Does sex affect residency application to surgery?

Objective

To determine whether women are proportionately underselected at the level of the annual residency match.

Methods

Data were obtained from the Royal College of Physicians and Surgeons of Canada and the Canadian Residency Matching Service. The odds of men being rejected from their top choice of surgical discipline were compared with the corresponding odds for women for the surgical specialties of general surgery, orthopedic surgery, neurosurgery, otolaryngology, urology, cardiac surgery and plastic surgery.

Results

Women continue to be underrepresented among surgery residents and surgeons in practice; however, the number of women has increased. Neither sex was overselected among the surgical specialties examined.

Conclusions

There was no evidence of overselection of either sex at the level of the annual resident selection committee.     

Canadian human resource needs in vascular surgery

Objective

To outline the distribution of vascular surgeons in Canada and to determine the present and future human resource needs in vascular surgery practice in Canada.

Design

Voluntary questionnaires sent to all members of the Canadian Society for Vascular Surgery (CSVS), the administrators of hospitals in Canada with more than 100 beds, and interrogation of the membership database of the CSVS.

Main outcome measures

The perceived present and future needs for fulltime and part-time vascular surgeons, determined by a variety of methods.

Participants

One hundred and forty active members of the CSVS and administrators of 120 hospitals.

Main results

From the CSVS members 62 responses were received from those residing in Canada, revealing 47 fulltime vascular (more than 75% of the practice) surgeons working with 0 to 5 colleagues (mean 1.8 [SD 1.3]). Fifteen responding surgeons combined the practice of vascular surgery with another specialty. Perceived immediate needs were 24 surgeons, with 42 required in 4.8 (1.8) years. Of 120 hospitals offering vascular surgery services, 90 stated that they met the needs of their community; however, additional immediate manpower requirements totalled 27 surgeons. Hospital administrators predicted a need of 55 additional vascular surgeons in a mean of 5.5 (4.6) years. Over 85% of hospitals stated that they had the resources to support the currently practising surgeons and their immediately required additions.

Conclusions

Prediction of the need for additional vascular surgeons should be based on an estimated retirement age of 65 years, with an adjustment for the increasing percentage of the Canadian population reaching the age of 60 years. All methodologies used in this study predict the need for additional human resources in vascular surgery. The need for continued training of new vascular surgeons is apparent, but the optimal number of trainees per year is less clear.     

Reconstructive or cosmetic plastic surgery? Factors influencing the type of practice established by Canadian plastic surgeons

BACKGROUND:

Some argue that the specialty of plastic surgery is facing a changing identity. Challenged by factors such as increasing competition in the cosmetic marketplace and decreasing reimbursement for reconstructive procedures, many American plastic surgeons have increasingly adopted cosmetic-focused practices. The present study investigated the currently unknown practice profiles of Canadian plastic surgeons to determine the reconstructive-cosmetic mix, as well as factors that influence practice type to determine whether a similar pattern exists in Canada.

METHODS:

An anonymous online survey regarding practice profiles was distributed to all 352 Canadian plastic surgeons with e-mail accounts registered with the Canadian Society of Plastic Surgeons and/or the Canadian Society for Aesthetic Plastic Surgery.

RESULTS:

The survey response rate was 34% (120 responses), of which 75% of respondents currently had a reconstructive practice and 25% had a cosmetic practice. Reconstructive surgeons had more educational debt following their training, spent more time on emergency call, academics and teaching and, when deciding which type of practice to establish, were more influenced by academic opportunities and less influenced by financial and nonfinancial metrics. Similarities between the groups included hours worked per week and academic achievements.

CONCLUSIONS:

The field of reconstructive plastic surgery appears to be thriving in Canada. While a transition from reconstructive to cosmetic practice is common, compared with their American colleagues, a greater proportion of Canadian plastic surgeons maintain reconstructive practices. Differences between reconstructive and cosmetic plastic surgeons are discussed.     

