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  1. Article ; Online: Hepato

    Behman, Ramy / Auer, Rebecca C / Bubis, Lev / Xu, Grace / Coburn, Natalie G / Martel, Guillaume / Hallet, Julie / Balaa, Fady / Law, Calvin / Bertens, Kimberly A / Abou Khalil, Jad / Karanicolas, Paul Jack

    BMJ open

    2024  Volume 14, Issue 4, Page(s) e072159

    Abstract: Introduction: Surgical stress results in immune dysfunction, predisposing patients to infections in the postoperative period and potentially increasing the risk of cancer recurrence. Perioperative immunonutrition with arginine-enhanced diets has been ... ...

    Abstract Introduction: Surgical stress results in immune dysfunction, predisposing patients to infections in the postoperative period and potentially increasing the risk of cancer recurrence. Perioperative immunonutrition with arginine-enhanced diets has been found to potentially improve short-term and cancer outcomes. This study seeks to measure the impact of perioperative immunomodulation on biomarkers of the immune response and perioperative outcomes following hepatopancreaticobiliary surgery.
    Methods and analysis: This is a 1:1:1 randomised, controlled and blinded superiority trial of 45 patients. Baseline and perioperative variables were collected to evaluate immune function, clinical outcomes and feasibility outcomes. The primary outcome is a reduction in natural killer cell killing as measured on postoperative day 1 compared with baseline between the control and experimental cohorts.
    Ethics and dissemination: This trial has been approved by the research ethics boards at participating sites and Health Canada (parent control number: 223646). Results will be distributed widely through local and international meetings, presentation, publication and ClinicalTrials.gov (identifier: NCT04549662). Any modifications to the protocol will be communicated via publications and ClinicalTrials.gov.
    Trial registration number: ClinicalTrials.gov identifier: NCT04549662.
    MeSH term(s) Humans ; Neoplasms ; Research Design ; Immunomodulation ; Immunity ; Canada ; Randomized Controlled Trials as Topic ; Clinical Trials, Phase II as Topic
    Language English
    Publishing date 2024-04-05
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2023-072159
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  2. Article ; Online: Exploring human factors in the operating room: scoping review of training offerings for healthcare professionals.

    Lee, Alex / Finstad, Alexandra / Tipney, Ben / Lamb, Tyler / Rahman, Alvi / Devenny, Kirsten / Abou Khalil, Jad / Kuziemsky, Craig / Balaa, Fady

    BJS open

    2022  Volume 6, Issue 2

    Abstract: Background: Human factors (HF) integration can improve patient safety in the operating room (OR), but the depth of current knowledge remains unknown. This study aimed to explore the content of HF training for the operative environment.: Methods: We ... ...

    Abstract Background: Human factors (HF) integration can improve patient safety in the operating room (OR), but the depth of current knowledge remains unknown. This study aimed to explore the content of HF training for the operative environment.
    Methods: We searched six bibliographic databases for studies describing HF interventions for the OR. Skills taught were classified using the Chartered Institute of Ergonomics and Human Factors (CIEHF) framework, consisting of 67 knowledge areas belonging to five categories: psychology; people and systems; methods and tools; anatomy and physiology; and work environment.
    Results: Of 1851 results, 28 studies were included, representing 27 unique interventions. HF training was mostly delivered to interdisciplinary groups (n = 19; 70 per cent) of surgeons (n = 16; 59 per cent), nurses (n = 15; 56 per cent), and postgraduate surgical trainees (n = 11; 41 per cent). Interactive methods (multimedia, simulation) were used for teaching in all studies. Of the CIEHF knowledge areas, all 27 interventions taught 'behaviours and attitudes' (psychology) and 'team work' (people and systems). Other skills included 'communication' (n = 25; 93 per cent), 'situation awareness' (n = 23; 85 per cent), and 'leadership' (n = 20; 74 per cent). Anatomy and physiology were taught by one intervention, while none taught knowledge areas under work environment.
    Conclusion: Expanding HF education requires a broader inclusion of the entirety of sociotechnical factors such as contributions of the work environment, technology, and broader organizational culture on OR safety to a wider range of stakeholders.
    MeSH term(s) Clinical Competence ; Delivery of Health Care ; Humans ; Operating Rooms ; Patient Safety ; Surgeons
    Language English
    Publishing date 2022-03-29
    Publishing country England
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ISSN 2474-9842
    ISSN (online) 2474-9842
    DOI 10.1093/bjsopen/zrac011
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  3. Article ; Online: Should Cell Salvage Be Used in Liver Resection and Transplantation? A Systematic Review and Meta-analysis.

