surgery researh day - university of manitoba...current and future applications of robotics and...

SURGERY RESEARCH DAY

Recognizing accomplishments in Research and Innovation in the Department of Surgery, University of Manitoba

January 17, 2018 Theatre A Basic Medical Sciences Bannatyne Campus

8:00 am—4:00 pm

SPEAKERS

Dr. James Drake Professor of Surgery,

University of Toronto

Head, Neurosurgery

The Hospital for Sick Children

Dr. Kazuhiro Yasufuku Deputy Head, Division of

Surgical Oncology

Director of Endoscopy

University Health Network

Associate Professor of Surgery,

University of Toronto

Annual Surgery Research Day 2018 i

Surgery Research Day 2018

Department of Surgery

RESEARCH DAY SPONSORS The Surgery Research Day 2018 Planning Committee gratefully recognizes

the contributions of the sponsors for the Annual Surgery Research Day.

Research Program:

Department of Surgery GFT Surgeons

The Wayne Beecroft Western Surgical Lectureship Fund Awards Dinner:

Thorlakson Chair in Surgical Research

American College of Surgeons—Manitoba Chapter

Department of Surgery GFT Surgeons

ACKNOWLEDGEMENTS

The Surgery Research Day 2018 Planning Committee greatly appreciates

the support from the Pan Am Clinic Foundation and Department of Surgery

Research Advisory Committee members in the planning of our Annual

Surgery Research Day 2018.

Annual Surgery Research Day 2018 ii

RESEARCH DAY 2018 PLANNING COMMITTEE

Dr Biniam Kidane, Co-Chair

Dr Demitre Serletis, Co-Chair

Dr Richard Keijzer, Thorlakson Chair in Surgical Research

Dr Rebecca Whitley, Resident Representative

Mary Brychka, Administrator

WELCOME MESSAGE

Dear Colleagues,

On behalf of the Planning Committee, it is with great pleasure that we welcome you to the Department of Surgery’s Annual Research Day, 2018.

Over the past 17 years, surgeons, residents, medical students and fellows have made major contributions to research, teaching and clinical practice in all of our surgical specialties, resulting in a positive impact on patient care and education. Today, we wish to recognize the extensive accomplishments in research and innovation achieved within our Department, and we seek to share and exchange these ideas in a collaborative, interdisciplinary research environment.

On behalf of the members of the Surgery Research Day 2018 Planning Committee, we would like to extend our thanks to all those who have submitted an abstract, to our sponsors and to those attending this exciting department-wide event.

We hope you find this day enriching, with new concepts to implement in your practice, teachings and future research aspirations.

Sincerely,

Dr Biniam Kidane Dr Demitre Serletis

Co-Chairs, Surgery Research Day 2018 Planning Committee

Annual Surgery Research Day 2018 iii

To navigate in the electronic version of the Research Day 2018 Program click the coloured typeface

TABLE OF CONTENTS

Research Day Sponsors ........................................................................... i

Acknowledgements ................................................................................ i

Welcome Message .................................................................................. ii

Research Day 2018 Planning Committee ................................................ ii

Speakers

Dr James Drake ................................................................................... iv

Dr Kazuhiro Yasufuku ......................................................................... v

General Information

Research Day 2018 Objectives .......................................................... vi

Judges ................................................................................................ vi

Conflict of Interest Disclosure ............................................................ vii

Continuing Professional Development .............................................. vii

E-Program Navigation ........................................................................ vii

Program

Morning ............................................................................................. viii

Afternoon ........................................................................................... ix

Abstracts

Plenary (9:20 —11:00) ........................................................................ 1-10

Brief (11:15—12:00) .......................................................................... 11-20

Plenary (2:15—3:05) .......................................................................... 21-25

Brief (3:20—4:00) .............................................................................. 26-35

Evaluation & Certificate of Attendance ................................................... 36

History of Surgery Research Days ............................................................ 37

Surgery Research Day 2017 Presentation Award Winners ...................... 38

Presenter’s Abstract Index ...................................................................... 39

Annual Surgery Research Day 2018 iv

Head, Neurosurgery The Hospital for Sick Children

Senior Associate Scientist Neurosciences & Mental Health

Director, The Centre for Image-Guided Innovation and Therapeutic Intervention

Department of Surgery University of Toronto

Dr. James Drake is a Professor of Surgery, Division Chief of Pediatric

Neurosurgery at the Hospital for Sick Children and holds the Harold Hoffman

Shoppers Drug Mart Chair. He is a Senior Associate Scientist in the Sickkids

Research Institute, and leads the Centre of Image Guided Innovation and

Therapeutic Intervention (CIGITI) is the Co-lead of the Centre of Excellence in

Image Guided Care. He is also the Co-Director of the Centre of Mathematical

Medicine at the Fields Institute at the University of Toronto. He is president

elect of the American Society of Pediatric Neurosurgery and a director of the

American Board of Pediatric Neurosurgery, and the Accreditation Council of

Pediatric Neurosurgery Fellowships.

Dr. Drake’s primary research and clinical interests relate to engineering

applications to neurosurgery including hydrocephalus, image guided surgery

and robotics. This encompasses the main themes of CIGITI which is

broadened to include applications of imaging, robotics, and simulation for all

pediatric surgical disciplines. His clinical interests relate to the investigation

and management of hydrocephalus including the use of endoscopy, image

guided surgery for brain tumours and epilepsy, and the management of

complex spinal disorders.

DR. JAMES DRAKE

Annual Surgery Research Day 2018 v

Deputy Head, Division of Surgical Oncology Director of Endoscopy, University Health Network Director, Interventional Thoracic Surgery Program

Associate Professor of Surgery University of Toronto

Division of Thoracic Surgery Toronto General Hospital

University Health Network

Dr. Kazuhiro Yasufuku is currently Associate Professor of Surgery at University of Toronto, Division of Thoracic Surgery, Toronto General Hospital, University Health Network (UHN). He is also the Director of the Interventional Thoracic Surgery Program at the UHN. He graduated from Chiba University School of Medicine, Chiba, Japan in 1992. He pursued his General Surgery Training and Thoracic Surgery Training at Chiba University. He moved to Toronto in 2008 where he currently serves as the Deputy Head of Surgical Oncology and Director of Endoscopy at UHN. Dr. Yasufuku has been a leader in the field of minimally invasive diagnostics and therapeutics for thoracic malignancy. He co-developed the Convex Probe Endobronchial Ultrasound in collaboration with Olympus and has successfully introduced its clinical application in Thoracic Oncology. His clinical interests include minimally invasive diagnostic and surgery for thoracic oncology and lung transplantation. He leads the UHN Thoracic Robotic Surgery Program. He is a Scientist at the Latner Thoracic Surgery Research Laboratory Institute and Affiliated Faculty of Guided Therapeutics at the Techna Institute. His research interests include development of new technology in early diagnosis and ultra-minimally invasive thoracic surgery, translational research in thoracic image guided therapeutics, nanotenchnology-enabled image-guided intervention for lung cancer, and molecular profiling of advanced stage lung cancer by minimally invasive procedures. He has numerous ongoing clinical trials looking at the application of new technology in Thoracic Surgery and Interventional Pulmonology. Dr. Yasufuku is very active in International Societies related to Thoracic Surgery and Interventional Pulmonology. He serves as the Chair of the Interventional Chest/Diagnostics Procedure Network Committee for CHEST. He is also Associate Editor for 2 peer-reviewed journals.

DR. KAZUHIRO YASUFUKU

Annual Surgery Research Day 2018 vi

JUDGES

Dr James Drake

Head, Neurosurgery The Hospital for Sick Children Department of Surgery, University of Toronto

Dr Kazuhiro Yasufuku

Deputy Head, Division of Surgical Oncology Associate Professor of Surgery Department of Surgery University of Toronto

Dr Rebecca Whitley

MSc Graduate Student, General Surgery Resident

Department of Surgery, University of Manitoba

RESEARCH DAY 2018 OBJECTIVES

At the end of the Department of Surgery Annual Research Day, participants will be able to:

Present and evaluate current clinical, educational and basic science research being conducted in the Department of Surgery; and learn and discuss innovative advanced techniques and technology in a collaborative surgery research environment.

Become familiar with the concept of a hospital-based surgical innovation centre driven by collaborating surgeons and engineers; learn about the current and future applications of robotics and dexterous tools in a constrained work spaces, especially pediatrics; and describe the creation, use and evaluation of simulation models of training.

Understand the process of translation of new techniques and technologies into clinical practice; describe the concept of image guided thoracic surgery; and look into the future of advance transbronchial interventions for lung cancer.

Annual Surgery Research Day 2018 vii

CONFLICT OF INTEREST DISCLOSURE

Before each presentation, speakers will disclose on their first slide any

significant relationships that may be a perceived or apparent conflict of

interest to the subject of the proposed CME/CPD activity.

Each member of the Research Day 2018 Planning Committee were asked to

disclose any significant relationships with the manufacturer of any

commercial product that may have a direct or indirect conflict of interest in

the program content. All members reported no conflicts.

CONTINUING PROFESSIONAL DEVELOPMENT

This event is an Accredited Group Learning Activity (Section 1) as defined by

the Maintenance of Certification Program of The Royal College of Physicians

and Surgeons of Canada and approved by the CPD Medicine Program,

University of Manitoba for a maximum of 6.5 credits.

Participants should only claim credit for the actual number of hours

attended.

The University of Manitoba CPD Medicine Program is fully accredited by the

Committee on Accreditation of Continuing Medical Education (CACME).

E-PROGRAM NAVIGATION

For quick navigation— click the colour typeface located on the various pages

within the Program.

You will return to the Table of Contents by clicking the footer at the bottom

of each page.

Annual Surgery Research Day 2018 viii

7:45 LIGHT BREAKFAST Joe Doupe Atrium—Basic Medical Sciences

8:00 DR JAMES DRAKE, UNIVERSITY OF TORONTO The Centre of Image Guided Innovation and Therapeutic Intervention (CIGITI) - Engineering Surgical Technology & Training

Introduction—Dr Demitre Serletis (Co-Chair, Research Day 20178Planning Committee)

9:15 OPENING REMARKS - Dr Biniam Kidane (Co-Chair, Research Day 2018 Planning Committee)

PLENARY SESSION Moderator: Dr Ramzi Helewa (General Surgery)

Time Abstract Title Presenter

9:20 Effect of earlier extubation on post-operative delirium after coronary artery bypass grafting: A retrospective cohort study

Ricky Muller Moran* Cardiac Surgery

9:32 Profiling circular RNAs in normal and nitrofen-induced hypoplastic lung development due to congenital diaphragmatic hernia (CDH)

Shana Kahnamoui*

Pediatric Surgery

9:44 Does hospital volume impact the risk of local recurrence of rectal cancer? A retrospective cohort study

Megan Delisle* General Surgery

9:56 Predictors of mortality in patients with necrotizing fasciitis: A literature review and multivariate analysis

Lindsey Kjaldgaard* Plastic Surgery

10:08 Patient-specific alterations in CO2 cerebrovascular responsiveness in sub-acute sports-related concussion

Michael Ellis Neurosurgery

10:20 Is there oncologic benefit to wider margins in cutaneous melanoma of the head and neck?