Origins of the Canadian school of surgery

Background

Since its inception 50 years ago, the Canadian Journal of Surgery has published articles under the banner “History of Canadian Surgery.” Because no comprehensive history of surgery in this country has yet been written, these articles may provide its basis.

Method

The Canadian Journal of Surgery was searched from October 1957 to August 2007 for articles on the practice of surgery in Canada before 1957. Articles regarding the development of surgery in provinces, universities, hospitals and surgical specialty societies were included, as well as biographies and obituaries of surgeons.

Results

Thirty-six articles dealing with the lives of 57 Canadian surgeons were located. Three periods of Canadian surgery were covered: the French regime (1535–1759), the transition period (1759–1870) and the early modern period (1870–1945). The review shows that persistent efforts were made in Canada to develop surgical education and to regulate the practice of surgery. Isolation forced a spirit of adaptability that led to innovation and progress.

Conclusion

The practice of surgery in Canada today can be traced back to contributions made by pioneering surgeons over the entire history of modern Canada. An archive of materials related to the history of surgery in Canada is being created at www.historyofsurgery.ca to facilitate further research.     

Factors influencing prioritization for carpal tunnel syndrome consultation

BACKGROUND:

In a socialized medicine model, prioritization of referrals for specialist consultation is highly important in the distribution of heath care. For high-burden diseases, such as carpal tunnel syndrome (CTS), the factors that influence prioritization are not well understood.

OBJECTIVE:

To determine the factors that influence the prioritization of referrals for CTS consultation by plastic surgeons in Canada.

METHODS:

All members of the Canadian Society of Plastic Surgery with e-mail addresses were invited to participate in an online survey regarding the method by which they prioritize referrals for CTS.

RESULTS:

Forty per cent of invited members completed the survey (150 surgeons). Of these, 118 (79%) stated that they performed CTS surgery. The majority of respondents who performed CTS surgery prioritized their consultation list chronologically (77%). Factors that would alter the chronological order or prioritization included subsequent contact by the referring physician (24%); personal relationship with the patient (16%); and specific information in the referral letter (15%), which usually involved symptom severity or electromyography findings. Sixty-six per cent of plastic surgeons stated that there was no conscious decision on how they came to choose the method of prioritization they used for referrals regarding CTS.

DISCUSSION:

The majority of plastic surgeons in Canada prioritize referrals for consultation on CTS chronologically. A minority of respondents reported reassigning priority based on clinical severity. The rationale for the methods by which Canadian Society of Plastic Surgery members prioritize these referrals is poorly understood. Further study on developing evidence-based prioritization methods may be useful in assisting surgeons and their patients in outcome-based decisions.     

Practice profiles in breast reduction: A survey among Canadian plastic surgeons

BACKGROUND:

Breast reduction is an increasingly common procedure performed by Canadian plastic surgeons. Recent studies in the United States show that use of the inferior/central pedicle inverted T scar method is predominant. However, it is unknown what the practice preferences are among Canadian plastic surgeons.

OBJECTIVE:

The goal of the present study was to assess trends in breast reduction surgery among Canadian surgeons, including patient selection criteria, surgical techniques and outcomes.

METHOD:

Surveys were distributed to plastic surgeons at the Canadian Society for Plastic Surgery meetings in 2005 and 2006. Completed surveys were obtained from 140 respondents, and results were analyzed with Excel and SAS software.

RESULTS:

There was a 40% response rate. The majority of surgeons (66%) used more than one technique for breast reduction. Most commonly, surgeons use the inverted T scar technique (66%) followed by vertical scar techniques (26%). The most popular vertical scar techniques included the Hall-Findlay (14%) and Lejour (13%) methods. Most surgeons (55%) reported complication rates of less than 5% and the most common complication reported was wound dehiscence. There was no difference in overall complication rates between inverted T scar and vertical scar surgeries. The majority of surgeons (98%) carried out breast reduction either exclusively as day surgery or in combination with same-day admission. Breast reduction performed as day surgery resulted in cost savings of $873 per patient.

