of which 446 underwent liver resection (223 vs 223; 8.2% unresectability). The groups were well balanced. The mean phlebotomy volume was 7.6 ± 1.4 mL/kg. Both study groups received the same median volumes of intravenous crystalloid (2050 vs 2100 mL) and colloid (500 vs 500 mL). Vasopressors were administered more frequently with HP (98.2% vs 93.4%), leading to larger total doses of phenylephrine (median 2500 vs 1535 mcg) and norepinephrine (median 800 vs 544 mcg). At the start and the end of liver transection, HP produced a lower CVP and higher pulse pressure variation (table). Heart rate, systolic and diastolic blood pressure, and urine output were similar. Conclusion: Hypovolemic phlebotomy leads to a decrease in CVP and increase in PPV during liver transection, despite comparable volumes of intravenous fluids being administered, suggesting that HP induces greater hypovolemia.  

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Session Podium 3: 1515–1530 - Dr. Jakob Weirathmueller (PGY3): Geomapping and Epidemiological Evaluation of Burns in Eastern Ontario: A Retrospective Analysis of Pediatric Patients Presenting to CHEO Plastic Surgery Clinic

Presenter: Dr. Jakob Weirathmueller

Bojic S, Weirathmueller J, Malic C

Division of Plastic Surgery

Clinical Research

Purpose: Burn injuries remain a leading cause of morbidity in children, yet regional data guiding prevention remains limited. This study evaluates the epidemiology, mechanisms, healthcare utilization, and spatial distribution of pediatric burns at the Children’s Hospital of Eastern Ontario (CHEO) Plastic Surgery Clinic. Methods: A retrospective review of pediatric burn cases (2016–2024) was conducted using electronic medical records from CHEO’s Epic system. ICD-10 codes identified cases. Geographic Information Systems (GIS) were used to detect clustering across regions. Statistical analyses examined associations between burn mechanisms, demographics, healing outcomes, and prehospital care. Results: Among 1,458 pediatric cases, scald injuries were most common (54.9%), followed by contact (32.9%) and flame burns (9.0%). Mechanism varied significantly by age group (p < 0.0001): scalds predominated in children under five, contact burns peaked between ages one and five, while flame burns were disproportionately seen in adolescents aged 11–17. Prehospital first aid was reported in 71.8% of cases but was not associated with faster healing (22.3 vs. 22.0 days, p = 0.90). First aid administration declined with age - from 90.5% in toddlers to 66.7% in adolescents - a trend nearing significance (p = 0.058) and suggesting a potential educational gap in older cohorts. Healing time increased slightly with age (r = 0.11, p < 0.001), with adolescents taking longest to recover. Dyschromia was noted in 17.0% of patients at follow-up, though most required only a single clinic visit. Conclusions: Geospatial analysis revealed burn injury clusters within Eastern Ontario, as well as in parts of Quebec, Nunavut, and Alberta, reflecting broader regional disparities. These findings highlight the utility of GIS in pediatric burn epidemiology and underscore the need for targeted, region-specific burn prevention campaigns—particularly in areas with limited access to care or first aid education.

SUBMIT REVIEW

Session Podium 3: 1530–1545 - Dr. Katlin Mallette (Fellow): Cholecystectomy related complaints: a 20-year review of the Canadian medicolegal experience

Presenter: Dr. Katin Mallette

Mallette K, Ehlebracht A, Mimeault R, Savoy T, Garber G, Yan Q, MacIntyre A, Liu R, Mostafapour M, Balaa F

Division of General Surgery

Clinical Research

INTRODUCTION: Cholelithiasis is a common problem amongst adults, with 1-2% becoming symptomatic. Laparoscopic cholecystectomy remains the standard of care for symptomatic patients and is one of the most commonly performed procedures by general surgeons in Canada. Significant post cholecystectomy complications are rare, but can have devastating consequences on the patient, surgeon, and healthcare system. This is especially true for common bile duct injuries (BDI). This study aims to provide a 20-year review and examination of trends in Canadian medico-legal data related to post-cholecystectomy complaints. METHODS: This is a 20-year retrospective review of the Canadian Medical Protective Association’s (CMPA) repository of medico-legal cases involving cholecystectomy related complaints between 2003-2022. Cases included all those in which the physician contacted the CMPA for assistance, and included civil legal actions, medical regulatory (College) complaints, and hospital level complaints. Data analysis was limited to descriptive statistics using SAS software. RESULTS: A total of 488 cases were closed during the study time period, with initial events occurring from 1991-2021. There was a trend of decreasing complaints during the study period (p-value=0.0004), with the majority of patients identifying as female (66%), and majority being generally healthy (ASA I/II-73.6%). The top 5 complications leading to complaint initiation were BDI (35.9%), leak (15.2%), bowel injury (12.7%), sepsis (10.9%), and hemorrhage (10.2%). A total of 555 physicians were involved, with 484 operating surgeons named in complaints. Most surgeons had ³ 11 years in practice (70%). The mean time from incident to case closure was 63.2+/-42.3months. BDI cases were significantly more likely to result in a favourable medico-legal outcome for the patient (77%) compared to all cholecystectomy cases (54%). CONCLUSIONS: This study demonstrates that in the Canadian medico-legal landscape, the majority of post cholecystectomy complaints involved generally healthy female patients. Unsurprisingly, BDI was the most common complication resulting in a complaint and these cases were more likely to result in a successful claim for the patient. Surgeons later in practice were more likely to be named in a complaint in comparison to their early in practice colleagues.  

