Recognizing accomplishments in Research and Innovation in the
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Recognizing accomplishments in Research and Innovation in the
Recognizing accomplishments in Research and Innovation in the Department of Surgery, University of Manitoba 7:45 am—8:45 am Department of Surgery Grand Rounds Theatre C — Bannatyne Campus 9:00 am—5:00 pm Research Day Program Ambassador A — Canad Inns-HSC GRAND ROUNDS SPEAKER Dr Hans Kreder Head, Orthopaedic Division Program Chief, Holland Musculoskeletal Program University of Toronto KEYNOTE SPEAKER Dr Allan Okrainec Head, Division of General Surgery Peter A. Crossgrove Chair in General Surgery University of Toronto Annual Department of Surgery Research Day 2015 Sponsored by Department of Surgery GFT Surgeons The Wayne Beecroft Western Surgical Lectureship Fund Acknowledgements The 2015 Surgery Research Planning Committee would like to acknowledge the Pan Am Clinic Foundation and Department of Surgery Research Advisory Committee members for their support in the planning of our Annual Surgery Research Day 2015. i Table of Contents Research Day Sponsors ............................................................. i Acknowledgements ................................................................... i Maintenance of Certificate Program Event Information ......... ii Visiting Professor Bio ................................................................ iii Keynote Speaker Bio.................................................................. iv Judges, Research Day 2015 Planning Committee ..................... v Disclosure .................................................................................. v Research Day 2015 Objectives .................................................. vi Evaluation & Certificate of Attendance ..................................... vi Program Details—Morning ....................................................... vii Program Details—Afternoon ..................................................... viii Abstracts .................................................................................... 1-33 Participant’s Abstract Index ...................................................... 34 This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada and approved by the CPD Medicine Program, University of Manitoba for a maximum of 7.0 credits. Participants should only claim credit for the actual number of hours attended. ii VISITING PROFESSOR Dr Hans Kreder Head, Orthopaedic Division Program Chief, Holland Musculoskeletal Program Professor, University of Toronto Dr. Kreder, Head of the Orthopaedic Division and Program Chief of the Holland Musculoskeletal Program, has a subspecialty practice in pelvic and acetabular reconstruction and hip and knee joint replacement. He is the first recipient of the Marvin Tile Chair in Orthopaedic Surgery, a member of the Departments of Surgery (Division of Orthopaedics) and Health Policy Evaluation & Management at the University, and an Adjunct Scientist, ICES. Dr. Kreder is a Professor HPME (Health Policy, Management and Evaluation), Faculty of Medicine, University of Toronto as well as a Professor, Orthopaedic Surgery, University of Toronto. He works with the Core Faculty, Clinical Epidemiology Program, University of Toronto. He is an AO Trustee, AO North America, and Chair, Medical Advisory Committee. Dr. Kreder's main research interests involve the measurement of function and other outcomes following traumatic musculoskeletal injuries, arthritic conditions and metastatic disease, as well as policy issues regarding access to care and the effect of provider experience and volume on patient outcome. iii KEYNOTE SPEAKER Dr Allan Okrainec Head, Division of General Surgery Peter A. Crossgrove Chair in General Surgery Associate Professor, University of Toronto Dr. Allan Okrainec is Head of the Division of General Surgery, and Peter A. Crossgrove Chair in General Surgery at the University Health Network. He is an Associate Professor in the Department of Surgery at the University of Toronto. His clinical practice specializes in minimally invasive gastrointestinal and bariatric surgery. Dr. Okrainec is the Director of the Temerty/Chang International Centre for Telesimulation and Innovation in Medical Education. His research interests include the use of simulation and telesimulation for the teaching and assessment of laparoscopic skills and the assessment of clinical outcomes and enhanced recovery programs after surgery. He has published widely and has given numerous invited lectures both nationally and internationally. His