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1. Canadian Surgery Forum 2018: St. John’s, NL Sept. 13–15, 2018

Author

S, Jayaraman, L, Lee, J, Mata, R, Droeser, P, Kaneva, S, Liberman, P, Charlebois, B, Stein, G, Fried, L, Feldman, M, Schellenberg, K, Inaba, V, Cheng, J, Bardes, L, Lam, E, Benjamin, K, Matsushima, D, Demetriades, J, Cho, A, Strumwasser, D, Grabo, C, Bir, A, Eastman, N, Orozco, J, Chen, C, Park, T, Kang, J, Jung, J, Elfassy, T, Grantcharov, J, Taylor, M, Stem, D, Yu, S, Chen, S, Fang, S, Gearhart, B, Safar, J, Efron, P, Serrano, S, Parpia, D, McCarty, N, Solis, M, Valencia, S, Jibrael, A, Wei, S, Gallinger, M, Simunovic, A, Hummadi, M, Rabie, M, Al Skaini, H, Shamshad, S, Shah, K, Verhoeff, P, Glen, A, Taheri, B, Min, B, Tsang, V, Fawcett, S, Widder, M, Yang, K, Wanis, O, Gilani, K, Vogt, M, Ott, J, VanKoughnett, C, Vinden, S, Balvardi, E, St Louis, Y, Yousef, A, Toobaie, E, Guadagno, R, Baird, D, Poenaru, A, Kleiman, B, Mador, C, Moulton, E, Lee, C, Li, K, Beyfuss, H, Solomon, N, Sela, V, McAlister, A, Ritter, J, Hallet, M, Tsang, G, Martel, D, Jalink, M, Husien, C, Gu, M, Levine, S, Otiti, J, Nginyangi, C, Yeo, J, Ring, M, Holden, T, Ungi, G, Fichtinger, B, Zevin, B, Fang, J, Dang, S, Karmali, M, Kim, B, Zhang, E, Duceppe, S, Rieder, A, Maeda, A, Okrainec, T, Jackson, F, Kegel, S, Lachance, T, Landry, C, Mueller, S, Joharifard, E, Nyiemah, C, Howe, C, Dobboh, L Gizzie, Kortimai, A, Kabeto, J, Beste, N, Garraway, R, Riviello, S, Hameed, S, Shinde, G, Marcil, S, Prasad, J, Arminan, E, Debru, N, Church, R, Gill, P, Mitchell, M, Delisle, C, Chernos, J, Park, K, Hardy, A, Vergis, M, Guez, D, Hong, J, Koichopolos, R, Hilsden, D, Thompson, F, Myslik, J, Vandeline, R, Leeper, A, Doumouras, S, Govind, S, Valanci, N, Alhassan, T, Wong, N, Nadkarni, S, Chia, D, Seow, D, Carter, L, Ruo, O, Levine, L, Allen, P, Murphy, R, van Heest, F, Saleh, S, Minor, P, Engels, E, Joos, C, Wang, R, Nenshi, M, Meschino, C, Laane, N, Parry, M, Hameed, A, Lacoul, C, Chrystoja, J, Ramjist, R, Sutradhar, L, Lix, N, Baxter, D, Urbach, J, Ahlin, S, Patel, S, Nanji, S, Merchant, K, Lajkosz, S, Brogly, P, Groome, J, Sutherland, G, Liu, T, Crump, M, Bair, A, Karimuddin, A, Peterson, J, Hawel, E, Shlomovitz, I, Habaz, A, Elnahas, N, Alkhamesi, C, Schlachta, G, Akhtar-Danesh, T, Daodu, V, Nguyen, R, Dearden, I, Datta, L, Hampton, A, Kirkpatrick, J, McKee, J, Regehr, P, Brindley, D, Martin, A, LaPorta, L, Gillman, K, DeGirolamo, K, D'Souza, L, Hartford, D, Gray, C, Clarke, R, Wigen, C, Garcia-Ochoa, S, Gray, A, Maciver, J, Van Koughnett, K, Leslie, T, Zwiep, S, Ahn, J, Greenberg, F, Balaa, D, McIsaac, R, Musselman, I, Raiche, L, Williams, H, Moloo, M, Nguyen, D, Naidu, P, Karanicolas, A, Nadler, R, Raskin, V, Khokhotva, R, Poirier, C, Plourde, A, Paré, M, Marchand, M, Leclair, J, Deshaies, P, Hebbard, I, Ratnayake, K, Decker, E, MacIntosh, Z, Najarali, A, Alhusaini, A, McClure, M, Dakouo, R, Behman, A, Nathens, N