Chad G Ball

The University of Calgary, Calgary, Alberta, Canada

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Publications (223)478.44 Total impact

  • Canadian journal of surgery. Journal canadien de chirurgie 06/2015; 58(3):S85-S87. DOI:10.1503/cjs.013914 · 1.27 Impact Factor
  • Chad G Ball
    Canadian journal of surgery. Journal canadien de chirurgie 06/2015; 58(3):012814-12814. · 1.27 Impact Factor
  • Canadian journal of surgery. Journal canadien de chirurgie 06/2015; 58(3):212-5. DOI:10.1503/cjs.011414 · 1.27 Impact Factor
  • Canadian journal of surgery. Journal canadien de chirurgie 06/2015; 58(3):S88-90. DOI:10.1503/cjs.014214 · 1.27 Impact Factor
  • Chad G Ball
    Canadian journal of surgery. Journal canadien de chirurgie 06/2015; 58(3):005815-5815. · 1.27 Impact Factor
  • Source
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    ABSTRACT: Historical data suggests that many traumatic hemothoraces (HTX) can be managed expectantly without tube thoracostomy (TT) drainage. The purpose of this study was to identify predictors of TT, including whether the quantity of pleural blood predicted tube placement, and to evaluate outcomes associated with TT versus expected management (EM) of traumatic HTXs. A retrospective cohort study of all trauma patients with HTXs and an Injury Severity Score (ISS) ≥12 managed at a level I trauma centre between April 1, 2005 and December 31, 2012 was completed. Mixed-effects models with a subject-specific random intercept were used to identify independent risk factors for TT. Logistic and log-linear regression were used to compute odds ratios (ORs) for mortality and empyema and percent increases in length of hospital and intensive care unit stay between patients managed with TT versus EM, respectively. A total of 635 patients with 749 HTXs were included in the study. Overall, 491 (66%) HTXs were drained while 258 (34%) were managed expectantly. Independent predictors of TT placement included concomitant ipsilateral flail chest [OR 3.03; 95% confidence interval (CI) 1.04-8.80; p=0.04] or pneumothorax (OR 6.19; 95% CI 1.79-21.5; p<0.01) and the size of the HTX (OR per 10cc increase 1.12; 95% CI 1.04-1.21; p<0.01). Although the adjusted odds of mortality were not significantly different between groups (OR 3.99; 95% CI 0.87-18.30; p=0.08), TT was associated with a 47.14% (95% CI, 25.57-69.71%; p<0.01) adjusted increase in hospital length of stay. Empyemas (n=29) only occurred among TT patients. Expectant management of traumatic HTX was associated with a shorter length of hospital stay, no empyemas, and no increase in mortality. Although EM of smaller HTXs may be safe, these findings must be confirmed by a large multi-centre cohort study and randomized controlled trials before they are used to guide practice. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Injury 05/2015; 92. DOI:10.1016/j.injury.2015.04.032 · 2.46 Impact Factor
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    ABSTRACT: Previous studies have found that a higher volume of colorectal surgery was associated with lower mortality rates. While diverticulitis is an increasingly common condition, the effect of hospital volume on outcomes among diverticulitis patients is unknown. To evaluate the relationship between hospital volume and other factors on in-hospital mortality among patients admitted for diverticulitis. Data from the Nationwide Inpatient Sample (years 1993 to 2008) were analyzed to identify 822,865 patients representing 4,108,726 admissions for diverticulitis. Hospitals were divided into quartiles based on the volume of diverticulitis cases admitted over the study period, adjusted for years contributed to the dataset. Mortality according to hospital volume was modelled using logistic regression adjusting for age, sex, race, comorbidities, health care insurance, admission type, calendar year, colectomy, disease severity and clustering. Risk estimates were expressed as adjusted ORs with 95% CIs. Patients at high-volume hospitals were more likely to be admitted emergently, undergo surgical treatment and have more severe disease. In-hospital mortality was higher among the lowest quartile of hospital volume compared with the highest volume (OR 1.13 [95% CI 1.05 to 1.21]). In-hospital mortality was increased among patients admitted emergently (OR 2.58 [95% CI 2.40 to 2.78]) as well as those receiving surgical treatment (OR 3.60 [95% CI 3.42 to 3.78]). Diverticulitis patients admitted to hospitals with a low volume of diverticulitis cases had an increased risk for death compared with those admitted to high-volume centres.
