Effect of intraperitoneal local anesthesia on enhanced recovery outcomes after bariatric surgery: a randomized controlled pilot study.

Background: Patients with extreme obesity are at high risk for adverse perioperative events, especially when opioid-centric analgesic protocols are used, and perioperative pain management interventions in bariatric surgery could improve safety, outcomes and satisfaction. We aimed to evaluate the impact of intraperitoneal local anesthesia (IPLA) on enhanced recovery after bariatric surgery (ERABS) outcomes.

Methods: We conducted a prospective double-blind randomized controlled pilot study in adherence to an a priori peer-reviewed protocol.

Preinjury ASA score as an independent predictor of readmission after major traumatic injury.

Background: Patients with trauma have a high predisposition for readmission after discharge. Unplanned solicitation of medical services is a validated quality of care indicator and is associated with considerable economic costs. While the existing literature emphasizes the severity of the injury, there is heterogeneity in defining preinjury health status.

Assessing the feasibility of a randomised, double-blinded, placebo-controlled trial to investigate the role of intraperitoneal ropivacaine in gastric bypass surgery: a protocol.

Introduction: Postoperative pain control remains a major challenge for surgical procedures, including laparoscopic gastric bypass. Pain management is particularly relevant in obese patients who experience a higher number of cardiovascular and pulmonary events. Effective pain management may reduce their risk of serious postoperative complication, such as deep vein thrombosis and pulmonary emboli.

Enhancing the quality of morbidity and mortality rounds: the Ottawa M&M model.

Objectives: The objective of this study was to determine the feasibility and acceptability of a structured morbidity and mortality (M&M) rounds model through an innovative educational intervention.

Methods: The authors engaged the Departments of Emergency Medicine (EM) and Trauma Services at a tertiary care teaching hospital. A needs assessment was performed; the Ottawa M&M rounds model was developed, implemented, and then evaluated as a four-part intervention.

Delay in operative stabilization of spine fractures in multitrauma patients without neurologic injuries: effects on outcomes.

Background: Optimal timing for surgical stabilization of the fractured spine is controversial. Early stabilization facilitates mobilization and theoretically reduces associated complications.

Methods: We identified consecutive patients without neurologic injury requiring stabilization surgery for a spinal fracture at an academic tertiary-care hospital over a 12-year period.

National survey of Canadian general surgery program directors regarding focused assessment with sonography for trauma.

Introduction: Focused assessment with sonography for trauma (FAST) is an important modality in the initial assessment of trauma patients. Information regarding the current status, availability, as well as educational and training processes in the use of FAST is limited. The purpose of this study was to survey Canadian general surgery residency program directors regarding FAST.

Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort.

Study Objective: The first hour after the onset of out-of-hospital traumatic injury is referred to as the "golden hour," yet the relationship between time and outcome remains unclear. We evaluate the association between emergency medical services (EMS) intervals and mortality among trauma patients with field-based physiologic abnormality.

Methods: This was a secondary analysis of an out-of-hospital, prospective cohort registry of adult (aged > or =15 years) trauma patients transported by 146 EMS agencies to 51 Level I and II trauma hospitals in 10 sites across North America from December 1, 2005, through March 31, 2007.

Management of open abdominal wounds with a dynamic fascial closure system.

Background: In damage-control surgery, definitive abdominal closure may not be possible for several days or weeks after laparotomy until the patient has stabilized.

Methods: We present 23 patients treated with the Canica ABRA dynamic wound closure system that re-approximated open abdomens with silicone elastomers placed transfascially across the wound. This study aimed to assess the results of using this system and to identify risk factors for unsuccessful closure.

Advanced laparoscopic surgery in a free-standing ambulatory setting: lessons from the first 50 cases.

To decrease the impact and cost of surgery, there is a trend toward developing treatment models for complex conditions on a fully outpatient basis. This is a retrospective study of the initial experience of advanced laparoscopic procedures performed on a same-day outpatient basis in the ambulatory campus of a university hospital. Over 3 years, 55 patients underwent 50 Nissen fundoplications and 5 adrenalectomies.

A prospective study to validate an impairment questionnaire for major trauma survivors.

Objective: To develop and validate an impairment questionnaire that will provide an estimate of whole-person impairment in patients who have suffered major trauma.

Design: This was a multicenter prospective study involving a convenience sample of 43 volunteer participants who had sustained major trauma within 1 yr of study commencement. Patients were recruited from two trauma centers in Ontario, Canada.

Subacute tricuspid valve rupture after traumatic cardiac and pulmonary contusions.

Tricuspid valve rupture is a rare complication after blunt chest trauma. We report the unusual presentation of a patient that suffered traumatic cardiac and pulmonary contusions, contributing to the rupture of the posterior papillary muscle of the tricuspid valve 24 hours after presentation. We believe that this is the first reported case of subacute tricuspid valve rupture after a normal echocardiogram at admission after blunt chest trauma.

Isolated blunt splenic injury: do we transfuse more in an attempt to operate less?

Objective: To determine if blood transfusion requirements in patients with isolated blunt splenic injury (BSI) are greater if they are managed nonoperatively, we did a retrospective case study of patients with isolated BSI who were seen at a Canadian university teaching hospital over a 10-year period.

Method: Data such as number of units of packed erythrocytes transfused and mortality in the 75 patients with isolated BSI seen from 1992 to 2002 were separated into operative and nonoperative management groups.

Results: In the operative management group (n = 10), patients received more transfused erythrocytes (3.