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CollinsDay.org                 SUBMIT REVIEW

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Time

Event / Title

Session / Speaker(s) / Chair(s) / Room

0730-0745

Light Breakfast & Coffee

0745-0815

Opening Remarks

Dr. Jocelyn Côté, Vice Dean – Research
Dr. Vince Chan, DoS Vice Chair Research

 

0815-0930: Podiums 1
Large Skills Lab
Moderator: Dr. Guillaume Martel

0815-0830

Dr. Nicholas Nucci (PGY-3) - Comparison of eccentric reaming to posterior augment with varying degrees of correction in total shoulder arthroplasty with posterior glenoid wear

0830-0845

Dr. Kikachukwu Otiono (PGY-1) - The importance of erectile function in fostering intimacy in heterosexual relationships from the female perspective

0845-0900

Dr. Michael Nitikman (Fellow) - Iatrogenic superior gluteal nerve stretch in surgical fixation of posterior column acetabular fractures: a cadaveric study

0900-0915

Dr. Tori Lenet (PGY-4) - Hypovolemic Phlebotomy in Major Hepatic Resection: A Randomized Controlled Trial (PRICE-2)

0915-0930

Dr. Malavan Ragulojan (PGY-2) - Rapid ventricular pacing for clipping of intracranial aneurysms: a single-centre cohort study

940 – 1020: Morning Lightning Orals 1A
Small Conference Room
Moderator: Dr. Luke Lavallee

0940-0946

Dr. Eric Locke (PGY-3) - Radiologic review of osteolysis in the HINTEGRA total ankle prosthesis

0946-0952

Dr. Emily Nham (PGY-3) - Comprehensive scoring system predicts evidence-based management of adrenal incidentalomas

0952-0958

Dr. Thamer Alfawaz (Fellow) - Clinical outcomes of surgical treatment of degenerative cervical myelopathy; a long-term follow up study

0958-1004

Dr. Cristina Negrean (Fellow) - Preoperative MRI membranous urethral length as a predictor of urinary continence and severe urinary incontinence at 12 months after radical prostatectomy: a systematic review and meta-analysis

1004-1010

Dr. Julian Wang (PGY-4) - Navigating Uncertainty: A national survey on surgeon and patient decision-making with CRS and HIPEC for colorectal cancer peritoneal metastases in Canada.

1010-1016

Dr. Cristina Bassi (Fellow) - Potential Etiologies of Primary Glenohumeral Osteoarthritis and Posterior Humeral Head Subluxation: A Systematic Review

940 – 1020: Morning Lightning Orals 1B
Small Skills Lab
Moderator: Dr. Nada Gawad

0940-0946

Nicole Wisener (Medical Student) - Perioperative Sustainability: How is Ottawa Doing?

0946-0952

Withdrawn

0952-0958

Dr. Victoria Ivankovic (PGY-2) - A scoping review of criteria used to evaluate red blood cell transfusion appropriateness

0958-1004

Dr. Alick Wang (PGY-5) - Embolization of the middle meningeal artery for chronic subdural hematoma: meta-analysis of randomized controlled trials

1004-1010

Withdrawn

 

1030-1200: Podiums 2
Large Skills Lab
Moderators: Dr. Isabelle Raiche

1030-1045

Dr. Reza Ojaghi (PGY-5) - Comparative Efficacy of Local Infiltration Analgesia Alone Versus Combined with Adductor Canal Block in ACL Reconstruction: A Double-Blind Randomized Clinical Trial

1045-1100

Dr. Laura Kerr (PGY-6) - The impact of a Regional Communities of Practice to improve quality of melanoma care: setting guidelines for preoperative diagnostic imaging in early stage melanoma

1100-1115

Dr. Kellen Walsh (Fellow) - Prevalence of posterior humeral head subluxation in the normal population aComparison of scapulo-humeral and gleno-humeral subluxation indices in non-pathologic shoulders

1115-1130

Dr. Ian Malnis (PGY-3) - Addressing Vascular Health Disparities: Implementing a Clinic for Undiagnosed Vascular Disease in Ottawa's Homeless Population – A Resident-Lead Quality Initiative

1130-1145

Dr. Mojgan Rezaaifar (PGY-3) - Mitigating bias in the residency selection process by comparing live and transcribed interview scores

1145-1200

Dr. Lubina Nayak (PGY-2) - Surgeon variability in oncologic and patient reported outcomes in radical prostatectomy

1200-1300

Lunch and Visit the Sponsors

1300-1400

Collins Day Visiting Professor: Dr. Philipp Dahm, University of Minnesota

The Past, Present and Future of Evidence-Based Guidelines

Introduction by Dr. Rodney Breau

1410 – 1505: Afternoon Lightning Orals 2A
Small Conference Room
Moderator: Dr. Luke Witherspoon

1410-1416

Khaled Skaik (Medical Student) - Effect of elective cervical spine surgery on mental health of patients with degenerative cervical myelopathy (DCM): a CSORN study

1416-1422

Dr. Anastasia Turner (PGY-2) - Evaluating the impact of shared care surgical practices on trainee education and experience, a qualitative study

1422-1428

Dr. Alexandra Allard-Coutu (PGY-7) - Neoadjuvant Radiotherapy in Retroperitoneal Sarcoma (RPS): Data Dissemination and Practice Patterns Post STRASS

1428-1434

Dr. Natalie Kruger (PGY-1) - Increasing diversity among medical students at the admissions level: a scoping review

1434-1440

Dr. Emmitt Hayes (PGY-3) - Anterior Cruciate Ligament Rupture is Associated with Decreased Performance in National Hockey League Players

1410 – 1505: Afternoon Lighting Orals 2B
Small Skills Room
Moderator: Dr. Jad Abou Khalil

1410-1416

Dr. Anne Sophie Parent (Unk) - 5-ALA Fluorescence Guided Spinal Cord Resection for Management of High-Grade Glioma

1416-1422

Dr. Laura Halyk  (PGY-5) - Ulnar Collateral Ligament Reconstruction in an Ambulatory Setting: A Retrospective Study evaluating surgical outcomes.

1422-1428

Dr. Lauren Wong (PGY-4) - Surgical Management of Ptosis in the context of Nipple-Sparing Mastectomy and Immediate Breast Reconstruction: A Comprehensive Treatment Algorithm

1428-1434

Dr. Scott Clarke (PGY-2) - How late is too late to operate: A retrospective evaluation of the outcomes following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer

1434-1440

Dr. Ryan Sandarage (PGY-2) - Comparative Analysis of Spinal Cord-Derived and Induced Pluripotent-Derived Neural Stem & Progenitor Cells for SCI Therapy

 

1515-1630: Podiums 3
Large Skills Lab
Moderator: Dr. Jing Zhang

1515-1530

Dr. Richard Hu (PGY-3) - Evaluating Patient Selection for Surgery in Older Patients with Non-Metastatic Colorectal Cancer in Ontario: a Population-Based Cohort Study

1530-1545

Dr. Hannah Koury (PGY-2) - Systematic Review of Clinical Practice Guidelines for Management of Perioperative Delirium After Major Surgery

1545-1600

Dr. Yuan Qiu (PGY-2) - Evaluating left carotid artery pressures during circulatory arrest with unilateral antegrade cerebral perfusion

1600-1615

Dr. Adolfo Alejandro López Rios (PGY-1) - Impact of the COVID-19 Pandemic on Breast Cancer Screening, Staging, and Management: A Canadian Perspective

1615-1630

Dr. Aroub Alkaaki  (PGY-7) - Thoracic surgery group practice: a retrospective review of patient outcomes, patient satisfaction, and implications for a group surgical practice during the covid-19 era

1630-1635

Closing Remarks
Dr. Vince Chan, DoS Vice Chair Research

 

 Session Podium 1: 0815-0830 - Comparison of eccentric reaming to posterior augment with varying degrees of correction in total shoulder arthroplasty with posterior glenoid wear

Nucci N, DeVries Z, Walsh K, Parisien A, Pollock J, Speirs A, Mcilquham K, Lapner P

Presenter: Dr. Nicholas Nucci

Division of Orthopaedic Surgery

Clinical Research

Contribution to Project: Data collection, data analysis, abstract preparation

Introduction: Idiopathic glenohumeral arthritis is typically associated with glenoid retroversion and posterior bone loss. The aim of this study was to compare glenoid component survivorship with eccentric anterior reaming and insertion of a standard component, versus a posteriorly augmented component in a B2 glenoid model. Methods: This was a biomechanical cyclic loading study.  Thirty sawbone shoulders models were generated from a CT scan of a scapula with a B2 glenoid and 15o retroversion. The study consisted of two groups with ‘low’ correction, two groups with ‘high’ correction, and a control.  Group A1 consisted of a 70 eccentric ream and a standard component;  group A2 consisted of a 15o posteriorly augmented glenoid component (70 correction);  group B1  consisted of a 12o anterior ream and standard component;  group B2 used a 25o posteriorly augmented component (12o correction);  group C (control) consisted of a standard component inserted in retroversion with no correction. Mechanical stability testing was performed through cyclic loading and resulting displacement was determined at 1, 10, 1000, 10,000, 50,000, and 100,00 cycles to assess for loosening. Results: A total of 28 samples were included in the analysis, with all reaching 100,000 cycles. Displacement increased significantly from baseline to 100,000 cycles in all groups (p<0.05).  At 100,000 cycles, the A1 group was not statistically different compared with A2 (0.782mm vs 1.10; p=261); the B1 group had significantly less displacement compared to B2 (0.659mm vs 1.03mm; p=0.014); and A2 group showed no difference between the B2 group (1.10mm vs 1.03mm; p=53). The A2 group had significantly greater displacement than controls (1.10mm vs. 0.873mm p=0.021) and the B2 showed no difference compared with controls (0.873mm vs 1.03mm; p=0.215). Conclusions: Our data demonstrated that the use of higher-degree posteriorly augmented components resulted in statistically greater translational displacement over time compared with high-side reaming and use of a standard component.   Further prospective clinical studies are needed to confirm these findings.

