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Not long ago, driving along the side roads in my neighborhood, I saw what I thought was a traffic pylon on the street ahead. Drawing closer, I realized it was [...], Is the hero role the best self-image for surgeons in the modern world? As Donald Berwick, founder of the Institute for Healthcare Improvement, has pointed out, health care is an exercise in interdependency, not personal heroism. In my president's address to the Canadian Association of General Surgeons, I examine the role of the surgeon as hero and citizen.

Background: Little is known about the association between the COVID-19 pandemic and early survival among newly diagnosed cancer patients. Methods: This retrospective population-based cohort study used linked administrative datasets from Ontario, Canada. Adults (=18 years) who received a cancer diagnosis between March 15 and December 31, 2020, were included in a pandemic cohort, while those diagnosed during the same dates in 2018/2019 were included in a pre-pandemic cohort. All patients were followed for one full year after the date of diagnosis. Cox proportional hazards regression models were used to assess survival in relation to the pandemic, patient characteristics at diagnosis, and the modality of first cancer treatment as a time-varying covariate. Interaction terms were explored to measure the pandemic association with survival for each cancer type. Results: Among 179,746 patients, 53,387 (29.7%) were in the pandemic cohort and 37,741 (21.0%) died over the first post-diagnosis year. No association between the pandemic and survival was found when adjusting for patient characteristics at diagnosis (HR 0.99 [95% CI 0.96-1.01]), while marginally better survival was found for the pandemic cohort when the modality of treatment was additionally considered (HR 0.97 [95% CI 0.95-0.99]). When examining each cancer type, only a new melanoma diagnosis was associated with a worse survival in the pandemic cohort (HR 1.25 [95% CI 1.05-1.49]). Conclusions: Among patients able to receive a cancer diagnosis during the pandemic, one-year overall survival was not different than those diagnosed in the previous 2 years. This study highlights the complex nature of the COVID-19 pandemic impact on cancer care. [ABSTRACT FROM AUTHOR]

Objectives: To assess the association between surgeons thyroidectomy case volume and disease‐free survival (DFS) for patients with well‐differentiated thyroid cancer (WDTC). A secondary objective was to assess a surgeon volume cutoff to optimize outcomes in those with WDTC. We hypothesized that surgeon volume will be an important predictor of DFS in patients with WDTC after adjusting for hospital volume and sociodemographic and clinical factors. Methods: In this retrospective population‐based cohort study, we identified WDTC patients in Ontario, Canada, who underwent thyroidectomy confirmed by both hospital‐level and surgeon‐level administrative data between 1993 and 2017 (N = 37,233). Surgeon and hospital volumes were calculated based on number of cases performed in the year prior by the physician and at an institution performing each case, respectively and divided into quartiles. A multilevel hierarchical Cox regression model was used to estimate the effect of volume on DFS. Results: A crude model without patient or treatment characteristics demonstrated that both higher surgeon volume quartiles (p < 0.001) and higher hospital volume quartiles (p < 0.001) were associated with DFS. After controlling for clustering and patient/treatment covariates and hospital volume, moderately low (18–39/year) and low (0–17/year) volume surgeons (hazard ratios [HR]: 1.23, 95% confidence interval [CI]: 1.09–1.39 and HR: 1.34, 95% CI: 1.17–1.53 respectively) remained an independent statistically significant negative predictor of DFS. Conclusion: Both high‐volume surgeons and hospitals are predictors of better DFS in patients with WDTC. DFS is higher among surgeons performing more than 40 thyroidectomies a year. Level of Evidence: 3 Laryngoscope, 133:S1–S15, 2023 [ABSTRACT FROM AUTHOR]

Quality improvement is an important component of health care systems. Quality in health care can be evaluated in terms of the structures, processes and outcomes of care. (1) Process and/or [...], Background: Quality in health care can be evaluated using quality indicators (QIs). Elements contained in the surgical operative report are potential sources for QI data, but little is known about the completeness of the narrative operative report (NR). We evaluated the completeness of the NR for patients undergoing a pancreaticoduodenectomy. Methods: We reviewed NRs for patients undergoing a pancreaticoduodenectomy over a 1-year period. We extracted 79 variables related to patient and narrator characteristics, process of care measures, surgical technique and oncology-related outcomes by document analysis. Data were coded and evaluated for completeness. Results: We analyzed 74 NRs. The median number of variables reported was 43.5 (range 13-54). Variables related to surgical technique were most complete. Process of care and oncology-related variables were often omitted. Completeness of the NR was associated with longer operative duration. Conclusion: The NRs were often incomplete and of poor quality. Important elements, including process of care and oncology-related data, were frequently missing. Thus, the NR is an inadequate data source for QI. Development and use of alternative reporting methods, including standardized synoptic operative reports, should be encouraged to improve documentation of care and serve as a measure of quality of surgical care. Contexte : Il est possible d'evaluer la qualite des soins de sante au moyen d'indicateurs de qualite (IQ). Les elements contenus dans les notes operatoires (NO) sont une source potentielle de renseignements pouvant servir d'IQ, mais on en sait peu sur leur exhaustivite. Nous avons voulu evaluer l'exhaustivite des NO dans les dossiers de patients soumis a une pancreatoduodenectomie. Methodes : Nous avons passe en revue les NO dans les dossiers de patients soumis a une pancreatoduodenectomie sur une periode d'un an. Par analyse des documents, nous avons extrait 79 variables liees aux caracteristiques des patients et aux redacteurs des NO, aux mesures des protocoles operatoires, a la technique chirurgicale et aux resultats oncologiques. Nous avons encode et evalue ces donnees en fonction de leur exhaustivite. Resultats : Nous avons analyse les NO pour 74 interventions. Le nombre median de variables relevees etait de 43,5 (entre 13 et 54). Les variables liees au protocole de soins et les variables oncologiques etaient souvent omises. L'exhaustivite des NO etait proportionnelle a la duree de l'intervention. Conclusion : Les NO sont souvent incompletes et leur qualite laisse a desirer. Des elements importants, dont le protocole operatoire et les donnees oncologiques, etaient souvent manquants. Ainsi, les NO constituent une source inadequate de donnees en ce qui concerne les IQ. Il faudra encourager la mise au point et l'utilisation d'autres types de rapports, dont des synopsis operatoires standardises, pour mieux documenter les soins chirurgicaux prodigues et pour en evaluer la qualite.