Benjamin Turner* Head & Neck Oncology

10:32 Increasing body mass index and hours of sleep lost are associated with a reduction in testosterone levels in US adults males: Results from the National Health & Nutrition Survey

Premal Patel* Urology

10:44 Arthroscopic bankart repair with and without arthroscopic infraspinatus remplissage in anterior shoulder instability with Hill-Sachs defect: Randomized controlled study

Peter MacDonald Orthopedic Surgery

11:00 COFFEE BREAK

BRIEF SESSION Moderator: Dr Perry Dhaliwal (Neurosurgery)


11:15 The use of viscoelastic hemostatic testing in cardiac surgery patients: A systematic review and meta-analysis

Carly Lodewyks* Cardiac Surgery

11:20 Program director consensus on the status of flexible endoscopy training in general surgery residency programs in Canada

Courtney Chernos* General Surgery

11:25 Transcranial focused ultrasound neuromodulation in a rodent model Anton Fomenko* Neurosurgery

11:30 Maternal substance use and mortality rates in children with gastroschisis Matthew Levesque* Pediatric Surgery

11:35 Metabolic needs of patients with necrotizing faciitis: A case series Chris Nguyen* Plastic Surgery

11:40 Active surveillance for low and intermediate risk prostate cancer: An analysis of pathologic outcomes among patients treated with radical prostatectomy

Justin Oake* Urology

11:45 High-frequency vs. conventional mechanical ventilation at the time of CDH repair is associated with, but does not contribute to, higher morality and BPD rates: A case-control study

Gabrielle Derraugh* Pediatric Surgery

11:50 Early in vivo wear measurement of 98 total knee replacement patients using radiostereometric analysis

Thomas Turgeon Orthopedic Surgery

PROGRAM — MORNING

Annual Surgery Research Day 2018 ix

12:00 LUNCH BUFFET Joe Doupe Atrium—Basic Medical Sciences

1:30 DR KAZUHIRO YASUFUKU, UNIVERSITY OF TORONTO Innovation in Thoracic Interventions for Lung Cancer—Translation from Bench to Bedside

Introduction—Dr Biniam Kidane (Research Day 2018 Planning Committee)

PLENARY SESSION Moderator: Dr Mohammad Zarrabian (Orthopedic Surgery)


2:15 Advancement in the quality of operative documentation: A systematic review and meta-analysis of synoptic versus narrative operative reporting

Shannon Stogryn* General Surgery

2:27 The relationship between injury to surgery time and the incidence of secondary joint injury in an ACL injured population: A randomized control trial

Gabriel Larose* Orthopedic Surgery

2:39 Development of risk calculator to predict non-institutionalized survival in patients with prolonged length of stay after cardiac surgery

Rizwan Manji Cardiac Surgery

2:51 Natural talent: Myth or reality? The ability to learn laparoscopic surgery Giuseppe Retrosi Pediatric Surgery

3:05 COFFEE BREAK

BRIEF SESSION Moderator: Dr Michael Yamashita (Cardiac Surgery)


3:20 A systematic review and meta-analysis of the impact of preoperative sleep disturbance on post cardiac surgery outcomes

Aaron Martin* Cardiac Surgery

3:25 Repair of complete distal biceps tendon rupture with the endo-button technique: A retrospective study

Tiffany Huynh* Orthopedic Surgery

3:30 Epithelial cell marker cadherin-26 expression is lower in nitrofen-induced abnormal lung development in congenital diaphragmatic hernia

Lojine Ayoub* Pediatric Surgery

3:35 Long-term outcome of geriatric patients managed non-operatively for choledocolithiasis

Kaitlin Edwards* General Surgery

3:40 A retrospective study of SRS for ARUBA eligible BAVMs at a single centre Lucas Vasas* Neurosurgery

3:45 Identifying barriers for successful discharge following cardiac surgery Mackenzie King* Cardiac Surgery

3:50 Factors associated with an increased risk of developing a post-operative infection following spine surgery

Mark Xu* Orthopedic Surgery

3:55 The role of endothenlin-receptor A in the development of pulmonary hypertension of the miR-200b knockout mouse

Chelsea Day* Pediatric Surgery

4:00 CLOSING REMARKS - Dr Demitre Serletis (Co-Chair, Research Day 2018 Planning Committee)

SURGERY RESEARCH DAY AWARDS DINNER Qualico Family Centre | 55 Pavilion Crescent | Assiniboine Park Conservancy Cocktails—6:30PM (cash bar)

* Speaker eligible for a presentation award

PROGRAM — AFTERNOON

Annual Surgery Research Day 2018 1

9:20—11:00 PLENARY SESSION Moderator: Dr Ramzi Helewa Section of General Surgery

Time Abstract

9:20 Effect of earlier extubation on post-operative delirium after coronary artery bypass grafting: A retrospective cohort study Ricky Muller Moran1, Duncan Maguire3, Douglas Maguire3, Stephen Kowalski3, Eric Jacobsohn3, Scott Mackenzie3, Hilary P. Grocott3, Rakesh Arora2

1 Cardiac Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Cardiac Surgery, Department of Surgery, University of Manitoba 3 Department of Anesthesia & Perioperative Medicine, University of Manitoba

9:32 Profiling circular RNAs in normal and nitrofen-induced hypoplastic lung development due to congenital diaphragmatic hernia (CDH) Shana Kahnamoui1,2,3, Naghmeh Khoshgoo,1,2,3, Thomas Mahood1,3, Daywin Patel1,3, Richard Keijzer1,2,3

1 Department of Physiology and Pathophysiology, University of Manitoba 2 Department of Surgery, University of Manitoba 3 Children’s Hospital Research Institute of Manitoba, University of Manitoba

9:44 Does hospital volume impact the risk of local recurrence of rectal cancer? A retrospective cohort study Megan Delisle1, Ramzi Helewa2, David Hochman2, Andrew McKay2

1 General Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of General Surgery, Department of Surgery, University of Manitoba

9:56 Predictors of mortality in patients with necrotizing fasciitis: A literature review and multivariate analysis Lindsey Kjaldgaard1, Nora Cristall2, Justin Gawaziuk3, George Zhanel3, Sarvesh Logsetty2,4

1 BSc Med Research Program, Max Rady College of Medicine Program, Rady Faculty of Health Sciences, University of Manitoba 2 Manitoba Firefighters’ Burn Unit, Sections of General Surgery & Plastic Surgery, Department of Surgery, University of Manitoba 3 Department of Medical Microbiology & Infectious Diseases, University of Manitoba 4 Department of Surgery, University of Manitoba


Time Abstract

10:08 Patient-specific alterations in CO2 cerebrovascular responsiveness in sub-acute sports-related concussion Michael J. Ellis, Lawrence N. Ryner, Patrick J. McDonald, Marc P. Morissette, Philip Pries, Marco Essig, David J. Mikulis, James Duffin, Joseph A. Fisher, W. Alan C. Mutch Section of Neurosurgery, Department of Surgery, University of Manitoba

10:20 Is there oncologic benefit to wider margins in cutaneous melanoma of the head and neck? Anupam Das1, Kristin Buchko2, Benjamin Turner1, Alok Pathak1

1 Head & Neck Surgical Oncology Fellowship, Department of Surgery, University of Manitoba 2 Rady Faculty of Health Sciences, University of Manitoba

10:32 Increasing body mass index and hours of sleep lost are associated with a reduction in testosterone levels in US adult males: Results from the National Health and Nutrition Survey Premal Patel1, Taylor Kohn2, Ranjith Ramasamy3

1 Urology Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Baylor College of Medicine, Houston, Texas, USA 3 Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA

10:44 Arthroscopic bankart repair with and without arthroscopic infraspinatus remplissage in anterior shoulder instability with Hills-Sachs defect: Randomized controlled trial Peter MacDonald1, Jason Old1, Randhir Mascarenhas2, Sharad Prabhaker3, Sheila McRae3, Jonathan Marsh1, James Dubberley1, Gregory Stranges1, Jeff Leiter3, Peter Lapner4

1 Section of Orthopedic Surgery, Department of Surgery, University of Manitoba 2 Orthopedic Surgery, University of Texas, Austin, Texas, USA 3 Pan Am Clinic, Department of Surgery, University of Manitoba 4 Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada

9:20—11:00 PLENARY SESSION Moderator: Dr Ramzi Helewa Section of General Surgery


Effect of earlier extubation on post-operative delirium after coronary artery bypass grafting: A retrospective cohort study

Ricky Muller Moran1, Duncan Maguire3, Douglas Maguire3, Stephen Kowalski3, Eric Jacobsohn3, Scott Mackenzie3, Hilary P. Grocott3, Rakesh Arora2 1 Cardiac Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Cardiac Surgery, Department of Surgery, University of Manitoba 3 Department of Anesthesia & Perioperative Medicine, University of Manitoba

Introduction

Modern cardiac anesthesia strategies seek to improve outcomes by achieving earlier

extubation after cardiac surgery. Previous reports have described benefits of early

extubation on length of stay (LOS) and complication rates after cardiac surgery, but its

impact on the occurrence of postoperative delirium (PoD) remains unclear. We sought

to determine the effect of earlier extubation on PoD rates after coronary artery bypass

grafting (CABG).

Methods

A single-centre retrospective review of all consecutive patients undergoing isolated

CABG from January 1, 2010 to December 31, 2015 was conducted. Baseline

demographics, preoperative comorbidities, intraoperative data and postoperative

data including major adverse events (need for dialysis, pneumonia, sepsis, myocardial

infarction, stroke and death) were collected for all patients. A logistic regression was

performed with a priori adjustments made for age, sex, and EuroSCORE II risk in order

to investigate the association between earlier extubation and PoD. Analysis was

limited to extubation within the first 24 hours of ICU admission in order to exclude

relatively sicker, likely non-candidates for early extubation.

Results

We identified 2561 eligible patients. PoD occurred in 13.9% (n = 357) of the cohort.

Duration of postoperative intubation was associated with a higher PoD incidence

following adjustment (hourly odds ratio 1.05; 95% CI, 1.03–1.07; P < 0.001). This effect

was pronounced in patients extubated after 12-hours (hourly odds ratio 1.12; 95% CI

1.05 – 1.19; P < 0.001). Earlier extubation was associated with reductions in hospital

LOS, ICU LOS, and risk of major adverse events.

Conclusion

Our findings suggest that the risk of PoD increases for every hour that a patient is kept

intubated in the ICU. This study provides the basis for consideration of the

appropriate selection of earlier extubation to minimize PoD in the cardiac surgery

patient.


Profiling circular RNAs in normal and nitrofen-induced hypoplastic lung development due to congenital diaphragmatic hernia (CDH)

Shana Kahnamoui1,2,3, Naghmeh Khoshgoo,1,2,3, Thomas Mahood1,3, Daywin Patel1,3, Richard Keijzer1,2,3

1 Department of Physiology and Pathophysiology, University of Manitoba 2 Department of Surgery, University of Manitoba 3 Children’s Hospital Research Institute of Manitoba, University of Manitoba

Introduction

Circular RNAs (circRNAs) have recently been identified as endogenous non-coding

RNAs that are evolutionarily conserved in eukaryotic cells. CircRNAs have covalent

closed loop structures formed by back-splicing events. Compared with linear RNAs,

circRNAs are more stable, more abundant and specific. CircRNAs regulate gene

expression at transcriptional and post-transcriptional levels by serving as microRNA

sponges and interact with long-non-coding RNAs, mRNA, or proteins. However, the

role of circRNAs in lung development is currently undefined. We aimed to identify

circRNAs in normal lung development and nitrofen-induced hypoplastic lung

development due to congenital diaphragmatic hernia (CDH).