CONCLUSIONS:

Canadian plastic surgeons are performing more vertical scar breast reductions than American surgeons. However, both groups rely predominantly on inverted T scar techniques.     

A look at the thoracic surgery workforce in Canada: how demographics and scope of practice may impact future workforce needs

Background

The purpose of this study is to describe the demographics, training and practice characteristics of physicians performing thoracic surgery across Canada to better assess workforce needs.

Methods

We developed a questionnaire using a modified Delphi process to generate questionnaire items. The questionnaire was administered to all Canadian thoracic surgeons via email (n = 102) or mail (n = 35).

Results

In all, 97 surgeons completed the survey (71% response rate). The mean age of respondents was 47.7 (standard deviation 9.1) years; 10.3% were older than 60. Ninety respondents (88.7%) were men, 95 (81.1%) practised in English and 93 (76%) were born in Canada. Most (90.4%) had a medical school affiliation, with an equal proportion practising in community or university teaching hospitals. Only 18% of respondents reported working fewer than 60 hours per week, and 34% were on call more than 1 in 3. Three-quarters of work hours were devoted to clinical care, with the remaining time split among research, administration and teaching. Malignant lung disease accounted for 61.2% of practice time, with the remaining time equally split between benign and malignant thoracic diseases. Preoperative testing (49.4%) and insufficient operating time (49.5%) were the most common factors delaying delivery of care. More than 80% of respondents reported being satisfied with their careers, with 62.1% planning on retiring after age 60.

Conclusion

This survey characterizes Canadian thoracic surgeons by providing specific demographic, satisfaction and scope of practice information. Despite challenges in obtaining adequate resources for providing timely care, job satisfaction remains high, with a balanced workforce supply and demand anticipated for the foreseeable future.     

Surgical site infection prevention: a survey to identify the gap between evidence and practice in University of Toronto teaching hospitals

Background

A gap exists between the best evidence and practice with regards to surgical site infection (SSI) prevention. Awareness of evidence is the first step in knowledge translation.

Methods

A web-based survey was distributed to 59 general surgeons and 68 residents at University of Toronto teaching hospitals. Five domains pertaining to SSI prevention with questions addressing knowledge of prevention strategies, efficacy of antibiotics, strategies for changing practice and barriers to implementation of SSI prevention strategies were investigated.

Results

Seventy-six individuals (60%) responded. More than 90% of respondents stated there was evidence for antibiotic prophylaxis and perioperative normothermia and reported use of these strategies. There was a discrepancy in the perceived evidence for and the self-reported use of perioperative hyperoxia, omission of hair removal and bowel preparation. Eighty-three percent of respondents felt that consulting published guidelines is important in making decisions regarding antibiotics. There was also a discrepancy between what respondents felt were important strategies to ensure timely administration of antibiotics and what strategies were in place. Checklists, standardized orders, protocols and formal surveillance programs were rated most highly by 75%–90% of respondents, but less than 50% stated that these strategies were in place at their institutions.

Conclusion

Broad-reaching initiatives that increase surgeon and trainee awareness and implementation of multifaceted hospital strategies that engage residents and attending surgeons are needed to change practice.     

Canadian practice patterns for pancreaticoduodenectomy

Background

Discordant practice patterns may be a consequence of evidence–practice gaps or deficiencies in knowledge translation. We examined the current strategies used by hepato-pancreatico-biliary (HPB) surgeons in Canada for the perioperative management of pancreaticoduodenectomy (PD).

Methods

We generated a web-based survey that focused on the perioperative measures surrounding PD. The survey was distributed to all members of the Canadian Hepato-Pancreatico-Biliary Association.

Results

The survey was distributed to 74 surgeons and received a response rate of 50%. Many similarities in surgical techniques were reported; for example, most surgeons (86.5%) reconstruct the pancreas with pancreaticojejunostomy rather than pancreaticogastrostomy. In contrast, variable techniques regarding the use of peritoneal drainage tubes, anastomotic stents, octreotide and other intraoperative modalities were reported. Most surgeons (75.7%) reported that their patients frequently required preoperative biliary drainage, yet there was minimal agreement with the designated criteria. There was variability in postoperative care, including the use of epidural analgesia and timing of postoperative oral nutrition.