 SUBMIT REVIEW

Session Podium 1: 0830-0845 - The importance of erectile function in fostering intimacy in heterosexual relationships from the female perspective

Nham E, Vigil H, Flannigan R, Brotto L, Witherspoon L

Presenter: Dr. Kikachukwu Otiono

Division of Urology

Clinical Research

Contribution to Project: - Contribution to the project includes data review and drafting of the abstract/manuscript

Introduction: Heterosexual men pursue invasive treatments to maintain erections, yet female views on their significance in healthy relationships remain underexplored. This study examines female perspectives on the importance of erections in relationships. Methods: A survey-based study employed a virtual 35-item questionnaire adapted from the McCoy Female Sexuality Questionnaire. Participants included heterosexual females aged 18 years and older. Results: From May to November 2024, 217 survey responses were received, excluding 89 incomplete entries. The average age of participants and their male partners was 33 (Standard Deviation, SD=11.2) and 35 (SD=10.5) years, respectively. A majority were either married or in long-term relationships (73%). Seventy percent of females considered penetrative intercourse important for their connection with their partners, citing narrative reasons such as partner satisfaction, stress relief, and viewing intercourse as an expression of love, attraction, intimacy, and vulnerability. 37% of females felt that a lack of penetrative intercourse would negatively impact their relationships with narrative concerns around changes in relationship dynamics, male partner masculinity, his mental well-being, and female sexual gratification. Conversely, 26% of females saw penetrative intercourse as non-essential, emphasizing other aspects of intimacy. Majority of females (62%) indicated they would not end a relationship due to a partner’s erectile dysfunction. When asked if they would start a relationship with a male with erectile dysfunction, 45% of females said they were open to it, while 40% were not. Conclusion: Heterosexual females view penetrative intercourse as an important factor in their relationships, alongside other forms of connection and intimacy. The outcomes of our study can help counsel men considering invasive treatments for erections and provide context on the significance women attribute to erections in relationships.

 SUBMIT REVIEW

Session Podium 1: 0845-0900 - Iatrogenic superior gluteal nerve stretch in surgical fixation of posterior column acetabular fractures: a cadaveric study

Nitikman M, Tubin N, Liew A, Wilkin G, Papp S

Presenter: Dr. Michael Nitikman

Division of Orthopaedic Surgery

Clinical Research

Contribution to Project: Research protocol and methodology development, obtaining ethics approval, performing cadaveric dissections and measurements, data analysis, and manuscript preparation

 

Purpose: Fixation of posterior column fractures through a Kocher-Langenbeck approach requires retraction of the gluteus medius and minimus, and therefore also the superior gluteal nerve (SGN). Iatrogenic nerve injury may result in functional limitations including hip abductor weakness and altered gait patterns. The purpose of this study is to measure the amount of stretch to the SGN relative to placement of a surgical acetabular retractor during a posterior approach for fracture fixation. Methods: An REB approved cadaveric study was performed. A Kocher-Langenbeck approach was performed on ten hips in five cadaveric donors. The superior gluteal nerve was reproducibly identified and isolated exiting the greater sciatic notch (GSN) and traversing between the gluteus minimus and medius. The length of the nerve was measured with a caliper between the GSN and its insertion into the gluteus medius. An acetabular retractor was placed anterior to the gluteal pillar and the length of the SGN was measured with the retractor 0, 30, and 60 degrees relative to the horizontal. The measurements were completed with the leg in neutral and 15 degrees of abduction, and then repeated by a second investigator to determine interobserver reliability. The percent of change in length of the SGN relative to retractor positioning was calculated. Results:The SGN was consistently found exiting the most proximal aspect of the GSN. The length of the SGN from GSN to muscular insertion was 29mm +/- 2mm. The nerve stretched 21.2% (+/- 2.5%) of its length at 30 degrees of retraction, and 44.9% (+/- 6.4%) at 60 degrees of retraction. The nerve was stretched over a short segment and tethered at the level of GSN. Hip abduction did not significantly reduce the amount of stretch to the SGN. Conclusion: The superior gluteal nerve is subject to significant stretch during anterior retraction of the gluteal muscles during posterior column exposure in acetabular fracture fixation. Surgeons should proceed with caution when retracting for exposure of the posterior column. A clinical study with electrodiagnostic studies and gait analysis is required to determine if iatrogenic nerve stretch is consequential.

 SUBMIT REVIEW

Session Podium 1: 0900-0915 - Hypovolemic Phlebotomy in Major Hepatic Resection: A Randomized Controlled Trial (PRICE-2)

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

Presenter: Dr. Tori Lenet

Division of General Surgery

Clinical Research

Contribution to Project: Protocol development and writing, manuscript editing

 

Introduction: Blood loss and red blood cell (RBC) transfusion are common in liver surgery. Hypovolemic phlebotomy (HP) has been associated with decreased blood loss and RBC transfusion in observational studies. This trial aimed to investigate whether HP is superior to usual care in reducing RBC transfusions in patients undergoing liver resection.

Methods: PRICE-2 was a multi-center randomized controlled trial. Patients undergoing major liver resection for any indication were randomized to HP or usual care. HP consisted of the removal of 7-10mL/kg of whole blood, without volume replacement, prior to liver transection. The primary outcome was the administration of perioperative RBC transfusion up to 30 days post-randomization. Secondary outcomes included mortality, morbidity, blood loss, blood products transfusion, and surgeon perception of operative conditions. Surgeons and outcome assessors were blinded.

Results: We included 446 patients who underwent liver resection (223 in each group). The groups were well balanced for baseline characteristics. Thirty-day perioperative RBC transfusion occurred in 7.6% of patients allocated to HP and 16.1% with usual care (risk ratio 0.47 (95% confidence interval 0.27 to 0.82). There was no significant difference in overall or severe complications, including end-organ ischemic complications. No deaths occurred. Blood loss and blinded surgeon-reported operative conditions were significantly improved with HP.

Conclusion: In patients undergoing major liver resection, hypovolemic phlebotomy reduced perioperative RBC transfusion and improved operative conditions, without added significant complications compared to usual care. The observed reduction in RBC transfusion was clinically significant, supporting hypovolemic phlebotomy as standard care in major liver resection. (Funded by the Canadian Institutes of Health Research; PRICE-2 ClinicalTrials.gov number, NCT03651154.)

 SUBMIT REVIEW

Session Podium 1: 0915-0930 - Rapid ventricular pacing for clipping of intracranial aneurysms: a single-centre cohort study

Ragulojan M, Al Aufi S, Wang A, Sinclair J, Budiansky A

Presenter: Dr. Malavan Ragulojan

Division of Neurosurgery

Clinical Research

Contribution to Project: study design, data collection, analysis and interpretation of results, and manuscript preparation.

 

Introduction: Despite advances in endovascular management of intracranial aneurysms, important indications remain for microsurgical clipping. Rapid ventricular pacing (RVP) is a technique for aneurysm relaxation that can induce transient episodes of profound hypotension which facilitates proximal vascular control and microdissection during complex aneurysm surgery. This study reports the indications and outcomes of intraoperative RVP for microsurgical clipping of ruptured and unruptured intracranial aneurysms. Methods: A retrospective review was completed of adult patients who underwent elective and emergent microsurgical clipping by a single senior neurosurgeon. All patients had been reviewed for suitability for microsurgical clipping via a multidisciplinary case conference including interventional neuroradiologists. Charts were reviewed for baseline patient demographics, intra-operative procedural and RVP data, and post-operative outcomes. Results: Forty patients who underwent RVP assisted clipping between 2016 and 2023 were identified. The number of pacing episodes ranged up to 27 and on average lasted 53.3 seconds with a median mean arterial pressure of 36.5 mmHg. One patient developed wide complex tachycardia intra-operatively which resolved after cardioversion. One patient had a markedly elevated troponin associated with post-operative ST changes in keeping with anterolateral ischemia; this was in the context of post-operative intracranial hemorrhage. Only two patients had significant neuromonitoring changes during pacing. RVP subjectively facilitated safe arachnoid dissection when temporary clipping was difficult, particularly with narrow surgical corridors and with pre- or intra-operative rupture. Thirty-seven patients had complete obliteration of their intracranial aneurysm with another two having trace neck residual. Conclusion: RVP is an effective and safe adjunct to microsurgical clipping, associated with a small number of cardiac and neurological complications well within expected rates associated with aneurysm treatment. This is the largest cohort reported incorporating RVP in microsurgical clipping of intracranial aneurysms.

 SUBMIT REVIEW

Session Lightning Oral 1A: 0940-0946 - Radiologic review of osteolysis in the HINTEGRA total ankle prosthesis

Division of Orthopaedic Surgery

Clinical Research

Presenter: Dr. Eric Locke

Contribution to Project:

Dr. Lalonde provided guidance through the entire project.

Background: Total ankle replacement (TAR) is a surgical option for patients with ankle arthritis who have failed conservative measures. Newer implants have markedly improved, however periprosthetic osteolysis causing aseptic loosening continues to be a main cause of TAR failure. The HINTEGRA prosthesis reports fewer implant failures. The objective of this study was to review the HINTEGRA TAR experience at a single institution specifically evaluating the presence and outcomes of osteolysis. Methods: Retrospective study including all HINTEGRA TARs completed by one experienced foot and ankle surgeon from 2006 to 2014. X-rays were reviewed, assessing for implant positioning, presence, location and progression of cysts as well as relationship with reoperations and revisions. Results: 51 TARs were identified with radiographic follow up of 5.8 ± 3.5 years. 84 cysts were detected in 37 patients, with increasing number and size of cysts being correlated to length of time from surgery. The most common location was the posterior tibia. 13 patients had enlarging cysts identified over time with the lateral malleolus being the most common location. 7 patients met criteria for malaligned prosthesis, 7 patients met definition for a loosening prosthesis, 12 patients required a reoperation and 2 patients experienced implant failure. Conclusion: Cysts are a very common finding after TAR using the HINTEGRA prosthesis, specifically on long-term radiographic follow up despite a press fit prosthesis design. Progressive cysts and prosthesis coronal malalignment were correlated with prosthesis loosening and TAR failure.