Methods

We induced abnormal lung development and CDH by gavaging nitrofen to dams on

embryonic day (E) 9. We collected control and nitrofen-induced hypoplastic lung

tissues at E21 and isolated total RNA. We performed an Arraystar rat circRNAs

Microarray, version 2 (Arraystar Inc., Rockville, MD, USA) for to globally profile the

RNA samples. In-depth statistical data analysis was performed to identify differentially

expressed circRNAs. Pathway analysis was inferred using KEGG and Ingenuity Pathway

Analysis (Qiagen) to elucidate high-level circRNAs roles.

Results

The results of hierarchical clustering show distinct circRNAs expression profiling

among the samples. In total 18 circRNAs were altered, including 89 up-regulated and

95 down-regulated circRNAs, in nitrofen-induced hypoplastic lungs compared to

control lungs (FC>=2, p<=0.05). Of interest, mmu_circRNA_31436 (FC=9.8, p=0.02) and

rno_circRNA_007475 (FC=12.3, p=0.04) were the most prominent up and down

regulated, respectively. We are currently validating these “hits” using in situ

hybridization and RT-qPCR.

Conclusion

This discovery can built a model, capacity and foundation for future studies and

prenatal transplacental therapies.


Does hospital volume impact the risk of local recurrence of rectal cancer? A retrospective cohort study

Megan Delisle1, Ramzi Helewa2, David Hochman2, Andrew McKay2


Introduction

Our objective was to compare the risk of local recurrence in patients who underwent

rectal cancer surgery in Manitoba between 2004-2014 in high versus low volume

centers.

Methods

A retrospective cohort study was conducted using data collected from the Manitoba

Cancer Registry and chart reviews. All patients with stage II or III rectal cancer who

underwent curative resection were included. High volume centers were defined as

those performing greater than the median number of cases in the study period.

Baseline characteristics were compared using chi squared and t-test analyses. A

univariable competing risk regression model with death as the competing risk was

used to compare the risk of local recurrence. A multivariable model was used to

control for age, collaborative stage, geographic area at diagnosis, neoadjuvant/

adjuvant therapy, margin status and number of positive lymph nodes.

Results

A total of 1,192 patients diagnosed with stage II or III underwent curative resection for

rectal cancer during the study period. The overall incidence of local recurrence was

9.8% (n=116). Four of the 18 centers were considered high volume and together

performed 69.4% of the total operations over the study (n=828). Patients who

underwent surgery in low volume centers were significantly less likely to have a

negative resection margin, >12 lymph nodes harvested and neoadjuvant therapy. In

the univariable competing risk analysis, patients receiving surgery in high volume

centers had 34% less risk of local recurrence compared to low volume centers (SHR

0.64, 95% CI=0.44-0.95, p=0.025). High versus low volume centers remained a

significant predictor of local recurrence in the multivariable model (SHR 0.64, 95%

CI=0.43-0.97, p=0.034).

Conclusion

Our study demonstrates there is a significant difference in local recurrence rates

between high and low volume centers. These findings strengthen the practice of

creating rectal cancer surgery centers of excellence.


Predictors of mortality in patients with necrotizing fasciitis: A literature review and multivariate analysis

Lindsey Kjaldgaard1, Nora Cristall2, Justin Gawaziuk3, George Zhanel3, Sarvesh Logsetty2,4

1 BSc Med Research Program, Max Rady College of Medicine Program, Rady Faculty of Health Sciences, University of Manitoba 2 Manitoba Firefighters’ Burn Unit, Sections of General Surgery & Plastic Surgery, Department of Surgery, University of Manitoba 3 Department of Medical Microbiology & Infectious Diseases, University of Manitoba 4 Department of Surgery, University of Manitoba

Introduction

Necrotizing fasciitis (NF) is a life-threatening infectious disease that can result in

significant morbidity and mortality. Previous work has identified older age, diabetes

mellitus, renal impairment, cardiovascular disease, cirrhosis, low hemoglobin, lower

platelets, elevated creatinine, admission to ICU and hospital length of stay. The

objective of this study is to further examine the relationship of patient factors in NF

mortality.

Methods

This retrospective review examined patients ≥ 18 years old diagnosed with NF at one

of the two regional referral centres from 2004-2016 in one province. The following

was examined: demographics, comorbidities, laboratory values and length of stay.

Results

321 patients satisfied the inclusion criteria: 278 survived and were discharged, 43 died

in hospital. Using multivariate analysis, age >60, elevated creatinine and presence of

Group A Beta-Hemolytic Streptococcuc spp. (GABS) infection were significant

predictors for mortality in NF patients.

Conclusions

Multiple factors were associated with mortality in NF. The strongest association with

mortality in multivariate analysis was age > 60, elevated creatinine and presence of

GABS infection.


Patient-specific alterations in CO2 cerebrovascular responsiveness in sub-acute sports-related concussion

Michael J. Ellis, Lawrence N. Ryner, Patrick J. McDonald, Marc P. Morissette, Philip Pries, Marco Essig, David J. Mikulis, James Duffin, Joseph A. Fisher, W. Alan C. Mutch Section of Neurosurgery, Department of Surgery, University of Manitoba

Introduction

Preliminary studies suggest sports-related concussion (SRC) is associated with

alterations in cerebral blood flow (CBF) regulation. Here, we use advanced magnetic

resonance imaging (MRI) techniques to measure CBF and cerebrovascular

responsiveness (CVR) in individual SRC patients and healthy control subjects.

Methods

Fifteen SRC patients (mean age=16.3, range 14-20 years) and 27 healthy control

subjects (mean age=17.6, range 13-21 years) underwent anatomical MRI, pseudo-

continuous arterial spin labeling (pCASL) MRI and model-based prospective end-tidal

targeting (MPET) of CO2 during blood oxygenation level-dependent (BOLD) MRI.

Group differences in global mean resting cerebral blood flow (CBF) were examined.

Voxel-by-voxel group and individual differences in regional CVR were examined using

statistical parametric mapping (SPM). Leave-one-out receiver operating characteristic

curve analysis was used to evaluate the utility of brain MRI CO2 stress testing

biomarkers to correctly discriminate between SRC patients and healthy control

subjects.

Results

All studies were tolerated with no complications. Traumatic structural findings were

identified in one SRC patient. No significant group differences in global mean resting

CBF were observed. There were no significant differences in the CO2 stimulus and O2

targeting during BOLD MRI. Significant group and patient-specific differences in CVR

were observed with SRC patients demonstrating a predominant pattern of increased

CVR. Leave-one-out ROC analysis for voxels demonstrating a significant increase in

CVR was found to reliably discriminate between SRC patients and healthy control

subjects (AUC of 0.879, p=0.0001). The optimal cut-off for increased CVR declarative

for SRC was 1899 voxels resulting in a sensitivity of 0.867 and a specificity of 0.778 for

this specific ROC analysis. There was no correlation between abnormal voxel counts

and PCSS scores among SRC patients.

Conclusions

Sports-related concussion is associated with alterations in CVR that can be reliably

detected by brain MRI CO2 stress testing in individual patients.


Is there oncologic benefit to wider margins in cutaneous melanoma of the head and neck?

Anupam Das1, Kristin Buchko2, Benjamin Turner1, Alok Pathak1

1 Head & Neck Surgical Oncology Fellowship, Department of Surgery, University of Manitoba 2 Rady Faculty of Health Sciences, University of Manitoba

Introduction

Proximity to critical functional and cosmetic structures limits the width of margins in

the excision of cutaneous melanoma of the head and neck (HNCM). We analyzed the

effect of margins of excision on the oncological outcome in a population-based cohort

of HNCM.

Methods

All cases of HNCM registered in the Manitoba Cancer Registry from Jan. 1, 1970 to

Dec. 31, 2012 were identified. Patient and tumour parameters and oncological status

on July 1, 2016 were collected. Cause-specific survival (CSS) and disease-free survival

(DFS) were calculated using the Kaplan–Meier method and compared with a log-rank

test. Impact of margins on disease-specific survival (DSS) in patients with intermediate

thickness tumours (T2/T3) with no evidence of nodal or distant metastases was

determined by multivariable analysis using SPSS version 24.0.

Results

745 patients were identified, 306 (41.1%) women and 439 (58.9%) men. Mean age

was 67 ± 17.9 years. Stage was: I in 381 (51.1%), II in 202 (27.1%), III in 56 (7.5%) and

IV in 13 (1.7%). Staging was impossible in 93 (12.5%). At 5 year follow-up, CSS was

83.5% and DFS was 69.3%. In intermediate-thickness melanoma, T stage, age and sex

had no impact on recurrence. Negative margins had an independent influence on CSS

(p= 0.007). The distance of the margin from the primary tumour had no influence on

CSS.

Conclusion

The distance of margin from the primary tumour had no significant influence on the

risk of death from HNCM.


Increasing body mass index and hours of sleep lost are associated with a reduction in testosterone levels in US adult males: Results from the National Health and Nutrition Survey

Premal Patel1, Taylor Kohn2, Ranjith Ramasamy3 1 Urology Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Baylor College of Medicine, Houston, Texas, USA 3 Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA

Introduction

Testosterone deficiency has been linked to several adverse health outcomes –

including cardiovascular disease, erectile dysfunction, and metabolic syndrome.

Recent data has suggested that abnormal sleep quality may result in lower

testosterone levels. Using the 2011-2012 National Health and Nutrition Surveys

(NHANES) we assess the effect of self-reported sleep patterns on serum testosterone

while controlling for physical activity levels, co-morbidities, and baseline

demographics.

Methods

NHANES is a national cross-sectional survey research program designed to assess the

health and nutritional status of adults and children in the United States. Using the

2011-2012 NHANES dataset, we extracted serum testosterone levels, sleep durations,

physical activity, demographic and co-morbidities for men aged 16 years and older.

Uni-variate and multi-variate linear regression were used to estimate the association

with serum testosterone.

Results

During the NHANES 2011-2012, a total of 9,756 individuals were included and of

those, 2,672 (27%) were males 16 years and older who had serum testosterone levels

drawn. On multi-variate logistic regression, we found serum testosterone decreased

by 6.376 ng/dL per hour loss of sleep (p = 0.0288) and 2.147 ng/dL per unit of body

mass index (BMI) increase (p = 1.03 x 10-6). Physical activity levels and prior co-

morbidities (i.e. coronary artery disease, stroke, prior myocardial infarction, and

diagnosis of malignancy) were associated with serum testosterone on uni-variate

linear regression; however, these variables were not found to be significant on multi-

variate linear regression.

Conclusions

Among men aged 16-80 in the United States, we found serum testosterone decreased

with a reduction in number of hours slept as well as increasing BMI.


