Canadian journal of surgery. Journal canadien de chirurgie (Can J Surg)

Publisher: Canadian Medical Association, Canadian Medical Association

Journal description

Mission Statement: To contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Current impact factor: 1.27

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 1.267
2012 Impact Factor 1.631
2011 Impact Factor 1.054
2010 Impact Factor 0.723
2009 Impact Factor 0.85
2008 Impact Factor 0.961
2007 Impact Factor 0.917
2006 Impact Factor 0.515
2005 Impact Factor 0.591
2004 Impact Factor 0.567
2003 Impact Factor 0.627
2002 Impact Factor 0.448
2001 Impact Factor 0.503
2000 Impact Factor 0.422
1999 Impact Factor 0.527
1998 Impact Factor 0.57
1997 Impact Factor 0.522
1996 Impact Factor 0.563
1995 Impact Factor 0.476
1994 Impact Factor 0.658
1993 Impact Factor 0.427
1992 Impact Factor 0.312

Impact factor over time

Impact factor

Additional details

5-year impact 1.31
Cited half-life 7.80
Immediacy index 0.42
Eigenfactor 0.00
Article influence 0.43
Website Canadian Journal of Surgery / Journal Canadien de Chirurgie website
Other titles Canadian journal of surgery (Online), Canadian journal of surgery, Journal canadien de chirurgie, CJS
ISSN 1488-2310
OCLC 45048853
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Canadian Medical Association

  • Pre-print
    • Author cannot archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Conditions
    • Articles are placed in PubMed Central immediately on behalf of authors.
  • Classification
    ​ white