Operating rooms (ORs) are a hospital's largest cost centre and greatest source of revenue. (1) Consequently, there is substantial incentive to recognize greater efficiencies within OR management. (2) Operating room [...], Background: In Canadian hospitals, which are typically financed by global annual budgets, overuse of operating rooms is a financial risk that is frequently managed by cancelling elective surgical procedures. It is uncertain how different scheduling rules affect the rate of elective surgery cancellations. Methods: We used discrete event simulation modelling to represent perioperative processes at a hospital in Toronto, Canada. We tested the effects of the following 3 scenarios on the number of surgical cancellations: scheduling surgeons' operating days based on their patients' average length of stay in hospital, sequencing surgical procedures by average duration and variance, and increasing the number of postsurgical ward beds. Results: The number of elective cancellations was reduced by scheduling surgeons whose patients had shorter average lengths of stay in hospital earlier in the week, sequencing shorter surgeries and those with less variance in duration earlier in the day, and by adding up to 2 additional beds to the postsurgical ward. Conclusion: Discrete event simulation modelling can be used to develop strategies for improving efficiency in operating rooms. Contexte : Dans les hopitaux canadiens, qui sont generalement finances par des budgets annuels globaux, la surutilisation des blocs operatoires comporte un risque financier qui est souvent gere par l'annulation des interventions chirurgicales non urgentes. On ignore comment les differentes regles de preparation des calendriers affectent le taux d'annulation des chirurgies non urgentes. Methodes : Nous avons utilise un modele de simulation d'evenements discrets pour representer les marches a suivre perioperatoires dans un hopital de Toronto, au Canada. Nous avons verifie les effets des 3 scenarios suivants sur le nombre de chirurgies annulees : preparation du calendrier des chirurgiens selon la duree moyenne de l'hospitalisation de leurs patients, enchainement des interventions chirurgicales selon leur duree moyenne et la variabilite de leur duree et augmentation du nombre de lits dans les unites postoperatoires. Resultats : Le nombre de chirurgies non urgentes annulees a diminue lorsqu'on a planifie les interventions des chirurgiens dont les patients sejournaient moins longtemps a l'hopital plus tot au cours de la semaine, lorsqu'on a programme les chirurgies plus breves et les chirurgies a duree moins variable plus tot au cours de la journee et lorsqu'on a ajoute 2 lits supplementaires a l'unite postoperatoire. Conclusion : Les modeles de simulation d'evenements discrets peuvent servir a developper des strategies pour ameliorer l'efficience des blocs operatoires.

The term 'evidence-based medicine' was first coined by Sackett and colleagues as 'the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual [...], Objective: To determine whether an association existed between the Veterans Health Administration (VHA) medical team training and surgical outcomes. Study design: Retrospective cohort study. Setting: 108 VHA hospitals (74 with and 34 without team training). Intervention: Medical team training consisted of a 1-day session with nurses, surgeons and anesthesiologists in attendance, followed by 4 quarterly structured telephone interviews. Data sources: VHA Surgical Quality Improvement Program (VASQIP), which included 182 409 patients between 2006 and 2008. Main outcome measure: Postoperative mortality. Results: The 74 facilities in the training program experienced an 18% reduction in annual mortality (rate ratio [RR] 0.82, 95% confidence interval [CI] 0.760.91, p = 0.01) compared with a 7% decrease among the 34 facilities that had not yet undergone training (RR 0.93, 95% CI 0.80-1.06, p = 0.59). Risk-adjusted mortality at baseline was 17 per 1000 procedures per year for the trained and 15 per 1000 per year for the nontrained facilities. At the end of the study, the rates were 14 per 1000 per year for both groups. Propensity matching of the trained and nontrained groups demonstrated that the decline in risk-adjusted surgical mortality was about 50% greater in the trained (RR 1.49, 95% CI 1.10-2.07, p = 0.01) than in the nontrained group. A dose-response relationship for additional quarters of the training program was also demonstrated: for every quarter of the training program a reduction of 0.5 deaths per 1000 procedures occurred (95% CI 0.2-1.0, p = 0.001). Conclusion: Participation in the VHA Medical Team Training program was associated with lower surgical mortality.