Canadian Journal of Surgery (CJS)

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Canadian Journal of Surgery | Journal canadien de chirurgie Providing surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research Subscribe to CJS email alerts: canjsurg.ca/email-alerts

E194 Tanner Schrank on how the Journal of Medical Insight's long-form surgical videos can prepare students and surgical trainees for the operating room. Alt text: Episode 194 of the Cold Steel Podcast features Tanner Schrank discussing how the Journal of Medical Insight's long-form surgical videos can prepare students and surgical trainees for the operating room. Graphic includes podcast title, episode number, and an illustration of headphones/microphone
Treatment and survival varied by region, with most surgeries performed in urban areas and the poorest outcomes observed in remote regions. Research Trends in the incidence and surgical treatment of hepatocellular carcinoma in Ontario Muaddi et al. Can J Surg June 24, 2026 69 (3) E306-E315; DOI: https://doi.org/10.1503/cjs.005825
Overall, 60% of patients with peripheral nerve injuries had a delay in referral, and rurality predicted a higher risk in delay. Research: Referral patterns and wait times in complex peripheral nerve injuries: a review of a multidisciplinary clinic in Canada. Kim et al. Can J Surg June 24, 2026 69 (3) E299-E305; DOI: https://doi.org/10.1503/cjs.010524
CJS Volume 69, Issue 3. Read the latest on: referral patterns and wait times in complex peripheral nerve injuries, trends in the surgical treatment for hepatocellular carcinoma in Ontario. Image: Man standing next to a motor vehicle collision wincing and holding his neck, suggesting brachial plexus injury.
Free flap reconstruction, bilateral procedures, and advanced age are key drivers of hospital admission costs. Research Cost of hospital admission after autologous breast reconstruction and factors associated with increased cost: a population-based cohort study Olaiya et al. Can J Surg June 10, 2026 69 (3) E290-E298; DOI: https://doi.org/10.1503/cjs.010925
Structured radiology reporting, multidisciplinary oversight and provincial collaboration remain essential to ensure consistent, evidence-based care, especially for rare diseases where experience is limited. Discussions in Surgery Management of cystic echinococcosis in British Columbia: outcomes and suggestions to improve guideline adherence Colucci et al. Can J Surg June 10, 2026 69 (3) E280-E282; DOI: https://doi.org/10.1503/cjs.018925
E193 Mark Soth on finances for Canadian physicians and how financial planning can help us all to live “the good life.” Alt text: Episode 193 of the Cold Steel Podcast features Mark Soth discussing finances for Canadian physicians and how financial planning can help us all to live “the good life.” Graphic includes podcast title, episode number, and an illustration of headphones/microphone
There were significant gaps in both the accessing of surgical consultation and in the completion of proposed surgical procedures among people experiencing homelessness, representing an ongoing unmet need for surgical care. Research Outpatient surgical referrals from primary care providers for people experiencing homelessness: a retrospective review McDonald et al. Can J Surg June 10, 2026 69 (3) E283-E289; DOI: https://doi.org/10.1503/cjs.004524
Text: New articles on outpatient surgical referrals for people experiencing homelessness, management of cystic echinococcosis in B.C., and hospital admission costs after breast reconstruction in Volume 69, Issue 3 of the CJS. Image: Man sitting on a bed in a homeless shelter
Nous vivons un paradoxe quant auz effectifs dans lequel nous faisons face à la fois à une pénurie en matière d'accès chirurgical et à un nombre excédentaire de diplômé(e)s en chirurgie qui ne sont pas en mesure de trouver un poste. Éditorial. Les soins chirurgicaux au Canada et le coût de l’inaction. Harvey et Ball. Can J Surg June 4, 2026 69 (3) E275-E276; DOI: https://doi.org/10.1503/cjs.012226
We are living in a workforce paradox in which we simultaneously face a shortage of surgical access and an excess of surgical graduates who cannot find jobs. Editorial. Surgical care in Canada and the cost of inaction Harvey and Ball. Can J Surg June 4, 2026 69 (3) E270-E271; DOI: https://doi.org/10.1503/cjs.011526
Switching endoscopy irrigation from sterile to tap water cuts costs, plastic waste, and CO2 emissions without compromising safety. Research. Sustainability in endoscopy: switching from sterile water to tap water Li et al. Can J Surg June 4, 2026 69 (3) E277-E279; DOI: https://doi.org/10.1503/cjs.014025
Anterior-approach THA involves release of key hip tendons in most patients. Research. Inadvertent short external rotator tendon release during anterior-approach total hip arthroplasty: a prospective magnetic resonance imaging study. Sharma et al. Can J Surg June 4, 2026 69 (3) E264-E269; DOI: https://doi.org/10.1503/cjs.005225
With opioid overdoses posing a public health crisis, we call on surgeons to be leaders in responsible prescribing to reduce adverse effects of opioid use while maintaining adequate postoperative pain control. Discussions in surgery. Do no harm: Surgeons should be leaders in opioid stewardship. Antonsen et al. Can J Surg June 4, 2026 69 (3) E272-E274; DOI: https://doi.org/10.1503/cjs.012125
CJS Volume 69 Issue 3. Read the latest on: surgeons should be leaders in opioid stewardship, inadvertent short external rotator tendon release, sterile v. tap water in endoscopy. Image: several prescription bottles for various opioids with warning labels.