Look, Hong, P, Pechlivanoglou, K, Lung, P, Simone, E, Schemitsch, L, Chen, L, Rosenkrantz, N, Schuurman, R, George, E, Shavit, A, Pawliwec, Z, Rana, D, Evans, P, Dawe, R, Brown, G, Lefebvre, K, Devenny, D, Héroux, C, Bowman, R, Mimeault, L, Calder, L, Baker, R, Winter, C, Cahill, D, Fergusson, T, Schroeder, K, Kahnamoui, S, Elkheir, F, Farrokhyar, B, Wainman, O, Hershorn, S, Lim, A, Arora, F, Wright, J, Escallon, L, Gotlib, M, Allen, N, Gawad, I, Raîche, G, Jeyakumar, D, Li, M, Aarts, A, Giles, T, Dumitra, R, Alam, J, Fiore, M, Vassiliou, O, Al Busaidi, A, Brobbey, T, Stelfox, T, Chowdhury, J, Kortbeek, C, Ball, N, AlShahwan, S, Fraser, A, Tran, A, Martel, N, Manhas, D, Mannina, A, Behman, B, Haas, A, Fowler, L, Findlay-Shirras, H, Singh, N, Biswanger, A, Gosselin-Tardif, M Abou, Khalil, J Mata, Gutierrez, A, Guigui, L, Ferri, D, Roberts, L, Moore, J, Holcomb, J, Harvin, J, Sadek, P, Belanger, K, Nadeau, K, Mullen, D, Aitkens, K, Foss, D, MacIsaac, S, Zhang, M, Methot, L, Hookey, J, Yates, I, Perelman, E, Saidenberg, S, Khair, J, Lampron, A, Tinmouth, S, Hammond, D, Hochman, M, Lê, R, Rabbani, A, Abou-Setta, R, Zarychanski, B, Elsoh, B, Goldacre, G, Nash, M, Trepanier, N, Wong-Chong, C, Sabapathy, P, Chaudhury, N, Bradley, C, Dakin, N, Holm, W, Henderson, M, Roche, A, Sawka, E, Tang, B, Huang, T, Gimon, R, Rochon, M, Lipson, W, Buie, A, MacLean, E, Lau, V, Mocanu, I, Tavakoli, N, Switzer, C, Tian, C, de Gara, D, Birch, P, Young, C, Chiu, A, Meneghetti, G, Warnock, M, Meloche, O, Panton, A, Istl, A, Gan, P, Colquhoun, R, Habashi, S, Stogryn, J, Metcalfe, K, Clouston, N, Zondervan, K, McLaughlin, J, Springer, J, Lee, N, Amin, M, Caddedu, C, Eskicioglu, A, Warraich, D, Keren, N, Kloos, S, Gregg, R, Mohamed, E, Dixon, R, Rochan, A, Domouras, S, Kelly, I, Yang, S, Forbes, R, Garfinkle, S, Bhatnagar, G, Ghitulescu, C, Vasilevsky, N, Morin, M, Boutros, A, Petrucci, P, Sylla, S, Wexner, G, Sigler, J, Faria, P, Gordon, L, Azoulay, A, Liberman, S, Khorasani, A, de Buck van Overstraeten, E, Kennedy, N, Pecorelli, D, Mouldoveanu, A, Gosselin-Tardiff, J, Chau, F Rouleau, Fournier, P, Bouchard, J Abou, Khalil, J, Motter, J, Mottl, G, Hwang, J, Kelly, G, Nassif, M, Albert, J, Monson, J, McLeod, J, Cha, M, Raval, T, Phang, C, Brown, R, Robertson, F, Letarte, A, Antoun, V, Pelsser, E, Hyun, K, Clouston-Chambers, R, Helewa, S, Candy, Z, Mir, N, Hanna, A, Azin, D, Hirpara, F, Quereshy, C, O'Brien, S, Chadi, S, Punnen, H, Yoon, W, Xiong, H, Stuart, J, Andrews, R, Selvam, S, Wong, W, Hopman, P, MacDonald, F, Dossa, B, Medeiros, C, Keng, S, Acuna, J, Hamid, A, Ghuman, N, Kasteel, D, Buie, T, McMullen, A, Elwi, T, MacLean, H, Wang, F, Coutinho, Q, Le, L, Shack, H, Roy, R, Kennedy, J, Bunn, W, Chung, M, Elmi, E, Wakeam, R, Presutti, S, Keshavjee, T, Cil, D, McCready, V, Cheung, C, Schieman, J, Bailey, G, Nelson, T, Batchelor, S, Grondin, A, Graham, N, Safieddine, S, Johnson, W, Hanna, D, Low, A, Seely, E, Bedard, C, Finley, R, Nayak, D, Lougheed, D, Petsikas, A, Kinio, V