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Lavallée LT, Fitzpatrick R, Wood LA, Basiuk J, Knee C, Cnossen S, Mallick R, Witiuk K, Vanhuyse M, Tanguay S, Finelli A, Jewett MAS, Basappa N, Lattouf JB, Gotto GT, Al-Asaaed S, Bjarnason GA, Moore R, North S, Canil C, Pouliot F, Soulières D, Castonguay V, Kassouf W, Cagiannos I, Morash C, Breau RH. Development and Implementation of a Continuing Medical Education Program in Canada: Knowledge Translation for Renal Cell Carcinoma (KT4RCC). J Cancer Educ 2019; 34:14-18. [PMID: 28779441 DOI: 10.1007/s13187-017-1259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An in-person multidisciplinary continuing medical education (CME) program was designed to address previously identified knowledge gaps regarding quality indicators of care in kidney cancer. The objective of this study was to develop a CME program and determine if the program was effective for improving participant knowledge. CME programs for clinicians were delivered by local experts (uro-oncologist and medical oncologist) in four Canadian cities. Participants completed knowledge assessment tests pre-CME, immediately post-CME, and 3-month post-CME. Test questions were related to topics covered in the CME program including prognostic factors for advanced disease, surgery for advanced disease, indications for hereditary screening, systemic therapy, and management of small renal masses. Fifty-two participants attended the CME program and completed the pre- and immediate post-CME tests. Participants attended in Ottawa (14; 27%), Toronto (13; 25%), Québec City (18; 35%), and Montréal (7; 13%) and were staff urologists (21; 40%), staff medical oncologists (9; 17%), fellows (5; 10%), residents (16; 31%), and oncology nurses (1; 2%). The mean pre-CME test score was 61% and the mean post-CME test score was 70% (p = 0.003). Twenty-one participants (40%) completed the 3-month post-CME test. Of those that completed the post-test, scores remained 10% higher than the pre-test (p value 0.01). Variability in test scores was observed across sites and between French and English test versions. Urologists had the largest specialty-specific increase in knowledge at 13.8% (SD 24.2, p value 0.02). The kidney cancer CME program was moderately effective in improving provider knowledge regarding quality indicators of kidney cancer care. These findings support continued use of this CME program at other sites.
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Affiliation(s)
- Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Ryan Fitzpatrick
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- University of Ottawa, Ottawa, Canada
| | - Lori A Wood
- QEII Health Sciences Centre, Halifax, Canada
- Dalhousie University, Halifax, Canada
| | | | | | | | | | | | | | | | - Antonio Finelli
- University Health Network, Toronto, Canada
- Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | - Naveen Basappa
- Cross Cancer Institute, Edmonton, Canada
- University of Alberta, Edmonton, Canada
| | - Jean-Baptiste Lattouf
- Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Université de Montréal, Montreal, Canada
| | | | | | | | - Ronald Moore
- Cross Cancer Institute, Edmonton, Canada
- University of Alberta, Edmonton, Canada
| | - Scott North
- Cross Cancer Institute, Edmonton, Canada
- University of Alberta, Edmonton, Canada
| | - Christina Canil
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | | | - Denis Soulières
- Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | | | | | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- University of Ottawa, Ottawa, Canada
| | - Chris Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- University of Ottawa, Ottawa, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
- Ottawa Hospital Research Institute, Ottawa, Canada.
- University of Ottawa, Ottawa, Canada.
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Breau RH, Cagiannos I, Knoll G, Morash C, Cnossen S, Lavallée LT, Mallick R, Finelli A, Jewett M, Leibovich BC, Cook J, LeBel L, Kapoor A, Pouliot F, Izawa J, Rendon R, Fergusson DA. Renal hypothermia during partial nephrectomy for patients with renal tumours: a randomised controlled clinical trial protocol. BMJ Open 2019; 9:e025662. [PMID: 30610026 PMCID: PMC6326302 DOI: 10.1136/bmjopen-2018-025662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Partial nephrectomy is a standard of care for non-metastatic renal tumours when technically feasible. Despite the increased use of partial nephrectomy, intraoperative techniques that lead to optimal renal function after surgery have not been rigorously studied. Clamping of the renal hilum to prevent bleeding during resection causes temporary renal ischaemia. The internal temperature of the kidney may be lowered after the renal hilum is clamped (renal hypothermia) in an attempt to mitigate the effects of ischaemia. Our objective is to determine if renal hypothermia during open partial nephrectomy results in improved postoperative renal function at 12 months following surgery as compared with warm ischaemia (no renal hypothermia). METHODS AND ANALYSES This is a multicentre, randomised, single-blinded controlled trial comparing renal hypothermia versus no hypothermia during open partial nephrectomy. Due to the nature of the intervention, complete blinding of the surgical team is not possible; however, surgeons will be blinded until the time of hilar clamping. Glomerular filtration will be based on plasma clearance of a radionucleotide, and differential renal function will be based on renal scintigraphy. The primary outcome is overall renal function at 12 months measured by the glomerular filtration rate (GFR). Secondary outcomes include change in GFR, GFR of the affected kidney, change in GFR of the affected kidney, serum creatinine, haemoglobin, spot urine albumin to creatinine ratio, quality of life and postoperative complications. Data will be collected at baseline, immediately postoperatively and at 3, 6, 9 and 12 months postoperatively. ETHICS AND DISSEMINATION Ethics approval was obtained for all participating study sites. Results of the trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT01529658; Pre-results.
