Operating room use for emergency general surgery cases: analysis of the Patterns of Complex Emergency General Surgery in Canada study.

Background: Access to the operating room (OR) is variable among emergency general surgery (EGS) services, with some having dedicated EGS ORs, and others only a shared queue. Currently in Canada, only a limited number of acute care surgery services have dedicated daytime operating room (OR) access; hence, we aimed to describe the burden of after-hours EGS operating in Canada and differences associated with OR access.

Methods: In this multicentre retrospective cohort study, we used data from a previously conducted study designed to evaluate nonappendiceal, nonbiliary disease across 8 Canadian hospitals.

Failure to rescue in emergency general surgery in Canada.

Background: The risk of death after a postoperative complication - known as failure to rescue (FTR) - has been proposed to be superior to traditional benchmarking outcomes, such as complication and mortality rates, as a measure of system quality. The purpose of this study was to identify the current FTR rate in emergency general surgery (EGS) centres across Canada. We hypothesized that substantial variability exists in FTR rates across centres.

Impact of interhospital transfer on patient outcomes in emergency general surgery.

Background: Emergency general surgery patients are at an increased risk for morbidity and mortality compared to their elective surgery counterparts. The complex nature of emergency general surgery conditions can challenge community hospitals, which may lack appropriate systems and personnel. Outcomes related to transfer have not been well-established.

Patterns of complex emergency general surgery in Canada.

Background: Most of the literature on emergency general surgery (EGS) has investigated appendiceal and biliary disease; however, EGS surgeons manage many other complex conditions. This study aimed to describe the operative burden of these conditions throughout Canada.

Methods: This multicentre retrospective cohort study evaluated EGS patients at 7 centres across Canada in 2014.

Drivers of Inpatient Costs After Colorectal Surgery Within a Publicly Funded Healthcare System.

Background: The morbidity and mortality associated with colorectal resections are responsible for significant healthcare use. Identification of efficiencies is vital for decreasing healthcare cost in a resource-limited system.

Objective: The purpose of this study was to characterize the short-term cost associated with all colon and rectal resections.

The value of surgical experience: excess costs associated with the Roux-en-Y gastric bypass learning curve.

Background: Gastric bypass has a steep learning curve that is associated with increased adverse outcomes and these adverse outcomes are associated with increases in cost. This study sought to quantify the effect of cumulative procedure volume on inpatient cost and characterize the excess cost associated with a surgeon's learning curve.

Methods: This was a retrospective study of 29 high-volume surgeons during the first 6 years of performing gastric bypass in a regionalized center of excellence system.

The effect of distance on short-term outcomes in a regionalized, publicly funded bariatric surgery model.

Background: While high-volume Centers of Excellence (COE) for bariatric surgery may have improved clinical outcomes, their disparate distribution results in longer travel distances for patients. The purpose of this study was to investigate effect of distance from COE on outcomes and readmission.

Methods: This was a retrospective study of all adults, aged 18 years or older, receiving bariatric surgery from April 2009 to March 2012 in the province of Ontario.

A Longitudinal Analysis of Short-Term Costs and Outcomes in a Regionalized Center of Excellence Bariatric Care System.

Background: Evaluating how morbidity and costs evolve for new bariatric centers is vital to understanding the expected length of time required to reach optimal outcomes and cost efficiencies. Accordingly, the objective of this study was to evaluate how morbidity and costs changed longitudinally during the first 5 years of a regionalized center of excellence system.

Methods: This was a longitudinal analysis of the first 5 years of a bariatric center of excellence system.

The effect of health system factors on outcomes and costs after bariatric surgery in a universal healthcare system: a national cohort study of bariatric surgery in Canada.

Introduction: Previous data demonstrate that patients who receive bariatric surgery at a Center of Excellence are different than those who receive care at non-accredited centers. Canada provides a unique opportunity to naturally exclude confounders such as insurance status, hospital ownership, and lack of access on comparisons between hospitals and surgeons in bariatric surgery outcomes. The objective of this study was to determine the effect of hospital accreditation and other health system factors on all-cause morbidity after bariatric surgery in Canada.

Mastery in Bariatric Surgery: The Long-term Surgeon Learning Curve of Roux-en-Y Gastric Bypass.

Objective: To determine the effect of cumulative volume on all-cause morbidity and operative time.

Background: Gastric bypass is an important public health procedure, but it is difficult to master with little data about how surgeon cumulative volume affects outcomes longitudinally.

Methods: This was a longitudinal study of 29 surgeons during the first 6 years of performing bariatric surgery in a high-volume, regionalized center of excellence system.

Outcomes the Ontario Bariatric Network: a cohort study.

Background: Bariatric surgery centres of excellence are relatively new in Canada and were first started in Ontario in 2009. This study presents short-term outcomes of Canada's largest bariatric collaborative, from Ontario, during its first 3 years.