Arthroscopic bankart repair with and without arthroscopic infraspinatus remplissage in anterior shoulder instability with Hills-Sachs defect: Randomized controlled trial

Peter MacDonald1, Jason Old1, Randhir Mascarenhas2, Sharad Prabhaker3, Sheila McRae3, Jonathan Marsh1, James Dubberley1, Gregory Stranges1, Jeff Leiter3, Peter Lapner4 1 Section of Orthopedic Surgery, Department of Surgery, University of Manitoba 2 Orthopedic Surgery, University of Texas, Austin, Texas, USA 3 Pan Am Clinic, Department of Surgery, University of Manitoba 4 Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada

Introduction

The purpose of this prospective, randomized, double blinded controlled trial was to

compare subjective outcomes and objective clinical results between arthroscopic

Bankart repair with and without arthroscopic infraspinatus remplissage in patients

with anterior shoulder instability with a Hill-Sachs lesion.

Methods

A hundred and four patients with a confirmed Hill Sach’s lesion were randomized

intraoperatively after confirming an engaging Hill Sach’s lesion to either undergo

arthroscopic infraspinatus remplissage or no remplissage during arthroscopic Bankart

repair. The primary outcome measure was the Western Ontario Shoulder Instability

score (WOSI). Secondary outcomes included the Simple Shoulder Test (SST), American

Shoulder and Elbow Society assessment of shoulder function (ASES), range of motion,

and redislocation rates, assessed at pre-, 3-, 6-, 12-, and 24-months post-operative.

Results

There were 53 patients randomized to the remplissage group (REMP) and 52 patients

in the no remplissage group (NO REMP) while undergoing arthroscopic Bankart repair.

The groups were comparable with regards to age, weight and height and sex. Both

groups demonstrated a similar improvement in all function scores over time with no

difference between the groups (collection of data to 24-months post-operative is

ongoing until 2019). WOSI improved in REMP from a mean (SD) of 43.1(17.5)

preoperatively ty to 81.1(14.9) postoperatively at 12 months and from 43.0 (21.7) to

79.1 (19.8) in NO REMP. Similarly the ASES and SST scores followed a similar trend.

There were no differences between groups in ROM. There was no statistically

significant difference in redislocations between the two groups with 2/53

redislocations in REMP versus 6/52 redislocations in NO REMP.

Conclusion

There is no difference in functional outcome scores and redislocation rates between

remplissage and no remplissage for an engaging Hill Sach's lesion with arthroscopic

Bankart stabilization.


11:15—12:00 BRIEF SESSION Moderator: Dr Perry Dhaliwal Section of Neurosurgery

Time Abstract

11:15 The use of viscoelastic hemostatic testing in cardiac surgery patients: A systematic review and meta-analysis Carly Lodewyks1, Jeffrey Heinrichs2, Hilary Grocott3

1 Cardiac Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Department of Anesthesia & Perioperative Medicine, University of Manitoba

11:20 Program director consensus on the status of flexible endoscopy training in general surgery residency programs in Canada Megan Delisle1, Courtney Chernos1, Jason Park2, Krista Hardy2, Ashley Vergis3


11:25 Transcranial focused ultrasound neuromodulation in a rodent model Anton Fomenko1, Andres Lozano2 1 Neurosurgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Institute of Medical Science, University of Toronto

11:30 Maternal substance use and mortality rates in children with gastroschisis Matthew Levesque1, Melanie Morris2, Suyin Lum Min2, Richard Keijzer2

1 Undergraduate, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Pediatric Surgery, Department of Surgery, University of Manitoba


11:15—12:00 BRIEF SESSION Moderator: Dr Perry Dhaliwal Section of Neurosurgery

Time Abstract

11:35 Metabolic needs of patients with necrotizing fasciitis: A case series Chris Nguyen1, N. Coutris2, Justin Gawaziuk2, Nora Cristall2, Sarvesh Logsetty3

Plastic Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Manitoba Firefighters’ Burn Unit, Health Sciences Centre, Winnipeg, Manitoba 3 Section of Plastic Surgery, Department of Surgery, University of Manitoba

11:40 Active surveillance for low and intermediate risk prostate cancer: An analysis of pathologic outcomes among patients treated with radical prostatectomy Premal Patel1, Jeff W. Saranchuk2, Darrel E. Drachenberg2, Jasmir G. Nayak2, Justin Oake1

1Urology Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Urology, Department of Surgery, University of Manitoba

11:45 High-frequency vs. conventional mechanical ventilation at the time of CDH repair is associated with, but does not contribute to, higher mortality and BPD rates—A case-control study Gabrielle Derraugh1, Matthew Levesque1, Suyin Lum Min2, Daryl Schantz3, Melanie Morris2, John Baier 3, Molly Seshia3, Richard Keijzer2

1 Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Pediatric Surgery, Department of Surgery, University of Manitoba 3 Department of Pediatrics & Child Health, University of Manitoba

11:50 Early in vivo wear measurement of 98 total knee replacement patients using radiostereometric analysis Trevor Gascoyne1, Sara Parashin1, Elise Laende2, Eric Bohm3, Michael Dunbar2, Thomas Turgeon3

1 Orthopaedic Innovation Centre, Winnipeg Manitoba 2 Department of Surgery, Dalhousie University 3 Section of Orthopedic Surgery, Department of Surgery, University of Manitoba


The use of viscoelastic hemostatic testing in cardiac surgery patients: A systematic review and meta-analysis

Carly Lodewyks1, Jeffrey Heinrichs2, Hilary Grocott3

1 Cardiac Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Department of Anesthesia & Perioperative Medicine, University of Manitoba

Introduction

Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are point-of

-care viscoelastic tests used to monitor hemostasis and guide blood product

administration during cardiac surgery. Previous studies have shown inconsistent

benefit of TEG/ROTEM when compared to traditional laboratory tests. The objective

of this review is to identify, appraise and meta-analyze data from randomized trials

(RCTs) evaluating the utility of viscoelastic testing in adult cardiac surgery patients.

Methods

A highly sensitive search strategy was used to query MEDLINE, EMBASE and Cochrane

CENTRAL. Two independent reviewers screened trials and extracted data. Risk of bias

assessment was conducted using the Cochrane Risk of Bias tool. Pooled data was

analyzed using a random-effects model and results were reported as mean difference

(MD) or risk ratio (RR) with 95% confidence intervals (CI).

Results

A total 1153 records were identified of which 8 trials (808 patients) met the inclusion

criteria. There was no significant difference between the point-of-care and control

groups with respect to all-cause mortality at longest follow up (RR, 0.55; 95% CI, 0.21

to 1.43; I2 26%; 4 trials; 485 patients), or the proportion of patients transfused with

any blood product (RR, 0.76; 95% CI, 0.54 to 1.08; I2 61%; 3 trials; 223 patients). There

was a significant difference in the proportion of patients receiving red blood cells,

fresh frozen plasma and platelets. The rate of reoperation and hospital or intensive

care unit length of stay were not significantly different between groups.

Conclusion

Viscoelastic testing significantly reduced the proportion of patients requiring

transfusion of individual blood products. The clinical impact of this is uncertain as

there was no associated effect on overall mortality or proportion of patients receiving

any transfusion. Incorporation of data from a recent large multicenter cluster RCT will

hopefully provide a more definitive answer


Program director consensus on the status of flexible endoscopy training in general surgery residency programs in Canada

Megan Delisle1, Courtney Chernos1, Jason Park2, Krista Hardy2, Ashley Vergis3


Introduction

Our objective was to assess endoscopy training in General Surgery residency

programs. Implementation of competency-based education for General Surgery

residencies is to occur in 2019. Relevant milestones for endoscopy should be defined

by pre-existing evidence-based curriculum guidelines.

Methods

A 35-question survey was developed using guidelines from the Society of American

Gastrointestinal and Endoscopic Surgeons and the American Board of Surgery. A

survey of all 17 General Surgery program directors was conducted via the Survey

Monkey.ca® platform.

Results

All 17 programs completed the survey. Programs average 2.8 months (range 0-4) of

dedicated training. Half of the programs have pre-rotation cognitive (46.7%) and

technical (53.3%) skills training. Endoscopy simulation is available in 10 programs

(83.3%). Seven programs (46.6%) have a didactic curriculum and 11 programs (73.3%)

have exposure to gastrointestinal bleeding. Upon completion of rotations, four

programs (26.7%) have formal skills assessments and two have formal knowledge

examinations (13.3%). All programs require endoscopy procedures be logged, but only

three include quality indicators (21.4%). The number of months of dedicated

endoscopy training is correlated with the total number of procedures performed

(p=0.03). Eleven program directors (73.3%) believe residents are prepared for

independent endoscopy, while four disagree (26.7%). Program directors’ perceptions

of residents’ preparedness correlated with the number of endoscopic procedures

performed (p<0.01).

Conclusion

There is a great deal of variation in training in residencies across Canada. Resident

competency appears to be correlated with procedure numbers and few programs

have adopted formal curriculums and assessments. As we move towards competency-

based education training should be supported by evidence-based, skills and

knowledge assessments.


Transcranial focused ultrasound neuromodulation in a rodent model

Anton Fomenko1, Andres Lozano2 1 Neurosurgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Institute of Medical Science, University of Toronto

Introduction

Ultrasound (US) is a noninvasive, common, and inexpensive medical imaging modality.

Recently, it has been studied for its ability to non-invasively and reversibly excite and

suppress neural activity. Low-intensity focused US (LIFUS) offers high spatial

selectivity, deep brain penetration, and may eliminate the need for an incision,

burrhole, or electrical leads currently used in Deep Brain Stimulation (DBS). Few

studies have examined the parameters required to induce reversible neural excitation

in the cortex, and resulting patterns of protein expression.

Methods

A 500 kHz US transducer is focused over the shaved scalp of a lightly-anesthetized

Wistar rat at several positions using a stereotactic frame. The brain is sonicated with

parameters that vary the intensity, pulse duration, and duty cycle of the ultrasound

wave. The animal`s limb movements are simultaneously recorded using a video

camera. Animals are then awoken, observed for 1 hour, and humanely euthanized.

The brains are sectioned and immunohistochemistry is performed for c-fos, a marker

of neural activity.

Results

Sonication over the right posterior parietal cortex reproducibly elicits bilateral

forepaw twitches at these parameters:[500 kHz fundamental frequency/2 kHz pulse

repetition frequency/50% duty cycle/250ms sonication duration]. Surprisingly, no limb

or tail movement was elicited on sonication of the motor cortex. The animals awoke

with no neurological deficits and no injury to the brain cortex or deeper structures

could be seen on H&E stain. Immunohistochemistry showed diffuse, but unilateral

expression of c-fos, a protein marker of neuronal activity.

Conclusion

Transcranial LIFUS can noninvasively, reversibly, and safely stimulate cortical

pathways in the rat. Further experiments will aim to determine the mechanism of

action through electrophysiology and refine successful parameters. Potential human

applications may include safer treatment for Parkinson’s Disease.


Maternal substance use and mortality rates in children with gastroschisis

Matthew Levesque1, Melanie Morris2, Suyin Lum Min2, Richard Keijzer2

1 Undergraduate, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Pediatric Surgery, Department of Surgery, University of Manitoba

Introduction

Each year over 100 children are born in Canada with gastroschisis (GS). No studies to

date have examined the relationship between maternal substance use during

pregnancy and mortality in these children. We hypothesized that maternal substance

use is associated with higher mortality in children with GS

Methods

We performed a retrospective case-control study among all children managed for GS

between 1991 and 2016 at Health Sciences Centre and St. Boniface Hospital. This data

was extracted from our clinical database which includes all children treated for a

congenital surgical anomaly over this time period. The GS patients were separated

into two groups based on maternal self-reported substance use during pregnancy. We

defined substance use as the ingestion of tobacco, alcohol, or illicit drugs during

pregnancy. The mortality rates were then compared using a Fisher’s exact test, and

confounding variables were compared using t-tests and chi-squared analyses.