    05/2015; 29(4):193-197.
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    ABSTRACT: Work-related injuries (WRIs) represent a significant economic and logistical burden to healthcare systems. All patients with severe WRIs (Injury Severity Score [ISS] ≥ 12) (1995 to 2013) were compared with patients with non-WRIs using standard methodology (P < .05). A total of 1,270 (8.5%) trauma admissions were for severe WRIs (mean age = 45 years, male:female ratio = 2.8:1, mean ISS = 22.7). Compared with patients with non-WRIs, WRI patients were younger, male, and had fewer comorbidities. Despite equivalent ISS, WRIs had a longer intensive care unit length of stay, length of mechanical ventilation, and number of surgical/operative procedures. Fewer patients with WRIs died in hospital and more were discharged home without support services. The acute care economic burden of WRIs was higher (because of intensive care unit and operating theatre, and physician compensation) (all analyses, P < .05). Patients with WRIs were younger, less comorbid, male, and had significantly higher utilization of acute care resources despite a similar ISS. Copyright © 2015 Elsevier Inc. All rights reserved.
    American journal of surgery 05/2015; DOI:10.1016/j.amjsurg.2015.01.023 · 2.41 Impact Factor
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    ABSTRACT: It has been suggested that pancreaticogastrostomy (PG) is a safer reconstruction than pancreaticojejunostomy (PJ), resulting in lower morbidity, including lower pancreatic leak rates and decreased postoperative mortality. We compared PJ and PG after pancreaticoduodenectomy (PD). A randomized clinical trial was designed. It was stopped with 50% accrual. Patients underwent either PG or PJ reconstruction. The primary outcome was the pancreatic fistula rate, and the secondary outcomes were overall morbidity and mortality. We used the Student t, Mann-Whitney U and χ;(2) tests for intention to treat analysis. The effect of randomization, American Society of Anesthesiologists score, soft pancreatic texture and use of pancreatic stent on overall complications and fistula rates was calculated using logistic regression. Our trial included 98 patients. The rate of pancreatic fistula formation was 18% in the PJ and 25% in the PG groups (p = 0.40). Postoperative complications occurred in 48% of patients in the PJ and 58% in the PG groups (p = 0.31). There were no significant predictors of overall complications in the multivariate analysis. Only soft pancreatic gland predicted the occurrence of pancreatic fistula (odds ratio 5.89, p = 0.003). There was no difference in the rates of pancreatic leak/fistula, overall complications or mortality between patients undergoing PG and and those undergoing PJ after PD.
    Canadian journal of surgery. Journal canadien de chirurgie 04/2015; 58(2):010014-10014. DOI:10.1503/cjs.010014 · 1.27 Impact Factor
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    ABSTRACT: The single best diagnostic and staging test for pancreatic cancer remains a contrast-enhanced computed tomography scan. It is frequently the only imaging test required before surgical resection for solid pancreatic lesions. Unfortunately, many patients undergo additional testing that often delays definitive care. A retrospective review of all patients with solid pancreatic lesions concerning for adenocarcinoma referred to a high volume Hepato-Pancreato-Biliary (HPB) service over 4 y (2008-2012) was completed. The time intervals between the initial imaging test and both consultation with HPB surgery and operative intervention, as well as the number of additional tests, were evaluated. Standard statistical methodology was used (P < 0.05). Among 130 patients with solid pancreatic lesions, the index imaging modality was ultrasonography and computed tomography for 75 (58%) and 52 (40%), respectively. Patients underwent a mean of 1.3 diagnostic tests after the index study and before consultation with HPB surgery (range: 0-5). There was a significant increase in time to HPB consultation and operative intervention with an increasing number of interval imaging tests. The mean time to surgical consultation and operation if 0 interval diagnostic tests were performed was 15.9 and 45.4 d, respectively. If four interval tests were conducted, the mean was 69.4 and 122.6 d, respectively. Sixty-two patients (48%) were initially referred to a nonsurgical service. The mean time to surgical consultation and operation if an intervening referral occurred was 36.6 and 66.8 d, respectively. This compares to 19.8 and 48.1 d, respectively, in cases of direct referral to an HPB surgeon. The mean number of diagnostic tests performed before HPB consultation if a nonsurgical referral occurred was 2.1 (versus 0.7 if direct HPB surgeon referral). Despite a relatively simple algorithm for the investigation of solid pancreatic lesions, considerable heterogeneity remains in how these patients are evaluated before referral to HPB surgery. As the number of investigations increases after the index imaging test, there is increasing delay to both surgical consultation and definitive intervention. Education is required to expedite care and mitigate excess diagnostic tests. