Predictors and outcomes of same day discharge after minimally invasive hysterectomy in gynecologic oncology within the National Surgical Quality Improvement Program database.

Objective: To assess trends over time of same day discharge after minimally invasive hysterectomy in oncology, identify perioperative factors influencing same day discharge, and evaluate 30 day postoperative morbidity.

Methods: A retrospective cohort of elective minimally invasive hysterectomies performed for gynecologic oncologic indications between January 2013 and December 2021 was identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Clinical and surgical characteristics, length of stay, and 30 day postoperative complications were captured.

Virtual fundamentals of laparoscopic surgery (FLS) boot-camp using telesimulation: an educational solution during the COVID-19 pandemic.

Background: The Fundamentals of Laparoscopic Surgery (FLS) is an internationally recognized educational and certification program designed to teach the knowledge and skills required for basic laparoscopic surgery. Previously, our institution has organized an FLS boot-camp to teach PGY1 residents the FLS manual skills. During the COVID-19 pandemic, in-person sessions were not possible.

Adverse postoperative outcomes associated with perioperative blood transfusion in gynecologic oncology surgery.

Objective: To examine the incidence of perioperative blood transfusion and association with 30 day postoperative outcomes in gynecologic cancer surgery.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify all gynecologic oncology cases from 2013 to 2019. Clinical and surgical characteristics and 30 day postoperative complications were retrieved.

A regional approach to reduce postoperative opioid prescribing in Ontario, Canada.

Background: Opioid-related morbidity and mortality continue to rise in the province of Ontario. We implemented a provincial campaign to reduce the number of opioid pills prescribed at discharge after surgery in the Ontario Surgical Quality Improvement Network (ON-SQIN).

Methods: Activities related to the provincial campaign were implemented between April 2019 and March 2020 and between October 2020 and March 2021.

Cost of postoperative complications after general surgery at a major Canadian academic centre.

Background: In a fiscally constrained health care environment, the need to reduce unnecessary spending is paramount. Postoperative complications contribute to hospital costs and utilization of health care resources.

Objective: The purpose of this observational study was to identify the cost associated with complications of common general surgery procedures performed at a major academic hospital in Toronto, Ontario.

Weight loss outcomes for patients undergoing conversion to Roux-en-Y-gastric bypass after sleeve gastrectomy.

Background: Despite excellent reported outcomes after laparoscopic sleeve gastrectomy (LSG), a percentage of patients go on to have a secondary bariatric surgery to manage side-effects or address weight regain after LSG. Reported weight loss outcomes for patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) after previous LSG are variable. We sought to determine the weight-loss outcomes of patients undergoing LRYGB after LSG in the largest bariatric surgical network in Canada and to determine whether outcomes differ according to indications for conversion.

Low incidence of venous thromboembolism after gynecologic oncology surgery: Who is at greatest risk?

Objective: To determine the 30-day incidence of venous thromboembolism (VTE) after gynecologic oncologic surgery and identify perioperative factors associated with postoperative VTE.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify all gynecologic oncology cases from 2013 to 2019. Clinical and surgical characteristics, VTE events and 30-day postoperative complications were retrieved.

Operative management of recalcitrant marginal ulcers following laparoscopic Roux-en-Y gastric bypass for morbid obesity: a systematic review.

One of the short- and long-term complications following Roux-en-Y gastric bypass (RYGB) for morbid obesity is the development of marginal ulcers (MUs). Although chronic and recalcitrant/recurrent marginal ulcers (rMUs) are common, there is no consensus on their optimal management. The objective of this study was to perform a systematic review of the elective operative management of rMUs.

Committed to Better Outcomes: Reducing Infection after Surgery Across the Ontario Surgical Quality Improvement Network.

Background: In 2015, the Ontario Surgical Quality Improvement Network was established to create a community of practice for Ontario hospitals to improve surgical quality. A provincial campaign to decrease postsurgical infections was launched in 2017.

Study Design: Thirty hospitals implemented activities related to the campaign from April 2018 to March 2019.

The Effect of Tissue Adhesive on Surgical Site Infection Following Elective Bariatric Surgery: a Retrospective Cohort Study.

Purpose: The reported incidence of surgical site infection (SSI) following bariatric surgery ranges from 1.4 to 30%. The use of skin staples and tissue adhesive was shown to be superior to sutures in reducing SSI in a variety of surgical disciplines; however, this area is under-investigated in elective bariatric surgery.

Efficiency of Lithium Cations in Hydrolysis Reactions of Esters in Aqueous Tetrahydrofuran.

Lithium cations were observed to accelerate the hydrolysis of esters with hydroxides (KOH, NaOH, LiOH) in a water/tetrahydrofuran (THF) two-phase system. Yields in the hydrolysis of substituted benzoates and aliphatic esters using the various hydroxides were compared, and the effects of the addition of lithium salt were examined. Moreover, it was presumed that a certain amount of LiOH was dissolved in THF by the coordination of THF with lithium cation and hydrolyzed esters even in the THF layer, as in the reaction by a phase-transfer catalyst.