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Affiliation(s)
- Rodney H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Greg Knoll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christopher Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sonya Cnossen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Michael Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | | | - Jonathan Cook
- Oxford Clinical Trial Research Unit, University of Oxford, Oxford, UK
| | - Louise LeBel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Frederic Pouliot
- Division of Urology, Université Laval, Quebec City, Quebec, Canada
| | - Jonathan Izawa
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Breau RH, Kumar RM, Lavallee LT, Cagiannos I, Morash C, Horrigan M, Cnossen S, Mallick R, Stacey D, Fung-Kee-Fung M, Morash R, Smylie J, Witiuk K, Fergusson DA. The effect of surgery report cards on improving radical prostatectomy quality: the SuRep study protocol. BMC Urol 2018; 18:89. [PMID: 30340572 PMCID: PMC6194548 DOI: 10.1186/s12894-018-0403-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background The goal of radical prostatectomy is to achieve the optimal balance between complete cancer removal and preserving a patient’s urinary and sexual function. Performing a wider excision of peri-prostatic tissue helps achieve negative surgical margins, but can compromise urinary and sexual function. Alternatively, sparing peri-prostatic tissue to maintain functional outcomes may result in an increased risk of cancer recurrence. The objective of this study is to determine the effect of providing surgeons with detailed information about their patient outcomes through a surgical report card. Methods We propose a prospective cohort quasi-experimental study. The intervention is the provision of feedback to prostate cancer surgeons via surgical report cards. These report cards will be distributed every 3 months by email and will present surgeons with detailed information, including urinary function, erectile function, and surgical margin outcomes of their patients compared to patients treated by other de-identified surgeons in the study. For the first 12 months of the study, pre-operative, 6-month, and 12-month patient data will be collected but there will be no report cards distributed to surgeons. This will form the pre-feedback cohort. After the pre-feedback cohort has completed accrual, surgeons will receive quarterly report cards. Patients treated after the provision of report cards will comprise the post-feedback cohort. The primary comparison will be post-operative function of the pre-feedback cohort vs. post-feedback cohort. The secondary comparison will be the proportion of patients with positive surgical margins in the two cohorts. Outcomes will be stratified or case-mix adjusted, as appropriate. Assuming a baseline potency of 20% and a baseline continence of 70%, 292 patients will be required for 80% power at an alpha of 5% to detect a 10% improvement in functional outcomes. Assuming 30% of patients may be lost to follow-up, a minimum sample size of 210 patients is required in the pre-feedback cohort and 210 patients in the post-feedback cohort. Discussion The findings from this study will have an immediate impact on surgeon self-evaluation and we hypothesize surgical report cards will result in improved overall outcomes of men treated with radical prostatectomy. Electronic supplementary material The online version of this article (10.1186/s12894-018-0403-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - R M Kumar
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
| | - L T Lavallee
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - I Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - C Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Horrigan
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - S Cnossen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - R Mallick
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - D Stacey
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - R Morash
- The Ottawa Hospital Cancer Program, Ottawa, Canada
| | - J Smylie
- The Ottawa Hospital Cancer Program, Ottawa, Canada
| | - K Witiuk
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - D A Fergusson
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Abdi H, Elzayat E, Cagiannos I, Lavallée LT, Cnossen S, Flaman AS, Mallick R, Morash C, Breau RH. Female radical cystectomy patients have a higher risk of surgical site infections. Urol Oncol 2018; 36:400.e1-400.e5. [PMID: 30064934 DOI: 10.1016/j.urolonc.2018.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/13/2018] [Accepted: 05/21/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Surgical site infections (SSI) are common after radical cystectomy. The objectives of this study were to evaluate if female sex is associated with postoperative SSI and if experiencing an SSI was associated with subsequent adverse events. METHODS This was a historical cohort study of radical cystectomy patients from the American College of Surgeons' National Surgical Quality Improvement Program database between 2006 and 2016. The primary outcome was development of a SSI (superficial, deep, or organ/abdominal space) within 30 days of surgery. Multivariable logistic regression analyses were performed to determine the association between sex and other patient/procedural factors with SSI. Female patients with SSI were also compared to those without SSI to determine risk of subsequent adverse events. RESULTS A total of 9,275 radical cystectomy patients met the inclusion criteria. SSI occurred in 1,277(13.7%) patients, 308 (16.4%) females and 969 (13.1%) males (odds ratio = 1.27; 95% confidence interval 1.10-1.47; P = 0.009). Infections were superficial in 150 (8.0%) females versus 410 (5.5%) males (P < 0.0001), deep in 40 (2.1%) females versus 114 (1.5%) males (P = 0.07), and organ/abdominal space in 118 (6.2%) females versus 445 (6.0%) males (P = 0.66). On multivariable analysis, female sex was independently associated with SSI (odds ratio = 1.21 confidence interval 1.01-1.43 P = 0.03). Females who experience SSI had higher probability of developing other complications including wound dehiscence, septic shock, and need for reoperation (all P < 0.05). CONCLUSIONS Female sex is an independent risk factor for SSI following radical cystectomy. More detailed study of patient factors, pathogenic microbes, and treatment factors are needed to prescribe the best measures for infection prophylaxis.
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Affiliation(s)
- Hamidreza Abdi
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Ehab Elzayat
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Sonya Cnossen
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Anathea S Flaman
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Chris Morash
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada.