The authors found no significant delays in surgical care for lung cancer during the COVID-19 pandemic; timelines to surgery may have been expedited owing to increased resource allocation. Research. Understanding the long-lasting impact of the COVID-19 pandemic on the diagnosis and management of lung cancer: a retrospective community hospital experience Sohi et al. Can J Surg May 12, 2026 69 (3) E258-E263; DOI: https://doi.org/10.1503/cjs.015925
Positive deviance seminars can improve OR efficiency for joint replacement in medium-sized rural community hospitals. Research. Improving operating room efficiency for primary joint replacements in a medium-sized rural community hospital using positive deviance seminars. Nucci et al. Can J Surg May 12, 2026 69 (3) E251-E257; DOI: https://doi.org/10.1503/cjs.012425
Although health care professionals produced better-quality videos than general users, they were not the main producers in this study. Research. Quality assessment of videos on anterior cruciate ligament tear rehabilitation exercises: Is TikTok a good source of medical information for patients? Sonesaksith-Turcotte et al. Can J Surg May 12, 2026 69 (3) E243-E250; DOI: https://doi.org/10.1503/cjs.006625
CJS Volume 69, Issue 3. Read the latest on: TikTok videos on ACL tear rehabilitation exercises, positive deviance seminars to improve OR efficiency, the pandemic's impact on surgical care for lung cancer. Image: Young woman viewing TikTok videos on her phone after anterior cruciate ligament surgery.
Episode 191 of the Cold Steel Podcast features Dr. Varun Kapila discussing his six lessons of leadership and how to apply them to your own life.
Liver transplantation from donations following MAiD demonstrates comparable graft and patient survival to donation following circulatory or brain death. Research. Liver transplantation from donors following medical assistance in dying: a scoping review and retrospective cohort study. Ganescu et al. Can J Surg May 1, 2026 69 (3) E230-E242; DOI: https://doi.org/10.1503/cjs.017825
Specialist travel to Nunavik saved about $1.7 million annually compared with Montreal-based consultations. Research. Improving access to surgical care for Inuit communities in Nunavik: a cost-savings analysis of a surgeon outreach program. Mashal et al. Can J Surg May 1, 2026 69 (3) E221-E229; DOI: https://doi.org/10.1503/cjs.013525
Some residents felt as though this curriculum made them more likely to engage in an innovation and entrepreneurship project moving forward. Research Innovation and Entrepreneurship in Surgical Training (INVEST): the first Canadian curriculum for innovation and entrepreneurship for surgical trainees McKechnie et al. Can J Surg May 1, 2026 69 (3) E211-E220; DOI: https://doi.org/10.1503/cjs.015624
New articles on an innovation and entrepreneurship curriculum for surgical trainees, a cost-savings analysis of surgical care for Inuit communities in Nunavik, and liver transplantation after MAiD in Volume 69, Issue 3 of the CJS. Image: Rear view of a lecturer gesturing with hand while speaking to a group of trainees on chairs in front of him.
Le JCC offre depuis longtemps aux chirurgiennes et aux chirurgiens au Canada une tribune nationale pour débattre des politiques de santé, des défis du système et des opinions stimulantes qui contribuent à faire progresser les soins de manière opportune et réfléchie. Éditorial. État de la situation et perspectives d’avenir — Contributions du Journal canadien de chirurgie à l’ensemble de la communauté chirurgicale. Ball. Can J Surg April 22, 2026 69 (2) E174-E175; DOI: https://doi.org/10.1503/cjs.008226
CJS has a long history of offering surgeons in Canada a national platform to discuss health policy, health system challenges, and provocative opinions that help to move health care forward on a timely and thoughtful pathway. Editorial: Where have we been and where are we going? Contributions of the Canadian Journal of Surgery to the greater surgical community. Ball. Can J Surg April 22, 2026 69 (2) E173; DOI: https://doi.org/10.1503/cjs.007726
Persistent opioid use is common after both THA and hemiarthroplasty for hip fracture. Research. Persistent postoperative opioid use in patients treated with total hip arthroplasty and hemiarthroplasty for femoral neck fracture: a propensity-score-matched analysis. Tohidi et al. Can J Surg April 22, 2026 69 (2) E200-E210; DOI: https://doi.org/10.1503/cjs.020425
CJS remains an important part of Canadian surgical discourse through its continued dissemination of quality research across Canada and beyond. Research: The evolution and contributions of the Canadian Journal of Surgery: a bibliometric study. Boersma Robertson. Can J Surg April 22, 2026 69 (2) E176-E187; DOI: https://doi.org/10.1503/cjs.003226
This review outlines essential skills for effective global surgical care, emphasizing bidirectional partnerships, sustainability, and self-governance. Review: Core competencies for global surgery training: a scoping review. Hilzenrat et al. Can J Surg April 22, 2026 69 (2) E188-E199; DOI: https://doi.org/10.1503/cjs.014525
Read the latest on global surgical training, the impact of CJS, opioid use after hip surgery in Volume 69, Issue 2 of the CJS. Image: Image of a globe over a pile of medical masks. Global surgery concept.