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Surgical Research 04/2015; DOI:10.1016/j.jss.2015.04.026 · 2.12 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-789-S-790. DOI:10.1016/S0016-5085(15)32697-4 · 13.93 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-1180. DOI:10.1016/S0016-5085(15)34027-0 · 13.93 Impact Factor
  • Jean M Butte, Morad Hameed, Chad G Ball
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    ABSTRACT: Hepatopancreatobiliary (HPB) emergencies include an ample range of conditions with overlapping clinical presentations and diverse therapeutic options. The most common etiologies are related to cholelithiasis (acute cholecystitis, pancreatitis, and cholangitis) and non-traumatic injuries (common bile duct or duodenal). Although the true incidence of HPB emergencies is difficult to determine due to selection and reporting biases, a population-based report showed a decline in the global incidence of all severe complications of cholelithiasis, primarily based on a reduction in acute cholecystitis. Even though patients may present with overlapping symptoms, treatment options can be varied. The treatment of these conditions continues to evolve and patients may require endoscopic, surgical, and/or percutaneous techniques. Thus, it is essential that a multidisciplinary team of HPB surgeons, interventional gastroenterologists and radiologists are available on an as needed basis to the Acute Care Surgeon. This focused manuscript is a contemporary review of the literature surrounding HPB emergencies in the context of the acute care surgeon. The main aim of this review is to offer an update of the diagnosis and management of HPB issues in the acute care setting to improve the care of patients with potential HPB emergencies.
    World Journal of Emergency Surgery 03/2015; 10(1):13. DOI:10.1186/s13017-015-0004-y · 1.06 Impact Factor
  • Annals of Surgery 02/2015; DOI:10.1097/SLA.0000000000001146 · 7.19 Impact Factor
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    ABSTRACT: Objective: To determine whether the reported clinical presentation of tension pneumothorax differs between patients who are breathing unassisted versus receiving assisted ventilation. Background: Animal studies suggest that the pathophysiology and physical signs of tension pneumothorax differ by subject ventilatory status. Methods: We searched electronic databases through to October 15, 2013 for observational studies and case reports/series reporting clinical manifestations of tension pneumothorax. Two physicians independently extracted clinical manifestations reported at diagnosis. Results: We identified 5 cohort studies (n = 310 patients) and 156 case series/reports of 183 cases of tension pneumothorax (n = 86 breathing unassisted, n = 97 receiving assisted ventilation). Hypoxia was reported among 43 (50.0%) cases of tension pneumothorax who were breathing unassisted versus 89 (91.8%) receiving assisted ventilation (P < 0.001). Pulmonary dysfunction progressed to respiratory arrest in 9.3% of cases breathing unassisted. As compared to cases who were breathing unassisted, the adjusted odds of hypotension and cardiac arrest were 12.6 (95% confidence interval, 5.8–27.5) and 17.7 (95% confidence interval, 4.0–78.4) times higher among cases receiving assisted ventilation. One cohort study reported that none of the patients with tension pneumothorax who were breathing unassisted versus 39.6% of those receiving assisted ventilation presented without an arterial pulse. In contrast to cases breathing unassisted, the majority (70.4%) of those receiving assisted ventilation who experienced hypotension or cardiac arrest developed these signs within minutes of clinical presentation. Discussion: The reported clinical presentation of tension pneumothorax depends on the ventilatory status of the patient. This may have implications for improving the diagnosis and treatment of this life-threatening disorder.
