Allan Okrainec

University Health Network, Toronto, Ontario, Canada

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Publications (56)155.89 Total impact

  • Robert Wu, Allan Okrainec, Todd Penner
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    ABSTRACT: Laparoscopic peritoneal dialysis catheter (LPDC) implantation using nitrous oxide (N2O) pneumoperitoneum under procedural sedation is a technique that has many advantages over conventional insertion methods. The purpose of this study was to review the LPDC insertion results at our center.
    World journal of surgery. 09/2014;
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    ABSTRACT: Experts identified camera navigation and cannulation as important skills that are not assessed by the Fundamentals of Laparoscopic Surgery (FLS) hands-on examination. The purpose of this study was to create metrics for and evaluate the validity for two new tasks: camera navigation (N) and cannulation (C), and to explore the potential value of adding these tasks to the FLS program.
    Surgical endoscopy. 07/2014;
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    ABSTRACT: Recent evidence raises concern about the use of perioperative non-steroidal anti-inflammatory drug (NSAID) use after colorectal resection. The purpose of this retrospective cohort study was to investigate the relationship between perioperative ketorolac use and anastomotic leakage after colorectal surgery.
    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 06/2014;
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    ABSTRACT: This study serves to establish the re-endoscopy rate in patients undergoing surgery for colorectal cancer (CRC) at a tertiary academic center and to identify significant factors that may influence the decision for preoperative re-endoscopy.
    Surgical endoscopy. 05/2014;
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    ABSTRACT: An Enhanced Recovery after Surgery (ERAS) Clinical Practice Guideline (CPG) was developed at the University of Toronto. Before implementation, general surgery residents were surveyed to assess their current stated practices and their perceived barriers and enablers to early discharge. The survey, which consisted of 33 questions related to the postoperative management of patients undergoing laparoscopic colectomy (LAC), open colectomy (OC) and open low anterior resection (LAR), was distributed to all residents. Chi-square and Fisher exact tests were used to test differences. Open-ended questions were analyzed using content analysis. Of 77 residents surveyed, 58 (75%) responded. Residents stated that a fluid diet would be ordered on POD#0 and regular diet on POD#1 by 67.9% and 49.1%, respectively, following LAC, and 50.0% and 25.9%, respectively, following OC. On POD#1, 89.3% expected patients to ambulate following LAC compared with 67.9% following OC. Residents indicated that urinary catheters would be removed on POD#1 by 87% following LAC and by 81.3% following OC, and by POD#3 by 89.1% following LAR. However, in patients with an epidural, approximately 50% of residents stated that they would wait until it was removed. Overall, 76.4% of residents agreed that an ERAS CPG should be adopted. Residents cited setting expectations, encouragement of early ambulation and feeding, and good pain control as enablers to early discharge. However, patient and family expectations, surgeon preferences, and beliefs of the health care team were mentioned as barriers to early discharge. Residents have a reasonable approach to the management of patients who underwent LAC, but there are gaps that exist in their management, especially following OC and LAR. Although most residents agreed with the implementation of an ERAS CPG, barriers exist, and strategies aimed at ensuring adherence with the recommendations are required.
    Journal of Surgical Education 05/2014; · 1.07 Impact Factor
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    ABSTRACT: There is controversy surrounding the safety and feasibility of next-day discharge following laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity. The objective of this study was to determine if next-day discharge following LRYGB is comparable to standard discharge (i.e. postoperative day two) with respect to 30-day patient outcomes. A retrospective cohort analysis was performed using data from the American College of Surgeons' National Surgery Quality Improvement Program participant use files. The study population consisted of patients discharged on either postoperative day (POD) 1 or 2 that underwent an elective LRYGB for morbid obesity between 2005 and 2012. Patients were excluded if they had recent surgery, any relative contraindication to bariatric surgery, or any recorded complication/death during their principal admission. The primary outcome was 30-day overall complications and secondary outcomes were 30-day major complications and reoperations. A multiple logistic regression analysis was performed to evaluate each outcome based on discharge day. The study population consisted of 6,166 and 30,966 patients discharged on POD 1 and 2, respectively. No major clinical differences were found between the two groups with respect to relevant patient and operative characteristics. After adjustment, the odds ratios for 30-day overall complications, major complications, and reoperations with next-day discharge were 0.98 (p = 0.870, 95 % CI [0.81-1.19]), 0.81 (p = 0.204, 95 % CI [0.58-1.12]) and 1.06 (p = 0.717, 95 % CI [0.79-1.41]), respectively. Body mass index ≥50, operative time ≥3 h, diabetes, dyspnea and hypertension were significant predictors for complications in patients discharged the next day. Using this large national surgical database, LRYGB patients discharged on POD 1 did not have a significantly higher rate of adverse events compared to patients discharged on POD 2. Understanding the important predictors of adverse events following LRYGB will help bariatric surgeons implement next-day discharge protocols based on the appropriate perioperative evaluation.