Methods: We performed a population-based cohort study that included all patients (age ≥ 18) who received a Roux-en-Y gastric bypass or sleeve gastrectomy for the purpose of weight loss from March 2009 to April 2012 within Ontario.

A comparison of endoscopic localization error rate between operating surgeons and referring endoscopists in colorectal cancer.

Background: Colonoscopy for colorectal cancer (CRC) has a localization error rate as high as 21 %. Such errors can have substantial clinical consequences, particularly in laparoscopic surgery. The primary objective of this study was to compare accuracy of tumor localization at initial endoscopy performed by either the operating surgeon or non-operating referring endoscopist.

Neighborhood Variation in the Utilization of Laparoscopy for the Treatment of Colon Cancer.

Background: The rates of laparoscopic colectomy for colon cancer have steadily increased since its inception. Laparoscopic colectomy currently accounts for a third of colectomy procedures in the United States, but little is known regarding the spatial pattern of the utilization of laparoscopy for colon cancer.

Objective: This study evaluated the utilization of laparoscopy for colon cancer at the neighborhood level in Ontario.

A population-based comparison of 30-day readmission after surgery for colon and rectal cancer: How are they different?

Background: An implicit assumption in the analysis of colorectal readmission is that colon and rectal cancer patients are similar enough to analyze together. However, no studies have examined this assumption and whether substantial differences exist between colon and rectal cancer patients.

Methods: This was a retrospective analysis of the differences in predictors, diagnoses, and costs of readmission between colon and rectal cancer cohorts for 30-day readmission.

A population-based analysis of the drivers of short-term costs after bariatric surgery within a publicly funded regionalized center of excellence system.

Background: The most significant driver of healthcare utilization for bariatric surgery is the index admission and readmissions within the first 30 days after a procedure. Identifying areas to create efficiencies during this period is essential to decreasing overall healthcare costs.

Objective: The objective of the study was to characterize the short-term costs of bariatric surgery within a regionalized center of excellence bariatric care system.

Regional Variations in the Public Delivery of Bariatric Surgery: An Evaluation of the Center of Excellence Model.

Objective: We evaluated regional access to bariatric surgery within the high-volume, center of excellence (COE) model of Ontario, Canada.

Background: In 2009, Ontario implemented Canada's first regionalized bariatric surgical care system based on a COE. Because of this, a small number of COEs service a large population and geographic area.

Perception and Awareness of Bariatric Surgery in Canada: a National Survey of General Surgeons.

Background: The objective of this study was to assess Canadian general surgeons' knowledge of bariatric surgery and perceived availability of resources to manage bariatric surgery patients.

Methods: A self-administered questionnaire was developed using a focus group of general surgeons. The questionnaire was distributed at two large general surgery conferences in September and November 2012.

30-Day readmission after bariatric surgery in a publicly funded regionalized center of excellence system.

Background: Avoidable readmission after surgery is a major burden on healthcare resources and is common after major surgery. Bariatric surgery is one of the most common surgical procedures in North America, and there is a paucity of strategies to prevent readmission. Strategies for prevention must first identify actual risk factors before interventions can be designed.

Bariatric surgery in patients with reduced kidney function: an analysis of short-term outcomes.

Background: With rates of obesity among patients with chronic kidney disease (CKD) mirroring that of the general population, there is growing interest in offering bariatric surgery to these patients. We sought to determine the safety of bariatric surgery in this patient population.

Methods: Patients who underwent selected laparoscopic bariatric procedures between 2005 and 2011.

Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes.

Background: Laparoscopic management of adhesive small bowel obstruction (SBO) has become an established technique within the domain of acute care surgery. As minimally invasive management of SBO becomes more widely accepted, there is increased need for reporting of outcomes.

Objective: To compare outcomes of laparoscopic versus open surgery for adhesive SBO.

Preoperative endoscopy localization error rate in patients with colorectal cancer.

Background: Preoperative repeat endoscopy in colorectal cancer (CRC) patients is considered by many to be an integral component of surgical planning. Little is known, however, about the utility of re-endoscopy.

Methods: A retrospective review of 342 consecutive patients undergoing elective surgical resection for CRC from January 2008 to December 2011 was performed.

Management of umbilical hernias in patients with ascites: development of a nomogram to predict mortality.

Background: The objective of this study was to develop an easy-to-use nomogram to assist clinicians in predicting patient-specific mortality in this patient population.

Methods: American College of Surgeons National Surgical Quality Improvement Program participant use files were used from 2005 to 2011. Multivariable logistic regression was used to model 30-day postoperative mortality in patients with ascites who underwent umbilical hernia repair.

Short-term morbidity associated with removal and revision of the laparoscopic adjustable gastric band.

Background: Laparoscopic adjustable gastric band (LAGB) insertion is a commonly performed bariatric procedure with low associated short-term risk. Given that a significant number of patients will require additional revision/removal procedures, overall morbidity may be underestimated. The objective of this study was to define the 30-day morbidity associated with LAGB removal and revision procedures.