Delays in health care are increasing in Canada, with wait time intervals a particular area of concern. Research: The growing burden of spine surgical wait times: a retrospective cohort study of longitudinal trends and impact on perioperative outcomes. Wang et al. Can J Surg March 31, 2026 69 (2) E164-E172; DOI: https://doi.org/10.1503/cjs.000625
Surgeons who graduated more recently are emigrating from Canada to the US out of necessity, supporting the notion of graduates not having adequate opportunities in Canada. Research: Where are orthopedic surgery graduates practising? A critical look at the last 30 years in Ontario. Ndoja et al. Can J Surg March 31, 2026 69 (2) E155-E163; DOI: https://doi.org/10.1503/cjs.011525
The provincial shoulder database demonstrates the early stages of a registry, which contains useful, granular data. Research: Implementation of and findings from a regional shoulder replacement registry. Woodmass et al. Can J Surg March 31, 2026 69 (2) E137-E145; DOI: https://doi.org/10.1503/cjs.014624
A BMI of 45 or higher is a risk factor for re-revision, postoperative infection, and readmission rates after TKA an increase 90-day costs. Research: The effect of obesity on revision total knee arthroplasty: a retrospective cohort study. Nassereddine et al. Can J Surg March 31, 2026 69 (2) E146-E154; DOI: https://doi.org/10.1503/cjs.003525
New articles the effect of obesity on revision total knee arthroplasty, a regional shoulder replacement registry, where ortho surgery grads are practising, and spine surgical wait times in Volume 69, Issue 2 of the CJS. Image: Three-dimensional illustration of a shoulder implant in an outline of a human skeleton.
The ZMR taper stem demonstrated favourable functional outcomes for the management of Vancouver B2 and B3 periprosthetic femur fractures. Research Clinical outcomes of revision arthroplasty with a modular taper fluted titanium stem for the treatment of Vancouver B2 and B3 periprosthetic femur fractures Kubik et al. Can J Surg March 17, 2026 69 (2) E122-E129; DOI: https://doi.org/10.1503/cjs.011125
While most resident salaries met living wage benchmarks, some programs fell short, forcing residents to cover the gap. Research Comparison of resident salary and living wage in Canada: a cross-sectional study Yin et al. Can J Surg March 17, 2026 69 (2) E130-E136; DOI: https://doi.org/10.1503/cjs.013025
Text: New articles on resident salaries, revision arthroplasty with a modular taper fluted titanium stem in Volume 69, Issue 2 of the CJS. Image: Female resident in her apartment paying bills.
Damage-control laparotomy performed at rural hospitals before transfer to a trauma centre is not associated with higher morbidity or mortality, and collaboration between lead trauma hospitals and rural centres should be encouraged in select cases. Research. Reinforcing the role of rural trauma laparotomy Chaulk et al. Can J Surg March 3, 2026 69 (2) E108-E113; DOI: https://doi.org/10.1503/cjs.013325
Stimulant misuse is a relevant issue in the trauma population, associated with increased hospital length of stay, but no significant difference in mortality. Research. Stimulant drug misuse in patients presenting to level 1 trauma centres: a retrospective analysis of 80 000 patients in Canada and the United States. Cristofaro et al. Can J Surg March 3, 2026 69 (2) E114-E120; DOI: https://doi.org/10.1503/cjs.010024
CJS Volume 69 Issue 2. Read the latest on: stimulant drug misuse in trauma patients, rural trauma laparotomy. Image: 3,4-methylenedioxy-methamphetamine (MDMA) crystals.
Cold Steel Podcast E187. Krista Goulding on pelvic sarcomas, 3D printing, and what patients really want. Graphic includes podcast title, episode number, and an illustration of headphones/microphone.