    Annals of Surgery 01/2015; 261(6). DOI:10.1097/SLA.0000000000001073 · 7.19 Impact Factor
  • Journal of Trauma and Acute Care Surgery 01/2015; 78(6):1187-1196. DOI:10.1097/TA.0000000000000647 · 1.97 Impact Factor
  • C. G. Ball
    British Journal of Surgery 01/2015; 102(1). DOI:10.1002/bjs.9718 · 5.21 Impact Factor
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    ABSTRACT: To determine whether active negative pressure peritoneal therapy with the ABThera temporary abdominal closure device reduces systemic inflammation after abbreviated laparotomy. Excessive systemic inflammation after abdominal injury or intra-abdominal sepsis is associated with poor outcomes. We conducted a single-center, randomized controlled trial. Forty-five adults with abdominal injury (46.7%) or intra-abdominal sepsis (52.3%) were randomly allocated to the ABThera (n = 23) or Barker's vacuum pack (n = 22). On study days 1, 2, 3, 7, and 28, blood and peritoneal fluid were collected. The primary endpoint was the difference in the plasma concentration of interleukin-6 (IL-6) 24 and 48 hours after temporary abdominal closure application. There was a significantly lower peritoneal fluid drainage from the ABThera at 48 hours after randomization. Despite this, there was no difference in plasma concentration of IL-6 at baseline versus 24 (P = 0.52) or 48 hours (P = 0.82) between the groups. There was also no significant intergroup difference in the plasma concentrations of IL-1β, -8, -10, or -12 p70 or tumor necrosis factor α between these time points. The cumulative incidence of primary fascial closure at 90 days was similar between groups (hazard ratio, 1.6; 95% confidence interval, 0.82-3.0; P = 0.17). However, 90-day mortality was improved in the ABThera group (hazard ratio, 0.32; 95% confidence interval, 0.11-0.93; P = 0.04). This trial observed a survival difference between patients randomized to the ABThera versus Barker's vacuum pack that did not seem to be mediated by an improvement in peritoneal fluid drainage, fascial closure rates, or markers of systemic inflammation. identifier NCT01355094.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
    Annals of Surgery 12/2014; 262(1). DOI:10.1097/SLA.0000000000001095 · 7.19 Impact Factor
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    ABSTRACT: To evaluate the incidence, surgery, mortality, and readmission of upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD). Administrative databases identified all hospitalizations for UGIB secondary to PUD in Alberta, Canada from 2004 to 2010 (n = 7079) using the International Classification of Diseases Codes (ICD-10). A subset of the data was validated using endoscopy reports. Positive predictive value and sensitivity with 95% confidence intervals (CI) were calculated. Incidence of UGIB secondary to PUD was calculated. Logistic regression was used to evaluate surgery, in-hospital mortality, and 30-d readmission to hospital with recurrent UGIB secondary to PUD. Co-variants accounted for in our logistic regression model included: age, sex, area of residence (i.e., urban vs rural), number of Charlson comorbidities, presence of perforated PUD, undergoing upper endoscopy, year of admission, and interventional radiological attempt at controlling bleeding. A subgroup analysis (n = 6356) compared outcomes of patients with gastric ulcers to those with duodenal ulcers. Adjusted estimates are presented as odds ratios (OR) with 95%CI. The positive predictive value and sensitivity of ICD-10 coding for UGIB secondary to PUD were 85.2% (95%CI: 80.2%-90.2%) and 77.1% (95%CI: 69.1%-85.2%), respectively. The annual incidence between 2004 and 2010 ranged from 35.4 to 41.2 per 100000. Overall risk of surgery, in-hospital mortality, and 30-d readmission to hospital for UGIB secondary to PUD were 4.3%, 8.5%, and 4.7%, respectively. Interventional radiology to control bleeding was performed in 0.6% of patients and 76% of these patients avoided surgical intervention. Thirty-day readmission significantly increased from 3.1% in 2004 to 5.2% in 2010 (OR = 1.07; 95%CI: 1.01-1.14). Rural residents (OR rural vs urban: 2.35; 95%CI: 1.83-3.01) and older individuals (OR ≥ 65 vs < 65: 1.57; 95%CI: 1.21-2.04) were at higher odds of being readmitted to hospital. Patients with duodenal ulcers had higher odds of dying (OR = 1.27; 95%CI: 1.05-1.53), requiring surgery (OR = 1.73; 95%CI: 1.34-2.23), and being readmitted to hospital (OR = 1.54; 95%CI: 1.19-1.99) when compared to gastric ulcers. UGIB secondary to PUD, particularly duodenal ulcers, was associated with significant morbidity and mortality. Early readmissions increased over time and occurred more commonly in rural areas.