 SUBMIT REVIEW

 

Session Lightning Oral 1A: 0946-0952 - Comprehensive scoring system predicts evidence-based management of adrenal incidentalomas

Division of Urology

Clinical Research

Presenter: Dr. Emily Nham

Contribution to Project:

- Literature review, development of scoring system, data analysis, preparation of abstract

 

Introduction and Objectives: The objective of the study is to develop a precision scoring system to aid in managing adrenal masses based on the most recent Canadian Urological Association (CUA) guideline for incidental adrenal masses. Methods: An adrenal risk stratification model was developed by allocating points based on Hounsfield units (HU), functionality, size, and characteristics on second-line imaging (computed tomography [CT] or magnetic resonance imaging [MRI]). Points were allocated accordingly and totalled to five mutually exclusive outcomes and multiplied by a factor denoted as T if ancillary tests were recommended. Results: A total of 48 combinations of adrenal characteristics were accounted for in our scoring system. Ancillary tests were recommended in 33% of adrenal lesions with indeterminate functionality, leaving 32 incidentalomas for concordance testing. All functional (n=14) and malignant lesions on CT or MRI (n=10) scored 80 points or more, suggesting adrenalectomy as per the CUA guideline. Benign, low density, non-functional, < 4 cm adenomas (n=1) scored 0 points indicating no further follow up. Low density, non-functional, >4 cm lesions (n=1) scored 10 points, indicating repeat CT in 6-12 months. Repeat imaging in 3-6 months vs. adrenalectomy was recommended for all high density, small or large, equivocal non-functional lesions (n=5). Non-functional incidentalomas with either low or high density and features suggestive of suspected metastasis (n= 5) scored between 50-70 points, indicating possible biopsy or positron emission tomography (PET)/CT. Conclusions: Our scoring system provides CUA guideline-based recommendations for the management of adrenal incidentalomas. Further studies are required to validate this scoring system and assess its performance in various populations.

 SUBMIT REVIEW

 

Session Lightning Oral 1A: 0952-0958 - Clinical outcomes of surgical treatment of degenerative cervical myelopathy; a long-term follow up study

Division of Neurosurgery

Clinical Research

Presenter: Dr. Thamer Alfawaz

Contribution to Project:

Review of literature, contributed in research design, collected data, coordination with statistician, writing.

 

Introduction:

Degenerative cervical myelopathy (DCM) is considered the most common cause of spinal cord dysfunction and it is expected to become more prevalent as populations age.

Methods:

Using CSORN database (multicenter retrospective database). Patients who underwent surgery for DCM and completed 5 years follow up were included. Variables included demographics, duration of symptoms, numeric arm and neck pain, NDI, mJOA and SF-12. Mean (SD) or median (IQR) were reported. Paired T-test was used to compare means of outcome between follow-ups (F/U) and baseline. Wilcoxon signed-rank test was applied to compare median of outcome between follow-ups and baseline. For all statistical tests, two-tailed test was used to determine significance at 5% level.

Results:

171 patients were included. 47% had a duration of symptoms over 2 years. There was a statistically significant improvement in the median score for arm and neck pain that was sustained in all F/U periods. NDI score showed improvement the continued throughout F/U. mJOA mean score at baseline was 13.2, at 5 years F/U the mean score was 15. Improvement in mJOA score at each F/U was statistically significant compared to baseline (p <0.0001). SF-12 MCS and PCS showed improvement in our data with PCS showed peak improvement at 1 year F/U (mean 38.9) compared to baseline (mean 32.4). The mean MCS improvement was apparent at the 3 months F/U. At 2 and 5 years F/U the mean scores showed a mild decline (PCS at 2 years =38 and 5 years =37.9 and mean MCS at 2 years =48.1 and at 5 years =47.2). Within the database 186 patients reached the 5 years F/U and 3.8% of them were lost to follow up.

Conclusion:

Patients undergoing surgery for DCM showed improved clinical results. This improvement was sustained at 5 years follow up. No significant deterioration in PROMs was noted.

 SUBMIT REVIEW

 

Session Lightning Oral 1A: 0958-1004 - Preoperative MRI membranous urethral length as a predictor of urinary continence and severe urinary incontinence at 12 months after radical prostatectomy: a systematic review and meta-analysis

Division of Urology

Clinical Research

Presenter: Dr. Cristina Negrean

Contribution to Project:

- systematic review protocol development

- article screening (in collaboration with another author)

- data extraction (in collaboration with another author)

- risk of bias assessment (in collaboration with another author)

- preliminary analysis

- abstract writing

- presentation assembly

 

Introduction: Import outcomes after radical prostatectomy is urinary continence and severe urinary incontinence. Pre-operative factors consistently associated with continence include age, preoperative continence status, and MRI-measured membranous urethral length (MUL). The objective of this systematic review is to describe the association between preoperatively measured MUL on MRI and continence/severe incontinence 12 months following radical prostatectomy.

Methods: A systematic search of the literature was conducted in Embase, MEDLINE and Cochrane. Screening was done independently by two authors. Pre-specified data extraction including risk-of-bias was conducted in duplicate. A meta-analysis will be performed using a random-effects. Heterogeneity will be assessed visually and using I2. Sensitivity analysis including low risk-of-bias studies will be conducted and publication bias will be assessed using a Funnel plot.

Results: The literature search yielded 766 records and after screening, 25 articles were included. Fifteen studies reported continence, nine reported incontinence and one study reported both continence and incontinence one year after prostatectomy. Most frequent surgical approach was robotic. MUL was most frequently assessed on T2 sagittal plane. The mean MUL ranged from 9.3 mm to 15.6 mm. Adjusted OR of MUL were significantly associated with continence in 9 of 16 studies. Adjusted OR of MUL were significantly associated with incontinence in 7 of 10 studies. Most frequent covariates used for adjustment include: age, BMI, nerve sparing and prostate volume. ROB due to participation, outcome measure and reporting was considered low in 75% of studies. ROB due to MUL measure and confounding was low in 60% of studies. ROB due to attrition was high in 70% of studies.

Conclusion: Pre-operative MUL on MRI is consistently associated with urinary continence and incontinence at 12 months after radical prostatectomy. MUL should help inform pre-operative discussions with patients regarding their risk of urinary incontinence following surgery.

 SUBMIT REVIEW

Session Lightning Oral 1A: 1004-1010 - Navigating Uncertainty: A national survey on surgeon and patient decision-making with CRS and HIPEC for colorectal cancer peritoneal metastases in Canada.

Division of General Surgery

Clinical Research

Presenter: Dr. Julian Wang

Contribution to Project:

Participated in study design and implementation, wrote the abstract.

 

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly specialized procedure performed in eight centers across Canada for peritoneal surface malignancies. The treatment decision process for CRS and HIPEC is complex and multifactorial. We report the results of a survey administered to surgeons who perform CRS and HIPEC in Canada to gain perspectives on how these decisions are made with patients.

Methods

A survey was disseminated to surgeons across Canada who perform CRS and HIPEC for colorectal cancer peritoneal metastases. The survey investigated practice patterns, the roles of  clinicians and patients in decision-making, and the incorporation of support systems.

Results

A total of 14/24 (54%) of surgeons responded. Patients' preferences were deemed important by 11/14 (79%) of the surgeons. Respondents noted patients experienced challenges when deciding on CRS and HIPEC due to  information overload (7/14, 50%) and the magnitude of the surgery (11/14, 79%). As part of the treatment decision making process, 10/14 (71%) surgeons reported patients were unsure of what to do. To aid in decision making, 11/14 (79%) of surgeons provided booklets/pamphlets and 5/14 (36%) used websites for patient information. Half of respondents 8/14 (57%) reported  that patients would benefit from additional support in making decisions regarding CRS and HIPEC.

Conclusion

The results of our survey underscore the importance of patient preferences in the treatment decision-making process for surgeons performing CRS and HIPEC in Canada. The sources of information provided to patients and decision-making methodologies vary. Decision making is becoming increasingly complex as new evidence emerges, such as the recent publication of PRODIGE-7 casting uncertainty on the benefit of the addition of HIPEC to CRS. There may be justification for the further development of standardized support tools across the country to aid in this process.

 SUBMIT REVIEW

Session Lightning Oral 1A: 1010-1016 - Potential Etiologies of Primary Glenohumeral Osteoarthritis and Posterior Humeral Head Subluxation: A Systematic Review

Division of Orthopaedic Surgery

Clinical Research

Presenter: Dr. Cristina Bassi

Contribution to Project:

writer

 

Background: Posterior humeral head subluxation (PHHS) is thought to be a precursor to idiopathic glenohumeral osteoarthritis (GHOA), but its cause remains unknown.  PHHS can become painful as joint degeneration progresses, and the eventual impact of GHOA on quality of life is significant, particularly with respect to function, pain, and prolonged disability.  There is a need to establish the underlying cause of PHHS/GHOA to develop strategies that arrest or slow its progression. The aim of this systematic review was to provide a concise narrative summary of potential etiologies that have been studied to date.  

Methods: A systematic search of Ovid MEDLINE, Embase and the Cochrane Library databases was conducted through to April of 2023.  Two reviewers independently screened for studies meeting eligibility criteria: English-language studies of any type with findings discussed in the context of having a possible contribution to glenohumeral osteoarthritis or PHHS. Results were categorized by themes, and overall quality of the included studies was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.  

Discussion: This narrative systematic review provides a summary and evaluation of possible etiologies of PHHS including potentially predisposing scapular geometry such as retroversion and critical shoulder angle, soft tissue factors such as muscular or capsular imbalance, and other causes (e.g., genetic, metabolic).

Conclusion: While the exact cause of glenohumeral osteoarthritis remains uncertain, this summary has identified gaps in the evidence and areas of promise that require further investigation.

 SUBMIT REVIEW

 

 

Session Lightning Oral 1B: 0940-0946 - Perioperative Sustainability: How is Ottawa Doing?

Division of General Surgery

Quality Improvement Research

Presenter: Nicole Wisener

Contribution to Project:

Not eligible for awards, because substitute presenter

MT Presenter: Project conception and protocol development, title and abstract screening, full text review, data synthesis

GC Presenter: Title and abstract screening, full text review, data synthesis, equal contribution to abstract

NK Presenter: Equal contribution to abstract

 

Introduction: Planetary health is a critical determinant of human health: an estimated 13 million people die each year due to avoidable environmental causes such as poor air quality and heat-related illness. Paradoxically, the healthcare sector is a leading contributor to Greenhouse Gas emissions and pollution. Additionally, between 1/3 and 1/5 of these emissions are from the operating room. With this in mind, a working group from the Sustainable Health Systems Community of Practice developed a scorecard across the Toronto Academic Health Science Network to assess the sustainability of a hospital’s operating rooms. This was subsequently adapted by the Creating a Sustainable Canadian Health System in a Climate Crisis (CASCADES) organization to develop the Sustainable Perioperative Care Scorecard. The purpose of this quality improvement project was to assess the environmental sustainability of operating rooms at University of Ottawa affiliated hospitals. Methods: The 2023 version of the Sustainable Operating Room Scorecard was used to assess environmental sustainability of the operating rooms of University of Ottawa affiliated hospitals. A group of residents and staff from surgical and anesthesia departments at each hospital assessed each strategy’s level of implementation using the scorecard’s established criteria. Once completed at each hospital, the results were combined to establish the total number of hospitals that have implemented each sustainability strategy. Results: Consensus data for the three campuses of The Ottawa Hospital (TOH) was obtained. Each site obtained the same score across thirteen assessment points. Only four sustainability strategies were considered achieved. Three additional strategies were considered partially achieved. The remaining six strategies were not achieved. Conclusion: This study demonstrated the feasibility of a national, freely available assessment tool for resident-led assessment of perioperative sustainability practice. Moving forward, this scorecard can be used as a framework to guide future interventions and as a way to track progress.