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Breau RH, Lavallée LT, Cnossen S, Witiuk K, Cagiannos I, Momoli F, Bryson G, Kanji S, Morash C, Turgeon A, Zarychanski R, Mallick R, Knoll G, Fergusson DA. Tranexamic Acid versus Placebo to Prevent Blood Transfusion during Radical Cystectomy for Bladder Cancer (TACT): Study Protocol for a Randomized Controlled Trial. Trials 2018; 19:261. [PMID: 29716640 PMCID: PMC5930484 DOI: 10.1186/s13063-018-2626-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radical cystectomy for bladder cancer is associated with a high risk of needing red blood cell transfusion. Tranexamic acid reduces blood loss during cardiac and orthopedic surgery, but no study has yet evaluated tranexamic acid use during cystectomy. METHODS A randomized, double-blind (surgeon-, anesthesiologist-, patient-, data-monitor-blinded), placebo-controlled trial of tranexamic acid during cystectomy was initiated in June 2013. Prior to incision, the intervention arm participants receive a 10 mg/kg loading dose of intravenously administered tranexamic acid, followed by a 5 mg/kg/h maintenance infusion. In the control arm, the patient receives an identical volume of normal saline that is indistinguishable from the intervention. The primary outcome is any blood transfusion from the start of surgery up to 30 days post operative. There are no strict criteria to mandate the transfusion of blood products. The decision to transfuse is entirely at the discretion of the treating physicians who are blinded to patient allocation. Physicians are allowed to utilize all resources to make transfusion decisions, including serum hemoglobin concentration and vital signs. To date, 147 patients of a planned 354 have been randomized to the study. DISCUSSION This protocol reviews pertinent data relating to blood transfusion during radical cystectomy, highlighting the need to identify methods for reducing blood loss and preventing transfusion in patients receiving radical cystectomy. It explains the clinical rationale for using tranexamic acid to reduce blood loss during cystectomy, and outlines the study methods of our ongoing randomized controlled trial. TRIAL REGISTRATIONS Canadian Institute for Health Research (CIHR) Protocol: MOP-342559; ClinicalTrials.gov, ID: NCT01869413. Registered on 5 June 2013.
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Affiliation(s)
- Rodney H Breau
- Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Luke T Lavallée
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Sonya Cnossen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kelsey Witiuk
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Franco Momoli
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Gregory Bryson
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Anesthesiology and Pain Medicine, University of Ottawa and Ottawa Hospital, Ottawa, ON, Canada
| | - Salmaan Kanji
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christopher Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Alexis Turgeon
- CHU de Québec, Université Laval, Québec City, QC, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, MB, Canada
| | | | - Greg Knoll
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
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Wallace B, Breau RH, Cnossen S, Knee C, Mcisaac D, Mallick R, Cagiannos I, Morash C, Lavallée LT. Age-stratified perioperative mortality after urological surgeries. Can Urol Assoc J 2018; 12:256-259. [PMID: 29629861 DOI: 10.5489/cuaj.5022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION More elderly patients are presenting for surgical consultation. Understanding the risk of mortality by age group after urological surgery is important for patient selection and counselling. METHODS A historical cohort study of The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2006-2015 was performed. Current procedural terminology (CPT) codes for similar surgical procedures were grouped for analyses. Urological procedures commonly performed in elderly patients were identified and stratified by patient age and surgical approach (open vs. laparoscopic/robotic). The primary outcome was the absolute risk of death by 30 days stratified by age for each surgical procedure. The secondary outcome was risk of death by surgical approach (open vs. laparoscopic/robotic). RESULTS Twelve urological procedures were reviewed including 124 262 patients. A total of 1011 (0.8%) deaths occurred by 30 days after surgery. The procedure with the highest incidence of mortality by 30 days was open nephroureterectomy (2.9 %). In patients 80 years and over, the procedure with the highest incidence of death was open radical nephrectomy (5.32%). There was an increased risk of mortality with increasing age group for all procedures. Unadjusted risk of mortality was consistently higher in patients who receive open compared to laparoscopic surgery. CONCLUSIONS There is an increasing risk of mortality with age and with open surgical approach in urology. Knowledge regarding the absolute risk of mortality in patients receiving common urological surgeries may improve patient selection and counselling.