    Surgical Endoscopy 05/2014; · 3.43 Impact Factor
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    ABSTRACT: Morbid obesity is strongly associated with nonalcoholic fatty liver disease. However, the effect of underlying liver disease on clinical outcomes following bariatric surgery has not been well studied. This study aims to determine the effect of underlying liver disease on short-term outcomes in bariatric patients using the model of end-stage liver disease (MELD) scoring system as a practical measure of hepatic dysfunction. A retrospective cohort analysis was performed using data from the American College of Surgeons' National surgery quality improvement program participant use files. The study population consisted of patients that underwent elective laparoscopic-stapled bariatric surgery for morbid obesity between 2005 and 2012. Patients were excluded if they had a bleeding disorder or renal failure requiring dialysis. The optimal MELD cut-off score to predict 30-day adverse events was determined and used to stratify patients into two groups. The primary outcome was 30-day adverse events, defined as a postoperative complication or reoperation. The secondary outcome was 30-day mortality. A multiple logistic regression was performed to adjust the odds ratio (OR) estimate for 30-day adverse events based on the MELD cut-off score. 38,875 patients were included in the study population. A MELD score of 7.9 was determined to be the optimal cut-off to predict 30-day adverse events based on the maximized linear combination of specificity and sensitivity. After adjusting for confounding, the OR estimates for 30-day adverse events and mortality using the cut-off score as the key predictor were 1.22 [95 % CI 1.06-1.41] and 2.33 [95 % CI 1.19-4.56], respectively. Using this large national surgical registry, bariatric patients with MELD scores ≥7.9 had a significant but marginal risk of 30-day adverse events and mortality. This suggests that severity of liver disease may affect bariatric surgery outcomes and should be considered during preoperative evaluations.
    Surgical Endoscopy 04/2014; · 3.43 Impact Factor
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    ABSTRACT: Laparoscopy in acute care surgery continues to expand. While adhesive small bowel obstruction (SBO) has traditionally been managed via an open approach, appropriately selected patients may benefit from laparoscopy. The objective of our study was to compare short-term postoperative outcomes in patients with adhesive SBO treated with laparotomy versus laparoscopy. Using the ACS NSQIP participant use files (2005-10), patients with a postoperative diagnosis of adhesive SBO were selected for inclusion in this study. Patients with bowel resections or concomitant procedures were excluded. Both univariate analyses and multivariate logistic regression were performed to compare 30-day outcomes in the open and laparoscopic groups. A total of 4,616 patients with adhesive SBO were identified: 3,697 (80.1 %) and 919 (19.3 %) in the open and laparoscopic groups, respectively. Mean operative time was similar in both groups. The mortality and overall complications were 84 (2.3 %) and 819 (22.2 %), respectively, in the open group compared to 7 (0.8 %) and 81 (8.8 %) in the laparoscopic group, with respective unadjusted odds ratios (ORs) of 0.33 (0.13-0.71, P < 0.01) and 0.39 (0.30-0.49, P < 0.01). The adjusted OR for overall complications was 0.46 (0.37-0.59, P < 0.01) favouring the laparoscopic group. The mean postoperative length of stay (LOS) was 8.4 days compared to 3.8 in the open and laparoscopic groups, respectively (P < 0.01). The laparoscopic approach to treating adhesive SBO resulted in significantly fewer complications and shorter LOS.