Nous risquons l’exode de toute une génération d’extra­ordinaires talents en devenir et de médecins aux compétences hors pair qui risquent de refuser d’exercer la profession au Québec dans les conditions contraignantes de la loi 83 et de la loi 2. Éditorial. Les médecins mis à mal par François Legault. Harvey. Can J Surg February 18, 2026 69 (1) E104-E105; DOI: https://doi.org/10.1503/cjs.003826
We risk a generational exodus where the brightest minds and most capable physicians are unwilling to practise in Quebec under constraints from Bill 83 and Bill 2. Editorial: Legault took aim at Quebec physicians. Harvey. Can J Surg February 18, 2026 69 (1) E102-E103; DOI: https://doi.org/10.1503/cjs.003126
Changing a small number of events affects the significance of results comparing carotid endarterectomy to carotid artery stenting. Research. Assessing the fragility index of randomized controlled trials on carotid artery stenosis: a systematic review. Liu et al. Can J Surg February 18, 2026 69 (1) E90-E96; DOI: https://doi.org/10.1503/cjs.008525
As key contributors to surgical emissions and as leaders in the OR, surgeons have an important role in addressing surgical sustainability and advocating for greener OR practices. Discussions in Surgery. Environmental sustainability in the operating room: perspectives and practice patterns of general surgeons in Canada. Ma et al. Can J Surg February 18, 2026 69 (1) E84-89; DOI: https://doi.org/10.1503/cjs.012325
Adoption of a national guideline would empower trainees, promote inclusivity, and encourage more women to consider orthopedic surgery careers. Discussions in Surgery. Provincial agreements for pregnant and parenting orthopedic surgery residents: a call for a national residency guideline. Morrison et al. Can J Surg February 18, 2026 69 (1) E97-E101; DOI: https://doi.org/10.1503/cjs.015623
CJS Volume 69 Issue 1. Read the latest on: pregnant and parenting ortho surgery residents, environmental sustainability in the OR, fragility index of RCTs, Quebec physicians. Image: Pregnant surgeon preparing for the operating room.
Surgical mortality among nonagenarian patients is nearly 3 times higher than among octogenarian patients; comprehensive geriatric assessment is essential before operating. Research. Surgical outcomes in nonagenarian versus octogenarian patients: a propensity-matched analysis with implications for shared decision-making. Kanani et al. Can J Surg February 4, 2026 69 (1) E71-E83; DOI: https://doi.org/10.1503/cjs.009525
The relocation of appropriate gynecologic procedures from the OR to an ambulatory setting provides quality care and improves access without increasing cost to the system. Commentary: The migration of hysteroscopy from the operating room to an ambulatory setting. Thiel et al. Can J Surg February 4, 2026 69 (1) E68-E70; DOI: https://doi.org/10.1503/cjs.008825
The poorer prognosis associated delayed or missing follow-up highlights the importance of respecting provincial guidelines for follow-up after incomplete colonoscopies. Research. The impact of incomplete colonoscopies: a single-centre retrospective study. Abdelli et al. Can J Surg February 4, 2026 69 (1) E59-E67; DOI: https://doi.org/10.1503/cjs.003425
CJS Volume 69 Issue 1. Read the latest on: Incomplete colonoscopies, Hysteroscopy in an ambulatory setting, Surgical outcomes in nonagenarians. Image: Doctor explaining colonoscopy results to patient using monitor images on screen.
Upper-extremity amputation has high health care costs exceeding controls, with implications for vascularized composite allotransplantation. Research: Health care costs of major upper-extremity amputations in Ontario: a retrospective matched-cohort analysis with considerations for transplantation. Duru et al. Can J Surg January 20, 2026 69 (1) E48-E58; DOI: https://doi.org/10.1503/cjs.000525
Immigrant females with breast cancer in Ontario undergo immediate and delayed breast reconstruction less often than nonimmigrant females. Research: Reconstructive surgery and immigration status among females with breast cancer. Lovrics et al. Can J Surg January 20, 2026 69 (1) E38-E47; DOI: https://doi.org/10.1503/cjs.012324
Read the latest on - Reconstructive surgery and immigration status - Costs of major upper-extremity amputations. Image: Surgical image showing breast reconstruction after mastectomy in a breast cancer patient with pale skin.
There is a marked disparity in trauma-related mortality between Eeyou Istchee and the rest of Quebec, with motor vehicle collisions the leading cause of trauma death. Research - The burden of trauma in Eeyou Istchee (Cree territories, James Bay): epidemiology, transfers, and patient outcomes. Alsuwaidi et al. Can J Surg January 13, 2026 69 (1) E30-E36; DOI: https://doi.org/10.1503/cjs.011325.
Pneumonectomy remains a valuable therapeutic option when treating patients with non–small cell lung cancer with a curative intent with regard to their overall survival, but it remains a procedure with high perioperative morbidity and mortality. Research: Is pneumonectomy still relevant for non–small cell lung cancer? Long-term overall survival from a 15-year experience. Hache et al. Can J Surg January 13, 2026 69 (1) E22-E29; DOI: https://doi.org/10.1503/cjs.007524