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Affiliation(s)
- Brendan Wallace
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sonya Cnossen
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Knee
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Mcisaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Greenaway C, Shrier I, Abou Chakra CN, Cnossen S, Cheng MP, Yansouni CP, Menzies D. Reply to Dobler. Clin Infect Dis 2017; 65:1423-1424. [PMID: 29017250 DOI: 10.1093/cid/cix521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Christina Greenaway
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital.,Division of Infectious Diseases, Jewish General Hospital, McGill University
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Claire Nour Abou Chakra
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Sonya Cnossen
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Matthew P Cheng
- Division of Infectious Diseases and Department of Medical Microbiology
| | - Cedric P Yansouni
- Division of Infectious Diseases and Department of Medical Microbiology
| | - Dick Menzies
- Respiratory Epidemiology Unit, McGill University Health Centre, Montreal, Quebec, Canada
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Nguyen LN, Head L, Witiuk K, Punjani N, Mallick R, Cnossen S, Fergusson DA, Cagiannos I, Lavallée LT, Morash C, Breau RH. The Risks and Benefits of Cavernous Neurovascular Bundle Sparing during Radical Prostatectomy: A Systematic Review and Meta-Analysis. J Urol 2017; 198:760-769. [DOI: 10.1016/j.juro.2017.02.3344] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Laura N. Nguyen
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Linden Head
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kelsey Witiuk
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nahid Punjani
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Sonya Cnossen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Luke T. Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christopher Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rodney H. Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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da Silva V, Cagiannos I, Lavallée LT, Mallick R, Witiuk K, Cnossen S, Eastham JA, Fergusson DA, Morash C, Breau RH. An assessment of Prostate Cancer Research International: Active Surveillance (PRIAS) criteria for active surveillance of clinically low-risk prostate cancer patients. Can Urol Assoc J 2017; 11:238-243. [PMID: 28798822 DOI: 10.5489/cuaj.4093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Active surveillance is a strategy to delay or prevent treatment of indolent prostate cancer. The Prostate Cancer Research International: Active Surveillance (PRIAS) criteria were developed to select patients for prostate cancer active surveillance. The objective of this study was to compare pathological findings from PRIAS-eligible and PRIAS-ineligible clinically low-risk prostate cancer patients. METHODS A D'Amico low-risk cohort of 1512 radical prostatectomy patients treated at The Ottawa Hospital or Memorial Sloan Kettering Cancer Centre between January 1995 and December 2007 was reviewed. Pathological outcomes (pT3 tumours, Gleason sum ≥7, lymph node metastases, or a composite) and clinical outcomes (prostate-specific antigen [PSA] recurrence, secondary cancer treatments, and death) were compared between PRIAS-eligible and PRIAS-ineligible cohorts. RESULTS The PRIAS-eligible cohort (n=945) was less likely to have Gleason score ≥7 (odds ratio [OR] 0.61; 95% confidence interval [CI] 0.49-0.75), pT3 (OR 0.41; 95% CI 0.31-0.55), nodal metastases (OR 0.37; 95% CI 0.10-1.31), or any adverse feature (OR 0.56; 95% CI 0.45-0.69) compared to the PRIAS-ineligible cohort. The probability of any adverse pathology in the PRIAS-eligible cohort was 41% vs. 56% in the PRIAS-ineligible cohort. At median follow-up of 3.7 years, 72 (4.8%) patients had a PSA recurrence, 24 (1.6%) received pelvic radiation, and 13 (0.9%) received androgen deprivation. No difference was detected for recurrence-free and overall survival between groups (recurrence hazard ratio [HR] 0.71; 95% CI 0.46-1.09 and survival HR 0.72; 95% CI 0.36-1.47). CONCLUSIONS Low-risk prostate cancer patients who met PRIAS eligibility criteria are less likely to have higher-risk cancer compared to those who did not meet at least one of these criteria.
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Affiliation(s)
- Vitor da Silva
- University of Ottawa, Division of Urology, Department of Surgery, Ottawa, ON, Canada
| | - Ilias Cagiannos
- University of Ottawa, Division of Urology, Department of Surgery, Ottawa, ON, Canada
| | - Luke T Lavallée
- University of Ottawa, Division of Urology, Department of Surgery, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Kelsey Witiuk
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sonya Cnossen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - James A Eastham
- Memorial Sloan Kettering Cancer Centre, Urology Service, Department of Surgery, New York, NY, United States
| | | | - Chris Morash
- University of Ottawa, Division of Urology, Department of Surgery, Ottawa, ON, Canada
| | - Rodney H Breau
- University of Ottawa, Division of Urology, Department of Surgery, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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McAlpine K, Breau RH, Mallick R, Cnossen S, Cagiannos I, Morash C, Carrier M, Lavallée LT. Current guidelines do not sufficiently discriminate venous thromboembolism risk in urology. Urol Oncol 2017; 35:457.e1-457.e8. [DOI: 10.1016/j.urolonc.2017.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/14/2016] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
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Montroy J, Fergusson NA, Hutton B, Lavallée LT, Morash C, Cagiannos I, Cnossen S, Fergusson DA, Breau RH. The Safety and Efficacy of Lysine Analogues in Cancer Patients: A Systematic Review and Meta-Analysis. Transfus Med Rev 2017; 31:141-148. [DOI: 10.1016/j.tmrv.2017.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
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Kumar RM, Lavallée LT, Desantis D, Cnossen S, Mallick R, Cagiannos I, Morash C, Breau RH. Are renal tumour scoring systems better than clinical judgement at predicting partial nephrectomy complexity? Can Urol Assoc J 2017; 11:199-203. [PMID: 28652879 DOI: 10.5489/cuaj.4228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION We aimed to determine how renal tumour scoring systems, such as RENAL, PADUA, and Centrality (C)-index, compare to clinical judgement at predicting time required for tumour removal and kidney reconstruction during partial nephrectomy. METHODS A consecutive cohort of partial nephrectomy patients treated at The Ottawa Hospital, a tertiary care uro-oncological centre, was retrospectively reviewed. Preoperative axial images were reviewed by four experienced urological oncologists who independently rated the complexity of a partial nephrectomy from 1-10 to generate a clinical judgement score. Two independent reviewers determined the RENAL, PADUA, and C-index scores. The time to complete tumour resection and renal reconstruction during partial nephrectomy was prospectively recorded. RESULTS During the study period, 104 partial nephrectomies were performed. The mean partial nephrectomy complexity score based on clinical judgement was 3.4 (standard deviation [SD] 2.1) out of 10. There was good agreement between surgeons in assessing tumour complexity (intraclass correlation coefficient 0.72; 95% confidence interval [CI] 0.65, 0.78). The mean RENAL score was 6.7 (SD 1.6) out of a maximum of 12, the mean PADUA score was 8.5 (SD 1.5) out of a maximum of 14, and the mean C-index score was 3.8 (SD 2). Mean resection and reconstruction time was 24 minutes (SD 10 minutes). The correlation between clinical judgement score and time was 0.27 (p=0.005). The correlation between renal tumour scoring systems and time was 0.20 (p=0.04) for RENAL, 0.21 (p=0.03) for C-index, and 0.26 (p=0.007) for PADUA. RENAL and PADUA scores were significantly associated with surgical and total complications. CONCLUSIONS The majority of variance in ischemia time is not explained by clinical judgement or renal tumour scoring systems. Renal tumour scoring systems were not better than the clinical judgement of urological oncologists at predicting ischemia time during partial nephrectomy.