Publications in this journal

  • Canadian journal of surgery. Journal canadien de chirurgie 08/2015; 58(4):001315-1315.
  • Canadian journal of surgery. Journal canadien de chirurgie 08/2015; 58(4):223-4. DOI:10.1503/cjs.007915
  • Canadian journal of surgery. Journal canadien de chirurgie 08/2015; 58(4):220-1. DOI:10.1503/cjs.009915
  • [Show abstract] [Hide abstract]
    ABSTRACT: Orthopedic surgical education in Canada has seen major change in the last 15 years. Work hour restrictions and external influence have led to new approaches for surgical training. With a change toward competency-based educational models under the CanMEDS headings there is a need to ensure the validity of modern assessment methods. Our objective was to evaluate the reliability of a currently used surgical skill assessment tool within an orthopedic residency program, as measured by the Surgical Encounters Form. A surgical assessment tool has previously been created at our institution that comprises 15 items spanning 4 of the CanMEDS competencies. Results were blinded to the primary investigator and coded by a third party. The assessments were collected, and we measured percent agreement using Cronbach's α and Fleiss κ. Over a 5-month period 11 staff members assessed 10 residents. Eighty-eight assessments were completed in total. Weighted percent agreement was 90.9%. Cronbach's α averaged 0.865 for the medical expert role, 0.920 for technical skills, 0.934 for the communicator role, 1.00 for the collaborator role and 1.00 for the health advocate role. The mean Fleiss κ score was 0.147 (95% confidence interval -0.071 to 0.364), demonstrating low interrater reliability. Despite the development of a validated assessment tool to evaluate surgical skills acquisition, interrater reliability results suggest low levels of agreement among assessors.
    Canadian journal of surgery. Journal canadien de chirurgie 08/2015; 58(4):010614-10614.
  • Canadian journal of surgery. Journal canadien de chirurgie 08/2015; 58(4):002015-2015.
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    ABSTRACT: Existing literature demonstrating the negative impact of delayed hip fracture surgery on mortality consists largely of observational studies prone to selection bias and may overestimate the negative effects of delay. We conducted an intervention study to assess initiatives aimed at meeting a 48-hour benchmark for hip fracture surgery to determine if the intervention achieved a reduction in time to surgery, and if a general reduction in time to surgery improved mortality and length of stay. We compared time to surgery, length of stay and mortality between pre- and postintervention patients with a hip fracture using the Kaplan-Meier estimator and Cox proportional hazards model adjusting for age, sex, comorbidities, type of surgery and year. We included 3525 pre- and 3007 postintervention patients aged 50 years or older. The proportion of patients receiving surgery within the benchmark increased from 66.8% to 84.6%, median length of stay decreased from 13.5 to 9.7 days, and crude in-hospital mortality decreased from 9.6% to 6.8% (all p < 0.001). Adjusted analyses revealed reduced mortality in hospital (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.57-0.81) and at 1 year (HR 0.87, 95%CI 0.79-0.96). Independent of the intervention period, having surgery within 48 hours demonstrated decreased adjusted risk of death in hospital (HR 0.51, 95%CI 0.41-0.63) and at 1 year postsurgery (HR 0.72, 95% CI 0.64-0.80). Coordinated, region-wide efforts to improve timeliness of hip fracture surgery can successfully reduce time to surgery and appears to reduce length of stay and adjusted mortality in hospital and at 1 year.
    Canadian journal of surgery. Journal canadien de chirurgie 08/2015; 58(3):257-63. DOI:10.1503/cjs.017714
  • Canadian journal of surgery. Journal canadien de chirurgie 08/2015; 58(4):224-5. DOI:10.1503/cjs.008015
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    ABSTRACT: 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. We conducted nationwide surveys that included all accredited general surgery residency programs in the United States and Canada. 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. 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.
    Canadian journal of surgery. Journal canadien de chirurgie 08/2015; 58(3):269-77. DOI:10.1503/cjs.016414
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    ABSTRACT: Extended thromboprophylaxis after hospital discharge following cancer surgery has been shown to reduce the incidence of venous thromboembolism (VTE); however, this practice has not been universally adopted. We conducted a population-based analysis to determine the proportion of patients with symptomatic VTE diagnosed within 90 days after initial discharge following major abdominopelvic cancer surgery who might have benefited from extended thromboprophylaxis. We used the Manitoba Cancer Registry to identify patients who underwent major abdominopelvic cancer surgery between 2004 and 2009. The proportion in whom VTE was diagnosed during the initial hospital stay was determined by accessing the Hospital Separations Abstracts. The proportion in whom VTE was diagnosed after discharge was determined by examining repeat admissions within 90 days and by accessing Drug Programs Information Network records for newly prescribed anticoagulants. Detailed tumour and treatment-specific data allowed calculation of VTE predictors. Of 6612 patients identified, 106 (1.60%) had VTE diagnosed during the initial stay and 96 (1.45%) presented with VTE after discharge. Among patients in whom VTE developed after discharge, 33.3% had a pulmonary embolus, 24% had deep vein thrombosis, and 6.3% had both. Predictors of presenting with VTE after discharge within 90 days of surgery included advanced disease, presence of other complications, increased hospital resource utilization, primary tumours of noncolorectal gastrointestinal origin and age younger than 45 years. The development of VTE was an independent predictor of decreased 5-year overall survival. The cumulative incidence of VTE within 90 days of major abdominopelvic oncologic surgery was 3.01%, with about half (1.45%) having been diagnosed within 90 days after discharge.
    Canadian journal of surgery. Journal canadien de chirurgie 08/2015; 58(4):012314-12314.
  • Canadian journal of surgery. Journal canadien de chirurgie 08/2015; 58(4):221-222. DOI:10.1503/cjs.010015