Conclusion

We identified heterogeneity among Canadian HPB surgeons, suggesting a number of evidence–practice gaps within specific domains of pancreatic resections. Focused research in these areas may facilitate technical agreement and improve patient outcomes following PD.     

Development of an Acute Care Plastic Surgery Service in the Saskatoon Health Region: Effects on flexor tendon management

BACKGROUND:

The acute care surgery model has gained favour in general surgery, but has yet to be widely adopted in other specialties. An Acute Care Plastic Surgery (ACS) Service was recently implemented in the Saskatoon Health Region in an effort to improve trauma care.

OBJECTIVE:

To evaluate the impact of ACS on the management of flexor tendon lacerations. The authors hypothesize that ACS has resulted in more timely intervention, improved outcomes and decreased ‘after hours’ surgery.

METHODS:

A retrospective review of patients treated for flexor tendon lacerations from 2007 to 2013 was performed. Patients were stratified into two groups based on whether they received treatment before (group A) or after (group B) ACS implementation. Variables included dates and times of patient referral, consultation and tendon repair; postoperative complications; and admissions. A surgeon survey was administered on the perceived impact of ACS.

RESULTS:

Group A was more likely to have surgery performed after hours (P=0.0019) and be admitted to hospital (P=0.0211) compared with group B. Time from referral to consultation and injury-to-surgery interval were slightly increased post-ACS (Group B). Surgeons were highly satisfied with the new system, citing benefits to patients and surgeons.

CONCLUSION:

ACS was designed to improve trauma care, while favourably impacting surgeon workload. Surprisingly, the injury-to-surgery interval was slightly increased. However, this was not clinically significant and did not lead to increased postoperative complications. This finding was likely due to a favourable change in practice patterns observed after ACS implementation. ACS has resulted in fewer hospital admissions, decreased after-hours surgeries and improved surgeon satisfaction.     

Initial assessment of patient handoff in accredited general surgery residency programs in the United States and Canada: a cross-sectional survey

Background

Communication errors are considered one of the major causes of sentinel events. Our aim was to assess the process of patient handoff among junior surgical residents and to determine ways in which to improve the handoff process.

Methods

We conducted nationwide surveys that included all accredited general surgery residency programs in the United States and Canada.

Results

Of the 244 American and 17 Canadian accredited surgical residency programs contacted, 65 (27%) and 12 (71%), respectively, participated in the survey. Of the American and Canadian respondents, 66% and 69%, respectively, were from postgraduate year (PGY) 1, and 32% and 29%, respectively, were from PGY 2; 85 (77%) and 50 (96%), respectively, had not received any training about patient handoff before their surgical residency, and 27% and 64%, respectively, reported that the existing handoff system at their institutions did not adequately protect patient safety. Moreover, 29% of American respondents and 37% of Canadian respondents thought that the existing handoffs did not support continuity of patient care. Of the American residents, 67% and 6% reported receiving an incomplete handoff that resulted in minor and major patient harm, respectively. These results mirrored those from Canadian residents (63% minor and 7% major harm). The most frequent factor reported to improve the patient handoff process was standardization of the verbal handoff.

Conclusion

Our survey results indicate that the current patient handoff system contributes to patient harm. More efforts are needed to establish standardized forms of verbal and written handoff to ensure patient safety and continuity of care.     

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

Background

Enhanced Recovery After Surgery (ERAS) is a multimodal pathway developed to overcome the deleterious effect of perioperative stress after major surgery. In colorectal surgery, ERAS pathways reduced perioperative morbidity, hospital stay and costs. Similar concept should be applied for liver surgery. This study presents the specific ERAS Society recommendations for liver surgery based on the best available evidence and on expert consensus.