    Surgical Endoscopy 03/2014; · 3.43 Impact Factor
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    ABSTRACT: AML is the most common form of leukemia in adults. In rare circumstances AML may present in the form of extra-medullary disease. Gallbladder infiltration with myeloblasts is rare and only a few cases exist in the literature describing this entity. We present a rare case of AML relapse in the form of extramedullary infiltration of the gallbladder in a 50-year-old male patient. The leukemic infiltration presented as symptomatic cholecystitis and sepsis. A laparoscopic cholecystectomy was performed and the gallbladder was pathologically examined. Histopathologic examination demonstrated multiple scattered, highly atypical single cells admixed with some plasma cells, small lymphocytes and macrophages consistent with leukemic infiltration. The abnormal cells demonstrated immunohistochemical staining for CD68, CD33 and CD117. The patient did well post-operatively but the relapse precluded him from bone marrow transplantation. Although AML is relatively common, 3 cases per 100,000 population, extramedullary disease in the form of gallbladder infiltration is exceedingly rare. An extensive review of the literature revealed only four cases of myeloid infiltration of the gallbladder. To our knowledge this is the only case of relapsing disease in the form of gallbladder infiltration presenting as symptomatic cholecystitis in a pre-bone marrow transplantation patient. This case highlights the importance of maintaining a high index of suspicion of atypical manifestations of AML when managing refractory sepsis. Extramedullary manifestations of AML in the form of gallbladder infiltration must be considered in the differential diagnosis of patients with a history of myeloid malignancies and for patients whom fail conventional non-operative management.
    International journal of surgery case reports. 03/2014; 5(6):302-305.
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    ABSTRACT: Explore the barriers and enablers to adoption of an Enhanced Recovery after Surgery (ERAS) program by the multidisciplinary perioperative team responsible for the care of elective colorectal surgical patients. ERAS programs include perioperative interventions that when used together have led to decreased length of stay while increasing patient recovery and satisfaction. Despite the known benefits of ERAS programs, uptake remains slow. Semistructured interviews were conducted with general surgeons, anesthesiologists, and ward nurses at 7 University of Toronto-affiliated hospitals to identify potential barriers and enablers to adoption of 18 ERAS interventions. Grounded theory was used to thematically analyze the transcribed interviews. Nineteen general surgeons, 18 anesthesiologists, and 18 nurses participated. The mean time of each interview was 18 minutes. Lack of manpower, poor communication and collaboration, resistance to change, and patient factors were cited by most as barriers. Discipline-specific issues were identified although most related to resistance to change. Overall, interviewees were supportive of implementation of a standardized ERAS program and agreed that a standardized guideline based on best evidence; standardized order sets; and education of the staff, patients, and families are essential. Multidisciplinary perioperative staff supported the implementation of an ERAS program at the University of Toronto-affiliated hospitals. However, major barriers were identified, including the need for patient education, increased communication and collaboration, and better evidence for ERAS interventions. Identifying these barriers and enablers is the first step toward successfully implementing an ERAS program.
    Annals of surgery 03/2014; · 7.90 Impact Factor
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    ABSTRACT: Introduction An Enhanced Recovery after Surgery (ERAS) Clinical Practice Guideline (CPG) was developed at the University of Toronto. Before implementation, general surgery residents were surveyed to assess their current stated practices and their perceived barriers and enablers to early discharge. Methods The survey, which consisted of 33 questions related to the postoperative management of patients undergoing laparoscopic colectomy (LAC), open colectomy (OC) and open low anterior resection (LAR), was distributed to all residents. Chi-square and Fisher exact tests were used to test differences. Open-ended questions were analyzed using content analysis. Results Of 77 residents surveyed, 58 (75%) responded. Residents stated that a fluid diet would be ordered on POD#0 and regular diet on POD#1 by 67.9% and 49.1%, respectively, following LAC, and 50.0% and 25.9%, respectively, following OC. On POD#1, 89.3% expected patients to ambulate following LAC compared with 67.9% following OC. Residents indicated that urinary catheters would be removed on POD#1 by 87% following LAC and by 81.3% following OC, and by POD#3 by 89.1% following LAR. However, in patients with an epidural, approximately 50% of residents stated that they would wait until it was removed. Overall, 76.4% of residents agreed that an ERAS CPG should be adopted. Residents cited setting expectations, encouragement of early ambulation and feeding, and good pain control as enablers to early discharge. However, patient and family expectations, surgeon preferences, and beliefs of the health care team were mentioned as barriers to early discharge. Conclusion Residents have a reasonable approach to the management of patients who underwent LAC, but there are gaps that exist in their management, especially following OC and LAR. Although most residents agreed with the implementation of an ERAS CPG, barriers exist, and strategies aimed at ensuring adherence with the recommendations are required.