Results

The mortality rate of the 190 children with GS was 7.8%. Of the 190 children, 93

mothers reported substance use, 81 reported no substance use, and 16 were

unknown. Of the 93 patients in the exposure group, 12 patients died (12.9%). In

contrast, of the 81 patients in the control group, 1 patient died (1.2%). This difference

was statistically significant (p = 0.003). Despite the difference in mortality rates, there

were no differences in birth weight, gestational age, maternal age, Apgar scores,

presence of co-morbidities, or GS properties (atresia, perforation, matting or defect

size).

Conclusion

To our knowledge, this is the first report that associates maternal substance use

during pregnancy with increased mortality rates in children with GS. Importantly, the

mortality rates were independent of GS properties, co-morbidities and maternal age.

These observations need to be confirmed using a larger, nationally representative

sample of children with GS.


Metabolic needs of patients with necrotizing fasciitis: A case series

Chris Nguyen1, N. Coutris2, Justin Gawaziuk2, Nora Cristall2, Sarvesh Logsetty3

1 Plastic Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Manitoba Firefighters’ Burn Unit, Health Sciences Centre, Winnipeg, Manitoba 3 Section of Plastic Surgery, Department of Surgery, University of Manitoba

Introduction

Necrotizing Fasciitis (NF) is a soft tissue infection that causes necrosis at the fascia

level. Due to the underlying inflammatory process and surgical requirements

associated with this condition, close attention needs to be given to the metabolic

demands of this population. Although NF is managed in a similar fashion as a burn

injury, with debridement and grafting, limited data exists on the metabolic

requirements of NF patients.

Methods

We conducted a prospective case series of 10 adult patients with NF (6 male, 4

female) admitted to our centre. Data collected includes age, sex, body mass index

(BMI), length of hospital stay (LOS), energy requirements from predictive equations

compared to measured requirements via indirect calorimetry (IC), days to first OR and

number of procedures.

Results

Mean NF patient age was 49 yr. NF patients had a mean of 4 surgeries and were in

hospital for 36 days. Metabolic cart measurements were taken 15 ± 12 days from

hospital admission. Mean respiratory quotient was 0.86 ± 0.10. Mean measured

caloric requirement was 1920 ± 390 kcal whereas predicted requirements were 1565 ±

247 kcal. Overall, measured caloric needs were 119 ± 14% of predicted requirements.

Conclusions

NF patients have elevated nutrition requirements that exceed that of predicted

equations. We have shown that metabolic needs for NF patients are 119% of

predicted requirements.


Active surveillance for low and intermediate risk prostate cancer: An analysis of pathologic outcomes among patients treated with radical prostatectomy

Premal Patel1, Jeff W. Saranchuk2, Darrel E. Drachenberg2, Jasmir G. Nayak2, Justin Oake1

1Urology Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Urology, Department of Surgery, University of Manitoba

Introduction

Active Surveillance (AS) is a means to avoid treatment associated morbidity in men

with low risk prostate cancer (PCs) and select men with intermediate risk PCs. We

sought to evaluate outcomes among men with intermediate risk PCa who were

initially placed on AS compared with low risk patients.

Methods

Patients followed at the Manitoba Prostate Centre from Jan 1, 2004 to Dec 31 2005

were included. AS patients were identified by a retrospective electronic chart review

of patients who received more than one prostate biopsy. Our primary objective was

to evaluate pathological outcomes between groups among those who were treated

with radical prostatectomy (RP). Our secondary objective was to compare the

proportion of patients who subsequently required salvage and/or adjuvant therapies

following surgery between groups.

Results

271 prostate cancer patients were included, 187 (69%) were low and 84 (31%) were

intermediate risk disease. There were no significant differences between RP

pathological outcomes between low and intermediate risk groups. The number of

patients undergoing salvage and/or adjuvant treatment after RP did not differ

between patients with low and intermediate risk disease, although a nonsignificant

higher proportion of patients with intermediate risk disease required salvage or

systemic therapies (16% of patients in the intermediate risk group compared with 10%

in the low risk group).

Conclusion

Among AS patients, low and intermediate risk disease have similar pathological

outcomes at time of RP. Among patients who received RP, there were no significant

differences in the receipt of adjuvant or salvage therapies between low and

intermediate risk disease suggesting that select patients with intermediate risk

disease may be appropriate candidates for initial AS.


High-frequency vs. conventional mechanical ventilation at the time of CDH repair is associated with, but does not contribute to, higher mortality and BPD rates—A case-control study

Gabrielle Derraugh1, Matthew Levesque1, Suyin Lum Min2, Daryl Schantz3, Melanie Morris2, John Baier 3, Molly Seshia3, Richard Keijzer2

1 Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Pediatric Surgery, Department of Surgery, University of Manitoba 3 Department of Pediatrics & Child Health, University of Manitoba

Introduction

The multi-centre VICI trial reported that conventional mechanical ventilation (CMV) and

high-frequency oscillatory ventilation have similar effects on mortality and

bronchopulmonary dysplasia (BPD) in patients with congenital diaphragmatic hernia

(CDH). At our centre, we use CMV and high-frequency ventilation (HFV), both jet and

oscillatory. The objectives of this study were to compare the outcomes of death or BPD

according to the mode of ventilation at the time of surgery, and to compare the

characteristics of patients on CMV or HFV.

Methods

We performed a retrospective case-control study of CDH patients (n=55) at our centre

between 1990 and 2015. Analysis was conducted using Fischer's exact, Mann-Whitney

U and t-tests.

Results

At the time of surgery, 30 (54.55%) patients were on CMV and 25 (45.45%) were on

HFV. Four patients (13.33%) on CMV had BPD or died compared to 15 patients (60%)

on HFV. The odds ratio was 9.38 (95% CI 2.49-35.25, p<0.01). Patients on CMV had

fewer instances of severe pulmonary hypertension (33.33% vs. 84%, p<0.01), required

less sildenafil (3.33% vs 36%, p<0.05), vasoactive medications (66.67% vs 96%, p<0.05)

and inhaled nitric oxide (16.67% vs 76%, p<0.01) compared to patients on HFV. Infants

requiring HFV had larger defects (p<0.01), took longer to stabilize before surgery

(p<0.05) and had more non-cardiac congenital anomalies (p<0.05). After controlling for

confounding variables, ventilation mode was not an independent contributor to BPD or

death.

Conclusions

These results show that CDH patients repaired on HFV have higher rates of BPD and

mortality but also required more support than patients repaired on CMV. Therefore,

the association of BPD or death with HFV may reflect a prognostic association rather

than a causal association - HFV indicates a sicker child with a poorer prognosis. We did

not find that mode of ventilation contributed to development of BPD of death


Early in vivo wear measurement of 98 total knee replacement patients using radiostereometric analysis

Trevor Gascoyne1, Sara Parashin1, Elise Laende2, Eric Bohm3, Michael Dunbar2, Thomas Turgeon3

1 Orthopaedic Innovation Centre, Winnipeg Manitoba 2 Department of Surgery, Dalhousie University 3 Section of Orthopedic Surgery, Department of Surgery, University of Manitoba

Introduction

In total knee replacement (TKR), the articulation of the polyethylene (PE) insert can

wear leading to revision surgery. Recent advancements in PE have resulted in

improved wear resistance measured via in vitro wear simulators. However, such wear

tests may not accurately predict in vivo wear. We sought to develop a novel

technique to assess in vivo wear of modern PE inserts in TKR using model-based

radiostereometric analysis (MBRSA).

Methods

We obtained MBRSA films on 98 patients who underwent primary TKA in Halifax, NS.

Radiographs were obtained post-operatively and at 6-, 12-, and 24-months. Highly

accurate 3-dimensional virtual models of each in vivo TKA for each follow-up time

point for each patient were developed. Computer models of the tibial and femoral

components were obtained through reverse engineering and computer models of the

PE inserts were provided by the manufacturer. PE insert models were then inserted

between the tibial and femoral models to facilitate wear analysis. Linear PE insert

wear was measured as the change in joint space from post-operative to 24 months.

Volumetric insert wear was measured as the change in overlapping volume between

the femoral component and the tibial insert models from post-operative to 24

months.

Results

The mean linear wear rate was virtually zero for both the medial and lateral

condyles. Conversely, mean volumetric wear rate was 10.4 mm3/yr (SD: 20.8 mm3/

yr), with the majority of wear occurring on the medial side. Measured wear did not

correlate significantly to patient age or body mass index (Pearson Correlation:

R<0.14, p>0.05).

Conclusion

Linear PE wear measurement was found to be less reliable than volumetric methods

as evidenced by higher occurrence of negative wear rates. Volumetric PE wear

measurement using MBRSA determined an annual wear rate of 10.4 mm3/yr. This

novel methodology can feasibly detect TKR wear on conventional PE inserts within 2-

3 years if adequately powered.


2:15—3:05 PLENARY SESSION Moderator: Dr Mohammad Zarrabian Section of Orthopedic Surgery

Time Abstract

2:15 Advancement in the quality of operative documentation: A systematic review and meta-analysis of synoptic versus narrative operative reporting Shannon Stogryn1, Jennifer Metcalfe1, Krista Hardy2, Ahmed Abou-Setta3, Ashley Vergis2

1 General Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of General Surgery, Department of Surgery, University of Manitoba 3 the George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba

2:27 The relationship between injury to surgery time and the incidence of secondary joint injury in an ACL injured population: A randomized control trial Gabriel Larose1, Meaghan Rollins2, Peter MacDonald3, Greg Stranges3, Jason Peeler3, Sheila Mcrae3, Jeff Leiter3 1 Orthopedic Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Orthopedic Surgery, Department of Surgery, University of Manitoba 3 Pan Am Clinic, Department of Surgery, University of Manitoba

2:39 Development of a risk calculator to predict non-institutionalized survival in patients with prolonged length of stay after cardiac surgery Rizwan Manji,1, Rohit Singal1, Brett Hiebert2, Eric Jacobsohn3, Alan H. Menkis1, Rakesh Arora1 1 Section of Cardiac Surgery, Department of Surgery, University of Manitoba 2 Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba 3 Department of Anesthesia & Perioperative Medicine, University of Manitoba

2:51 Natural talent: Myth or reality? The ability to learn laparoscopic surgery Giuseppe Retrosi1, Thomas Cundy2, Elizabeth Carson3, Ian Clark3

1 Section of Pediatric Surgery, Department of Surgery, University of Manitoba 2 Department of Pediatric Surgery, Women’s and Children’s Hospital, Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia 3 Department of Ophthalmology, Health Sciences Centre, Children’s Hospital of Winnipeg, University of Manitoba


Advancement in the quality of operative documentation: A systematic review and meta-analysis of synoptic versus narrative operative reporting

Shannon Stogryn1, Jennifer Metcalfe1, Krista Hardy2, Ahmed Abou-Setta3, Ashley Vergis2

1 General Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of General Surgery, Department of Surgery, University of Manitoba 3 the George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba

Introduction

The operative report is a vital document for the surgical patient and central to quality

assessment processes for surgical care. Despite this, data suggests that traditional

narrative operative reports are often of poor quality. Synoptic reporting has emerged

as a means to improve this document and has shown promise across multiple

investigations.