Impact of a Mobile App to Support Home Recovery of Patients Undergoing Bariatric Surgery.

Background: Perioperative patient education and engagement are critical components of care in patients undergoing bariatric surgery, given the short length of stay and the requirements to adhere to various instructions. The use of patient engagement mobile technology may promote adherence to perioperative protocols and improve care by potentially identifying complications earlier and reducing associated health care costs.

Materials And Methods: We introduced a mobile app that provides bariatric patients with access to educational materials and the ability to report on their symptoms.

Engineering functional microvessels in synthetic polyurethane random-pore scaffolds by harnessing perfusion flow.

Recently reported biomaterial-based approaches toward prevascularizing tissue constructs rely on biologically or structurally complex scaffolds that are complicated to manufacture and sterilize, and challenging to customize for clinical applications. In the current work, a prevascularization method for soft tissue engineering that uses a non-patterned and non-biological scaffold is proposed. Human fibroblasts and HUVECs were seeded on an ionomeric polyurethane-based hydrogel and cultured for 14 days under medium perfusion.

Marginal ulceration following Roux-en-Y gastric bypass: risk factors for ulcer development, recurrence and need for revisional surgery.

Background: Marginal ulcer formation is a known complication following RYGB. While most respond to medical therapy, many patients have recurrent or chronic MU. Although non-steroidal anti-inflammatory drug (NSAID) use, smoking and Helicobacter pylori infection are known risk factors of MU, little is known about what increases the likelihood of developing recalcitrant ulcers.

Impact of preoperative opioid use on health outcomes after bariatric surgery.

Background: Opioid consumption in North America has risen to alarming levels and represents a potentially modifiable risk factor in perioperative management. Chronic pain and obesity are commonly associated and bariatric surgery remains the most effective intervention for weight loss in morbidly obese patients.

Objectives: To understand how preoperative opioid use impacts surgical outcomes in patients undergoing bariatric surgery.

Preoperative Helicobacter pylori Screening and Treatment in Patients Undergoing Laparoscopic Sleeve Gastrectomy.

Background: The role of preoperative screening and treatment of Helicobacter pylori (HP) in asymptomatic patients undergoing laparoscopic sleeve gastrectomy (LSG) remains unclear. This study aims to define the preoperative prevalence and management of HP and their effect on postoperative outcomes at our institution.

Materials And Methods: We reviewed the medical records and surgical specimens of all LSG performed at an academic centre in Toronto, ON between 2010 and 2017.

Unexpected histopathological findings after sleeve gastrectomy.

Background: Laparoscopic sleeve gastrectomy (LSG) represents one of the most commonly performed bariatric procedures and, in contrast to the Roux-en-Y gastric bypass, produces a specimen for pathologic examination. This study aims to describe unexpected histopathological findings in order to better define preoperative management of patients undergoing LSG.

Methods: All LSG cases performed at an academic center in Toronto, Ontario between 2010 and 2017 were reviewed.

Physical activity and its association with psychosocial health following bariatric surgery.

Physical activity (PA) helps sustain weight loss and may also provide psychological benefits in patients undergoing bariatric surgery. Using a set of questionnaires, we demonstrated that bariatric patients with increased level of PA at 1-year follow-up had better psychosocial outcomes including depressive symptoms and mental health-related quality of life compared with those who had reduced or unchanged level of PA. Our findings indicate the benefit of incorporating PA in the postoperative care for bariatric patients.

Accelerating surgical quality improvement in Ontario through a regional collaborative: a quality-improvement study.

Background: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) collaborative in Ontario, the Ontario Surgical Quality Improvement Network (ON-SQIN), was launched in January 2015. We describe its approaches to support surgical quality improvement and examine its early impact on member hospitals.

Methods: All Ontario hospitals that participated in the ON-SQIN and NSQIP were included in this quality-improvement study.

Utilization of Public System for Gastric Bands Placed by Private Providers: a 4-Year Population-Based Analysis in Ontario, Canada.

Laparoscopic adjustable gastric band (LAGB) placement remains a common bariatric procedure. While LAGB procedure is performed within private clinics in most Canadian provinces, public health care is often utilized for LAGB-related reoperations. We identified 642 gastric band removal procedures performed in Ontario from 2011 to 2014 using population-level administrative data.

Reducing the rate of post-surgical urinary tract infections in orthopedic patients.

Urinary tract infection (UTI) is the fourth leading cause of healthcare-associated infections, with approximately 70%-80% being attributed to the inappropriate use of indwelling catheters. In many cases, indwelling catheters are used inappropriately without any valid indication, creating potentially avoidable and significant patient distress, discomfort, pain and activity restrictions, together with substantial care burden, cost and hospitalisation. In the Division of Orthopedic Surgery at Toronto Western Hospital (TWH), we identified UTI rate reduction as a quality improvement priority.