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Affiliation(s)
- Ravi M Kumar
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa.,Ottawa Hospital Research Institute; Ottawa, ON, Canada
| | - Darren Desantis
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa
| | - Sonya Cnossen
- Ottawa Hospital Research Institute; Ottawa, ON, Canada
| | | | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa
| | - Chris Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa
| | - Rodney H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa.,Ottawa Hospital Research Institute; Ottawa, ON, Canada
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Lavallée LT, Fitzpatrick R, Cnossen S, Witiuk K, Wood L, Basiuk J, Vanhuyse M, Tanguay S, Pautler SE, Finelli A, Jewett MA, Cagiannos I, Morash C, Breau RH. Needs Assessment Survey for the Management of Kidney Cancer. Urol Pract 2017; 4:257-263. [PMID: 37592641 DOI: 10.1016/j.urpr.2016.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In this study we determined self-perceived knowledge gaps and continuing medical education preferences among Canadian urologists and medical oncologists related to the treatment of patients with kidney cancer. METHODS A needs assessment survey was created by the Quality Initiative group of the Kidney Cancer Research Network of Canada using an iterative feedback process. The survey determined knowledge gaps and continuing medical education preferences pertaining to 23 previously validated quality indicators of kidney cancer care. Topics included screening, diagnosis, prognosis, surgical management, systemic therapies and followup care. The survey was distributed via e-mail to Canadian urologists and medical oncologists. RESULTS Among the 164 respondents 121 (74%) were urologists and 43 (26%) were medical oncologists. The majority of respondents practice in academic (72, 57%) or large urban community centers (40, 32%). Of the 23 quality indicators examined 14 were designated as priority continuing medical education topics based on perceived inadequate knowledge or high interest in the topic. Priority topics were similar for urologists and medical oncologists, and covered the spectrum of kidney cancer care with an emphasis on hereditary kidney cancer and management of advanced disease. Most respondents preferred that continuing medical education be delivered through in person, case based group discussions. CONCLUSIONS Canadian urologists and medical oncologists report similar knowledge gaps and continuing medical education preferences regarding kidney cancer care. Priority topics include screening for hereditary kidney cancer and management of advanced disease.
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Affiliation(s)
- Luke T Lavallée
- Division of Urology, Department of Surgery, the Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ryan Fitzpatrick
- Division of Urology, Department of Surgery, the Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Sonya Cnossen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kelsey Witiuk
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lori Wood
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Joan Basiuk
- University Health Network, Toronto, Ontario, Canada
| | - Marie Vanhuyse
- McGill University, Montreal, Quebec, and University of Alberta, Edmonton, Alberta, Canada
| | - Simon Tanguay
- McGill University, Montreal, Quebec, and University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | - Ilias Cagiannos
- Division of Urology, Department of Surgery, the Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher Morash
- Division of Urology, Department of Surgery, the Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Rodney H Breau
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Cheng MP, Abou Chakra CN, Yansouni CP, Cnossen S, Shrier I, Menzies D, Greenaway C. Risk of Active Tuberculosis in Patients with Cancer: A Systematic Review and Meta-Analysis. Clin Infect Dis 2016; 64:635-644. [DOI: 10.1093/cid/ciw838] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Indexed: 11/13/2022] Open
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Paterson NR, Lavallée LT, Nguyen LN, Witiuk K, Ross J, Mallick R, Shabana W, MacDonald B, Scheida N, Fergusson D, Momoli F, Cnossen S, Morash C, Cagiannos I, Breau RH. Prostate volume estimations using magnetic resonance imaging and transrectal ultrasound compared to radical prostatectomy specimens. Can Urol Assoc J 2016; 10:264-268. [PMID: 27878049 DOI: 10.5489/cuaj.3236] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to evaluate the accuracy of prostate volume estimates in patients who received both a preoperative transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) in relation to the referent pathological specimen post-radical prostatectomy. METHODS Patients receiving both TRUS and MRI prior to radical prostatectomy at one academic institution were retrospectively analyzed. TRUS and MRI volumes were estimated using the prolate ellipsoid formula. TRUS volumes were collected from sonography reports. MRI volumes were estimated by two blinded raters and the mean of the two was used for analyses. Pathological volume was calculated using a standard fluid displacement method. RESULTS Three hundred and eighteen (318) patients were included in the analysis. MRI was slightly more accurate than TRUS based on interclass correlation (0.83 vs. 0.74) and absolute risk bias (higher proportion of estimates within 5, 10, and 20 cc of pathological volume). For TRUS, 87 of 298 (29.2%) prostates without median lobes differed by >10 cc of specimen volume and 22 of 298 (7.4%) differed by >20 cc. For MRI, 68 of 298 (22.8%) prostates without median lobes differed by >10 cc of specimen volume, while only 4 of 298 (1.3%) differed by >20 cc. CONCLUSIONS MRI and TRUS prostate volume estimates are consistent with pathological volumes along the prostate size spectrum. MRI demonstrated better correlation with prostatectomy specimen volume in most patients and may be better suited in cases where TRUS and MRI estimates are disparate. Validation of these findings with prospective, standardized ultrasound techniques would be helpful.