Methods

A systematic review was performed on ERAS for liver surgery by searching EMBASE and Medline. Five independent reviewers selected relevant articles. Quality of randomized trials was assessed according to the Jadad score and CONSORT statement. The level of evidence for each item was determined using the GRADE system. The Delphi method was used to validate the final recommendations.

Results

A total of 157 full texts were screened. Thirty-seven articles were included in the systematic review, and 16 of the 23 standard ERAS items were studied specifically for liver surgery. Consensus was reached among experts after 3 rounds. Prophylactic nasogastric intubation and prophylactic abdominal drainage should be omitted. The use of postoperative oral laxatives and minimally invasive surgery results in a quicker bowel recovery and shorter hospital stay. Goal-directed fluid therapy with maintenance of a low intraoperative central venous pressure induces faster recovery. Early oral intake and mobilization are recommended. There is no evidence to prefer epidural to other types of analgesia.

Conclusions

The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol.

     

A systematic review of patient reported outcomes and patient experience in enhanced recovery after orthopaedic surgery

Introduction

Orthopaedic enhanced recovery after surgery (ERAS) providers are encouraged to estimate the actual benefit of ERAS according to the patient’s opinion by using patient generated data alongside traditional measures such as length of stay. The aim of this paper was to systemically review the literature on the use of patient generated information in orthopaedic ERAS across the whole perioperative pathway.

Methods

Publications were identified using Embase^™, MEDLINE^®, AMED, CINAHL^® (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Library and the British Nursing Index. Search terms related to experiences, acceptance, satisfaction or perception of ERAS and quality of life (QoL).

Findings

Of the 596 abstracts found, 8 papers were identified that met the inclusion criteria. A total of 2,208 patients undergoing elective hip and knee arthroplasty were included. Patient satisfaction was reported in 6 papers. Scores were high in all patients and not adversely affected by length of stay. QoL was reported in 2 papers and showed that QoL scores continued to increase up to 12 months following ERAS. Qualitative methods were used in one study, which highlighted problems with support following discharge. There is a paucity of data reporting on patient experience in orthopaedic ERAS. However, ERAS does not compromise patient satisfaction or QoL after elective hip or knee surgery. The measurement of patient experience should be standardised with further research.     

Survey of senior resident training in urologic laparoscopy,robotics and endourology surgery in Canada

Introduction:

We determined the status of Canadian training during senior residency in laparoscopic, robotic and endourologic surgery.

Methods:

Fifty-six residents in their final year of urology residency training were surveyed in person in 2007 or 2008.

Results:

All residents completed the survey. Most residents (85.7%) train at centres performing more than 50 laparoscopic procedures yearly and almost all (96.4%) believe laparoscopic radical nephrectomy is the gold standard. About 82% of residents participated in a laparoscopic partial nephrectomy in 2008, compared to 64.7% in 2007. Of the respondents, 66% have participated in a laparoscopic prostatectomy and 54% believe the procedure has promising potential. Exposure and training in robotic-assisted laparoscopic procedures seem to be increasing as 35.7% of 2008 residents have access to a surgical robot and 7% consider themselves trained in robotic-assisted procedures. Most residents (71.4%) train at centres that perform percutaneous ablation. However, 65% state the procedure is performed solely by radiologists. Percutaneous nephrolithotomy is widely performed (98.2%), but only 37.5% of residents report training in obtaining primary percutaneous renal access. Despite only 12.5% of residents ranking their laparoscopic experience as below average or poor, an increasing proportion of graduating residents are pursuing fellowships in minimally-invasive urology.

Conclusion:

Laparoscopic nephrectomy is commonly performed and is considered the standard of care by Canadian urology residents. Robotic-assisted surgery is becoming more common but will require continued evaluation by educators who will ultimately define its role in the urological residency training curriculum. Minimally-invasive surgical fellowships remain popular, as Canadian residents do not feel adequately trained in certain advanced procedures. Urologists must strive to learn and adapt to new technologies or risk losing them to other specialties.     