 SUBMIT REVIEW

 

 

Session Lightning Oral 1B: 0946-0952 - A comparison of rotating and non-rotating aortic punches using an aortic wall model.

Division of Cardiac Surgery

Clinical Research

Presenter: Dr. Robert Bigsby

Contribution to Project:

The presenter designed and performed the experiments.

 

Introduction

Coronary artery bypass grafting is the gold-standard treatment for patients with severe, multivessel coronary artery disease and is a common surgery in the field of cardiac surgery. In this operation, bypass grafts are often anastomosed proximally to the ascending aorta before they are anastomosed distally to the diseased coronary arteries to restore blood flow to different myocardial territories. To do this, a small aortotomy must be created to which the bypass graft can be anastomosed. This is often done with commercially available aortic punches which aim to create a uniform, circular opening in the aorta. There are two broad categories of aortic punches, rotating and non-rotating. The experience at our institution has been that rotating punches produce superior aortotomies and seem to place less stress on the surrounding aortic tissues, which could translate into improved graft flows and anastomotic patency. The aim of this study is to compare a commercially available rotating punch with a non-rotating punch using both qualitative and quantitative metrics to determine which is superior.

Methods

Part 1

A commercial model of an aortic wall was used for the study. Aortotomies were made in a random order using either rotating or non-rotating punch.  Blinded volunteers were first shown an aortotomy made by each punch and asked to grade which one was superior based on it’s symmetry. They were then asked to identify which of aortotomies were made by which punch.

Part 2

Using the same aortic wall model, a commercial force gauge was used to determine the amount of force required to create an aortotomy with each punch.

Results

Blinded volunteers graded aortotomies made by the rotating punch to be more symmetrical and were reliably able to identify aortotomies made by rotating punch as compared to a non-rotating punch.

Rotating aortic punches require less force than non-rotating punches to generate an aortotomy.

Conclusions

Rotating aortic punches produce higher quality aortotomies as measured by qualitative measures such as symmetry and decreased distortion of the surrounding tissue, while also requiring less force to generate the aortotomy.

 SUBMIT REVIEW

 

 

Session Lightning Oral 1B: 0952-0958 - A scoping review of criteria used to evaluate red blood cell transfusion appropriateness

Division of General Surgery

Clinical Research

Presenter: Dr. Victoria Ivankovic

Contribution to Project:

Project idea, search strategy development, article screening (abstract and full text), data extraction, abstract writing

 

INTRODUCTION: Intraoperative red blood cell (RBC) transfusion strategies vary depending on multiple factors including patient-level, between-physician, and between-hospital differences. Several studies have investigated the variability of RBC transfusion during surgery which report significant variation in transfusion practice that cannot be solely explained by patient case mix. This scoping review aimed to identify and describe existing criteria or clinical decision-making tools used to evaluate perioperative RBC transfusion appropriateness.

METHODS: This scoping review was conducted in accordance with the five evidence-based strategies for scoping reviews. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with extension for scoping reviews was used to report study methods. A search of MedLINE and EMBASE was conducted.  Relevant references were also explored. Studies reporting on the development use or validation of clinical tools or criteria to adjudicate the appropriateness of intra- or post-operative RBC transfusion were eligible for inclusion. A descriptive summary of reported adjudication tools and transfusion criteria organized by method of adjudication was collected.

RESULTS: 3342 articles were identified. Of these 136 underwent full text review, 28 were included in the analysis. Adjudication was determined using pre-existing published society guidelines in 61% of studies.  Twenty-nine percent used a pre-defined set of clinical, hemodynamic, and demographic criteria decided by the study team, and one study used the RAND-UCLA method to achieve consensus on appropriate transfusion criteria. One study did not describe how appropriateness criteria were decided.

CONCLUSION: While adjudication criteria and clinical tools were applied in intra and postoperative periods, none were specifically designed for this setting. Most studies adjudicated transfusion appropriateness based on guidelines intended for clinical use outside of the perioperative setting. Further research is required to develop RBC transfusion adjudication criteria that specifically integrate unique factors that influence transfusion in perioperative settings.

 SUBMIT REVIEW

 

Session Lightning Oral 1B: 0958-1004 - Embolization of the middle meningeal artery for chronic subdural hematoma: meta-analysis of randomized controlled trials

Division of Neurosurgery

Clinical Research

Presenter: Dr. Alick Wang

Contribution to Project:

Conceived the study, performed data analysis, drafted the abstract

 

Background: Embolization of the middle meningeal artery embolization is a novel neuroendovascular therapy for chronic subdural hematoma. Recently, a number of randomized control trials were conducted to its efficacy in reducing the recurrence or progression rate of chronic subdural hematoma.

Methods: Preliminary data were reviewed from three randomized control trials (MAGIC-MT, EMBOLISE, STEM: SQUID) presented at the International Stroke Conference 2024. Meta-analysis was undertaken to compare patients undergoing middle meningeal artery embolization and standard care (intervention group) compared to standard care alone (control group); primary endpoints from each study (symptomatic recurrence, symptomatic progression, major adverse event, neurologic deterioration, stroke, MI, and/or death) were analyzed.

Results: A total of 1432 patients (712 intervention group, 720 control group) were included among the three trials. Heterogeneity was low (I2 = 5%, τ = 0.0133, p = 0.35), therefore a common-effect model was used. The primary endpoint was met in 58 patients (8.1%) in the intervention group compared to 128 patients (17.8%) in the control group. MMA embolization combined with standard management was associated a significantly lower rate of the primary outcome when compared to standard management alone (8.1% vs 17.8%; RR 0.46, 95% CI, 0.34–0.61; p < 0.001; NNT 10.3).

Conclusion: This preliminary meta-analysis demonstrates that middle meningeal artery embolization is effective in reducing symptomatic recurrence, symptomatic progression, major adverse event, neurologic deterioration, stroke, MI, and/or death among patients with chronic subdural hematoma. Further analysis will be performed once the trials are published in peer-reviewed journals.

 SUBMIT REVIEW

 

Session Lightning Oral 1B: 1004-1010 - Comparison of BioLIFT vs. LIFT for the treatment of trans-sphincteric anal fistula: A systematic review and meta-analysis

Division of General Surgery

Clinical Research

Presenter: Dr. Ishita Aggarwal

Contribution to Project:

Primarily data extraction and analysis

 

Background: Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-preserving procedure that treats transsphincteric fistulas while maintaining continence with reported healing rates of 40-95%. The BioLIFT is an augmentation of the LIFT with an intersphincteric bioprosthetic mesh and has reported healing rates between 69-94%. The aim of this study was to perform a systematic review and meta-analysis of the healing and complication rates of fistulas treated with BioLIFT vs LIFT.

Methods: EMBASE, MEDLINE, and Cochrane Database of Controlled Trials were searched by an information specialist using PRESS standards from study start to February 2022. Any comparative studies assessing adult patients undergoing BioLIFT vs. LIFT for transsphincteric anal fistula were included. Three reviewers performed abstract screening, full text review, and data extraction independently and in duplicate. A meta-analysis was performed using a random-effects inverse variance model. Outcomes included primary and secondary healing and complication rates.

Results: Of 528 citations screened, 3 studies (n=293) were included. All were retrospective cohort studies published in 2019-2020. All assessed cryptoglandular transsphincteric fistulas. Of 65 patients who underwent BioLIFT, 66% were male, 28% had previous procedure for fistula, and 14% had history of smoking, diabetes, or immunosuppression, compared to 66%, 39% and 11%, respectively, in 228 patients who underwent LIFT.  Meta-analysis revealed no significant impact of BioLIFT compared to LIFT on primary healing rate (OR 0.83, 95%CI [0.23-2.94], 3 studies, n=197), secondary healing rate (OR 0.97, 95%CI [0.26-3.69], 3 studies, n=237), and complication rate (OR 1.47, 95%CI [0.65-3.34], 2 studies, n=31).

Conclusion: BioLIFT may not have a significant effect on primary and secondary healing and complication rates for cryptoglandular transsphincteric anal fistulas compared to LIFT. Results should be interpreted cautiously given small number of studies and sample sizes.

 SUBMIT REVIEW

 

 

Session Podium 2: 1030-1045 - Comparative Efficacy of Local Infiltration Analgesia Alone Versus Combined with Adductor Canal Block in ACL Reconstruction: A Double-Blind Randomized Clinical Trial

Division of Orthopaedic Surgery

Clinical Research

Presenter: Dr. Reza Ojaghi

Contribution to Project:

•                 Study Design: Conceptualizing and outlining the research approach.

•                 Ethical Application: Handling the ethical approval process to meet regulatory standards.

•                 Funding Application: Crafting proposals to secure project funding.

•                 Patient Interaction: Recruiting, contacting, and obtaining consent from participants.

•                 Team Coordination: Liaising with anesthesia and surgery teams for operational synergy.

•                 Data Collection: Gathering and managing research data systematically.

•                 Data Analysis: Conducting statistical analysis to interpret study results.

•                 Report Writing: Documenting and presenting the research findings comprehensively.

 

Background: Effective analgesia following anterior cruciate ligament (ACL) reconstruction is crucial for promoting early ambulation and recovery. Adductor Canal Block (ACB) and Local Infiltration Analgesia (LIA) are both utilized for pain management but have not been extensively compared, particularly in combination.

Methods: In a double-blind randomized controlled trial, 262 patients scheduled for outpatient arthroscopic ACL surgery were assessed. Eligible patients aged 18-50 with a BMI ≤40 kg/m2 were randomized to receive either LIA alone or in combination with ACB. The primary endpoints included intraoperative morphine consumption and postoperative motor function as assessed by the straight leg raise (SLR). Secondary outcomes included recovery quality and knee function measured by QoR-15 and KOOS. Statistical significance was set at p<0.05.

Results: One hundred patients completed the trial with no significant differences in demographic or operative characteristics. A significant reduction in intraoperative morphine consumption was observed in the LIA + ACB group (p<0.05). There were no significant differences in postoperative morphine consumption, recovery, pain outcomes, or SLR ability between groups (p=0.334 for SLR; p=0.547 for KOOS).