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Affiliation(s)
- Nicholas R Paterson
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - Laura N Nguyen
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Kelsey Witiuk
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - James Ross
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - Wael Shabana
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Blair MacDonald
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Nicola Scheida
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Dean Fergusson
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - Franco Momoli
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - Sonya Cnossen
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - Christopher Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
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Bastiampillai R, Lavallée LT, Cnossen S, Witiuk K, Mallick R, Fergusson D, Schramm D, Morash C, Cagiannos I, Breau RH. Laparoscopic nephroureterectomy is associated with higher risk of adverse events compared to laparoscopic radical nephrectomy. Can Urol Assoc J 2016; 10:126-31. [PMID: 27217860 DOI: 10.5489/cuaj.3362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Laparoscopic radical nephrectomy (LRN) and laparoscopic nephroureterectomy (LNU) are similar procedures and some surgeons may believe the perioperative risks are the same. The purpose of this study is to characterize and compare complications following LRN and LNU. METHODS A historical cohort of patients who received either LRN or LNU between 2006 and 2012 was reviewed from the National Surgical Quality Improvement Program (NSQIP) database. Patient characteristics, surgical characteristics, and perioperative outcomes up to 30 days postoperatively were abstracted. Unadjusted and adjusted associations between procedure (LRN or LNU) and any adverse event were determined. RESULTS During the study period, 4904 patients met study inclusion criteria; 4159 (84.8%) received a LRN while 745 (15.2%) received a LNU. Overall, 651 (13.3%) patients experienced at least one postoperative complication. LNU was associated with more complications than LRN (21% and 12%, respectively, p value <0.01). The most common complications were: bleeding requiring blood transfusion (9.0% LNU vs. 6.0% LRN), urinary tract infection (4.6% LNU vs. 1.5% LRN), wound infection (1.3% LNU vs. 1.8% LRN), and unplanned intubation (2.3% LNU vs. 0.9% LRN). After adjusting for potential confounders, LNU was associated with higher risk of any complication compared to LRN (relative risk [RR] 1.41, 95% confidence interval [CI] 1.16-1.72). Other variables independently associated with an increased risk of complications included: increasing patient age (RR 1.01, 95% CI 1.01-1.02), American Society of Anesthesiologists (ASA) classification ≥3 (RR 1.34, 95% CI 1.10-1.63), higher preoperative creatinine (RR 1.11, 95% CI 1.06-1.17), >4 units of blood transfused within 72 hours before surgery (RR 1.93, 95% CI 1.29-2.86), and operative time >6 hours (RR 2.17, 95% CI 1.71-2.75). CONCLUSIONS Postoperative complications within 30 days of surgery are common after LNU and LRN. Despite having technical similarities, LNU carries a significantly higher risk of developing short-term complications compared to LRN. This information should be considered when counseling patients prior to surgery. Notable limitations of this study included the lack of information on tumour stage and management of the distal ureter.
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Affiliation(s)
- Ravin Bastiampillai
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - Sonya Cnossen
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - Kelsey Witiuk
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - Dean Fergusson
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
| | - David Schramm
- Division of Otolaryngology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON, Canada
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Lavallée LT, Stokl A, Cnossen S, Mallick R, Morash C, Cagiannos I, Breau RH. The effect of wide resection during radical prostatectomy on surgical margins. Can Urol Assoc J 2016; 10:14-7. [PMID: 26977200 DOI: 10.5489/cuaj.3326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The impact of nerve-sparing on positive surgical margins during radical prostatectomy (RP) remains unclear. The objective of this study was to determine the incidence of positive surgical margins with a wide resection compared to a nerve-sparing technique. METHODS A consecutive, single-surgeon patient cohort treated between August 2010 and November 2014 was reviewed. A standardized surgical approach of lobe-specific nerve-spare or wide resection was performed. Lobe-specific margin status and tumour stage were obtained from pathology reports. Univariable and multivariable associations between nerve management technique and lobe-specific positive surgical margin were determined. RESULTS Of 388 prostate lobes, wide resection was performed in 105 (27%) and nerve-sparing in 283 (73%). In 273 lobes without extra-prostatic extension (EPE), 0 of 52 (0%) had a positive margin when wide resection was performed compared to 20 of 221 (9%) if nerve-sparing was performed (p=0.02). In 115 lobes with EPE, 11 of 53 (21%) had a positive margin if wide resection was performed compared to 28 of 62 (45%) if nerve-sparing was performed (p=0.006). In multivariable analysis, the risk of a positive margin was decreased among patients who received wide resection as compared to nerve-spare (RR 0.43, 95% CI 0.26-0.71; p=0.001). CONCLUSIONS Surgical techniques to reduce positive surgical margins have become increasingly important as more patients with high-risk cancer are selecting surgery. The risk of a positive margin was greatly reduced using a standardized wide resection technique compared to nerve-sparing.
