Attitudes of patients and care providers toward a surgical site marking policy.

Background: In the fall of 2005, the University Health Network in Toronto, Canada, initiated a policy requiring the surgeon-or his or her delegate-to sign the incision site for all operations. Little is known about what health care providers and patients think about official surgical site marking policy.

Method: Twenty-one patients and health care providers were interviewed, and the authors conducted field observations of surgeons while they marked their patients.

Risk factors for bile duct injury during laparoscopic cholecystectomy: a case-control study.

Common bile duct injury is a serious but uncommon complication of laparoscopic cholecystectomy. A case-control epidemiologic study of patients who had undergone cholecystectomy in Ontario, Canada, between 1991 and 1997 was performed. Four patients who had undergone a laparoscopic cholecystectomy at the same hospital 2 months prior to a case were selected as controls.

Patient-centered measures for achalasia.

Background: Various instruments may be used to measure health-related quality of life in patients with achalasia.

Methods: We administered four patient-centered measures used for evaluation of achalasia severity [an achalasia severity questionnaire we developed previously, an achalasia symptom checklist, the Gastrointestinal Quality-of-Life Index (GIQLI), and the Medical Outcomes Study 36-item Short-Form survey (SF-36)] to 25 subjects enrolled in a randomized controlled trial comparing pneumatic dilatation and laparoscopic Heller myotomy. We estimated correlations between the different measures.

Adoption of an innovation to repair aortic aneurysms at a Canadian hospital: a qualitative case study and evaluation.

Background: Priority setting in health care is a challenge because demand for services exceeds available resources. The increasing demand for less invasive surgical procedures by patients, health care institutions and industry, places added pressure on surgeons to acquire the appropriate skills to adopt innovative procedures. Such innovations are often initiated and introduced by surgeons in the hospital setting.

Factors affecting the number of lymph nodes retrieved in colorectal cancer specimens.

Background: Staging of colorectal cancer is dependent on the number of lymph nodes in a surgical specimen that are positive for metastatic cancer. It is generally recommended that a minimum of 12 lymph nodes be examined to ensure adequate staging. It is unclear which factors specifically contribute to variation in the number of lymph nodes retrieved from surgical specimens.

How are decisions to introduce new surgical technologies made? Advanced laparoscopic surgery at a Canadian community hospital: A qualitative case study and evaluation.

The introduction of many new surgical technologies is associated with increased costs and uncertainty regarding risks and benefits. Currently, little is known about how decisions are made regarding the adoption of surgical innovations. To study the decision-making process for adoption of advanced laparoscopic surgical procedures at a community hospital in Toronto, Canada, we used qualitative case study methods.

Effect of surgeon on outcome of antireflux surgery.

Background: We sought to determine whether subjective outcomes one or more years after antireflux surgery are affected by the operating surgeon.

Methods: We reviewed records of patients who had antireflux surgery from June 2000 to June 2002 and mailed the patients a 19-item survey that focused on current medication use, postoperative symptom improvement, and satisfaction with surgery. We tested the significance of predictor variables using chi-squared and Fisher exact tests for categorical variables and analysis of variance for continuous variables.

A measure of quality of life after abdominal surgery.

Objective: To develop a reliable and valid measure of short-term quality of life after abdominal surgery.

Summary Background Data: A major limitation of clinical trials evaluating laparoscopic surgical procedures has been the lack of a measure of short-term quality of life after abdominal surgery.

Methods: We used existing health status measures, focus groups, and semi-structured patient interviews to generate a prototype questionnaire of 51 items, which was administered to patients within 2 weeks after an abdominal surgical procedure.

Short-term health-related quality of life after abdominal surgery: a conceptual framework.

We sought to develop a conceptual framework of health-related quality of life (QOL) after abdominal surgery to assist in the development of a QOL measure suitable for use in clinical trials comparing laparoscopic and conventional surgery. We conducted semi-structured interviews with 21 patients within 2 weeks after an abdominal surgical procedure. Responses were transferred into an electronic spreadsheet and coded to facilitate analysis.

A measure of disease-specific health-related quality of life for achalasia.

Objectives: To develop a measure of disease-specific health-related quality of life for achalasia for use as an outcome measure in clinical trials.

Methods: We generated a list of potential items for a measure of disease-specific health-related quality of life for achalasia by semistructured interviews with seven persons with achalasia, and by expert opinion. We then used factor analysis and item response theory methods for item reduction, using responses on the long-form questionnaire from 70 persons with achalasia.