    Rajendran, Luckshi / Lenet, Tori / Shorr, Risa / Abou Khalil, Jad / Bertens, Kimberly A / Balaa, Fady K / Martel, Guillaume

    Annals of surgery

    2022  Volume 277, Issue 3, Page(s) 456–468

    Abstract: Objective: To evaluate the effect of intraoperative blood cell salvage and autotransfusion (IBSA) use on red blood cell (RBC) transfusion and postoperative outcomes in liver surgery.: Background: Intraoperative RBC transfusions are common in liver ... ...

    Abstract Objective: To evaluate the effect of intraoperative blood cell salvage and autotransfusion (IBSA) use on red blood cell (RBC) transfusion and postoperative outcomes in liver surgery.
    Background: Intraoperative RBC transfusions are common in liver surgery and associated with increased morbidity. IBSA can be utilized to minimize allogeneic transfusion. A theoretical risk of cancer dissemination has limited IBSA adoption in oncologic surgery.
    Methods: Electronic databases were searched from inception until May 2021. All studies comparing IBSA use with control in liver surgery were included. Screening, data extraction, and risk of bias assessment were conducted independently, in duplicate. The primary outcome was intraoperative allogeneic RBC transfusion (proportion of patients and volume of blood transfused). Core secondary outcomes included: overall survival and disease-free survival, transfusion-related complications, length of hospital stay, and hospitalization costs. Data from transplant and resection studies were analyzed separately. Random effects models were used for meta-analysis.
    Results: Twenty-one observational studies were included (16 transplant, 5 resection, n=3433 patients). Seventeen studies incorporated oncologic indications. In transplant, IBSA was associated with decreased allogeneic RBC transfusion [mean difference -1.81, 95% confidence interval (-3.22, -0.40), P =0.01, I 2 =86%, very-low certainty]. Few resection studies reported on transfusion for meta-analysis. No significant difference existed in overall survival or disease-free survival in liver transplant [hazard ratio (HR)=1.12 (0.75, 1.68), P =0.59, I 2 =0%; HR=0.93 (0.57, 1.48), P =0.75, I 2 =0%] and liver resection [HR=0.69 (0.45, 1.05), P =0.08, I 2 =0%; HR=0.93 (0.59, 1.45), P =0.74, I 2 =0%].
    Conclusion: IBSA may reduce intraoperative allogeneic RBC transfusion without compromising oncologic outcomes. The current evidence base is limited in size and quality, and high-quality randomized controlled trials are needed.
    MeSH term(s) Humans ; Hepatectomy ; Blood Transfusion ; Blood Transfusion, Autologous ; Erythrocyte Transfusion ; Liver
    Language English
    Publishing date 2022-07-21
    Publishing country United States
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000005612
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  4. Article ; Online: Prevention of postoperative pancreatic fistula after pancreatectomy: results of a Canadian RAND/UCLA appropriateness expert panel.

    Hallet, Julie / Theodosopoulos, Evangelia / Abou-Khalil, Jad / Bertens, Kimberley / Pelletier, Jean-Sébastien / Segedi, Maja / Ouellet, Jean-François / Barkun, Jeffrey / Coburn, Natalie

    Canadian journal of surgery. Journal canadien de chirurgie

    2022  Volume 65, Issue 2, Page(s) E135–E142

    Abstract: Background: We aimed to define the appropriateness of interventions for the prevention of postoperative pancreatic fistulas (POPF) after pancreatectomy, given the lack of consistent data on this topic.: Methods: Using the RAND/UCLA appropriateness ... ...