Conclusion: ACB in combination with LIA reduces intraoperative morphine use without additional benefits in early postoperative recovery or knee function. These findings support the use of the LIA + ACB combination for possible intraoperative analgesia while suggesting that for postoperative management, combining these techniques offers limited advantage over LIA alone.

 SUBMIT REVIEW

 

Session Podium 2: 1045-1100 - The impact of a Regional Communities of Practice to improve quality of melanoma care: setting guidelines for preoperative diagnostic imaging in early stage melanoma

Division of General Surgery

Clinical Research

Presenter: Dr. Laura Kerr

Contribution to Project:

Worked on preparation of economic analysis

 

Background: Many current best practice guidelines suggest that preoperative staging imaging may not be warranted in patients with early-stage melanoma without clinically palpable lymph nodes. A Communities of practice (CoP) for the region of Eastern Ontario, set guidelines supporting the restricted use of preoperative diagnostic imaging in 2017. Purpose: This study assesses the economic impact that resulted from the reduction of inappropriate preoperative staging work up for patients with <T3b melanoma who are clinically node negative after the implementation and dissemination of the CoP guidelines. Methods: Retrospectively collected data of patients with biopsy-proven primary melanoma who underwent wide local excision and sentinel lymph node biopsy surgery were included for analysis. Patients with biopsy dates before and after May 24, 2018, were grouped into the pre- and post-guideline cohorts, respectively. Frequency, type, and positivity rate of preoperative imaging were collected and analyzed. Patient baseline demographics and tumour histological characteristics were collected for multivariate analysis. An economic analysis was performed based on the use of diagnostic work up pre- and post guideline dissemination. Results: A total of 645 patients were included for analysis [pre-guideline (n=339) and post-guideline (n=306)]. Patients in the post-guideline cohort had significantly lower rates of pre-operative imaging when compared with the pre-guideline cohort (p<0.0001). On economic analysis, a total cost savings of $9,641.50 was demonstrated (p<0.01) with most significant cost savings noted in reduction of the use of CT scans of the chest ($3,034.00, p<0.01) and CT scans of the abdomen/pelvis ($6,825.00, p<0.01).  Conclusion: These results demonstrated a reduction in inappropriate pre-operative imaging following CoP guideline dissemination, with favourable economic outcomes as a result. These findings support the importance of quality improvement programs such as a CoP to advance melanoma care and resource stewardship initiatives.

 SUBMIT REVIEW

 

Session Podium 2: 1100-1115 - Prevalence of posterior humeral head subluxation in the normal population a Comparison of scapulo-humeral and gleno-humeral subluxation indices in non-pathologic shoulders

Division of Orthopaedic Surgery

Translational Research

Presenter: Dr. Kellen Walsh

Contribution to Project:

Reviewing/measuring scans, data collection, data interpretation, presentation/manuscript writing

 

Background: The etiology of Idiopathic glenohumeral arthritis is unknown, but is typically associated with posterior humeral head subluxation (PHHS), glenoid retroversion and posterior bone loss.  Normative values of humeral head subluxation have not been previously defined.  

Methods: This was an observational study of a cohort of males and females > 18 years of age;  400 asymptomatic patients who underwent a chest/thorax MRI between 01 January 2017 – Apr 30 2023 without known shoulder girdle and humeral pathology. Patient demographics, glenoid retroversion, scapulo-humeral (SH) subluxation index, and gleno-humeral (GH) subluxation index were determined.

Results: The mean age of participants was 51 years (SD 18, range 17-91).  Fifty-nine percent were female, and 51% consisted of the right shoulder.  Mean glenoid version was -2.3 (negative indicating retroversion), SD 5.7, range -24 to 31.  The range of normal glenoid version (2 standard deviations from the mean) was 9.1 to -13.7.  The mean scapulo-humeral subluxation index was 55% (SD 6%, range 33%-75%).  The range of normal scapula-humeral subluxation (2 standard deviations from the mean) was 38% to 71%.  The mean gleno-humeral subluxation index was 51% (SD 5%, 38%-63%).  The range of normal glenohumeral subluxation (2 standard deviations from the mean) was 44% to 59%.  Multivariable regression analysis revealed that age was not associated with either the scapulo-humeral subluxation index or the glenohumeral subluxation index.   There was an association between glenoid version and the SH subluxation index (p<0.0001), and a stronger association between glenoid version and the GH subluxation index (p<0.0001).

Conclusions: Our data demonstrated that PHHS should be defined as a scapulo-humeral subxluation index outside the range of 38% to 71%, or with a glenohumeral subluxation index outside the range of 44% to 59%.  Glenoid version was associated with both the scapulo-humeral subluxation index and the gleno-humeral subluxation index, with a stronger association with the latter.  These findings may have significant implications for orientation of the glenoid component  in anatomic shoulder arthroplasty.

 SUBMIT REVIEW

 

 

Session Podium 2: 1115-1130 - Addressing Vascular Health Disparities: Implementing a Clinic for Undiagnosed Vascular Disease in Ottawa's Homeless Population – A Resident-Lead Quality Initiative

Division of Vascular Surgery

Quality Improvement Research

Presenter: Dr. Ian Malnis

Contribution to Project:

Created TOH Innovation QI Framework charter for project.

Held needs assessment meeting with downtown clinic stakeholders.

Attended each clinic as resident representative, saw each patient in project in consultation with vascular surgery staff.

Documented each visit, developed intake form.

Designed, organized and implemented vascular disease bootcamp with 4 front-line NPs from clinic.

Involved in data collection, analysis.

Drafting of abstract.

 

The objective of this project was to establish infrastructure to determine the prevalence of undiagnosed vascular disease, facilitate early identification and intervention, and identify barriers in vascular healthcare delivery for Ottawa’s homeless population. A needs assessment was conducted with key stakeholders at a shelter-based health center in Ottawa. A monthly outreach clinic was established, staffed by a vascular surgery resident, surgeon, and nurse practitioner where each patient was seen in full consultation. Patients were recruited from clinic, shelters, safe injection sites, and through flyer distribution. Antibiotics, homecare, and referrals were initiated on-site. Complex wounds were referred to the Vascular Surgery Limb Preservation Clinic at TOH. An educational workshop was provided to nurse practitioners to enhance their ability to identify and classify lower extremity wounds, and distinguish potential patients requiring further intervention by vascular surgery. 55 homeless patients with lower extremity wounds or vascular disease were identified, of which 24 attended their clinic appointments. None had previously consulted a vascular surgeon. Most patients were male (96%), homeless (79%), unemployed (92%), with concurrent substance use (58%), and a history of mental health diagnosis (50%). Active wounds were present in 58% of patients, primarily related to venous insufficiency (75%), with a smaller proportion exhibiting arterial disease (4%) and diabetic neuropathy (8%). 33% of patients required follow-up in the outreach clinic, while 8% were referred to the Limb Preservation Clinic. Nurse practitioner confidence increased in wound characterization and classification, and making vascular surgery referrals. This initiative has established basic infrastructure to begin addressing barriers in delivering vascular healthcare to Ottawa’s homeless population. The clinic has enhanced the characterization of vascular disease and fostered a relationship between the Division of Vascular Surgery and this vulnerable population. Future challenges include accessing compression therapy for treatment of venous disease and improving clinic no-show rate.

 SUBMIT REVIEW

 

Session Podium 2: 1130-1145 - Mitigating bias in the residency selection process by comparing live and transcribed interview scores

Division of General Surgery

Education Research

Presenter: Dr. Mojgan Rezaaifar

Contribution to Project:

Contributed to developing the study design and writing the protocol, recruited participants for the prospective cohort study, moderated the mock interviews as part of the study, collected data, participated in some data analysis

 

Introduction: The residency selection process heavily weights the interview, which is criticized for its subjectivity and inherent bias, thus potentially contributing to inequity and a lack of diversity. Despite attempts to mitigate unconscious bias, identifiable demographics may influence candidates’ interview scores. This study aimed to investigate the effect of blinding interviewers to candidate demographics to determine the impact on their interview scores. Methods: In this prospective cohort study, 2024 residency candidates completed a demographics survey followed by a mock virtual Multiple Mini Interview (MMI), after which their responses were transcribed. Six general surgery interviewers scored live and transcribed responses separately. Interviewers were blinded to candidate demographics when scoring the transcribed interviews. Data was analysed using Pearson’s correlations and t-tests to compare live vs transcribed scores based on candidate demographics. Results: Thirty-one candidates participated in mock interviews, with a total of 56 interviews performed across two MMI stations. Nineteen (61.3%) participants self-identified as a visible minority. There was a weak correlation between all participants’ live versus transcribed interview scores for Station A (r=0.25, p=0.11) and a moderate correlation for Station B (r=0.57, p<0.001). Visible minority participants had lower interview scores compared to non-visible minorities during Station A live interviews (12.5 vs 14.2, p=0.003), but no difference for transcribed interview scores (13.0 vs 13.1, p=0.43). There were no significant differences between visible minority and non-visible minority Station B scores in the live (13.3 vs 13.7, p=0.29) or transcribed (10.5 vs 10.7; p=0.11) scores. Conclusion: Visible minority candidates score lower during some live interview stations compared to scoring transcribed interview responses, where identifiable demographic characteristics and non-verbal communication cues are removed. This underscores the importance of using multiple independent interviews (i.e. MMI) and multiple interviewers to mitigate the impact of unconscious bias on the residency selection process.

 SUBMIT REVIEW

 

Session Podium 2: 1145-1200 - Surgeon variability in oncologic and patient reported outcomes in radical prostatectomy

Division of Urology

Clinical Research

Presenter: Dr. Lubina Nayak

Contribution to Project:

Study design, data analysis, manuscript and presentation preparation

Introduction: Radical prostatectomy requires a balance between complete cancer removal and preserving quality of life. Important structures around the prostate may be injured or purposely resected to ensure cancer removal, resulting in urinary incontinence and erectile dysfunction. We aimed to determine if differences in surgeon performance were due emphasizing cancer control over patient-function, or vice versa. Methods: A prospective cohort including 8 surgeons and all patients undergoing prostatectomy between 2015-2022 was used for this analysis. Patient function was assessed at baseline and 12 months after surgery using validated questionnaires. Cancer outcomes included surgical margin status and disease recurrence. Multivariate logistic regression models were used to calculate adjusted observed-to-expected ratios (O/E) for each outcome and surgeon (O/E >1.0 indicates higher than expected incidence). Results: 1,698 consecutive patients were included. After adjustment for differences in baseline characteristics, statistical differences were observed between surgeons for all outcomes (Wide resection performed O/E range 0.50- 2.08; positive surgical margin O/E range 0.59-1.61; cancer recurrence O/E range 0.79-1.84; urinary incontinence O/E range 0.64-1.65; erectile dysfunction O/E range 0.83-1.09). As expected, surgeons performing proportionally more nerve preservation had better functional outcomes. Counter to our hypothesis, surgeons with the best functional outcomes also had the best cancer-related outcomes. Conclusion: We observed large clinical and statistical differences in functional and cancer outcomes between surgeons. Surgeons who performed the most neurovascular preservation had better functional outcomes, but also had better oncologic outcomes. These data suggest variability between surgeons is not explained by differences in outcome prioritization.