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Session Podium 3: 1545–1600 - Dr. Brent Benavides (Fellow): Efficacy of Surgeon-performed, Intraoperative Adductor Canal Blocks in Same-Day Discharge Total Knee Arthroplasty

Presenter: Dr. Brent Benavides

Benavides B, Charlebois A, Dervin G, Feibel R, Kim P, Grammatopoulos G, Wong P, Duncan K, Garceau S

Division of General Surgery

Clinical Research

Introduction: The study compares the efficacy of surgeon-performed (sACB) to conventional anaesthesiologist-performed blocks (aACB). While ACBs improve pain management, mobility, they may increase procedure time, costs and require specialized skills. sACBs could be integrated into periarticular injections, but data on clinical efficacy are limited. Methods: This was a randomized controlled study; the control group received a preoperative ultrasound-guided block performed by anaesthesiologist, while the treatment group received an intraoperative ACB executed by the surgeon. The primary objective is to assess time to discharge, defined as the interval from spinal anaesthetic reversal to meeting discharge criteria. Secondary outcomes include NPRS pain scores at baseline and discharge, 24-hour opioid use post-discharge, failure to discharge, 24-hour readmission, and OKS, PROMIS, and EQ-5D-5L at baseline and 2 weeks post-op. Results: The sample included 117 eligible patients. The mean time to discharge home was 492.2±86.7 minutes for aACB and 496.5±111.5 minutes for sACB. Baseline NPRS scores averaged 0.2±0.7 for the aACB group and 0.5±1.8 for the sACB group. At discharge, NPRS scores were 2.3±2.1 for aACB and 2.9±2.2 for sACB. Failure of discharge requiring readmission for aACB was 8.62% and 6.7% in sACB group. No significant differences were found between groups from baseline to 2 weeks post-op in OKS (p = 0.71), PROMIS (p = 0.86), or EQ-5D-5L (p = 0.61). Overall, across all assessed outcomes, there was no statistical significance between patients who received blocks administered by an anaesthesiologist compared to those performed by a surgeon. Conclusion: The study highlights the potential for sACBs to serve as a feasible alternative to aACBs in TKAs without compromising clinical outcomes. Similar efficacy between sACB and aACB address the need for specialized anesthesiology support. Additionally, this approach could streamline postoperative pain management, facilitating broader access to effective analgesia in TKA while preserving patient outcomes.  

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Session Podium 3: 1600–1615 - Dr. Charles Paco (PGY2) - Patient and Physician Factors Associated with Adjuvant Pembrolizumab Utilization in the Setting of Surgically Resected Clear Cell Renal Cell Carcinoma (Translational)

Presenter: Dr. Charles Paco

Paco C, Kandappah S, Lavallee L

Division of Urology

Translational Research

Introduction: The 2021 KEYNOTE-564 trial demonstrated that adjuvant pembrolizumab, a PD-1 immune checkpoint inhibitor, improves disease-free and overall survival in patients with respected high-risk clear cell RCC. However, real-world adoption of this therapy remains uncertain despite guideline and expert endorsements. This study aims to assess the real-world utilization of adjuvant pembrolizumab in eligible patients with clear cell RCC post-nephrectomy at a high-volume academic center. Methods: A retrospective cohort study of adult patients with histologically confirmed clear cell RCC who underwent partial or radical nephrectomy was conducted between September 2022 and December 2024 and met KEYNOTE-564 criteria for adjuvant pembrolizumab. Demographic, clinical, surgical, pathological, and treatment-related data were extracted from electronic medical records using a standardized search and data collection tool. The primary outcome was the proportion of eligible patients who received adjuvant pembrolizumab. Secondary outcomes included referral rates, factors associated with treatment uptake, and regimen-specific details. Continuous variables were summarized using means or medians, and categorical variables as frequencies and percentages. Baseline characteristics were compared using Chi-square, Fisher’s exact, or t-tests. Univariate log-binomial regression assessed associations with referral or treatment. Results: Of the 124 patients who met KEYNOTE-564 criteria for adjuvant pembrolizumab, 65 (52.4%) were referred to medical oncology, and 24 (19.3%) went on to receive at least one dose of adjuvant pembrolizumab. The majority (96.8%) were classified as intermediate risk. Among referred patients who did not receive pembrolizumab, 63.4% declined treatment after informed discussions with their oncologist. Higher recurrence score was significantly associated with increased likelihood of referral to medical oncology (RR 1.48, p = 0.02), but was not associated with administration of adjuvant pembrolizumab (RR 0.86, p = 0.69). Patient age, sex, and surgical approach were not associated with referral to medical oncology or receipt of adjuvant therapy. Conclusions: These findings suggest that referral patterns and use of adjuvant pembrolizumab are not primarily influenced by patient or tumor characteristics, but rather by patient or physician values and preferences. These results highlight the need to better understand patient decision-making factors regarding adjuvant therapy.  

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