Methods

A comprehensive systematic review of the literature was performed including

comparative studies evaluating synoptic versus narrative operative reports. The

primary outcome of interest was completion of predetermined critical elements for an

operative report. Secondary outcomes considered were reliability, efficiency, quality,

and cost measures. Meta-analysis was performed where sufficient data was available.

A quality analysis was performed on all included source articles using the Newcastle-

Ottawa scale (NOS).

Results

Of the 1471 citations identified in the literature search, 16 studies met final inclusion

criteria. The mean NOS was 7.09 out of 9 (+/- SD 1.73). Synoptic reporting was

significantly more complete than narrative reporting (SMD 1.70, 95% CI 1.13 to 2.26; I2

98%; 14 studies; 2874 reports) suggesting that this format outperforms narrative

reporting in terms of completeness. The time to complete the operative report was

significantly shorter with synoptic reporting (mean difference -0.86, 95% CI -1.17 to -

0.55; 6 studies; 891 reports). All other secondary outcomes evaluated favoured the

synoptic reporting format.

Conclusion

This systematic review of the literature suggests that synoptic reporting platforms

outperform traditional narrative reporting in terms of completeness of critical items

and time required to complete it. This reporting format should be incorporated into

surgical practice.


The relationship between injury to surgery time and the incidence of secondary joint injury in an ACL injured population: A randomized control trial

Gabriel Larose1, Meaghan Rollins2, Peter MacDonald3, Greg Stranges3, Jason Peeler3, Sheila Mcrae3, Jeff Leiter3 1 Orthopedic Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Orthopedic Surgery, Department of Surgery, University of Manitoba 3 Pan Am Clinic, Department of Surgery, University of Manitoba

Introduction

There are over 100,000 ACL reconstruction surgeries every year in the US [Owings et

al 1998]. Previous studies showed that early fixation of the ACL would be cost

effective [Mather et al 2014]. Observational studies illustrate that delayed surgery

increase the incidence of secondary knee pathologies [Gupta et al 2016, Anstey et al

2015, Magnussen et al 2013]. However, new observational literature failed to show a

difference [Hur et al 2007]. A randomized prospective study would help determined

the incidence of secondary pathologies after delayed surgery.

Method

58 patients with acute ACL were recruited at the Pan Am Clinic. They were

randomized to either early fixation (EF) (<12 weeks) or delayed fixation (DF). 29

patients in each group. Secondary pathologies were assessed with an MRI at the time

of injury and during the surgery.

Results

The average waiting time for the early group was 10.5 weeks compared to 31.5 in the

delayed group (p<0.001). Both groups were similar for age, gender and smoking

status. There were no statistically differences in the incidence of cartilage injury at

the time of the injury (I-T) or at the time of the surgery (S-T) (I-T: medial

compartment: EF: 1, DF: 1; other compartments: EF: 0 DF:0; S-T: medial: EF:1, DF: 5,

p=0.19; lateral: EF:3, DF 1, p=0.61; patello-femoral: EF:2, dF:2). There were no

differences in meniscal injury (I-T: medial EF: 5, DF: 9; lateral EF: 8, DF: 12; S-T: medial

EF: 5, DF: 3 p= 0.70; lateral EF: 10 DF: 10).

Conclusion

Our study failed to demonstrate an increase in secondary injury with delayed surgery.

In the context of long waiting time in Manitoba, average of 17 months for ACL

reconstruction [Peeler et al 2008], this study illustrates that this wait may not be

detrimental to the patients. Further work would access with a randomized study the

long-term outcomes of early versus delayed surgery.


Development of a risk calculator to predict non-institutionalized survival in patients with prolonged length of stay after cardiac surgery

Rizwan Manji,1, Rohit Singal1, Brett Hiebert2, Eric Jacobsohn3, Alan H. Menkis1, Rakesh Arora1 1 Section of Cardiac Surgery, Department of Surgery, University of Manitoba 2 Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba 3 Department of Anesthesia & Perioperative Medicine, University of Manitoba

Introduction

Contemporary risk-stratifying scoring tools (eg.EUROSCORE II) to predict long term

morbidity and mortality are not useful for the increasing number of patients

needing prolonged intensive care unit length of stay (priCULOS) after cardiac

surgery (CS). Objective: We sought to develop a risk calculator to determine

functional survival (alive and not institutionalized) at 1year for patients with

priCULOS {ICULOSS days) after CS to help inform decision making for patients/

families and clinicians.

Methods

PriCULOS CS patients between April 1, 2006 to Dec 31, 2012 were divided into two

derivation cohort of 331 and validation cohort of 206. Univarible regression followed

by stepwise multivariable regression of predictors of functional survival in the

derivation cohort were applied to the validation cohort. Beta coefficients were used

to create a logistic risk calculator (like EuroSCORE II) for functional survival for

priCULOS patients.

Results

Variable predictive of functional survival in the derivation cohort had area under curve

of 0.80. Operative variables were not predictive of functional survival in priCULOS

patients. When the model was applied to the validation cohort, the observed to

expected ratio of 1-year functional survival was excellent at 0.82. A rick-score

calculator showing an example for an 80-year-old male with peripheral vascular

disease needing 2 red cell transfusions and being intubated for 7 days with a

preoperative infection and a maximum creatinine of 100 umol/L within the first 5 days

post-op. The patient’s functional survival at 1 year from surgery is predicted to be

54.7%.

Conclusion

A preliminary calculator to predict functional survival has been developed for

preCULOS CS patients. Further external validation may result in a reliable calculator to

assist and inform patients, families and physicians in their shared-decision making

discussions during a prolonged ICU stay after cardiac surgery.


Natural talent: Myth or reality? The ability to learn laparoscopic surgery

Giuseppe Retrosi1, Thomas Cundy2, Elizabeth Carson3, Ian Clark3

1 Section of Pediatric Surgery, Department of Surgery, University of Manitoba 2 Department of Pediatric Surgery, Women’s and Children’s Hospital, Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia 3 Department of Ophthalmology, Health Sciences Centre, Children’s Hospital of Winnipeg, University of Manitoba

Introduction

To identify learning curve patterns in pediatric laparoscopy and their relationships

with participants’ visual function.

Methods

Fourteen laparoscopy naïve participants performed 10 repetitions of the object

transfer task on a validated pediatric laparoscopic simulator following preliminary

visual function assessment (Randot test). Motion analysis software was used to track

instrument movements and assess performance. Proficiency was determined using

validated criteria thresholds for task completion time (<107 seconds) and total

instruments distance (<2.03 meters). Research Ethics Board Approval: HS20361.

Learning curve patterns were analyzed using the Friedman ANOVA test.

Results

We identified 4 distinct learning curve patterns. Participants in Group 1 (28.5%, n=4)

achieved pre-defined proficiency level ≤5 sessions, and demonstrated significant

learning curves (completion time p=0.001, instruments distance p=0.045). Group 2

(28.5%, n=4) achieved pre-defined proficiency level >5 sessions, with significant

learning curves (completion time p=0.003, instruments distance p=0.033). Group 3

(28.5%, n=4) failed to achieve proficiency but still showed progressive improvement

(completion time p=0.007, instruments distance p=0.034). Group 4 (14.5%, n=2) failed

to achieve the proficiency level without performance improvement (p=0.096 and

p=0.128 respectively). All participants had normal visual function, with stereo acuity

between 20” and 50”, and no significant differences among groups.

Conclusion

This study demonstrates different abilities to learn laparoscopy. Most participants

improved their performance during the training sessions, with variation in learning

speed. A distinct group of poor learners was identified. No relationship was identified

between visual function and learning curve patterns. Further research is required to

understand why subjects learn laparoscopy at differing rates.


3:20—4:00 BRIEF SESSION Moderator: Dr Michael Yamashita Section of Cardiac Surgery

Time Abstract

3:20 A systematic review of meta-analysis of the impact of preoperative sleep disturbance on post cardiac surgery outcomes Aaron Martin1, Rakesh Arora2, Rohan Sanjanwala3 1Cardiac Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Cardiac Surgery, Department of Surgery, University of Manitoba 3 Cardiac Sciences Program, St Boniface Hospital, Winnipeg Manitoba

3:25 Repair of complete distal biceps tendon rupture with the EndoButton Technique—A retrospective study Tiffany Huynh1, Jeff Leiter2, Jonathan Marsh3 1 Orthopedic Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Pan Am Clinic, Winnipeg, Manitoba 3 Section of Orthopedic Surgery, Department of Surgery, University of Manitoba

3:30 Epithelial cell marker cadherin-26 expression is lower in nitrofen-induced abnormal lung development in congenital diaphragmatic hernia Lojine Ayoub1,2,3,4, Daywin Patel1,2, Naghmeh Khoshgoo1,2,3, Richard Keijzer1,2,3 1 Children’s Hospital Research Institute of Manitoba (CHRIM), Winnipeg, Manitoba 2 Section of Pediatric Surgery, Department of Surgery, University of Manitoba 3 Department of Physiology and Pathophysiology, University of Manitoba 4 Rabigh, King Abdulaziz University, Saudi Arabia

3:35 Long-term outcome of geriatric patients managed non-operatively for choledocolithiasis Kaitlin Edwards1, Robin Visser2, Ryan Dale1, Andrew McKay3 1General Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Hepatobiliary Transplant Surgery Fellowship, University of Toronto 3 Section of General Surgery, Department of Surgery, University of Manitoba


3:20—4:00 BRIEF SESSION Moderator: Dr Michael Yamashita Section of Cardiac Surgery

Time Abstract

3:40 A retrospective study of SRS for ARUBA eligible BAVMs at a single centre Lucas Vasas1, Anthony Kaufmann2 1Undergraduate, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Neurosurgery, Department of Surgery, University of Manitoba

3:45 Identifying barriers for successful discharge following cardiac surgery Mackenzie King1, Kristin Reynolds2, Rakesh Arora3, Alexandra Cornick4, Renée El-Gabalawy5, Sarvesh Logsetty6, Kelly Corispodi4, Todd Duhamel7, Cornelia van Ineveld8, Jackie Zander4, Coleen Metge9, Michelle Meade10

1 Undergraduate Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Department of Psychology, Faculty of Arts, University of Manitoba 3 Section of Cardiac Surgery, Department of Surgery, University of Manitoba 4 Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba 5 Clinical Health Psychology, Department of Psychology, Faculty of Arts, University of Manitoba 6 Sections of General Surgery & Plastic Surgery, Department of Surgery, University of Manitoba 7 Faculty of Kinesiology, University of Manitoba 8 Department of Medicine, University of Manitoba 9 George & Fay Yee centre fro HealthCare Innovation, Winnipeg, Manitoba 10 Winnipeg Regional Health Authority, Winnipeg Manitoba

3:50 Factors associated with an increased risk of developing a post-operative infection following spine surgery Mina Aziz1, Michael Johnson2, Greg McIntosh3, Michael Goyton2, Mark Xu1 1 Orthopedic Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Orthopedic Surgery, Department of Surgery, University of Manitoba 3 Canadian Spine Outcome Registry Network, Winnipeg, Manitoba

3:55 The role of endothenlin-receptor A in the development of pulmonary hypertension of the miR-200b knockout mouse Chelsea Day1, Nolan DeLeon2, Landon Falk1, Naghmeh Khoshgoo3 1 Undergraduate, Faculty of Science, University of Manitoba 2 Undergraduate, Faculty of Science, Université de Saint-Boniface 3 Department of Medicine, University of Manitoba 4 Faculty of Physiology & Pathophysiology and Department of Surgery, University of Manitoba


A systematic review of meta-analysis of the impact of preoperative sleep disturbance on post cardiac surgery outcomes

Aaron Martin1, Rakesh Arora2, Rohan Sanjanwala3 1Cardiac Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Cardiac Surgery, Department of Surgery, University of Manitoba 3 Cardiac Sciences Program, St Boniface Hospital, Winnipeg Manitoba

Introduction

The prevalence of sleep disturbance in cardiac surgery patients is high (33-78%),

however, the impact on post-operative outcomes has been inconsistent. The objective

of this study, therefore, was to undertake a systematic review of the literature to

assess the impact of preoperative sleep disturbance on post-operative morality in

adult patients undergoing cardiac surgery.