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Affiliation(s)
- Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada;; University of Ottawa, ON, Canada;; Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Andrew Stokl
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sonya Cnossen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Chris Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada;; University of Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada;; University of Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada;; University of Ottawa, ON, Canada;; Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Cristea O, Lavallée LT, Montroy J, Stokl A, Cnossen S, Mallick R, Fergusson D, Momoli F, Cagiannos I, Morash C, Breau RH. Active surveillance in Canadian men with low-grade prostate cancer. CMAJ 2016; 188:E141-E147. [PMID: 26927971 DOI: 10.1503/cmaj.150832] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recent guidelines recommend against routine screening for prostate cancer, partly because of the risks associated with overtreatment of clinically indolent tumours. We aimed to determine the proportion of patients whose low-grade prostate cancer was managed by active surveillance instead of immediate treatment. METHODS We reviewed data for patients who were referred to the Ottawa regional Prostate Cancer Assessment Clinic with abnormal results for prostate-specific antigen (PSA) or prostate examination between Apr. 1, 2008, and Jan. 31, 2013. Patients with subsequent biopsy-proven low-grade (Gleason score 6) cancer were included. Active surveillance was defined a priori as monitoring by means of PSA, digital rectal examination and repeat biopsies, with the potential for curative-intent treatment in the event of disease progression. RESULTS Of 477 patients with low-grade cancer, active surveillance was used for 210 (44.0%), and the annual proportion increased from 32% (11/34) in 2008 to 67% (20/30) in 2013. Factors associated with immediate treatment were palpable tumour, PSA density above 0.2 ng/mL(2) and more than 2 positive biopsy cores. Factors associated with surveillance were age over 70 years and higher Charlson comorbidity index. Of 173 men who received immediate surgical treatment, 103 (59.5%) had higher-grade or advanced-stage disease on final pathologic examination. Of the 210 men with active surveillance, 62 (29.5%) received treatment within a median of 1.3 years, most commonly (52 [84%]) because of upgrading of disease on the basis of surveillance biopsy. INTERPRETATION Active surveillance has become the most common management strategy for men with low-grade prostate cancer at our regional diagnostic centre. Factors associated with immediate treatment reflected those that increase the risk of higher-grade tumours.
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Affiliation(s)
- Octav Cristea
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Luke T Lavallée
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Joshua Montroy
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Andrew Stokl
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Sonya Cnossen
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Ranjeeta Mallick
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Dean Fergusson
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Franco Momoli
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Illias Cagiannos
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Christopher Morash
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont
| | - Rodney H Breau
- Division of Urology (Cristea, Lavallée, Cagiannos, Morash, Breau), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital Research Institute (Montroy, Stokl, Cnossen, Mallick, Fergusson, Momoli, Breau), Ottawa, Ont.; Children's Hospital of Eastern Ontario Research Institute (Momoli), Ottawa, Ont.; University of Ottawa (Cristea, Lavallée, Momoli, Cagiannos, Morash, Breau), Ottawa, Ont.
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Montroy J, Breau RH, Cnossen S, Witiuk K, Binette A, Ferrier T, Lavallée LT, Fergusson DA, Schramm D. Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0146254. [PMID: 26812596 PMCID: PMC4727780 DOI: 10.1371/journal.pone.0146254] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/15/2015] [Indexed: 11/19/2022] Open
Abstract
Background The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery. Study Design A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI). Results Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72–0.91), deep (pRR 0.82; 95% CI0.64–1.05) and organ space (pRR 1.15; 95% CI 0.96–1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39–0.77; deep pRR 0.61, 95% CI 0.50–0.75, and organ space pRR 0.60, 95% CI 0.50–0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program. Conclusions These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities.
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Affiliation(s)
- Joshua Montroy
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rodney H. Breau
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- * E-mail:
| | - Sonya Cnossen
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kelsey Witiuk
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrew Binette
- School of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Taylor Ferrier
- School of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Luke T. Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Dean A. Fergusson
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Schramm
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Lavallée LT, Binette A, Witiuk K, Cnossen S, Mallick R, Fergusson DA, Momoli F, Morash C, Cagiannos I, Breau RH. Reducing the Harm of Prostate Cancer Screening: Repeated Prostate-Specific Antigen Testing. Mayo Clin Proc 2016; 91:17-22. [PMID: 26688045 DOI: 10.1016/j.mayocp.2015.07.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/24/2015] [Accepted: 07/29/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine if repeating a prostate-specific antigen (PSA) test in men with an elevated PSA level is associated with a decreased risk of prostate biopsy and cancer diagnosis. PATIENTS AND METHODS A cohort of patients referred to the Ottawa Regional Prostate Cancer Assessment Clinic from April 1, 2008, through May 31, 2013, who had referral PSA levels between 4 and 10 ng/mL were included in the study. Univariate and multivariate associations between a normal result on repeated PSA testing and the risk of prostate biopsy, cancer diagnosis, and Gleason score of 7 or higher were examined. RESULTS The study cohort included 1268 patients. Repeated PSA test results were normal in 315 patients (24.8%). Men with normal results on repeated PSA testing were younger (mean ± SD age, 61.5±8.2 years vs 65.2±8.2 years; P<.001) and had lower referral PSA levels (mean ± SD, 5.5±1.4 ng/mL vs 6.6±1.5 ng/mL; P<.001) than men with an abnormal repeated PSA result. In multivariate analysis, men with normal results on repeated PSA testing were less likely to undergo prostate biopsy (relative risk [RR], 0.42; 95% CI, 0.34-0.50) and were at lower risk for cancer diagnosis (RR, 0.22; 95% CI, 0.14-0.34) and Gleason score of 7 or higher (RR, 0.16; 95% CI, 0.08-0.34) compared with men who had an abnormal repeated PSA test result. CONCLUSION Routinely repeating a PSA test in patients with an elevated PSA level is independently associated with decreased risk of prostate biopsy and prostate cancer diagnosis. Men with an elevated PSA level should be given a repeated PSA test before proceeding to biopsy.