 SUBMIT REVIEW

Session Lightning Oral 2A: 1410-1416 - Effect of elective cervical spine surgery on mental health of patients with degenerative cervical myelopathy (DCM): a CSORN study

Division of Orthopaedic Surgery

Clinical Research

Presenter: Khaled Skaik

Contribution to Project:

Author and

 

Introduction:

The objective of this investigation is to evaluate whether enhancements in health-related quality of life (HRQOL), consequent to efficacious cervical spine surgery in individuals diagnosed with degenerative cervical myelopathy (DCM), lead to improvements in mental health metrics.

Outcome measures:

The primary outcome assessed was the change between the preoperative and postoperative SF12 Mental Component Score (MCS) alongside the modified Japanese Orthopedic Association (mJOA) scores. Secondary outcomes include SF-12 Physical Component Score (PCS), EQ-D5, Neck Disability Index (NDI), Patient Health Questionaire-9 (PHQ9), and neck pain scale.

Methods:

The Canadian Spine Outcome Research Network registry was queried for all patients who recieved surgery for DCM with ≥12-month follow-up. Exclusion criteria were trauma, tumor, infection, and previous spine surgery. Patients were categorized into six distinct cohorts based on their SF-12 MCS (pre-operative presence or absence of depression) and mJOA (mild, moderate, or severe DCM). SF12 Mental Component Scores (MCS) were compared between those with and without significant improvement (reaching Minimally Clinically Important Differences (MCID)) for mJOA and between disease severity groups. Multivariate analysis examined factors predictive of MCS improvement.

Results:

22 hospitals contributed 500 eligible patients. There was a greater significant improvement in MCS and NDI 12-months post-op across all cohorts in the depressed cohort more than in their respective non-depressed cohorts. Patients exceeding MCID in mJOA had the greatest improvements in MCS regardless of disease severity. Major depression prevalence decreased by 43% following the degenerative cervical myelopathy surgery. Of all the factors studied, sole the presence of depression pre-operatively is predictive of improved MCS post-operatively with an odd ration of 4.

Conclusion:

Our data suggests that successful surgery for DCM is associated with improvement of MCS and decrease in prevalence of major depression, and this decrease in was more pronounced in patients with pre-operative depression regardless the severity of DCM.

 SUBMIT REVIEW

 

Session Lightning Oral 2A: 1416-1422 - Evaluating the impact of shared care surgical practices on trainee education and experience, a qualitative study

Division of General Surgery

Education Research

Presenter: Dr. Anastasia Turner

Contribution to Project:

This is a qualitative research project that uses semi-structured interviews. The presenting author created the semi-structured interview template, was one of 3 team members who performed data analysis of the transcribed interviews and synthesis of results, and wrote the abstract.

Background:

In comparison to traditional solo surgeon models, shared care models (SCMs) or team-based models are defined as groups of surgeons who share resources, teaching and clinical responsibilities. SCMs have been shown to bolster key vulnerabilities of the Canadian healthcare system by improving timely access to care and physician wellness, all without compromising patient outcomes. Although currently on the rise in Canada, the impact of SCMs on surgical trainee education is unknown. This study aimed to characterize the educational experience of surgical trainees working in SCMs, thus contributing to global understanding of how these practice models shape acquisition of knowledge, technical competencies, and interpersonal skills. Methods: Purposive sampling was used to identify postgraduate surgical trainees who have worked in SCMs. Semi-structured interviews were conducted using an interpretive phenomenological qualitative method to explore trainee lived experience within SCMs. Data analysis was conducted using a framework approach to thematic analysis until thematic saturation was reached. Results: Preliminary data include analysis of 6 in depth semi-structured qualitative interviews. After team analysis, several themes emerged. Residents identified a cultural difference between SCMs and solo surgeon models, with SCMs placing a greater emphasis on collaboration, mentorship, and asking for support when needed. Perceived benefits to residents included greater staff surgeon availability and structured teaching in SCMs. However, drawbacks to trainee education were also identified. These included a potential increased administrative burden due to shared consents and longer clinics, and decreased operative opportunities for trainees due to staff assisting one another. Solutions to mitigate these drawbacks were explored, such as a comprehensive team pre-brief before each surgery to set expectations for trainees’ involvement. Conclusion: Our results suggest that SCMs do not pose a strong detriment to trainee education in comparison to solo surgeon models and can be tailored to optimize learning with implementation of thoughtful measures.

 SUBMIT REVIEW

Session Lightning Oral 2A: 1422-1428 - Neoadjuvant Radiotherapy in Retroperitoneal Sarcoma (RPS): Data Dissemination and Practice Patterns Post STRASS

Division of General Surgery

Translational Research

Presenter: Dr. Alexandra Allard-Coutu

Contribution to Project:

Project design, data analysis and interpretation, manuscript creation

 

INTRODUCTION: The STRASS trial demonstrated no difference in the primary endpoint of 3-year abdominal-recurrence-free survival (HR 1.01, p=0.954) for patients with primary RPS treated with neoadjuvant radiotherapy (RT) followed by surgery compared to surgery alone. An international survey following initial presentation of the results at the American Society of Clinical Oncology (ASCO) Annual Meeting but prior to publication revealed only 20% of 80 responding clinicians adopted practice changes. This study (1) interprets an international survey of practice patterns among international sarcoma experts post STRASS and (2) explores integration of new knowledge into clinical practice.

METHODS: A 12-question survey was distributed to the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group and the Canadian Society of Surgical Oncology. Clinical scenarios established the likelihood of recommending neoadjuvant RT. The data were analyzed using STATA 12 (Statacorp, College Station, TX, USA).

RESULTS: 139/300 clinicians responded (46.3% response rate), including surgical (70.5%), radiation (18.0%) and medical oncologists (8.6%). While 51.1% identified practice changes subsequent to the abstract, 68.1% reported changes following manuscript publication. 63.7% now offered neoadjuvant RT to select patients with RPS based on histology, while 35.3% reported rarely/never offering preoperative RT. Recommendations for neoadjuvant RT for leiomyosarcoma fell from 58.7% to 18.4% following the abstract, and to 8.9% post publication. Recommendations for neoadjuvant RT for well-differentiated liposarcoma increased from 33.9% to 60.2% following the abstract, and to 70.5% following the manuscript. 56.3% offer neoadjuvant RT to dedifferentiated liposarcoma post STRASS. Clinical or institutional experience was not predictive of practice changes.

CONCLUSIONS: Practice patterns for neoadjuvant RT for primary RPS changed in response to STRASS. Ongoing recommendations for neoadjuvant RT for dedifferentiated liposarcoma and/or high grade histologies highlight the necessity of a systematic approach for disseminating practice-changing data.

 SUBMIT REVIEW

Session Lightning Oral 2A: 1428-1434 - Increasing diversity among medical students at the admissions level: a scoping review

Division of General Surgery

Education Research

Presenter: Dr. Natalie Kruger

Contribution to Project:

Not eligible for awards, because substitute presenter

MT Presenter: Project conception and protocol development, title and abstract screening, full text review, data synthesis

GC Presenter: Title and abstract screening, full text review, data synthesis, equal contribution to abstract

NK Presenter: Equal contribution to abstract

 

Background: Health disparities exist in our population based on gender, race, socioeconomic status and sexual orientation. Studies show a diverse physician workforce improves care for marginalized patients. The medical school admissions system is imperative in this process. Thus, it is important to understand what admission interventions increase diversity in the physician workplace. Methods: A scoping review of the evidence published between 2017-2022 examining interventions used by medical school admissions committees to increase diversity among medical school cohorts was performed. This was completed following the PRISMA-ScR guidelines. Results: 5157 articles were identified, 3106 of which met the inclusion criteria and underwent title and abstract screening. Thirty-four articles were included for full-text review. Eighteen articles reported implemented interventions and their results. Eight articles proposed but did not study or implement interventions. Most studies included a retrospective quantitative analysis of the number of admitted applicants belonging to one or more minority groups. Pre-admission pipeline programs were found to increase diversity among admitted applicants. Admissions committee level interventions including holistic review of applicant files, blinding interviewers to academic performance and virtual and multiple mini interview formats, increased the number of successful minority applicants. On a system level, socially accountable admissions processes were also described. Two articles investigated the effects of bias training on the admissions committees, demonstrating training made members more comfortable discussing bias. Proposed but unimplemented interventions included removing identifiable applicant information, bias training, lottery systems, and targeting recruitment to specific groups. Conclusions: Admissions committees are responsible for ensuring the selection process reflects a commitment to diversity. This scoping review describes strategies to improve diversity, however limited evidence is available for proposed and implemented strategies. Further research is needed to evaluate the efficacy of admissions level interventions.

SUBMIT REVIEW 

 

Session Lightning Oral 2A: 1434-1440 - Anterior Cruciate Ligament Rupture is Associated with Decreased Performance in National Hockey League Players

Division of Orthopaedic Surgery

Clinical Research

Presenter: Dr. Emmitt Hayes

Contribution to Project:

Literature review, study design, data collection, data analysis, abstract/manuscript writing.

 

Introduction: Prior studies assessing performance in National Hockey League (NHL) players following anterior cruciate ligament (ACL) reconstruction have relied on traditional statistics (goals, assists, points) which are influenced by randomness, coaching strategy, usage, teammate performance, game script, and other factors that can lead to systematic misjudgement. Our objective was to assess performance in NHL players following ACL tear using advanced statistics that do not have the shortcomings of traditional statistics.

Methods: We identified players who sustained an ACL tear between 2008 and 2022 using a publicly available injury database. We obtained demographic and outcome data for one-year pre and two years post injury. Our primary outcome was wins above replacement per 60 minutes played (WAR/60). Secondary outcomes were offensive and defensive goals above replacement. We created a position, draft year, and index season performance matched cohort. Pre and postinjury outcomes were compared between cases and controls with a paired T test.