work is supported by several research grants, including the Center of Excellence in Surgical Education, Research and Training, and Grand Challenges Canada Stars in Global Health. Dr. Okrainec has leadership roles in several national and international surgical societies. He currently serves on the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons. iv Judges Dr Allan Okrainec Associate Professor Department of Surgery, University of Toronto Dr Hans Kreder Professor Department of Surgery, University of Calgary Dr Markus Ziesmann General Surgery Resident Department of Surgery, University of Manitoba Research Day 2015 Planning Committee Dr Ted Tufescu, Co-Chair Dr Krista Hardy, Co-Chair Dr Richard Keijzer, Thorlakson Chair in Surgical Research Dr Christopher White, Resident Representative Mary Brychka, Administrator Disclosure Before each presentation, speakers will disclose on their first slide any significant relationships that may be a perceived or apparent conflict of interest to the subject of the proposed CME/CPD activity. Each member of the Research Day 2015 Planning Committee were asked to disclose any significant relationships with the manufacturer of any commercial product that may have a direct or indirect conflict of interest in the program content. All members reported no conflicts v Research Day 2015 Objectives At the end of the Department of Surgery Annual Research Day, participants will be able to: Discuss the findings from surgical research conducted in the Department of Surgery at the University of Manitoba with colleagues and translate knowledge into clinical practice, patient care and academic teaching. Understand why simulation is an important component in surgical training; describe the benefits of distance learning in resourcerestricted settings; and outline both successes and challenges in establishing an international surgical education and research program. Understand the effect of surgical skill on outcomes; how to monitor and improve quality; and to consider possible educational models to address the learning curve. Evaluation & Certificate of Attendance The Royal College’s Maintenance of Certification program requires that all accredited activities be evaluated. Your input is invaluable to help us know this event met your expectations; where there is room to improve; and to enrich the Department of Surgery’s Annual Research Day for surgeons, fellows, residents, medical students, researchers and staff. Today’s sessions will be evaluated electronically through the Department of Surgery website: http://umanitoba.ca/faculties/medicine/units/surgery/8768.html Upon completion of your evaluation, the Certificate of Attendance will be accessible to print for your records. Instructions have been provided on the website and an email reminder will be sent to all participants following the event. We appreciate your support and thank you for your time and collaboration. Thank you. vi 7:45 DEPARTMENT OF SURGERY GRAND ROUNDS Visiting Professor: Dr Hans Kreder, University of Toronto Surgical complications & outcomes: The effect of surgeons, hospitals and systems of care Theatre C – Bannatyne Campus—University of Manitoba 9:00 OPENING REMARKS - Dr Ted Tufescu (Co-Chair) Ambassador Room A (second floor) Canad Inns – Destination Health Sciences Centre PLENARY SESSION Moderator: Dr Sadeesh Srinathan Time Abstract Title Presenter 9:15 General vs. technique specific technical skills assessments – The wheel reinvented Sarah Steigerwald* General Surgery 9:26 Outcomes in adult survivors of childhood burn injuries as compared to matched controls James Stone* Plastic Surgery 9:37 Vestibulo-ocular dysfunction in pediatric sports-related concussion Michael Ellis Neurosurgery 9:48 Comparison of left and right laparoscopic living donor nephrectomies: A Cana- Claire Gardiner* dian single centre experience Urology 9:59 The DISCERN Study: Mid-term follow-up of post-operative health-related quality of life and mental health status in patients undergoing cardiac surgery Quyen Nguyen* Cardiac Surgery Targeting HMGA2-mediated chemoresistance in GB using DNA minor groove Suchitra Natarajan* Human Anatomy 10:10 binding drugs The AVATAR Trial: Applying VAcuum To Accomplish Reduced wound infections Robin Visser* Pediatric Surgery 10:21 in laparoscopic pediatric surgery 10:32 COFFEE BREAK (15 minutes) PLENARY SESSION Time Moderator: Dr Rakesh Arora Abstract Title Presenter 10:47 Avoidance of profound hypothermia during initial reperfusion improves the functional recovery of DCD hearts Christopher White* Cardiac Surgery 10:58 Normalizing miR-200b