    Journal of Surgical Education 01/2014; · 1.63 Impact Factor
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    ABSTRACT: Background The safety of next-day discharge following laparoscopic sleeve gastrectomy (SG) for the treatment of morbid obesity has not been well studied. Objective The objective of this study was to determine if next-day discharge following laparoscopic SG was comparable to standard discharge (i.e. postoperative day 2) with respect to the rate of 30-day adverse events. Setting American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) participant use file. Methods A retrospective cohort analysis was performed. Patients were selected if they underwent a laparoscopic SG for morbid obesity between 2010 and 2012 and discharged on either postoperative day (POD) 1 or 2. The primary outcome was the 30-day adverse event rate, which was a composite endpoint of complications, mortality or reoperations. A multivariable logistic regression was performed to determine an adjusted odds ratio (OR) of 30-adverse events for next-day discharge. Results There were 2982 (37.4%) and 4985 (62.6%) patients discharged on POD 1 and 2, respectively. Both groups were comparable with respect to clinical characteristics. The adjusted OR for 30-day adverse events with next-day discharge was 0.75 (p = 0.08, 95% CI [0.55-1.04]). Preoperative hypertension and dyspnea were significant predictors of adverse events for next-day discharge. Conclusions Based on data from the ACS-NSQIP registry, laparoscopic SG patients discharged on POD 1 did not have a worse rate of 30-day adverse events compared to the POD 2 group. Appropriate perioperative evaluation may help surgeons implement next-day discharge for select patients after uncomplicated laparoscopic SG.
    Surgery for Obesity and Related Diseases 01/2014; · 4.12 Impact Factor
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    ABSTRACT: Background Laparoscopic adjustable gastric band (LAGB) insertion is a commonly performed bariatric procedure with low associated short-term risk. Given that a significant number of patients will require additional revision/removal procedures, overall morbidity may be underestimated. Objective To define the 30-day morbidity associated with LAGB removal and revision procedures. Setting ACS-NSQIP hospitals performing LAGB procedures 2006-2011. Methods Patients undergoing revision or removal of LAGB were identified within the ACS-NSQIP participant use file using CPT and ICD-9 coding. Patients having concurrent procedures were excluded. Primary outcomes included 30-day morbidity. The rate of complications in the removal/revision patients versus primary LAGB insertion was compared. We also analyzed trends over time. Results 3,236 patients underwent LAGB removal (n = 1,580), revision (n=1,111) or port site revision (n=545) from 2006-2011. The overall 30-day complication rate was 5.6% (95% CI: 4.8%, 6.4%) and was higher in patients undergoing LAGB removal with a 6.8% (95% CI: 5.6%, 8.1%) adverse event rate (2.5% infectious, 2.3% wound, 2.4% reoperation). 24,438 patients underwent primary LAGB insertion within the dataset with a 30-day complication rate of 2.6% (95% CI: 2.4%, 2.8%). Patients undergoing LABG removal had a significantly higher complication rate than those having primary LAGB insertion with an OR 2.72 (95% CI: 2.18, 3.37). The proportion of LAGB revision/removal compared to primary placement increased annually over the study period (P for trend <0.001). Conclusions The 30-day morbidity associated with LAGB revision is significant and higher than that associated with primary LAGB insertions. The potential need for future procedures and the associated additional morbidity should be considered when evaluating LAGB as a treatment option for morbid obesity.
    Surgery for Obesity and Related Diseases 01/2014; · 4.12 Impact Factor
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    ABSTRACT: Background The objective of this study was to develop an easy-to-use nomogram to assist clinicians in predicting patient-specific mortality in this patient population. Methods American College of Surgeons National Surgical Quality ImprovementProgram participant use files were used from 2005-2011. Multivariable logistic regression was used to model 30-day postoperative mortality in patients with ascites who underwent umbilical hernia repair. Results A total of 688 patients with ascites undergoing umbilical hernia repair were included. There were 643 (94%) survivors and 45 (7%) mortalities. A total of 300 (44%) patients were classified as emergent cases. U;sing logistic regression to predict 30-day mortality, preoperative MELD score, albumin, white blood cell count, and platelet count were found to be significant predictors (P-value<0.05) of mortality and were included in our model. Conclusions We propose a nomogram to enable clinicians to better estimate mortality in patients with ascites undergoing umbilical hernia repair.