    Abstract Background: We aimed to define the appropriateness of interventions for the prevention of postoperative pancreatic fistulas (POPF) after pancreatectomy, given the lack of consistent data on this topic.
    Methods: Using the RAND/UCLA appropriateness method, we assembled an expert panel to rate clinical scenarios for interventions to prevent POPF after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP).
    Results: The following interventions were rated appropriate: individualized risk prediction for all patients; perioperative pasireotide administration for patients undergoing PD who have a soft pancreatic gland and a pancreatic duct size of less 3 mm and for patients undergoing DP; pancreaticogastrostomy for patients undergoing PD who have a soft pancreatic gland and pancreaticojejunostomy for PD for patients with a pancreatic duct size of 6 mm or greater regardless of pancreatic gland texture; duct-to-mucosa anastomosis for all patients undergoing PD and dunking anastomosis for patients undergoing PD who have a pancreatic duct size of less than 3 mm with a firm pancreatic gland; simple stapled and reinforced stapled transection for all DP; surgical drains for PD and DP in patients with a soft pancreatic gland; and open and minimally invasive surgery for DP and open surgery for PD. The following were rated inappropriate: gastrointestinal anastomosis for stump closure in all DP and omission of surgical drain in PD for patients with a pancreatic duct diameter less than 3 mm and a soft pancreatic gland.
    Conclusion: The expert panel identified appropriate and inappropriate scenarios for POPF prevention following pancreatectomy, to provide guidance to clinicians. However, the appropriateness of the interventions in the majority of the clinical scenarios was rated as uncertain, demonstrating equipoise.
    MeSH term(s) Canada ; Humans ; Pancreas ; Pancreatectomy/adverse effects ; Pancreatic Fistula/etiology ; Pancreatic Fistula/prevention & control ; Pancreaticoduodenectomy/adverse effects ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control
    Language English
    Publishing date 2022-03-02
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 410651-9
    ISSN 1488-2310 ; 0008-428X
    ISSN (online) 1488-2310
    ISSN 0008-428X
    DOI 10.1503/cjs.001520
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  5. Article ; Online: The impact of prophylactic negative pressure wound therapy on surgical site infections in pancreatic resection: A systematic review and meta-analysis.

    Lenet, Tori / Gilbert, Richard W D / Abou-Khalil, Jad / Balaa, Fady K / Martel, Guillaume / Brind'Amour, Alexandre / Bertens, Kimberly A

    HPB : the official journal of the International Hepato Pancreato Biliary Association

    2022  Volume 24, Issue 12, Page(s) 2035–2044

    Abstract: Background: Surgical site infections (SSI) cause significant morbidity. Prophylactic negative pressure wound therapy (NPWT) may promote wound healing and decrease SSI. The objective is to evaluate the effect of prophylactic NPWT on SSI in patients ... ...

    Abstract Background: Surgical site infections (SSI) cause significant morbidity. Prophylactic negative pressure wound therapy (NPWT) may promote wound healing and decrease SSI. The objective is to evaluate the effect of prophylactic NPWT on SSI in patients undergoing pancreatectomy.
    Methods: Electronic databases were searched from inception until April 2022. Randomized controlled trials (RCTs) comparing prophylactic NPWT to standard dressings in patients undergoing pancreatectomy were included. The primary outcome was the risk of SSI. Secondary outcomes included the risk of superficial and deep SSI and organ space infection (OSI). Random effects models were used for meta-analysis.
    Results: Four single-centre RCTs including 309 patients were identified. Three studies were industry-sponsored, and two were at high risk of bias. There was no significant difference in the risk of SSI in patients receiving NPWT vs. control (14% vs. 21%, RR = 0.72, 95%CI = 0.32-1.60, p = 0.42, I
    Conclusion: Prophylactic NPWT does not significantly decrease the risk of SSI among patients undergoing pancreatectomy. Insufficient evidence exists to justify the routine use of NPWT.
    MeSH term(s) Humans ; Negative-Pressure Wound Therapy/adverse effects ; Surgical Wound Infection/prevention & control ; Bandages ; Wound Healing ; Pancreatectomy/adverse effects
    Language English
    Publishing date 2022-08-28
    Publishing country England
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review
    ZDB-ID 2131251-5
    ISSN 1477-2574 ; 1365-182X
    ISSN (online) 1477-2574
    ISSN 1365-182X
    DOI 10.1016/j.hpb.2022.08.010
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  6. Article ; Online: Feasibility and Safety of a "Shared Care" Model in Complex Hepatopancreatobiliary Surgery: A 5-year Observational Study of Outcomes in Pancreaticoduodenectomy.