Methods

Studies involving cardiac surgery patients were included if: reported on adult (age >

18) patients and assessed the impact of sleep disturbance on cardiac surgery

outcomes. The primary outcome assessed was in-hospital mortality, with the

secondary outcomes being: ICU LOS, ICU readmission rates, in-hospital LOS, 1 year

post-operative hospital readmission rates, post-operative delirium, and postoperative

atrial fibrillation. EMBASE, CENTRAL, CINAHL, SCIE, Scopus, HTA, and ClinicalTrials.gov

were searched through to September 2017.

Results

A total of 11786 articles were screened of which 18 studies met inclusion criteria for

full-text review. (n= 130,924). Agreement in study selection with a kappa statistic of

0.57 for title and abstract screening and a kappa statistic of 1.00 for full article

screening. The primary outcome showed an in-hospital mortality (OR 2.30; 95% CI,

0.54-9.73). The secondary outcomes showed: ICU length of stay (MD 0.31; 95% CI,

0.28-0.33), hospital readmission rates (OR 4.63; 95% CI, 1.24-17.31), and in post-

operative atrial fibrillation (POAF) (OR 1.92; 95% CI, 1.32-2.80). There was no

difference in in-hospital LOS and ICU readmission.

Conclusion

This systematic review demonstrated that despite a heterogeneity of definition, pre-

operative sleep disturbance was not consistently associated with in-hospital mortality,

however was associated with an increased ICU LOS, hospital readmission rates and

POAF. These findings suggest that routine screening of sleep disturbance needs to be

studied in a prospective fashion to determine if inclusion in current risk model

improve the prediction for post-operative complications in the cardiac surgery patient.


Repair of complete distal biceps tendon rupture with the EndoButton Technique—A retrospective study

Tiffany Huynh1, Jeff Leiter2, Jonathan Marsh3 1 Orthopedic Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Pan Am Clinic, Winnipeg, Manitoba 3 Section of Orthopedic Surgery, Department of Surgery, University of Manitoba

Introduction

Surgical repair of a complete biceps brachii tendon rupture is considered standard of

care. Untreated injuries result in chronic arm pain and affects forearm flexion and

supination - the biceps' primary functions. The Endobutton technique is a relatively

new procedure that is considered minimally invasive and time efficient. The purpose

of this study is to assess long-term patient satisfaction and function after EndoButton

repair of distal biceps ruptures.

Methods

Retrospective assessment of patients who were diagnosed with complete distal biceps

tendon rupture within two months of the original injury and are beyond the 12-month

post-operative period. The patients' elbow range of motion and strength were

measured in the operative and uninjured arms. Patient satisfaction was assessed with

the Disability of the Arm, Shoulder and Hand (DASH) score. Radiographs of the

operative elbow were taken to assess for complications. Descriptive analysis was

generated for patient demographics and outcome variables. Paired t-tests was

performed for strength and range of motion assesssments, with a significance level of

p <0.5.

Results

Of the 41 patients who were assessed, all were male with a mean age of 47 years-old

at time of injury. The majority of the injuries resulted from lifting heavy objects

(68.3%) and sporting activities (22%). Most injuries did not occur at work (78%) and

the right arm was most often affected (63%). Postoperative complications included

heterotopic ossification (61%, 87.5% were Brooker Grade 1), neuropraxia (12.2%), and

re-rupture (7.3%). Mean DASH score was 7. There was no significant difference in

flexion or supination strength or range of motion between the two elbows.

Conclusion

Repair of distal bicep tendon ruptures with the EndoButton technique results in

excellent quality of life. Despite the high incidence of heterotopic ossification, range of

motion and strength were equivalent in the repaired and uninjured elbows.


Epithelial cell marker cadherin-26 expression is lower in nitrofen-induced abnormal lung development in congenital diaphragmatic hernia

Lojine Ayoub1,2,3,4, Daywin Patel1,2, Naghmeh Khoshgoo1,2,3, Richard Keijzer1,2,3 1 Children’s Hospital Research Institute of Manitoba (CHRIM), Winnipeg, Manitoba 2 Section of Pediatric Surgery, Department of Surgery, University of Manitoba 3 Department of Physiology and Pathophysiology, University of Manitoba 4 Rabigh, King Abdulaziz University, Saudi Arabia

Introduction

We have previously shown that nitrofen-induced congenital diaphragmatic hernia

(CDH) lungs have a disturbed mesenchymal/epithelial cell balance and less distal

airway branching. This might be the result of lower microRNA miR-200b expression

around the large airways. We recently found that cadherin-26 was down-regulated in

the lungs of our microRNA miR-200b knockout mice. Cadherins are critical for the

organization of the airway epithelium, thereby facilitating cell-cell adhesion, cellular

polarization, and proliferation. Cadherin-26 is abundantly expressed in airway

epithelial cells. We aimed to determine the expression of cadherin-26 during nitrofen-

induced abnormal lung development and CDH.

Methods

We induced abnormal lung development and CDH by gavaging nitrofen to dams on

embryonic day (E) 9. We collected control and nitrofen-induced hypoplastic lungs at

E15, E18 and E21. Lungs were processed and Cadherin-26 expression was determined

using immunohistochemistry and Western blotting.

Results

We observed lower cadherin-26 expression during the later stages of nitrofen-induced

abnormal lung development when compared to control. Expression was particularly

decreased in the large airways.

Conclusion

Lower cadherin-26 expression can explain the disturbed mesenchymal/epithelial cell

balance and reduced airway branching observed in nitrofen-induced abnormal lung

development and CDH.


Long-term outcome of geriatric patients managed non-operatively for choledocolithiasis

Kaitlin Edwards1, Robin Visser2, Ryan Dale1, Andrew McKay3 1General Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Hepatobiliary Transplant Surgery Fellowship, University of Toronto 3 Section of General Surgery, Department of Surgery, University of Manitoba

Introduction

Current gold standard management of choledocolithiasis is ERCP followed by prompt

cholecystectomy. In geriatric patients, higher rates of medical comorbidities increase

surgical risk. We sought to evaluate the safety of ERCP alone in patients 70 years old

and above as a method of avoiding undue risk associated with cholecystectomy.

Methods

The charts of all patients 70 years old and above who underwent ERCP at Health

Sciences Centre in Winnipeg, MB, between March 2004 and March 2014 were

collected for review. Timing and complication rates of subsequent surgical and

endoscopic treatment for recurrent symptoms were examined in a preliminary cohort

of 83 patients.

Results

43 of 83 patients were excluded based on residence outside of Manitoba, prior

cholecystectomy, ERCP prior to March 2004, diagnosis of biliary malignancy, age <70,

or inadequate documentation. 2/40 patients experienced complications following

ERCP (GI bleeding requiring transfusion). 36/40 patients were managed by ERCP alone

with the remaining 4/40 going on to have a planned cholecystectomy. The average

Age-Adjusted Charlson Comorbidity Index scores were 5.05 and 4.25 respectively.

There were no major complications in the surgery group. 13/36 in the ERCP group

required further ERCPs although the majority (10/13) were for biliary stent change or

removal. Only 3/36 endoscopically managed patients had a second episode of

symptomatic choledocolithiasis at an average of 1.4 years following initial

presentation.

Conclusion

Preliminary data suggests that the incidence of subsequent biliary symptoms requiring

treatment in elderly patients treated with ERCP alone is low and may be a safe option

for the treatment of choledocolithiasis in this patient population. However, the results

need to be confirmed. A further ~600 charts remain to be reviewed. Rates of

cholecystectomy and ERCP at other centres will also be collected from Manitoba

Health to increase the validity of our findings.


A retrospective study of SRS for ARUBA eligible BAVMs at a single centre

Lucas Vasas1, Anthony Kaufmann2 1Undergraduate, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Neurosurgery, Department of Surgery, University of Manitoba

Introduction

The results of A Randomized Control trial of Unruptured BAVMs (ARUBA) reported

better patient outcomes with conservative management versus interventional

treatment for BAVMs. We sought to determine the rate of serious complications and

obliteration in patients treated with Gamma Knife Stereotactic Radiosurgery (GK-SRS)

at our centre.

Method

Retrospective review of 67 ARUBA eligible patients with BAVMs treated by GK-SRS

between 2003 and 2016. Patient demographics, obliteration rates, and complication

rates were assessed.

Results

Patient BAVMs were classified by the Spetzler-Martin (SM) grading system, including

eleven of SM grade I, thirty of SM grade II, twenty of SM grade III, and six of SM grade

IV. No patients had SM grade V BAVMs. Twenty-seven (40.3%) patients presented

with seizures, and eight (12%) patients presented with neurological deficits. Failure to

obliterate in patients with five or more years of follow-up (n=50) was seen in 16% of

patients. Four patients (6%) suffered BAVM hemorrhage post-SRS. Adverse radiation

effects were visualized on MRI in thirty-four patients (50.7%), but only twelve patients

(17.9%) experienced symptomatic adverse radiation effects. Only one patient’s

radiation effect symptoms were permanent, and this patient was the only one to

experience permanent effects due to GK-SRS.

Conclusion

Patients receiving SRS for unruptured BAVMs have high obliteration rates, low

hemorrhage rates on follow-up, and rarely suffer from permanent symptoms due to

adverse radiation effects. SRS is an effective and safe intervention, favorable to the

natural history of the disease.


Identifying barriers for successful discharge following cardiac surgery

Mackenzie King1, Kristin Reynolds2, Rakesh Arora3, Alexandra Cornick4, Renée El-Gabalawy5, Sarvesh Logsetty6, Kelly Corispodi4, Todd Duhamel7, Cornelia van Ineveld8, Jackie Zander4, Coleen Metge9, Michelle Meade10

1 Undergraduate Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Department of Psychology, Faculty of Arts, University of Manitoba 3 Section of Cardiac Surgery, Department of Surgery, University of Manitoba 4 Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba 5 Clinical Health Psychology, Department of Psychology, Faculty of Arts, University of Manitoba 6 Sections of General Surgery & Plastic Surgery, Department of Surgery, University of Manitoba 7 Faculty of Kinesiology, University of Manitoba 8 Department of Medicine, University of Manitoba 9 George & Fay Yee centre fro HealthCare Innovation, Winnipeg, Manitoba 10 Winnipeg Regional Health Authority, Winnipeg Manitoba

Introduction

Cardiac surgical procedures are being performed on older and more frail patients with

numerous comorbidities. Despite successful hospital discharge, many of these patients

experience inadequately controlled persistent pain, decreased functional status,

depression, fatigue, sleep disturbances, and PTSD following surgery. Worse, patients with

prolonged ICU stays have higher rates of re-hospitalization, long-term morbidity and worse

non-institutional survival. The rate of prolonged ICU stays is increasing in Manitoba,

therefore, highlighting the need for a process to meet the needs of these complex patients.