    The American Journal of Surgery. 01/2014;
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    ABSTRACT: Background Obesity is a global epidemic and several surgical programs have been created to combat this public health issue. While demand for bariatric surgery has grown, so too has the attrition rate. In this study we identify patient characteristics and operational interventions that have contributed to high attrition in a multi-stage, multidisciplinary bariatric surgery program. Study Design A retrospective study of 1682 patients referred for bariatric surgery at the University Health Network in Toronto, Canada from June 2008 to July 2011 was conducted. Demographic information, pre-surgical assessment dates, and records describing operational changes were collected. Several penalized likelihood and mixed effects multivariable logistic regression models were used to determine whether patient characteristics, operational changes, and previous experience affected program completion and intermediate transitions between assessments. Results Although the majority of attrition appears to be the result of patient self-removal, males (OR 0.511, 95% CI 0.392-0.663, p < 0.001), and individuals with active substance use (OR 0.223, 95% CI 0.096–0.471, p < 0.001) were less likely to undergo surgery. Operational practices had a detrimental effect on program completion (OR 0.590, 95% CI 0.456–0.762, p < 0.001). Conversely, patients with a BMI > 40 (OR 1.756, 95% CI 1.233–2.515, p = 0.002), and who lived within 25–300 km of the centre (OR > 1.633, p < 0.001) were more likely to undergo surgery. Conclusions Certain subgroups in the referral population were found to be at a higher risk of non-completion. Specialized care pathways must be implemented to address this issue. Furthermore, careful consideration must be devoted to operational decisions as they may negatively impact access to care, as we have shown.
    Journal of the American College of Surgeons 01/2014; · 4.50 Impact Factor
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    ABSTRACT: Telementoring is a useful tool for laparoscopic surgical education. However, current systems have high barriers to entry that prevent widespread adoption. Using commercial videoconferencing applications for telementoring would lower cost and technical barriers. This study examines nine of these options.
    Studies in health technology and informatics 01/2014; 196:147-9.
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    ABSTRACT: The objective of this study was to compare the total hospital cost of laparoscopic (lap) and open colon surgery at a publicly funded academic institution. Patients undergoing elective laparoscopic or open colon surgery for all indications at the University Health Network, Toronto, Canada, from April 2004 to March 2009 were included. Patient demographic, operative, and outcome data were reviewed retrospectively. Hospital costs were determined from the Ontario Case Costing Initiative, adjusted for inflation, and compared using the Mann-Whitney U test. Linear regression was used to analyze the relationship between length of stay and total hospital cost. There were 391 elective colon resections (223 lap/168 open, 15.4 % conversion). There was no difference in median age, gender, or Charlson score. Body mass index was slightly higher for laparoscopic surgery (27.5/25.9 lap/open; p = 0.008), while the American Society of Anesthesiologists score was slightly higher for open surgery. Median operative time was greater for laparoscopic surgery (224/196 min, lap/open; p = 0.001). There was no difference in complication rates (21.6/22.5 % lap/open; p = 0.900), reoperations (5.8/6.5 % lap/open; p = 0.833) or 30-day readmissions (7.6/12.5 % lap/open; p = 0.122). Number of emergency room visits was greater with open surgery (12.6/20.8 % lap/open; p = 0.037). Operative cost was higher for laparoscopic surgery ($4,171.37/3,489.29 lap/open; p = 0.001), while total hospital cost was significantly reduced ($9,600.22/12,721.41 lap/open; p = 0.001). Median length of stay was shorter for laparoscopic surgery (5/7 days lap/open; p = 0.000), and this correlated directly with hospital cost. Laparoscopic colon surgery is associated with increased operative costs but significantly lower total hospital costs. The cost savings is related, in part, to reduced length of stay with laparoscopic surgery.
    Surgical Endoscopy 11/2013; · 3.43 Impact Factor
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    ABSTRACT: Approximately 175,000 umbilical hernia repairs are performed annually in the US. Controversy exists regarding the optimal approach for the elective repair of primary umbilical hernias. The objective of this study was to compare 30-day outcomes of elective primary open (OHR) and laparoscopic (LHR) umbilical hernia repairs, using a prospectively collected dataset. We performed a retrospective cohort study using the American College of Surgeons National Surgery Quality Improvement Program Participant Use Files during 2009 and 2010. Current Procedural Terminology and post-operative International Classification of Diseases, Ninth Revision diagnostic codes were used to identify primary umbilical hernia repairs. Primary outcomes included composite endpoints of 30-day mortality, and major and overall complications. Univariate analyses and multivariate logistic regression were performed controlling for relevant patient characteristics. Secondary outcomes included operative time and hospital length of stay (LOS). Overall, 14,652 patients were identified-13,109 (89.5 %) OHR and 1543 (10.5 %) LHR. Univariate analyses of primary outcomes demonstrated similar 30-day morbidity and mortality between groups. In our multivariate model, however, after controlling for body mass index, gender, American Society of Anesthesiologists class, and chronic obstructive pulmonary disease, the odds ratio (OR) for overall complications favored LHR (OR 0.60; p = 0.01). This difference was driven primarily by the reduced wound complication rate in the LHR group [OR 0.41 (0.20, 0.78); p = 0.005]. LHR was associated with significantly longer operative time [57.7 min (SD 32.6) vs. 38.3 min (SD 22.9); p < 0.001], longer LOS [0.29 days (SD 0.68) vs. 0.17 days (SD 1.47); p = 0.001], and an increased rate of respiratory (0.52 vs. 0.10 %; p < 0.001) and cardiac (0.26 vs. 0.05 %; p = 0.005) complications. This study identified potential decreased total and wound morbidity associated with LHR for elective primary umbilical hernia repairs at the expense of increased operative time, LOS, and respiratory and cardiac complications. These results should be considered within the context of a retrospective study with its inherent risks of bias and limitations.