General surgeons and clinical ethics: a survey

Objective

To determine the preoccupation of general surgeons concerning ethics.

Design

A survey by questionnaire.

Participants

One thousand members of the Canadian Association of General Surgeons were surveyed through a questionnaire, which inquired about the influence of ethics in their clinical practices. The questionnaire contained 12 questions. There was no recall for those who did not respond.

Main outcome measures

Responses to questions concerning the sex of the respondents, location of practice, number of years in practice, the presence of hospital support, surgeons’ interest in ethical issues, use of autonomy, beneficence, nonmaleficence and justice in solving ethical dilemmas and level of education in clinical ethics.

Results

Men made up 95% of the respondents; 64% of respondents had been in practice more than 16 years; 58% came from a community or regional hospital; only 10% had no interest in clinical ethics; only 3% stated that they experienced no ethical problems in their practices; and 52% had no formal education in ethics.

Conclusions

There was general sensitivity for clinical ethics but an evident lack of formal education and of the presence of ethics committees and ethics consultants in many hospitals.     

Treatment preferences for trigger digit by members of the American Association for Hand Surgery

Background

Trigger digit is a common pathology encountered by hand surgeons, but there is a lack of evidence-based guidelines. We investigated the treatment preferences of hand surgeons and explored whether geographic location, type of residency training, or clinical experience is associated with differences in practice.

Methods

An online survey was distributed via email by the American Association for Hand Surgery to 615 members. The survey consisted of 17 questions related to conservative and operative management of trigger digits.

Results

One hundred thirty-nine unique responses were received (22.6 %). Geographic distribution of respondents encompassed the entire USA and was not associated with variations in practice. Of the respondents, 56.8 % were trained in orthopedic surgery while 37.4 % had plastic surgery training. In regards to duration of practice, 8.6 % were in practice for up to 5 years, 29.5 % for 6–15 years, 33.8 % for 16–25 years, and 28.1 % for more than 25 years. Notably, the great majority of respondents preferred corticosteroid injections for initial treatment. Those who were willing to give three or more injections prior to surgery were more likely to be plastic surgeons in practice for 16 years or more. A large minority of surgeons utilized splinting in their conservative management. Orthopedic surgeons were more likely to perform tenolysis during pulley release and more likely to use monitored anesthesia care.

Conclusions

Variation exists between the treatment algorithms of hand surgeons when managing a trigger digit. Some of these differences may be attributable to the type of training or the duration of clinical practice.     

The operative treatment of pressure sores in the pelvic region: A 10-year period overview

Context

Pelvic region pressure sores often develop following spinal cord injury. Surgery is often necessary for long standing, large-sized pressure sores not responding to conservative treatment. Authors analyze their results of a 10-year period, and identify factors contributing to the reduction of the recurrence rate.

Methods

A total of 119 pressure sores were operated on 98 patients in two institutions during a 10-year period (1 January 2003 to 31 December 2012). The encountered perioperative complications are summarized, and the recurrence rate is analyzed with a patient follow-up questionnaire.

Results

We experienced 15 perioperative complications (12.6%). All complications were fully resolved by conservative treatment. Fifty-eight returned patient replies were processed. The average follow-up time after surgery was 5.2 years. The recurrence rate was 5.47%.

Conclusion

The strict adherence to surgical indications, full patient compliance, specialized pre- and post-operative patient care, our routinely used preferred surgical method, all contribute to a low post-operative complication rate, long-term flap survival, and an extended recurrence free period.     

Laparoscopic entry: a review of Canadian general surgical practice

Background

Laparoscopic surgery has gained popularity over open conventional surgery as it offers benefits to both patients and health care practitioners. Although the overall risk of complications during laparoscopic surgery is recognized to be lower than during laparotomy, inadvertent serious complications still occur. Creation of the pneumoperitoneum and placement of laparoscopic ports remain a critical first step during endoscopic surgery. It is estimated that up to 50% of laparoscopic complications are entry-related, and most injury-related litigations are trocar-related. We sought to evaluate the current practice of laparoscopic entry among Canadian general surgeons.