    Lee, Alex / Al-Arnawoot, Ahmed / Rajendran, Luckshi / Lamb, Tyler / Turner, Anastasia / Reid, Morgann / Rekman, Janelle / Mimeault, Richard / Abou Khalil, Jad / Martel, Guillaume / Bertens, Kimberly A / Balaa, Fady

    Annals of surgery

    2023  Volume 278, Issue 6, Page(s) 994–1000

    Abstract: Objective: To determine the safety of a fully functioning shared care model (SCM) in hepatopancreatobiliary surgery through evaluating outcomes in pancreaticoduodenectomy.: Background: SCMs, where a team of surgeons share in care delivery and ... ...

    Abstract Objective: To determine the safety of a fully functioning shared care model (SCM) in hepatopancreatobiliary surgery through evaluating outcomes in pancreaticoduodenectomy.
    Background: SCMs, where a team of surgeons share in care delivery and resource utilization, represent a surgeon-level opportunity to improve system efficiency and peer support, but concerns around clinical safety remain, especially in complex elective surgery.
    Methods: Patients who underwent pancreaticoduodenectomy between 2016 and 2020 were included. Adoption of shared care was demonstrated by analyzing shared care measures, including the number of surgeons encountered by patients during their care cycle, the proportion of patients with different consenting versus primary operating surgeon (POS), and the proportion of patients who met their POS on the day of surgery. Outcomes, including 30-day mortality, readmission, unplanned reoperation, sepsis, and length of stay, were collected from the institution's National Surgical Quality Improvement Program (NSQIP) database and compared with peer hospitals contributing to the pancreatectomy-specific NSQIP collaborative.
    Results: Of the 174 patients included, a median of 3 surgeons was involved throughout the patients' care cycle, 69.0% of patients had different consenting versus POS and 57.5% met their POS on the day of surgery. Major outcomes, including mortality (1.1%), sepsis (5.2%), and reoperation (7.5%), were comparable between the study group and NSQIP peer hospitals. Length of stay (10 day) was higher in place of lower readmission (13.2%) in the study group compared with peer hospitals.
    Conclusions: SCMs are feasible in complex elective surgery without compromising patient outcomes, and wider adoption may be encouraged.
    MeSH term(s) Humans ; Pancreatectomy/adverse effects ; Pancreaticoduodenectomy ; Postoperative Complications/etiology ; Feasibility Studies ; Retrospective Studies ; Sepsis/etiology ; Patient Readmission
    Language English
    Publishing date 2023-02-20
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000005826
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  7. Article ; Online: Surgical strategies and novel therapies for locally advanced pancreatic cancer.

    Abou-Khalil, Jad / Rocha, Flavio G

    Journal of surgical oncology

    2017  Volume 116, Issue 1, Page(s) 16–24

    Abstract: Many patients with pancreatic cancer are not candidates for surgical resection due to involvement of critical mesenteric vascular structures. We compare and contrast the commonly used classification systems for borderline resectable and locally advanced ... ...

    Abstract Many patients with pancreatic cancer are not candidates for surgical resection due to involvement of critical mesenteric vascular structures. We compare and contrast the commonly used classification systems for borderline resectable and locally advanced pancreatic cancer. We describe the current strategies in managing venous and arterial involvement, as well as the role of neoadjuvant chemotherapy and chemoradiation, before explanding on a novel clinical trial in this patient population.
    MeSH term(s) Adenocarcinoma/pathology ; Adenocarcinoma/therapy ; Albumins/administration & dosage ; Antibodies, Monoclonal/administration & dosage ; Antibodies, Monoclonal, Humanized ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Arteries/surgery ; Chemoradiotherapy, Adjuvant ; Chemotherapy, Adjuvant ; Deoxycytidine/administration & dosage ; Deoxycytidine/analogs & derivatives ; Digestive System Surgical Procedures ; Humans ; Neoadjuvant Therapy ; Paclitaxel/administration & dosage ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/therapy ; Randomized Controlled Trials as Topic ; Veins/surgery
    Chemical Substances 130-nm albumin-bound paclitaxel ; Albumins ; Antibodies, Monoclonal ; Antibodies, Monoclonal, Humanized ; Deoxycytidine (0W860991D6) ; gemcitabine (B76N6SBZ8R) ; Paclitaxel (P88XT4IS4D) ; pamrevlumab (QS5F6VTS0O)
    Language English
    Publishing date 2017-05-17
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 82063-5
    ISSN 1096-9098 ; 0022-4790
    ISSN (online) 1096-9098
    ISSN 0022-4790
    DOI 10.1002/jso.24654
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  8. Article ; Online: Exploring human factors in the operating room: a protocol for a scoping review of training offerings for healthcare professionals.