Ferreira, Resende, C, Anstee, D, Maziak, S, Gilbert, F, Shamji, S, Sundaresan, P, Villeneuve, J, Ojah, A, Ashrafi, A, Najjar, I, Yamani, S, Sersar, A, Batouk, D, Parente, A, Laliberte, M, McInnis, C, McDonald, Y, Hasnain, K, Yasufuku, T, Waddell, N, Chopra, C, Nicholson-Smith, R, Malthaner, R, Patel, M, Doubova, H, Robaidi, E, Delic, A, Fazekas, K, Hughes, P, Pinkney, Y, Lopez-Hernandez, M, Coret, L, Schneider, J, Agzarian, Y, Shargall, M, Mehta, K, Pearce, V, Gupta, N, Coburn, B, Kidane, K, Hess, C, Compton, J, Ringash, G, Darling, A, Mahar, P, Thomas, J, Vernon, J, Spicer, S, Renaud, J, Seitlinger, Y, Al Lawati, F, Guerrera, P, Falcoz, G, Massard, D, Hylton, J, Huang, S, Turner, D, French, C, Wen, J, Masters, C, Fahim, D, St-Pierre, E, Ruffini, M, Inra, Z, Abdelsattar, S, Cassivi, F, Nichols, D, Wigle, S, Blackmon, K, Shen, S, Gowing, F Sadegh, Beigee, K, Sheikhy, A Abbasi, Dezfouli, T, Schnurr, L, Linkins, M, Crowther, M, de Perrot, S, Uddin, J, Douketis, L, Angka, A, Jeong, M, Sadiq, M, Kilgour, C Tanese, de Souza, M, Kennedy, R, Auer, R, Adam, R, Memeo, D, Goéré, T, Piardi, E, Lermite, O, Turrini, M, Lemke, J, Li, M, Tun-Abraham, R, Hernandez-Alejandro, S, Bennett, F, Navarro, A, Sa Cunha, P, Pessaux, E, Isenberg-Grzeda, J, Kazdan, S, Myrehaug, S, Singh, D, Chan, C, Law, C, Nessim, G, Paull, A, Ibrahim, E, Sabri, S, Rodriguez-Qizilbash, D, Berger-Richardson, R, Younan, J, Hétu, S, Johnson-Obaseki, F, Angarita, Y, Zhang, A, Govindarajan, E, Taylor, Z, Bayat, D, Bischof, A, McCart, S, Sequeira, S, Samman, S, Cornacchi, G, Foster, L, Thabane, S, Thomson, O, Lovrics, S, Martin, P, Lovrics, N, Latchana, L, Davis, Y, Liu, A, Hammad, D, Kagedan, C, Earle, G, Pang, S, Kupper, M, Quan, R, Hsiao, P, Bongers, M, Lustgarten, D, Goldstein, P, Dhar, L, Rotstein, J, Pasternak, J, Nostedt, L, Gibson-Brokop, M, McCall, D, Schiller, S, Mukhi, L, Mack, N, Singh, M, Chanco, A, Hilchie-Pye, C, Kenyon, A, Mathieson, J, Burke, R, Nason, J, Austin, M, Brar, S, Hurton, S, Kong, Y, Xu, M, Thibedeau, W, Cheung, J, Dort, S, Karim, A, Bouchard-Fortier, Y, Jeong, Q, Li, L, Bubis, C, O'Rourke, N, Dharampal, K, Smith, A, Harvey, R, Pashcke, L, Rudmik, S, Chandarana, S, Buac, S, Latosinsky, N, Shahvary, M, Gervais, G, Leblanc, M, Brackstone, K, Guidolin, B, Yaremko, S, Gaede, K, Lynn, A, Kornecki, G, Muscedere, O, Shmuilovich, I, BenNachum, M, Mouawad, N, Gelman, M, Lock, J, Daza, M, Horkoff, F, Sutherland, O, Bathe, M, Moser, J, Shaw, G, Beck, Y, Luo, S, Ahmed, C, Wall, T, Domes, K, Jana, E, Waugh, J, Baird, P, Newell, P, Hansen, M, Gough, E, McArthur, A, Skaro, G, Gauvin, N, Goel, D, Mutabdzic, F, Lambreton, M, Kilcoyne, K, Ang, A, Karachristos, H, Cooper, J, Hoffman, S, Reddy, L, Park, R, Gilbert, R, Shorr, A, Workneh, K, Bertens, J, Abou-Khalil, H, Smith, J, Levy, J, Ellis, B, Bakanisi, M, Sadeghi, S, Michaelson, V, Tandan, M, Marcaccio, D, Dath, M, Connell, A, Bennett, N, Wasey, R, Sorial, S, Macdonald, D, Johnson, D, Klassen, C, Leung, C, Botkin, M, Bahasadri, S, MacLellan, J, Tan, H, Jun, H, Cheah, K, Wong, N, Harvey, A, Smith, S, Cassie, S, Sun, J, Vallis, L, Twells, K, Lester, D, Gregory, W, Sun, F, Raghavji, M, Laffin, J, Bourget-Murray, A, Reso, A, Jarrar, N, Eipe, A, Budiansky, C, Walsh, J, Mamazza, and M, Rashid