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    ABSTRACT: This study describes our experience with the placement of a skin-level gastrostomy device (MIC-KEY) in a single procedure. We identified infants, children and young adults who underwent laparoscopicassisted percutaneous endoscopic gastrostomy (LAPEG) tube insertion between October 2009 and June 2013. The steps of this procedure include upper endoscopy, single-port laparoscopy, gastropexy via percutaneous T-fasteners and placement of a skin-level gastrostomy device (MIC-KEY) using a "push" technique with a tear-away sheath. We included 92 patients in our study. Mean age was 3.7 years (range 3 wk-5 yr), and mean weight was 11.2 (range 2.8-54) kg. Median procedural time was 20 (range 12-76) minutes. Total median duration for the most recent 25 procedures was lower than that of the first 25 (62 v. 79 min, p = 0.004). There were no intraoperative complications or conversions to open surgery. Postoperative complications were observed in 6 (6.5%) patients. Three retained T-fasteners were assessed endoscopically (n = 1) or removed via local excision (n = 2). Two patients experienced early dislodged feeding tubes that were replaced via interventional radiology (n = 1) or repeat LAPEG (n = 1). There was also 1 intra-abdominal fluid collection that was drained percutaneously but ultimately required a laparotomy and washout. There were no major complications in the most recent 50 procedures. Our results suggest that LAPEG is a safe, minimally invasive procedure for infants, children and young adults. This approach allows for immediate use of a skin-level gastrostomy device without the need for postoperative tube exchanges.
    Canadian journal of surgery. Journal canadien de chirurgie 08/2015; 58(3):264-8. DOI:10.1503/cjs.014814
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    ABSTRACT: Carotid endarterectomy (CEA) is a very common operation, but there is no agreement on the appropriate orientation of the surgical incision. We retrospectively reviewed the charts of patients who had undergone CEA between Jul. 1, 2010, and Dec. 31, 2013. We contacted patients identified in the review to solicit participation in a clinical follow-up examination, during which the esthetic outcome of the scar was evaluated using the Patient and Observer Scar Assessment Scale (POSAS). During the study period 237 CEAs were performed. Nine patients refused the use of their personal health information in this study. There were no significant differences in the neurologic outcomes of patients based on the incision orientation (perioperative stroke and death 1.4% with transverse incision v. 0% with a vertical incision, p = 0.44). Fifty-two patients presented for follow-up examination. Thirty-three had a transverse incision and 19 had a vertical incision. Results of the POSAS significantly favoured the transverse incision (p = 0.03). Vertical incisions were more often associated with persistent, mild marginal mandibular nerve dysfunction (p = 0.04). Carotid endarterectomy performed through a transverse skin incision compared with a vertically oriented skin incision is associated with improved esthetic outcome, as measured by the POSAS, without an observed statistically significant difference in the risk of perioperative stroke or death between the 2 techniques.
    Canadian journal of surgery. Journal canadien de chirurgie 06/2015; 58(3):016714-16714. DOI:10.1503/cjs.016714
  • Canadian journal of surgery. Journal canadien de chirurgie 06/2015; 58(3):S81.
  • Canadian journal of surgery. Journal canadien de chirurgie 06/2015; 58(3):209-11. DOI:10.1503/cjs.011214
  • Canadian journal of surgery. Journal canadien de chirurgie 06/2015; 58(3):153. DOI:10.1503/cjs.004115
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    ABSTRACT: Door openings disrupt the laminar air flow and increase the bacterial count in the operating room (OR). We aimed to define the incidence of door openings in the OR during primary total joint arthroplasty (TJA) surgeries and determine whether measures were needed and/or possible to reduce OR staff traffic. We recorded the number of door openings during 100 primary elective TJA surgeries; the OR personnel were unaware of the observer's intention. Operating time was divided into the preincision period, defined as the time from the opening of surgical trays to skin incision, and the postincision period, defined as time from incision to dressing application. The mean number of door openings during primary TJA was 71.1 (range 35-176) with a mean operative time of 111.9 (range 53-220) minutes, for an average of 0.64 (range 0.36-1.05) door openings/min. Nursing staff were responsible for 52.2% of total door openings, followed by anesthesia staff at 23.9% and orthopedic staff at 12.7%. In the preincision period, we observed an average of 0.84 door openings/ min, with nursing and orthopedic personnel responsible for most of the door openings. The postincision period yielded an average of 0.54 door openings/min, with nursing and anesthesia personnel being responsible for most of the door openings. There is a high incidence of door openings during TJA. Because we observed a range in the number of door openings per surgery, we believe it is possible to reduce this number during TJA.
    Canadian journal of surgery. Journal canadien de chirurgie 06/2015; 58(3):011914-11914. DOI:10.1503/cjs.011914
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    ABSTRACT: The North Atlantic Treaty Organization (NATO) Role 3 Multinational Medical Unit (R3-MMU) is a tertiary care trauma facility that receives casualties, both coalition and civilian, and provides humanitarian medical assistance when able to the Kandahar province in southern Afghanistan. We examined the cohort of pediatric patients evaluated at the facility during a 16-month period to determine the characteristics and care requirements of this unique patient population. A database of Afghan patients younger than 18 years of age admitted to the NATO R3-MMU between January 2010 and April 2011 was developed from the Joint Theatre Trauma Registry. This patient cohort was analyzed to determine demographics, injury mechanism, injury severity, resource utilization and factors associated with mortality. A total of 263 children were admitted to the NATO R3-MMU during the study period, representing 12% of all trauma admissions during this time period. The median age was 9 years (range 3 mo-17 yr) with a predominance of male patients (82%). Battle-related trauma was responsible for 62% of admissions, with explosive blast injury constituting the predominant mechanism (42%). The average injury severity score was 12.3 ± 9.3. Overall mortality was 8%. Factors associated with increased risk of death included admission acidosis, coagulopathy, hypothermia and female sex. Children represent a significant proportion of traumatic injuries encountered in a modern war zone; many of them are critically injured. Organizations that provide health care in such environments should be prepared to care for this patient population where their mandates and facilities allow for it.
    Canadian journal of surgery. Journal canadien de chirurgie 06/2015; 58(3):S141-5. DOI:10.1503/cjs.017414