Results: We identified 48 eligible players. Preinjury, postinjury year one, and postinjury year two WAR/60 were 0.06, 0.027, and 0.019 in cases (p=.01, p=.00 compared to preinjury) and .05, .06, and .06 in controls (p=.62, p=.005, p=.003 compared to cases). Offensive and defensive performance was decreased compared to preinjury, but this did not reach statistical significance. Postinjury offensive performance was significantly decreased compared to controls at postinjury year one and two (p=.01, p=.00).

Conclusions: ACL tears are associated with significantly decreased hockey performance compared to preinjury and matched controls. This is driven by decreased offensive and defensive performance when compared to preinjury and decreased offensive performance when compared to controls.

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Session Lightning Oral 2B: 1410-1416 - 5-ALA Fluorescence Guided Spinal Cord Resection for Management of High-Grade Glioma

Division of Neurosurgery

Clinical Research

Presenter: Dr. Trivedi, Arunachala

Contribution to Project:

Not eligible for awards, because substitute presenter

I participated in the described operation. I subsequently collated information from the patient's chart, clinical history, and PACS imaging system to put together this project. My co-investigators retrieved intra-operative video samples, and provided voice-over for the video.

 

Introduction

Spinal high-grade glioma is an uncommon pathology, accounting for only 1.5% of all spinal cord tumors. Given their rarity, there is a paucity of literature to guide management. Here, we describe a case report of spinal high-grade glioma and the use of 5-ALA fluorescence-guided spinal cord transection to achieve supramaximal tumor resection. To our knowledge, this is the first video depiction of this rare technique.

Methods

A 56M presented to the Ottawa Civic Hospital with symptoms of progressive sensory loss, weakness, urinary incontinence, and bowel incontinence. He was worked up by the Neurology service and initially managed with steroids and plasma exchange for a possible diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Due to lack of response, the patient was referred to neurosurgery for biopsy. The biopsy was undertaken, and final pathology was consistent with high-grade glioma.  Following discussion at multi-disciplinary tumor board rounds, as well as conversation with the patient, we proceeded with 5-ALA fluorescence guided spinal cord resection for supra-maximal resection of the lesion.

Results

The patient underwent a spinal cord resection using 5-ALA fluorescence guidance. Sequential cordotomies were made and 400nm light was used to identify tumor fluorescence. This was performed cranially until no fluorescence could be identified. At this level (approximately T9-10 disc space), a complete cord transection was performed. The transected portion was once again visualized under 400nm light to ensure no fluorescence. Then, the caudal nerve roots were coagulated and divided with periodic use of fluorescence to ensure no fluorescence along the margins. A video of the procedure is included with all critical steps described.

Conclusion

Here, we describe the use of 5-ALA fluorescence to guide spinal cord transection for supramaximal resection of a spinal high-grade glioma. To our knowledge, this is the first intra-operative video depiction of this technique. Spinal astrocytoma is a rare entity with a paucity of literature. We hope this case report will contribute to the body of evidence helping to guide management.

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Session Lightning Oral 2B: 1416-1422 - Ulnar Collateral Ligament Reconstruction in an Ambulatory Setting: A Retrospective Study evaluating surgical outcomes.

Division of Plastic Surgery

Quality Improvement Research

Presenter: Dr. Laura Halyk

Contribution to Project:

REB, Chart review, stats analysis, manuscript

 

Purpose: Thumb ulnar collateral ligament injury (UCL) is a common hand injury. Treatment of these injuries aims to restore anatomy and function of the metacarpophalangeal joint with surgical reconstruction.

Literature is increasing on Wide-Awake, Local Anesthesia, No Tourniquet (WALANT) surgery done in minor procedure settings where full operating room (OR) sterility is consolidated, decreasing equipment and staffing. Studies demonstrate safety of this practice with limited procedures. It is important to consider risks associated with operative sterility in the ambulatory setting including non-laminar airflow, specifically related to surgical site infection. This is critical in permanent hardware fixation where infection may result in loss of fixation construct.

The purpose of this study is to evaluate the short and long-term outcomes with aims to demonstrate safety regarding surgical site infection rates, complication rates, and postoperative outcomes in patients with UCL reconstruction using permanent hardware in a clinic-based setting under field sterility.

Methods: This will be a retrospective chart review performed for patients undergoing UCL reconstruction in the ambulatory setting from a single surgeons practice at The Ottawa Hospital from 2019-2024. Outcomes to be collected from electronic records for estimated between 50-60 patients.

Results: Final data collection to completed.  There was noted to be no infection in these patients resulting in hardware removal. Results of long-term complications including hand function to be discussed pending further data collection.

Conclusions: The findings of this study will provide insight into the safety of reconstructing ulnar collateral ligament injury of the thumb in an ambulatory clinical setting. Demonstrating the safety of these procedures can increase patient access, decrease wait times, reduce cost and environmental impact.

Teaching Objectives: Assess safety of reconstructing ulnar collateral ligament injury of the thumb in an ambulatory clinical setting.

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Session Lightning Oral 2B: 1422-1428 - Surgical Management of Ptosis in the context of Nipple-Sparing Mastectomy and Immediate Breast Reconstruction: A Comprehensive Treatment Algorithm

Division of Plastic Surgery

Clinical Research

Presenter: Dr. Lauren Wong

Contribution to Project:

Data collection, data analysis, manuscript and abstract preparation

 

INTRODUCTION: The indications for nipple-sparing mastectomy (NSM) continue to expand with increasing recognition of its oncological safety and favorable aesthetic outcome. Surgeons are therefore increasingly being challenged by NSM candidates with large and ptotic breasts, traditionally whom were deemed poor candidates. The present study outlines a treatment algorithm for the ptotic breast in the context of NSM and immediate breast reconstruction. METHODS: Patients who underwent NSM and immediate autologous or alloplastic breast reconstruction from 2014 to 2023 were retrospectively reviewed. Data including pre-operative ptosis grade, patient wishes regarding ideal breast size, and surgical incision was collected. Surgical management was then grouped based on these variables. RESULTS: A total of 221 patients underwent NSM and immediate breast reconstruction within the 9-year study period. Four treatment groups emerged. Patients with grade 1-2 ptosis who wanted a larger breast size were treated with re-draping of the mastectomy skin flap using an IMF incision (Group 1). Patients with grade 1-2 ptosis who wanted a similar or smaller breast size were treated using a semiperiareolar vertical incision to address transverse skin redundancy (Group 2). Patients with grade 3 ptosis were treated using a Wise pattern incision to decrease both vertical and horizontal skin redundancy (Group 3). CONCLUSION: In patients with pre-operative ptosis undergoing NSM, achieving the ideal nipple position requires consideration of type of reconstruction, degree of ptosis, scar pattern, and patient preference. The presented algorithm offers surgeons a simple approach to the ptotic breast taking into account key variables to optimize breast aesthetics after NSM.

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Session Lightning Oral 2B: 1428-1434 - How late is too late to operate: A retrospective evaluation of the outcomes following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer

Division of Plastic Surgery

Clinical Research

Presenter: Dr. Scott Clarke

Contribution to Project:

Chart review, manuscript preparation

 

Traditionally, in patients with severe ulnar intrinsic dysfunction very little could be offered for regaining their motor function. Supercharge end-to-side (SETS) anterior interosseous nerve (AIN) to deep motor branch of ulnar nerve transfer has recently demonstrated promising results for recovery of hand function.1,2 At The Ottawa Hospital’s Peripheral Nerve and Trauma Clinic SETS AIN-to-ulnar motor nerve transfer is commonly performed to augment intrinsic hand function. At the authors’ institution, it was noted through observation of recovery patterns that not all patients regain equal muscular recovery. Reestablishment of motor function following peripheral nerve injury is primarily dependent on two factors: time to reinnervation and the number of axons reinnervating the target muscle.2 Literature suggests that outcomes are best when surgical intervention is preformed early, though controversy remains regarding efficacy and appropriate clinic indications of the SETS AIN-to-ulnar motor nerve transfer when onset of axonal loss is less clear. The purpose of this study is to perform a retrospective cohort analysis to compare patients functional recovery and determine correlation with duration of symptoms in patients undergoing SETS AIN-to-ulnar motor nerve transfer at The Ottawa Hospital Peripheral Nerve and Trauma Clinic for compression neuropathies. Additionally, there is no information in the literature regarding the regaining of sensory function along the ulnar nerve distribution. In theory, this parameter should not be as time sensitive as the motor function, however the degree with which it returns remains unknown. The charts of all patients having SETS AIN-to-ulnar motor nerve transfer from 2011-2021 will be reviewed. Electrodiagnostic studies, Medical Research Council (MRC) grade, and patient reported recovery will be measured and compared before and after surgery. The findings of this study will provide insight into the degree of hand function recovery that can be achieved dependent on time from symptoms onset to time of surgery. Dissemination of these findings may help guide clinical decision making and patient selection at other centers.

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Session Lightning Oral 2B: 1434-1440 - Comparative Analysis of Spinal Cord-Derived and Induced Pluripotent-Derived Neural Stem & Progenitor Cells for SCI Therapy

Division of Neurosurgery

Translational Research

Presenter: Dr. Ryan Sandarage

Contribution to Project:

Formulary of project, conducting experiments, analysis of results.

 

Induced pluripotent stem cells (iPSCs) have revolutionized spinal cord injury (SCI) treatment by enabling the creation of neural stem/progenitor cells (NSPCs). However, a comprehensive understanding of how iPSC-derived NSPCs compare to authentic spinal cord NSPCs in molecular and functional terms remains elusive. Our study aims to provide a comprehensive characterization of bona fide spinal cord NSPCs and their isogenic iPSC-derived counterparts, specializing in the spinal cord (iPSC-SC) and the brain (iPSC-Br). We obtained human spinal cord and skin tissue with ethics approval to establish primary NSPC cultures. From these primary cells, we derived iPSCs and differentiated them into iPSC-SC and iPSC-Br NSPCs. Assessments included differentiation, proliferation capabilities, immunostaining, and differential gene expression through RNA sequencing. Significant differences were identified in the functional and transcriptional properties of bona fide NSPCs compared to iPSC-SC and iPSC-Br. Bona fide and iPSC-SC NSPCs exhibited spinal cord regionalization, whereas iPSC-Br displayed a dorsal forebrain regionalization. Notably, iPSC-derived NSPCs shared functional and transcriptional features reminiscent of early developmental stages, including embryonic patterning genes and increased proliferation rates. Moreover, differentiation profiles were most similar between bona fide and iPSC-Br, while substantial distinctions were observed between bona fide and iPSC-SC. Our study unveils unique regional, developmental, and functional characteristics differentiating bona fide spinal cord NSPCs from iPSC-derived NSPCs. Addressing these disparities holds promise for enhancing the clinical effectiveness of iPSC-derived NSPC therapies for spinal cord injuries. This investigation sheds light on the distinct attributes of these two cell types, contributing to a deeper understanding of their potential applications in the realm of spinal cord injury treatment and regenerative medicine.