Subjects
Abstracts
Published
2018

2. Intraoral Neuromuscular Stimulation Device and Rapid Eye Movement-Dependent Obstructive Sleep Apnea.

Author

Wasey W, Manahil N, Wasey N, Saleh S, and Mohammed A

Abstract

Obstructive sleep apnea (OSA) is a sleep breathing disorder characterized by recurrent pharyngeal collapse secondary to the decreased tone of the pharyngeal dilator muscles. The genioglossus muscle is a major pharyngeal dilator responsible for maintaining the upper airway. Research has shown that patients with OSA have a stronger but less endurant genioglossus muscle. Research has also demonstrated that neuromuscular electrical stimulation of the skeletal muscles in the genioglossus was associated with improvement in muscular endurance and hence improvement in mild OSA. This has led to the development of a novel intraoral neuromuscular stimulation device for treating snoring and mild OSA. It is known that OSA is worse in rapid eye movement (REM) sleep compared to other stages of sleep due to neurologically mediated impairment of skeletal muscles. What has not been demonstrated so far is if the intraoral neuromuscular stimulation device improves the apnea-hypopnea index (AHI) in REM sleep. Our case report highlights the significant improvement of REM-dependent OSA in a middle-aged female with consistent use of an intraoral neuromuscular stimulation device marketed as eXciteOSA® (Signifier Medical Technologies, Needham, MA)., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Wasey et al.)

Published
2022
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3. Anterior Cervical Discectomy and Fusion: A Hidden Etiology of Obstructive Sleep Apnea.

Author

Wasey W, Saleh S, Manahil N, Mohammed A, and Wasey N

Abstract

Obstructive Sleep Apnea (OSA), a common variant of sleep-disordered breathing, is characterized by repeated complete or partial collapse of upper airways during sleep, leading to oxyhemoglobin desaturations. The obstruction may be iatrogenically induced in patients undergoing Anterior Cervical Discectomy and Fusion (ACDF). Damage to the pharyngeal plexus during the procedure may predispose to a new collapse of the upper airway, and the placement of the hardware for the fusion may lead to further narrowing of the upper airway. Literature does not exist associating this possible etiology prospectively. The association of ACDF and OSA has only been retrospectively documented by Guiilleminault and associates. We are reporting a case of a 49-year-old female who was evaluated pre and post surgery and established the evidence of worsening OSA in a patient who underwent ACDF., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Wasey et al.)

Published
2022
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4. Hidden Dangers of Severe Obstructive Sleep Apnea.