Methods

We conducted a national survey to identify general surgeon preferences for laparoscopic entry. Specifically, we sought to survey surgeons using the membership database from the Canadian Association of General Surgeons (CAGS) with regards to entry methods, access instruments, port insertion sites and patient safety profiles. Laparoscopic cholecystectomy was used as a representative general surgical procedure.

Results

The survey was completed by 248 of 1000 (24.8%) registered members of CAGS. Respondents included both community and academic surgeons, with and without formal laparoscopic fellowship training. The demographic profile of respondents was consistent nationally. A substantial proportion of general surgeons (> 80%) prefer the open primary entry technique, use the Hasson trocar and cannula and favour the periumbilical port site, irrespective of patient weight or history of peritoneal adhesions. One-third of surgeons surveyed use Veress needle insufflation in their surgical practices. More than 50% of respondents witnessed complications related to primary laparoscopic trocar insertion.

Conclusion

General surgeons in Canada use the open primary entry technique, with the Hasson trocar and cannula applied periumbilically to establish a pneumoperitoneum for laparoscopic surgery. This surgical approach is remarkably consistent nationally, although considerably variant across other surgical subspecialties. Peritoneal entry remains an important patient safety issue that requires ongoing evaluation and study to ensure translation into safe contemporary clinical practice.     

Substantial variation of both opinions and practice regarding perioperative fluid resuscitation

Background

There are no current standards of care guiding perioperative fluid administration, and clinicians continue to debate restrictive versus liberal fluid administration. We sought to simultaneously evaluate the opinions and practice of surgeons, intensivists and anesthesiologists in a single centre regarding perioperative fluid resuscitation.

Methods

A postal survey sent to surgeons, intensivists and anesthesiologists in a single academic health care centre presented case-based scenarios followed by questions on fluid requirements and 5-point Likert scales involving statements about resuscitation. We performed a retrospective chart review to evaluate amount and type of intra-and postoperative (72-h) fluid administration, urine output and postoperative ventilation time in patients undergoing uncomplicated esophagectomy or pneumonectomy.

Results

Seventy-four of 77 respondents (96%) agreed that precise fluid resuscitation diminishes the risk of adverse events. Surgeons overall gave less fluids than anesthesiologists or intensivists and used fewer resuscitation end points to estimate fluid requirements perioperatively. For right hemicolectomies, only 3% of surgeons chose a fluid rate greater than 150 mL/h, compared with 55% of intensivists. We reviewed 49 patients’ charts (25 who had pneumonectomies, 24 who had esophagectomies) retrospectively. The coefficient of variation (COV = standard deviation divided by its mean) of fluid administration intraoperatively was 0.56 for pneumonectomy and 0.35 for esophagectomy; postoperatively, the COV was greater than 0.50 for the first 24 hours, but less than 0.50 after 24 hours postoperatively.

Conclusion

The presence of substantial variability of both opinion and practice of perioperative fluid resuscitation in a single centre supports the need for further research to identify objective methods to define perioperative fluid requirements and standards of perioperative resuscitation.     

Knowledge about urology in the general population: alarming results

Introduction:

For different reasons, urology appears to be one of the least known specialties in medicine. In this study, the main objective was to measure the knowledge about urology in the general population.

Methods:

A questionnaire was completed by 150 respondents. Seventy-five respondents were from Sherbrooke, QC (a French-speaking city) and 75 were from Burlington, VT (an English-speaking city).

Results:

Of the 150 respondents, 75% (113) said they knew little or nothing about urology and 63% (95) did not know that urology involves surgery. Also, when asked to name 3 diseases within the field of urology, 59% (89) of the respondents were unable to name at least 1 disease.

Conclusion:

This study demonstrates the lack of knowledge about urology in the general population. As urologists, we have to consider the need to conduct an informational campaign to increase the awareness of urology and the services urologists provide.