expression in vivo improves nitrofen-induced lung Naghmeh Khoshgoo* Pediatric Surgery 11:09 Microsurgical reconstruction with ambulation preservation following lower Colin McInnes* Plastic Surgery 11:20 Ultrasound assessment of optic nerve sheath diameter (ONSD) in healthy Patrick Goeres* General Surgery 11:31 Renal nephrometry score and predictors of pathologic upstaging in patients Deepak Pruthi* Urology hypoplasia in the rat model of congenital diaphragmatic hernia extremity sarcoma resection volunteers undergoing partial and radical nephrectomies 11:42 Comparison of percutaneous fixation versus open reduction and internal plate Ricky Muller Moran* fixation for the treatment of calcaneal fractures Orthopedic Surgery 11:53 Genesis II SPC / Legion mid-term survivorship Alistair Ross Demcoe* Orthopedic Surgery 12:04 The effect of rater training on trainee assessments in medical education: A Reagan Maniar* General Surgery systematic review 12:15 LUNCH 12:45 AWARDS CEREMONY Presented by Dr Jack McPherson, Head & Dr Richard Keijzer, Thorlakson Chair in Surgical Research 2014 Resident Research Awards & 2014 Annual Department of Surgery GFT Research Awards * Speaker eligible for a presentation award vii 1:00 INTRODUCTION Dr Krista Hardy (Co-Chair) KEYNOTE SPEAKER Dr Allan Okrainec, University of Toronto Developing & delivering an international surgical education program: Lessons learned from around the world BRIEF SESSION Moderator: Dr Ashley Vergis Time Abstract Title Presenter 2:00 Computational fluid dynamics analysis of pulsatile flow in non-ruptured abdominal aortic aneurysms: A correlation between aortic hemodynamics and aortic matrix metalloproteinases Annie Ducas* Vascular Surgery 2:05 Utility of pre-operative magnetic resonance imaging in the prediction of prostate adenocarcinoma disease burden Jennifer Bjazevic* Urology 2:10 Ultrasound imaging of nodal metastases in the central compartment in differentiated thyroid cancer: Is it possible to increase sensitivity? Mohamed Sharaf Eldin* Head & Neck Surgery 2:15 Impact of necrotizing fasciitis on quality of life Robert Strazar* Plastic Surgery 2:20 Classification of facial pain: A 13-year population-based longitudinal study Lyra de Fatima Barchet* Neurosurgery 2:25 In vivo micromotion comparison of keeled versus pegged glenoid in a total shoulder replacement: A two-year radiostereometric analysis study Peter MacDonald Orthopedic Surgery 2:30 Transanal endoscopic microsurgery for giant rectal polyps Courtney Chernos* General Surgery 2:35 Early and late continence after bladder neck sparing radical prostatectomy Chun Huang* Urology 2:40 Comparison of physical fitness between surgical and non-surgical residents David Perrin* Orthopedic Surgery 2:45 A randomized clinical trial comparing the breast and abdominal related morbidity of DIEP and SIEA flaps Blair Peters* Plastic Surgery 2:50 Neuro-imaging findings in pediatric sports-related concussions: A clinical study Thomas Hall* Neurosurgery 2:55 The impact of body position and walking on neurophysiological outcome measure Mina Aziz* Orthopedic Surgery 3:00 COFFEE BREAK (15 minutes) PLENARY SESSION Moderator: Dr Patricia Larouche Time Abstract Title Presenter 3:15 Characteristics, long-term survival and predictors of mortality of patients needing prolonged intensive unit care stay post cardiac surgery Rizwan Manji Cardiac Surgery 3:26 Shit happens: Integrated knowledge translation to identify and prioritize knowledge needs faced by Hirschsprung’s Disease families Kendall Hobbs-Murison Pediatric Surgery 3:37 Mental and physical health outcomes in parents of children with burn injuries Jessica Enns* as compared to matched controls Plastic Surgery 3:48 The impact of lumbar spinal stenosis on lower extremity motor control: A pre Austin Enright* -surgical study Orthopedic Surgery 3:59 Non-neoplastic kidney and predictors of post-operative renal insufficiency in radical nephrectomies Ruchi Chhibba* Urology 4:10 Arthroscopic versus open lateral release for the treatment of lateral epicondylitis: A prospective randomized controlled trial Jamie Dubberley Orthopedic Surgery 4:30 RESEARCH DAY RECEPTION & PRESENTATION AWARDS Presented Dr Richard Keijzer, Thorlakson Chair in Surgical Research Come and celebrate with the winners of today’s top presentations viii General vs. technique specific technical skills assessments – The wheel reinvented Sarah Steigerwald, Jason park, Krista Hardy, Lawrence Gillman, Ashley Vergis (Section of General Surgery, Department of Surgery, University of Manitoba) Introduction Reliable and valid methods of evaluating