Author

Wasey W, Wasey N, Manahil N, Saleh S, and Mohammed A

Abstract

Obstructive sleep apnea (OSA) is a breathing disorder secondary to collapsing upper airways while sleeping. The collapse leads to a significant decrease or a complete cessation of airflow despite an ongoing effort to breathe. OSA leads to poor sleep quantity and quality, which, in turn, causes temporary cognitive impairments. Systematic manifestations of OSA can be seen as hypertension, arrhythmias, heart failure, obesity, and worsening of existing pulmonary or cardiac conditions. Severe untreated OSA also leads to significant sleep deprivation, which may eventually lead to sleep attacks. We present a case of a sleep attack leading to a motor vehicle accident that was presumptively diagnosed as syncope. During hospitalization, workup revealed that the patient had very severe OSA. He was treated with a continuous positive airway pressure device, which improved his daytime sleepiness with no new episodes of sleep attacks., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Wasey et al.)

Published
2022
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5. Tramadol Induced Jerks.

Author

Wasey W, Aziz I, Saleh S, Manahil N, and Wasey N

Abstract

Myoclonus is a sudden, involuntary jerking of a muscle or a group of muscles. Myoclonus may present in form of a pattern or, sporadically and infrequently. It is usually associated with neurological disorders such as epilepsy, multiple sclerosis or infections, and tumors of the central nervous system. Myoclonus is not commonly known to be caused by tramadol. We present a case of a 59-year-old male who developed myoclonus in the muscles of his trunk, 10 days after initiating tramadol for chronic pain. The myoclonus disappeared after withholding the medication. The purpose of this case report is to make clinicians aware of a rare reversible side effect from the use of tramadol., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Wasey et al.)

Published
2021
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6. The Many Fronts of Battling Obstructive Sleep Apnea.

Author

Wasey W, Wasey N, Saleh S, and Aziz I

Abstract

Obstructive sleep apnea (OSA) is a breathing disorder during sleep secondary to collapsing upper airways that leads to a significant decrease or a complete cessation of airflow despite an effort to breathe. As the name suggests, an obstruction, likely caused by an inherited narrow airway, is the most common cause. But there are less known factors that may contribute to the worsening of OSA. We present a case of very severe OSA contributed by weight gain, opioid use, and anterior cervical discectomy and fusion (ACDF), in addition to a genetically narrow airway. This case highlights the importance of battling OSA on many different fronts. Our patient eventually was able to stop positive airway pressure (PAP) therapy, once the contributing factors were addressed appropriately., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Wasey et al.)

Published
2021
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7. Canadian Surgery Forum 2018: St. John's, NL Sept. 13-15, 2018.