    Surgical Endoscopy 10/2013; · 3.43 Impact Factor
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    ABSTRACT: Bariatric surgery is an effective long-term solution for weight loss in the severely obese. Prevalence of bariatric surgery has increased over the recent years; however, the attrition rate of those referred who actually undergo surgery is high. The purpose of this study was to examine patients' attrition rates after referral for bariatric surgery at an academic tertiary care institution. When and why patients who were referred for bariatric surgery did not ultimately undergo surgical treatment was examined. Charts of 1,237 patients referred to the Toronto Western Hospital Bariatric Program from program inception to February 2011 were retrospectively reviewed. Patient demographics, appointment dates, no shows and cancellations, and when and why patients did not undergo surgery were summarized. Patients' mean age was 47. Most patients were female, and the mean body mass index was 47. Half (50.6 %) of the total persons referred left the program prior to being seen by a health-care professional, and only 36.2 % underwent surgical treatment. Only 2.75 % of persons were ineligible for surgery. A total of 60.6 % of persons self-removed from our program. Reasons for self-removal varied, with the most common reason for leaving the program recorded as "unknown." Our multidisciplinary program with in-hospital psychosocial resources resulted in very few persons being excluded from receiving surgical treatment. However, less than half of those referred underwent surgery as most persons self-removed from our program for unknown reasons. Further investigation is required to determine which patient, administrative, and system factors play a role in the patients' decision to not undergo bariatric surgical treatment.
    Obesity Surgery 10/2013; · 3.10 Impact Factor
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    ABSTRACT: Fundamentals of Laparoscopic Surgery (FLS) certification testing currently is offered at accredited test centers or at select surgical conferences. Maintaining these test centers requires considerable investment in human and financial resources. Additionally, it can be challenging for individuals outside North America to become FLS certified. The objective of this pilot study was to assess the feasibility of remotely administering and scoring the FLS examination using live videoconferencing compared with standard onsite testing. This parallel mixed-methods study used both FLS scoring data and participant feedback to determine the barriers to feasibility of remote proctoring for the FLS examination. Participants were tested at two accredited FLS testing centers. An official FLS proctor administered and scored the FLS exam remotely while another onsite proctor provided a live score of participants' performance. Participant feedback was collected during testing. Interrater reliabilities of onsite and remote FLS scoring data were compared using intraclass correlation coefficients (ICCs). Participant feedback was analyzed using modified grounded theory to identify themes for barriers to feasibility. The scores of the remote and onsite proctors showed excellent interrater reliability in the total FLS (ICC 0.995, CI [0.985-0.998]). Several barriers led to critical errors in remote scoring, but most were accompanied by a solution incorporated into the study protocol. The most common barrier was the chain of custody for exam accessories. The results of this pilot study suggest that remote administration of the FLS has the potential to decrease costs without altering test-taker scores or exam validity. Further research is required to validate protocols for remote and onsite proctors and to direct execution of these protocols in a controlled environment identical to current FLS test administration.
    Surgical Endoscopy 09/2013; · 3.43 Impact Factor

Publication Stats

314 Citations
155.89 Total Impact Points

Institutions

  • 2011–2014
    • University Health Network
      • Department of General Surgery
      Toronto, Ontario, Canada
    • Chinook Regional Hospital
      Lethbridge, Alberta, Canada
    • SickKids
      Toronto, Ontario, Canada
  • 2009–2014
    • University of Toronto
      • • Division of General Surgery
      • • Department of Surgery
      Toronto, Ontario, Canada
  • 2013
    • University of Manitoba
      • Department of Surgery
      Winnipeg, Manitoba, Canada
  • 2012
    • Ryerson University
      Toronto, Ontario, Canada
  • 2009–2012
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 2007–2008
    • McGill University
      • • Division of General Surgery
      • • Department of Surgery
      Montréal, Quebec, Canada