Methods

A single centre, prospective, mixed methods cohort study employing a Lean transformation

process and an interdisciplinary team in Manitoba, Canada, utilized patient and caregiver

focus groups as well as cardiac surgeon surveys to identify barriers for successful transition

of cardiac surgery patients from hospital to the community.

Results

The results show patients and caregivers are exposed to inadequacies surrounding

information exchange, challenges regarding communication with healthcare providers and

a significant financial burden when accessing healthcare. Furthermore, caregivers

experience significant fear and isolation and need additional resources for support in the

community. Lastly there appears to be a discordance in perception of “successful”

discharge between the surgical team and the patient-caregiver unit.

Conclusion

This study shows that barriers to successful discharge largely involves how information is

exchanged. An incongruent perception of discharge experiences between healthcare

provides and patients suggests the need for modification of current discharge

communication processes. Future study will seek to implement improvements in the

themes identified to determine efficacy in reducing re-hospitalization and improved

HRQoL.


Factors associated with an increased risk of developing a post-operative infection following spine surgery

Mina Aziz1, Michael Johnson2, Greg McIntosh3, Michael Goyton2, Mark Xu1 1 Orthopedic Surgery Residency Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba 2 Section of Orthopedic Surgery, Department of Surgery, University of Manitoba 3 Canadian Spine Outcome Registry Network, Winnipeg, Manitoba

Introduction

Post-operative infection is a serious complication of spine surgery and can contribute

to the strain on the healthcare system’s resources. Some studies have estimated the

cost of such an infection to be $200,000 per patient. We hypothesize that female

gender, smoking, diabetes, having thoracolumbar (TL) procedures, having a

neurological deficit, increased age, body mass index (BMI), medical co-morbidities and

number of operative levels increase the patients’ risk of developing a post-operative

infection.

Methods

Retrospective review of prospectively collected data within the Canadian Spine

Outcome Registry Network (CSORN). Data was analyzed using the Statistical Analysis

System software with ANOVA to analyze continuous variables while odds ratios and

Fisher’s exact tests were used to analyze categorical variables, p<0.05.

Results

Out of 4888 patients identified from the registry, 3152 patients had complete data

and were included in the analysis. There were 88 infections recorded representing a

2.8% risk of infection. There were no statistically significant differences in gender, age,

smoking status, neurology or number of co-morbidities between groups. Patients who

developed a post operative infection had more operative levels (3.1±2.4 vs 2.6±1.6,

p<0.01). Patients who are diabetic were 1.89 times more likely to develop an infection

(CI 1.13-3.15, p<0.02) and those undergoing TL procedures were 2.65 times more

likely to develop an infection (CI 1.27-5.51, p<0.01). Those who developed an infection

had significantly higher BMI (30.12±6.29 vs 28.68±6.15, p<0.03).

Conclusions

There is a 2.8% overall rate of post-operative spine infection in 20 Canadian centers.

The factors that were associated with patient risk of developing a post operative-

infection were diabetes, TL procedures, more operative levels and increased BMI. This

study establishes a benchmark against which the effectiveness of future interventions

to reduce infection can be compared.


The role of endothenlin-receptor A in the development of pulmonary hypertension of the miR-200b knockout mouse

Chelsea Day1, Nolan DeLeon2, Landon Falk1, Naghmeh Khoshgoo3 1 Undergraduate, Faculty of Science, University of Manitoba 2 Undergraduate, Faculty of Science, Université de Saint-Boniface 3 Department of Medicine, University of Manitoba 4 Faculty of Physiology & Pathophysiology and Department of Surgery, University of Manitoba

Introduction

Pulmonary hypertension (PH) is one of the leading causes of morbidity and mortality

in patients with congenital diaphragmatic hernia (CDH). Higher expression of

microRNA-200b (mir-200b) is associated with better outcomes in CDH patients. To

study the role of mir-200b we created a mir-200b KO mouse and found that these

mice present with PH, similar to CDH patients. The objective of this study was to

determine if endothelin-receptor A (ETA), a known vasoconstrictor and potential mir-

200b target, could contribute to the development of PH.

Methods

Lungs of 8-week-old mir-200b KO and WT mice were extracted and flash frozen.

Complete RNA was then extracted from these tissues and DNAse treated. cDNA, made

from RNA was used to run reverse transcriptase quantitative-PCR (RT-qPCR) to

determine expression levels of ETA mRNA. For immunohistochemistry (IHC), lungs of 8

-week-old mice were perfused with formalin before extraction, dehydrated and

embedded in paraffin. IHC was used to look for differences in expression of ETA

between KO and WT mice using antibody UMB-8 (Abcam).

Results

RT-qPCR showed that expression of ETA mRNA in the lungs of mir-200b KO mice was

higher then that in the lungs of WT mice (standardized to endogenous TBP). Though it

is not statistically significant (p=0.1109, n=6), the sample size is currently being

increased. IHC allowed us to see higher levels of expression of ETA protein around the

arteries in both mir-200b WT and KO mice. Though expression levels around the

arteries of mir-200b KO mice appear to be higher compared to WT mice.

Conclusion

Our data suggest that expression of ETA is higher in the mir-200b KO mouse then the

WT mouse and expression appears to be highest around the lung arteries. This shows

that mir-200b most likely regulates ETA expression and that higher levels of ETA could

be contributing to PH in the mir-200b KO mouse.


EVALUATION & CERTIFICATE OF ATTENDANCE

As an accredited event, an evaluation of today’s Surgery Research Day

2018 must be completed at the end of the event. Your input is invaluable

to help us know this event met your expectations and to enrich future

Department of Surgery Annual Research Days for surgeons, fellows,

residents, medical students, researchers and staff.

At the end of the on-line survey, a certificate of attendance will be

available for you to save and print for your records. Instructions have been

provided in the survey and on the Department of Surgery Research Day

webpage. An email reminder will be sent to all participants following the

event.

To complete the evaluation, please use this link:

www.surveymonkey.com/r/SurgeryResearch2018

The link will also be available through our website until the survey closes:

umanitoba.ca/faculties/health_sciences/medicine/units/

surgery/research_day.html

The survey will close February 14, 2018

On behalf of the Surgery Research Day 2018 Planning Committee we

appreciate your support and thank you for attending our event.

https://www.surveymonkey.com/r/SurgeryResearch2016

http://umanitoba.ca/faculties/health_sciences/medicine/units/surgery/research_day.html

http://umanitoba.ca/faculties/health_sciences/medicine/units/surgery/research_day.html


The Annual Surgery Research Day has provided a platform for residents,

faculty, fellows and medical students to present their clinical, educational

and basic science research achievements in the Department. It has also

been an opportunity to discuss with colleagues the advances in surgery in a

collaborative surgery research environment. The invited speakers have

presented innovative and advanced techniques and technology as part of the

day as well as judged the research presentations.

2010 Dr. Cy Frank, University of Toronto

2011 Dr. Ian Alwayn, Dalhousie University Fat, The Liver & Transplantation

2012 Dr. Harry Henteleff, Dalhousie University How to become an academic surgeon in 2012

2013 Dr. BJ Hancock, American College of Surgeons 100 year commemorative—Manitoba’s Memories

2014 Dr. Chad Ball, University of Calgary Penetrating Torso trauma: Non-Therapeutic is not good enough anymore

Dr. Mohit Bhandari, McMaster University Thinking INSIDE the box

2015 Dr. Hans Kreder, University of Toronto Surgical complications & outcomes: The effect of surgeons, hospitals and systems of care

Dr. Allan Okrainec, University of Toronto Developing and delivering an international surgical education program: Lessons learned from around the world

2016 Dr. Alan Dardik, Yale University Can surgeons turn veins into arteries?

Dr. Gerald Fried, McGill University Fostering surgical innovation: Aligning residency opportunities with

departmental priorities

2017 Dr. Rodney Breau, University of Ottawa Prevention of blood loss during radical cystectomy

Dr. Deepak Dath, McMaster University The surgeon teacher

HISTORY OF SURGERY RESEARCH DAYS


SURGERY RESEARCH DAY 2017 AWARD WINNERS

Congratulations to last year’s presentation award winners!

Plenary

First Place Shannon Stogryn, General Surgery & Master of Science

Synoptic operative reporting: Assessing the completeness,

accuracy, reliability and efficiency of synoptic reporting for

roux en Y gastric bypass

Second Place Weiang Yan, Cardiac Surgery

Long-term functional survival and re-hospitalization after

surgical aortic and mitral valve replacements in a large

provincial cardiac surgery centre

Third Place Oksana Maraschchak, Undergraduate, Max Rady College of

Medicine, Rady Faculty of Health Sciences

Analysis of short-and long-term outcomes of surgically

treated left-sided infective endocarditis patients: A 10-year

longitudinal follow-up study

Brief

First Place Anupam Das, Head & Neck Surgical Onology Fellowship

Program, Department of Surgery

Arterial phase CT scan for localization of missed parathyroid

adenoma on conventional imaging

Second Place Yiyang Zhang, Orthopedic Surgery

Cruciate ligament reconstruction: A provincial

epidemiological study


PRESENTER’S ABSTRACT INDEX

Ayoub, Lojine ..................................................................................................................... 30

Chernos, Courtney ............................................................................................................. 14

Day, Chelsea ...................................................................................................................... 35

Delisle, Megan ................................................................................................................... 5

Derraugh, Gabrielle ........................................................................................................... 19

Edwards, Kaitlin ................................................................................................................. 31

Ellis, Michael ..................................................................................................................... 7

Fomenko, Anton ................................................................................................................ 15

Huynh, Tiffany .................................................................................................................... 29

Kahnamoui, Shana ............................................................................................................ 4

King, Mackenzie ................................................................................................................ 33

Kjaldgaard, Lindsey ............................................................................................................ 6

Larose, Gabriel ................................................................................................................... 23

Levesque, Matthew ............................................................................................................ 16

Lodewyks, Carly ................................................................................................................. 13

Manji, Rizwan ..................................................................................................................... 24

Marsh, Jonathan ................................................................................................................ 10

Martin, Aaron ..................................................................................................................... 28

Muller Moran, Ricky ........................................................................................................... 3

Nguyen, Chris ..................................................................................................................... 17

Oake, Justin ....................................................................................................................... 18

Patel, Premal ...................................................................................................................... 9

Retrosi, Giuseppe ............................................................................................................... 25

Stogryn, Shannon ............................................................................................................... 22

Turgeon, Thomas ............................................................................................................... 20

Turner, Benjamin ............................................................................................................... 8

Vasas, Lucas ...................................................................................................................... 32

Xu, Mark ............................................................................................................................. 34

Research Office Department of Surgery

Max Rady College of Medicine Rady Faculty of Health Sciences

University of Manitoba

[email protected]

Annual Surgery Research Day Annual Surgery Research Day 2018

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