    Lee, Alex / Tipney, Ben / Finstad, Alexandra / Rahman, Alvi / Devenny, Kirsten / Abou Khalil, Jad / Kuziemsky, Craig / Balaa, Fady

    BMJ open

    2021  Volume 11, Issue 6, Page(s) e044721

    Abstract: Introduction: Applying human factors principles in surgical care has potential benefits for patient safety and care delivery. Although different theoretical frameworks of human factors exist, how providers are being trained in human factors and how ... ...

    Abstract Introduction: Applying human factors principles in surgical care has potential benefits for patient safety and care delivery. Although different theoretical frameworks of human factors exist, how providers are being trained in human factors and how human factors are being understood in vivo in the operating room (OR) remain unknown. The aim of this scoping review is to evaluate the application of human factors for the OR environment as described by education and training offerings for healthcare professionals.
    Methods and analysis: This scoping review will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. MEDLINE, Embase, PsycINFO, CINAHL, Health and Psychosocial Instruments and ERIC databases were searched on August 2020 from inception to identify relevant studies that describe the content, application and impact of human factors training for healthcare professionals or trainees who work in or interface with the OR environment. Titles, abstracts and full texts will be independently screened by two authors for eligible studies. Any disagreements will be resolved by discussion or by a third author when disagreement persists. Study information and training characteristics, such as the training tool used and type of learners and teachers, will be charted and summarised, and key themes in human factors training will be identified. Each training offering will be classified under the appropriate knowledge area(s) of human factors described by the Chartered Institute of Ergonomics & Human Factors (CIEHF). Themes that are not captured by the CIEHF framework will be independently recorded by two authors and included based on group discussion and consensus.
    Ethics and dissemination: Research ethics board approval is not required for this scoping review. The findings of this study will be disseminated at local and national conferences and will be published in a peer-reviewed journal.
    MeSH term(s) Delivery of Health Care ; Humans ; Operating Rooms ; Peer Review ; Research Design ; Review Literature as Topic ; Systematic Reviews as Topic
    Language English
    Publishing date 2021-06-02
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2020-044721
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  9. Article: Standardization of early drain removal following pancreatic resection: proposal of the "Ottawa pancreatic drain algorithm".

    Smith, Heather / Balaa, Fady K / Martel, Guillaume / Abou Khalil, Jad / Bertens, Kimberly A

    Patient safety in surgery

    2019  Volume 13, Page(s) 38

    Abstract: Background: Early drain removal after pancreatic resection is encouraged for individuals with low postoperative day 1 drain amylase levels (POD1 DA) to mitigate associated morbidity. Although various protocols for drain management have been published, ... ...

    Abstract Background: Early drain removal after pancreatic resection is encouraged for individuals with low postoperative day 1 drain amylase levels (POD1 DA) to mitigate associated morbidity. Although various protocols for drain management have been published, there is a need to assess the implementation of a standardized protocol.
    Methods: The Ottawa pancreatic drain algorithm (OPDA), based on POD1 DA and effluent volume, was developed and implemented at our institution. A retrospective cohort analysis was conducted of all patients undergoing pancreatic resection January 1, 2016-October 30, 2017, excluding November and December 2016 (one month before and after OPDA implementation).
    Results: 42 patients pre-implementation and 53 patients post-implementation were included in the analysis. The median day of drain removal was significantly reduced after implementation of the OPDA (8 vs. 5 days;
    Conclusions: Implementing the OPDA was associated with earlier drain removal and decreased length of stay in patients undergoing distal pancreatectomy who did not develop POPF, without increased morbidity. Standardizing drain removal may help facilitate early drain removal after pancreatic resection at other institutions.
    Language English
    Publishing date 2019-12-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 2409244-7
    ISSN 1754-9493
    ISSN 1754-9493
    DOI 10.1186/s13037-019-0219-z
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  10. Article ; Online: Red blood cell transfusions in liver surgery.

    Lenet, Tori / Baker, Laura / Vered, Michael / Workneh, Aklile / Zahrai, Amin / Rajendran, Luckshi / Abou-Khalil, Jad / Balaa, Fady K / Bertens, Kimberly A / McIsaac, Daniel I / Tinmouth, Alan / Fergusson, Dean A / Martel, Guillaume

    The British journal of surgery

    2022  

    Language English
    Publishing date 2022-11-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znac389
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