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Session Podium 3: 1515-1530 - Evaluating Patient Selection for Surgery in Older Patients with Non-Metastatic Colorectal Cancer in Ontario: a Population-Based Cohort Study

Division of General Surgery

Clinical Research

Presenter: Dr. Richard Hu

Contribution to Project:

Primary investigator

ICES data application and management

Data analysis using SAS with help from Dr. van Walraven

Data interpretation

Primary author for manuscript

 

Introduction

Surgeons are faced with an increasing number of patients over the age of 80 presenting with non-metastatic colorectal cancer (CRC). Justifying major surgery in a comorbid and frail population requires individualized decision making and remains a challenge for surgeons. Very few studies compared the outcomes of patients undergoing surgery versus no surgery and no studies evaluated survival outcomes from a patient selection perspective at a population level. This study aims to evaluate the quality of patient selection by surgeons in Ontario by comparing outcomes of those chosen to undergo surgery to those who did not undergo surgery.

Methods

A retrospective population-based cohort study was conducted using linked administrative health data in Ontario, Canada from 2010 to 2020. The cohort included all patients aged over 80 with a diagnosis of CRC through the Ontario Cancer Registry (OCR). We compared all-cause survival between the surgery and no-surgery groups. The primary covariate surgery was analyzed as a time-dependent variable. Unadjusted (Kaplan-Meier) and multivariable adjusted (Cox proportional hazard model) were used to examine the association of surgery with time of death.

Results

We identified 5782 patients diagnosed with stage I-III colon or rectal cancer. 4779 underwent elective colorectal surgery and 1003 did not. The surgery group was younger (84.4± 4.5 vs 86.9± 3.6), less frail (preoperative frailty index 0.12[IQR0.08-0.22] vs 0.15[IQR0.07- 0.18]) and more colon/rectosigmoid cancer (83.7% vs 62.6%). The most important covariates associated with survival (from most to least important) were surgery, frailty, age, stage, and sex. In both adjusted and unadjusted analyses, survival was statistically significantly better in the surgery group except in male patients with stage 3 rectal cancer with higher preoperative frailty index.

Conclusion

In patients over the age of 80 with stage I-III CRC, those selected by surgeons for resection had a better overall survival. This study demonstrates the excellence of Ontario surgeons at identifying older patients who would benefit from invasive procedures despite their advanced age and frailty.

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Session Podium 3: 1530-1545 - Systematic Review of Clinical Practice Guidelines for Management of Perioperative Delirium After Major Surgery

Division of Vascular Surgery

Clinical Research

Presenter: Dr. Hannah Koury

Contribution to Project:

Created the project proposal, performed the systematic review, analyzed CPG data, created, distributed, and analyzed pilot survey.

 

Objective: Many clinical practice guidelines (CPGs) have been published on the perioperative management of delirium. No reviews of guidelines or feasibility analyses exist. This review aims to create a summary of CPGs on perioperative delirium management.

Methods: Literature was systematically reviewed from 1965-2023 using the Cochrane Library, CINAHL, EMBASE, WOS, SCOPUS, MEDLINE databases and 11 websites and repositories. A pilot survey comprised of 11 5-point Likert scale questions was developed to evaluate the relevancy of strong-rated guideline recommendations to vascular surgery patients.

Results: The combined search yielded 1 480 citations. Forty-two underwent full-text review for eligibility, which yielded 9 CPGs. No guidelines included an applicability or implementation section, no guidelines were specific to the vascular surgery population. 26 health care providers from the Division of Vascular Surgery, Departments of Anesthesiology and Geriatric Medicine, and allied healthcare team members at The Ottawa Hospital completed the survey. Most strong recommendations were rated as either relevant or very relevant to the vascular surgery population.

Conclusions: No guidelines specific to a vascular surgery population on perioperative management of delirium exist. A pilot survey suggests most strong rated recommendations from existing CPGs are relevant to the vascular surgery population. Findings will inform formal feasibility and implementation studies of CPG recommendations.

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Session Podium 3: 1545-1600 - Evaluating left carotid artery pressures during circulatory arrest with unilateral antegrade cerebral perfusion

Division of Cardiac Surgery

Clinical Research

Presenter: Dr. Yuan Qiu

Contribution to Project:

I assisted with the concept development, data analysis, and presentation of the data. I also led the writing and editing of the abstract.

 

BACKGROUND: Surgical intervention for aortic arch disease requires a period of circulatory arrest with cerebral perfusion to reduce the risk of neurological sequelae. Right-sided unilateral antegrade cerebral perfusion (ACP) is a common method, given its shorter implementation time and avoidance of additional arch vessel manipulation. However, contralateral cerebral malperfusion can occur with variations in the circle of Willis. Left carotid pressure (LCP) monitoring can be a marker of left cerebral perfusion pressures. LCP monitoring is not routine during unilateral ACP and its role is not studied extensively in the literature. Our objective was to compare the LCP with right radial artery pressure (RRP) during unilateral ACP in a cohort of patients who underwent aortic arch surgery to analyze discrepancies in pressures. METHODS: A retrospective chart review was conducted from May 2022 to Feb 2024 of patients who underwent aortic arch surgeries with unilateral ACP and concurrent LCP monitoring at our institution. Patient demographics, RRP, left radial pressure, LCP, postoperative stroke, and 30- and 60-day mortality were recorded. The LCPs and RRPs were compared at ACP initiation, 5, 10, and 15 minutes. RESULTS: Twenty-three patients were included, with a mean age of 70±9.5 years and 65.2% male. None had a known history of cerebrovascular abnormalities. At ACP initiation, 7/21 patients had a >50% reduction in LCP compared with RRP. At 5 minutes, 7/23 patients had a >50% reduction, at 10 minutes, 5/23 patients had a >50% reduction, and at 15 minutes, 5/19 patients had a >50% reduction in LCP compared with RRP. There were no cerebrovascular events or mortalities within 60 days. CONCLUSION: Around one-third of patients had a >50% decrease in LCP compared with RRP. These results suggest that variation exists between the LCP and RRP during unilateral ACP, which could be an indicator of intracerebral perfusion pressure variation, with the contralateral side having lower perfusion pressures. This highlights the need to analyze a larger cohort to evaluate the effectiveness of unilateral ACP in preventing neurological sequelae, an important outcome for patients.

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Session Podium 3: 1600-1615 - Impact of the COVID-19 Pandemic on Breast Cancer Screening, Staging, and Management: A Canadian Perspective

Division of Plastic Surgery

Clinical Research

Presenter: Dr. Adolfo Alejandro López Rios

Contribution to Project:

Analyze data and aid in creation of the manuscript/abstract. Also approve edits and additions

 

Importance: The COVID-19 pandemic introduced many disruptions in healthcare services, including breast cancer screening and treatment, leading to delays in diagnosis and management. Understanding the pandemic's impact on breast cancer outcomes is crucial for optimizing patient care.

Objective: To evaluate the effects of the COVID-19 pandemic on breast cancer screening, staging at diagnosis, oncologic management, and immediate reconstruction in a Canadian setting.

Methods: A retrospective cohort study was conducted at The Ottawa Hospital, comparing breast cancer patients diagnosed between March 2018 to February 2020 (pre-pandemic), and March 2020 to February 2022 (post-pandemic). The study looked at patient demographics, cancer stages, timing of cancer treatments, treatment processes (including chemotherapy, endocrine therapy, and surgical treatment), and other related factors. Data on patient demographics, cancer stages, treatment modalities, and surgical interventions were analyzed.

Results: The study included 4,867 newly diagnosed breast cancer patients, with 2,577 diagnosed pre-pandemic and 2,290 post-pandemic. While the overall number of diagnoses decreased post-pandemic, there was a significant increase in stage 1 diagnoses (8.62%). Surgical interventions decreased post-pandemic, with a shift towards non-surgical therapies such as neo-adjuvant and adjuvant. Endocrine therapy and adjuvant radiotherapy utilization increased significantly post-pandemic. Immediate breast reconstruction rates also increased across all stages.

Conclusion: The COVID-19 pandemic led to changes in breast cancer diagnosis and management, including decreased surgical interventions, increased utilization of non-surgical therapies, and shorter treatment initiation times. These findings highlight the need for adaptive healthcare strategies to mitigate the impact on breast cancer outcomes. Further research is warranted to assess the long-term implications of these changes on patient morbidity and mortality.

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Session Podium 3: 1615-1630 - Thoracic surgery group practice: a retrospective review of patient outcomes, patient satisfaction, and implications for a group surgical practice during the covid-19 era

Division of Thoracic Surgery

Quality Improvement Research

Presenter: Dr. Aroub Alkaaki

Contribution to Project:

Analysis, manuscript writing

 

Objectives: Potential benefits to a surgical group practice include diverse surgeon expertise, improved efficiency, and timely surgical access. Surgeon benefits include continued professional development and shared responsibility in patient care. The objective of this study was to compare outcomes between patients for whom the consenting surgeon was the same as the operating surgeon, to those for whom consenting and operating surgeons differed in order to determine the outcomes of a shared surgical practice.

Methods: This is a retrospective review (2010-19) of 4853 patients undergoing thoracic surgical procedures at a high-volume centre. Patients were divided into Group I (operating surgeon same as consenting surgeon) and Group II (operating surgeon different from consenting surgeon). Postoperative adverse events (AE) were collected prospectively and defined and graded using the www.ottawatmm.org system. Patient satisfaction surveys obtained during a portion of this interval (2015-2016) were also evaluated. The survey utilized a 22-item questionnaire, based on previously validated questions, retrospectively assessing patients’ overall experience with the surgical team members during hospitalization and follow up visits.

Results: There was no difference in the median or average length of stay between the groups. There was also no difference in the frequency of adverse events post operatively, including minor (Clavien-Dindo grade I-II) and major (Clavien-Dindo III-V) adverse events. Patient satisfaction with their surgeons did not demonstrate any difference between the two groups.

Conclusion: A surgical group practice may allow for improved efficiency and timeliness of care, without sacrificing these elements of quality and patient experience. A group model may be especially applicable for the burdens and constraints on physicians and the healthcare system during the COVID-19 pandemic.

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