Author

Jayaraman S, Lee L, Mata J, Droeser R, Kaneva P, Liberman S, Charlebois P, Stein B, Fried G, Feldman L, Schellenberg M, Inaba K, Cheng V, Bardes J, Lam L, Benjamin E, Matsushima K, Demetriades D, Schellenberg M, Inaba K, Cho J, Strumwasser A, Grabo D, Bir C, Eastman A, Demetriades D, Schellenberg M, Inaba K, Bardes J, Orozco N, Chen J, Park C, Kang T, Demetriades D, Jung J, Elfassy J, Grantcharov T, Jung J, Grantcharov T, Jung J, Grantcharov T, Taylor J, Stem M, Yu D, Chen S, Fang S, Gearhart S, Safar B, Efron J, Serrano P, Parpia S, McCarty D, Solis N, Valencia M, Jibrael S, Wei A, Gallinger S, Simunovic M, Hummadi A, Rabie M, Al Skaini M, Shamshad H, Shah S, Verhoeff K, Glen P, Taheri A, Min B, Tsang B, Fawcett V, Widder S, Yang M, Wanis K, Gilani O, Vogt K, Ott M, VanKoughnett J, Vinden C, Balvardi S, St Louis E, Yousef Y, Toobaie A, Guadagno E, Baird R, Poenaru D, Kleiman A, Mador B, Widder S, Serrano P, Moulton C, Lee E, Li C, Beyfuss K, Solomon H, Sela N, McAlister V, Ritter A, Gallinger S, Hallet J, Tsang M, Martel G, Jalink D, Husien M, Gu C, Levine M, Otiti S, Nginyangi J, Yeo C, Ring J, Holden M, Ungi T, Fichtinger G, Zevin B, Fang B, Dang J, Karmali S, Serrano P, Kim M, Zhang B, Duceppe E, Rieder S, Maeda A, Okrainec A, Jackson T, Kegel F, Lachance S, Landry T, Feldman L, Fried G, Mueller C, Lee L, Kegel F, Kegel F, Lachance S, Lee L, Joharifard S, Nyiemah E, Howe C, Dobboh C, Kortimai LG, Kabeto A, Beste J, Garraway N, Riviello R, Hameed S, Shinde S, Marcil G, Prasad S, Arminan J, Debru E, Church N, Gill R, Mitchell P, Delisle M, Chernos C, Park J, Hardy K, Vergis A, Guez M, Hong D, Guez M, Hong D, Koichopolos J, Hilsden R, Thompson D, Myslik F, Vandeline J, Leeper R, Doumouras A, Govind S, Hong D, Govind S, Valanci S, Alhassan N, Lee L, Feldman L, Fried G, Mueller C, Wong T, Nadkarni N, Chia S, Seow D, Carter D, Li C, Valencia M, Ruo L, Parpia S, Simunovic M, Levine O, Serrano P, Vogt K, Allen L, Murphy P, van Heest R, Saleh F, Widder S, Minor S, Engels P, Joos E, Wang C, Nenshi R, Meschino M, Laane C, Parry N, Hameed M, Lacoul A, Lee L, Chrystoja C, Ramjist J, Sutradhar R, Lix L, Simunovic M, Baxter N, Urbach D, Ahlin J, Patel S, Nanji S, Merchant S, Lajkosz K, Brogly S, Groome P, Sutherland J, Liu G, Crump T, Bair M, Karimuddin A, Sutherland J, Peterson A, Karimuddin A, Liu G, Crump T, Koichopolos J, Hawel J, Shlomovitz E, Habaz I, Elnahas A, Alkhamesi N, Schlachta C, Akhtar-Danesh G, Doumouras A, Hong D, Daodu T, Nguyen V, Dearden R, Datta I, Hampton L, Kirkpatrick A, McKee J, Regehr J, Brindley P, Martin D, LaPorta A, Park J, Vergis A, Gillman L, DeGirolamo K, Hameed M, D'Souza K, Hartford L, Gray D, Murphy P, Hilsden R, Clarke C, Vogt K, Wigen R, Allen L, Garcia-Ochoa C, Gray S, Maciver A, Parry N, Van Koughnett J, Leslie K, Zwiep T, Ahn S, Greenberg J, Balaa F, McIsaac D, Musselman R, Raiche I, Williams L, Moloo H, Nguyen M, Naidu D, Karanicolas P, Nadler A, Raskin R, Khokhotva V, Poirier R, Plourde C, Paré A, Marchand M, Leclair M, Deshaies J, Hebbard P, Ratnayake I, Decker K, MacIntosh E, Najarali Z, Valencia M, Zhang B, Alhusaini A, Solis N, Duceppe E, Parpia S, Ruo L, Simunovic M, Serrano P, Murphy P, Murphy P, McClure A, Dakouo M, Vogt K, Vinden C, Behman R, Nathens A, Hong NL, Pechlivanoglou P, Karanicolas P, Lung K, Leslie K, Parry N, Vogt K, Leeper R, Simone P, Leslie K, Schemitsch E, Laane C, Chen L, Rosenkrantz L, Schuurman N, Hameed M, Joos E, George R, Shavit E, Pawliwec A, Rana Z, Laane C, Joos E, Evans D, Dawe P, Brown R, Hameed M, Lefebvre G, Devenny K, Héroux D, Bowman C, Mimeault R, Calder L, Baker L, Winter R, Cahill C, Fergusson D, Williams L, Schroeder T, Kahnamoui K, Elkheir S, Farrokhyar F, Wainman B, Hershorn O, Lim S, Hardy K, Vergis A, Arora A, Wright F, Nadler A, Escallon J, Gotlib L, Allen M, Gawad N, Raîche I, Jeyakumar G, Li D, Aarts M, Meschino M, Giles A, Dumitra T, Alam R, Fiore J, Mata J, Fried G, Vassiliou M, Mueller C, Lee L, Feldman L, Al Busaidi O, Brobbey A, Stelfox T, Chowdhury T, Kortbeek J, Ball C, AlShahwan N, Fraser S, Gawad N, Tran A, Martel A, Baxter N, Allen M, Manhas N, Balaa F, Mannina D, Khokhotva V, Tran A, Gawad N, Martel A, Manhas N, Allen M, Balaa F, Behman R, Behman A, Haas B, Hong NL, Pechlivanoglou P, Karanicolas P, Gawad N, Fowler A, Mimeault R, Raiche I, Findlay-Shirras L, Decker K, Singh H, Biswanger N, Park J, Gosselin-Tardif A, Khalil MA, Gutierrez JM, Guigui A, Feldman L, Lee L, Mueller C, Ferri L, Roberts D, Stelfox T, Moore L, Holcomb J, Harvin J, Sadek J, Belanger P, Nadeau K, Mullen K, Aitkens D, Foss K, MacIsaac D, Williams L, Musselman R, Raiche I, Moloo H, Zhang S, Ring J, Methot M, Zevin B, Yu D, Hookey L, Patel S, Yates J, Perelman I, Saidenberg E, Khair S, Taylor J, Lampron J, Tinmouth A, Lim S, Hammond S, Park J, Hochman D, Lê M, Rabbani R, Abou-Setta A, Zarychanski R, Patel S, Yu D, Elsoh B, Goldacre B, Nash G, Trepanier M, Alhassan N, Wong-Chong N, Sabapathy C, Chaudhury P, Liberman S, Charlebois P, Stein B, 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Published
2018
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8. Prophylaxis in elective colorectal surgery: the cost of ignoring the evidence.