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Affiliation(s)
- Luke T Lavallée
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Andrew Binette
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Kelsey Witiuk
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sonya Cnossen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | - Franco Momoli
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Chris Morash
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ilias Cagiannos
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rodney H Breau
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Asundi A, Ndao M, Ward B, Cnossen S, Libman M, Greenaway C. Seroprevalence of Strongyloidiasis and Schistosomiasis Among Immigrants and Refugees in Montreal, Canada. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Greenaway C, Thu Ma A, Kloda LA, Klein M, Cnossen S, Schwarzer G, Shrier I. The Seroprevalence of Hepatitis C Antibodies in Immigrants and Refugees from Intermediate and High Endemic Countries: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0141715. [PMID: 26558905 PMCID: PMC4641717 DOI: 10.1371/journal.pone.0141715] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/12/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) infection is a significant global health issue that leads to 350,000 preventable deaths annually due to associated cirrhosis and hepatocellular carcinoma (HCC). Immigrants and refugees (migrants) originating from intermediate/high HCV endemic countries are likely at increased risk for HCV infection due to HCV exposure in their countries of origin. The aim of this study was to estimate the HCV seroprevalence of the migrant population living in low HCV prevalence countries. METHODS Four electronic databases were searched from database inception until June 17, 2014 for studies reporting the prevalence of HCV antibodies among migrants. Seroprevalence estimates were pooled with a random-effect model and were stratified by age group, region of origin and migration status and a meta-regression was modeled to explore heterogeneity. RESULTS Data from 50 studies representing 38,635 migrants from all world regions were included. The overall anti-HCV prevalence (representing previous and current infections) was 1.9% (95% CI, 1.4-2.7%, I2 96.1). Older age and region of origin, particularly Sub-Saharan Africa, Asia, and Eastern Europe were the strongest predictors of HCV seroprevalence. The estimated HCV seroprevalence of migrants from these regions was >2% and is higher than that reported for most host populations. CONCLUSION Adult migrants originating from Asia, Sub-Saharan Africa and Eastern Europe are at increased risk for HCV and may benefit from targeted HCV screening.
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Affiliation(s)
- Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Ann Thu Ma
- Department of Internal Medicine, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | | | - Marina Klein
- Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, Canada
| | - Sonya Cnossen
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
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Elzayat E, Cagiannos I, Lavallée LT, Cnossen S, Mallick R, Morash C, Breau RH. MP68-19 FACTORS ASSOCIATED WITH SURGICAL SITE INFECTIONS FOLLOWING RADICAL CYSTECTOMY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rossi C, Shrier I, Marshall L, Cnossen S, Schwartzman K, Klein MB, Schwarzer G, Greenaway C. Seroprevalence of chronic hepatitis B virus infection and prior immunity in immigrants and refugees: a systematic review and meta-analysis. PLoS One 2012; 7:e44611. [PMID: 22957088 PMCID: PMC3434171 DOI: 10.1371/journal.pone.0044611] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 08/06/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND International migrants experience increased mortality from hepatocellular carcinoma compared to host populations, largely due to undetected chronic hepatitis B infection (HBV). We conducted a systematic review of the seroprevalence of chronic HBV and prior immunity in migrants arriving in low HBV prevalence countries to identify those at highest risk in order to guide disease prevention and control strategies. METHODS AND FINDINGS Medline, Medline In-Process, EMBASE and the Cochrane Database of Systematic Reviews were searched. Studies that reported HBV surface antigen or surface antibodies in migrants were included. The seroprevalence of chronic HBV and prior immunity were pooled by region of origin and immigrant class, using a random-effects model. A random-effects logistic regression was performed to explore heterogeneity. The number of chronically infected migrants in each immigrant-receiving country was estimated using the pooled HBV seroprevalences and country-specific census data. A total of 110 studies, representing 209,822 immigrants and refugees were included. The overall pooled seroprevalence of infection was 7.2% (95% CI: 6.3%-8.2%) and the seroprevalence of prior immunity was 39.7% (95% CI: 35.7%-43.9%). HBV seroprevalence differed significantly by region of origin. Migrants from East Asia and Sub-Saharan Africa were at highest risk and migrants from Eastern Europe were at an intermediate risk of infection. Region of origin, refugee status and decade of study were independently associated with infection in the adjusted random-effects logistic model. Almost 3.5 million migrants (95% CI: 2.8-4.5 million) are estimated to be chronically infected with HBV. CONCLUSIONS The seroprevalence of chronic HBV infection is high in migrants from most world regions, particularly among those from East Asia, Sub-Saharan Africa and Eastern Europe, and more than 50% were found to be susceptible to HBV. Targeted screening and vaccination of international migrants can become an important component of HBV disease control efforts in immigrant-receiving countries.
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Affiliation(s)
- Carmine Rossi
- Centre for Clinical Epidemiology and Community Studies of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.
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