    World Journal of Gastroenterology 12/2014; 20(46):17568-77. DOI:10.3748/wjg.v20.i46.17568 · 2.43 Impact Factor
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    ABSTRACT: Ischemic colitis is a potentially life-threatening condition that can require colectomy for management. To assess independent predictors of mortality following colectomy for ischemic colitis using a nationally representative sample of hospitals in the United States.METHODS: The Nationwide Inpatient Sample was used to identify all patients with a primary diagnosis of acute vascular insufficiency of the colon (International Classification of Diseases, Ninth Revision codes 557.0 and 557.9) who underwent a colectomy between 1993 and 2008. Incidence and mortality are described; multivariate logistic regression analysis was performed to determine predictors of mortality. The incidence of colectomy for ischemic colitis was 1.43 cases (95% CI 1.40 cases to 1.47 cases) per 100,000. The incidence of colectomy for ischemic colitis increased by 3.1% per year (95% CI 2.3% to 3.9%) from 1993 to 2003, and stabilized thereafter. The postoperative mortality rate was 21.0% (95% CI 20.2% to 21.8%). After 1997, the mortality rate significantly decreased at an estimated annual rate of 4.5% (95% CI -6.3% to -2.7%). Mortality was associated with older age, 65 to 84 years (OR 5.45 [95% CI 2.91 to 10.22]) versus 18 to 34 years; health insurance, Medicaid (OR 1.69 [95% CI 1.29 to 2.21]) and Medicare (OR 1.33 [95% CI 1.12 to 1.58]) versus private health insurance; and comorbidities such as liver disease (OR 3.54 [95% CI 2.79 to 4.50]). Patients who underwent colonoscopy or sigmoidoscopy (OR 0.78 [95% CI 0.65 to 0.93]) had lower mortality. Colectomy for ischemic colitis was associated with considerable mortality. The explanation for the stable incidence and decreasing mortality rates observed in the latter part of the present study should be explored in future studies.
    Canadian journal of gastroenterology = Journal canadien de gastroenterologie 12/2014; 28(11):600-604. · 1.97 Impact Factor

Publication Stats

2k Citations
478.44 Total Impact Points


  • 2004–2015
    • The University of Calgary
      • • Department of Surgery
      • • Division of General Surgery
      Calgary, Alberta, Canada
  • 2013
    • The University of Tennessee Health Science Center
      • Division of Surgical Oncology
      Memphis, TN, United States
  • 2007–2013
    • Emory University
      • Department of Surgery
      Atlanta, Georgia, United States
  • 2012
    • Calgary Laboratory Services
      Calgary, Alberta, Canada
  • 2010–2011
    • Indiana University-Purdue University Indianapolis
      • Department of Surgery
      Indianapolis, Indiana, United States
    • Indiana University-Purdue University School of Medicine
      • Surgery
      Indianapolis, Indiana, United States
  • 2009
    • Northside Hospital
      St. Petersburg, Florida, United States
    • Emory Hospitals
      Atlanta, Georgia, United States
    • University of Alberta
      • Department of Public Health Sciences
      Edmonton, Alberta, Canada
  • 2006
    • Vancouver General Hospital
      Vancouver, British Columbia, Canada
  • 2005
    • Tom Baker Cancer Centre
      Calgary, Alberta, Canada
    • University of Toronto
      • Department of Surgery
      Toronto, Ontario, Canada