Author

Wasey N, Baughan J, and de Gara CJ

Subjects
Adult, Aged, Aged, 80 and over, Alberta, Anticoagulants therapeutic use, Colectomy, Colonic Diseases economics, Colonic Diseases surgery, Cost of Illness, Digestive System Surgical Procedures standards, Drainage, Elective Surgical Procedures economics, Female, Heparin therapeutic use, Humans, Male, Middle Aged, Postoperative Complications economics, Rectal Diseases economics, Rectal Diseases surgery, Antibiotic Prophylaxis economics, Digestive System Surgical Procedures economics, Postoperative Complications prevention & control, Practice Patterns, Physicians' economics
Abstract

Introduction: Three strategies are used to prevent complications in colorectal surgery: heparin and antibiotics given perioperatively and abdominal drains placed intraoperatively. To investigate the appropriate and inappropriate use of these prophylactic techniques and to assess the costs associated with their inappropriate use, we studied patients who underwent elective colorectal procedures., Methods: We reviewed the charts of 103 patients operated on between April and December 1999 at a 519-bed tertiary care, teaching hospital in Edmonton, Alta. The procedures carried out were elective sigmoid resection, low anterior resection, left hemicolectomy, right hemicolectomy and total or subtotal colectomy for benign or malignant conditions. The data collected included patient age and sex, diagnosis, the operating surgeon, and the housestaff or surgeon writing the pre- and postoperative orders. Patients who required emergency colorectal surgery were excluded from the study. Antibiotic, heparin and drain prophylaxis was assessed and considered appropriate if prescribed according to the evidence or inappropriate if prescribed when not recommended., Results: Thirty-six of 98 patients had inappropriate heparin prophylaxis (5 of the 103 were excluded because they were already receiving heparin). Only 5 of 96 patients were treated appropriately with antibiotics preoperatively without postoperative doses (7 of the 103 were excluded due to intraoperative spillage with fecal contamination or an intra-abdominal abscess found intraoperatively); 95% of patients were inappropriately treated with antibiotics postoperatively. Half of all the patients had a drain inserted inappropriately for prophylaxis. On average, drains inserted inappropriately cost 30.40 dollars per patient, inappropriate antibiotic use cost 62.42 dollars per patient and inappropriate heparin use cost 89.30 dollars per patient. Preoperative orders were usually written by the staff surgeon, whereas postoperative orders were usually written by the resident or intern., Conclusions: We observed considerable inappropriate use of heparin, antibiotic and drain prophylaxis. Considering the number of elective colorectal procedures performed annually, these inappropriately used strategies represent a substantial cost to the health care system. Improved education of surgeons and residents is needed to change to evidence-based practice habits.

Published
2003

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