operative performance are essential for surgical training programs and education research. Laparoscopic surgery entails a unique skill set, but it is unclear whether it requires a specific assessment form or whether more general assessment tools can be applied. The purpose of this study was to assess the reliability and construct and concurrent validity of two previously validated assessment scales. One of these scales was designed specifically to assess laparoscopic skills, and the other to assess more general surgical skills. Methods 32 PGY 1 – 5 general surgery and urology residents performed a live human laparoscopic cholecystectomy. Three attending surgeon raters scored their performance using the previously well-validated Objective Structured Assessment of Technical Skills (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS) global rating scales. Results OSATS and GOALS demonstrated reliability with a Cronbach’s alpha of 0.958 and 0.959 respectively. Construct validity was demonstrated for both GOALS and OSATS with senior residents demonstrating significantly higher scores than the junior group (p<0.001). Pearson’s correlation coefficient between GOALS and OSATS was 0.975 (p=0.01). Conclusion Reliability and construct validity were confirmed for both GOALS and OSATS global rating scales. The near total correlation between the two scales questions the need for separate laparoscopic assessment tools. This study highlights the real strengths of the original OSATS forms, the use of which allows for more consistent nomenclature and standardized skills assessment across surgical platforms. 1 Outcomes in adult survivors of childhood burn injuries as compared to matched controls James Stone1, JP Gawaziuk2,3, S Khan4, D Chateau4, J Bolton5, J Sareen5, J Enns1, M Doupe4, M Brownell4, S Logsetty2,3 (1BSc Med Program, 2Manitoba Firefighters Burn Unit, 3Department of Surgery (Section of Plastic Surgery), 4 Manitoba Centre for Health Policy, 5Department of Psychiatry) Introduction Limited research exists examining long-term mental and physical health outcomes in adult survivors of pediatric burn injuries. We examine the post-injury lifetime prevalence of common DSM-IV mental and physical disorders in a population based pediatric burn cohort compared to matched controls. Methods 748 survivors of childhood burns were identified from the Winnipeg Children’s Hospital burn registry (between April 1, 1988 - March 31, 2010 with burn TBSA >1%). These individuals were matched 1:5 to children from the Manitoba general population based on age, sex and geographic residence. Post-burn prevalence and Odds Ratio (OR) comparisons of common Axis 1 mental and physical disorders were done. The diagnoses were made through physician billings, hospital claims and clinical data housed at the Manitoba Center for Health Policy Data Repository. Results The burn cohort was 5.43 ± 5.02 years old (mean ± SD) with a % TBSA of 11.94 ± 12.03 (mean ± SD). In burn survivors, anxiety was the most prevalent Axis 1 mental disorder (22.59%), followed by major depression (14.17%), substance abuse/ dependence (3.21%) and suicide attempts (1.2%). Total respiratory morbidity was the most prevalent physical disorder in burn survivors (51.34%), followed by arthritis (36.50%), fractures (30.21%), diabetes (3.61%) and cancer (1.47%). Compared to controls, the burn cohort showed a significant increase in major depression (OR = 1.76; CI 1.39-2.22), anxiety (OR=1.74; CI 1.44-2.12), substance abuse/dependence (OR=2.85; CI 1.71-4.73), suicide attempts (OR=5.68; CI 2.18-14.7), arthritis (OR=1.33; CI 1.13-1.56), cancer (OR=2.05; CI 1.01-4.16), diabetes (OR=1.71; CI 1.09-2.67), fractures (OR=1.73; CI 1.46-2.07) and total respiratory morbidity (OR=1.57; CI 1.32-1.84). Conclusion Adult survivors of childhood burns injury report significantly more frequent Axis 1 mental and physical health outcomes. Screening for these illnesses is essential when caring for this population. 2 Vestibulo-ocular dysfunction in pediatric sports-related concussion Michael J Ellis1,3,4,5, Dean Cordingley4, Sara Vis4, Karen Reimer4, Jeff Leiter1,4, Kelly Russell2,5 (1Department of Surgery, 2Department of Pediatrics & Child Health, 3Section of Neurosurgery, 4Pan Am Clinic, 5 Children’s Hospital Research Institute of Manitoba, Canada North Concussion Network) Introduction The objective of the present study was two-fold: 1.) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with sportsrelated concussion(SRC) or post-concussion syndrome (PCS) referred to a multidisciplinary pediatric concussion program. 2.) to determine if VOD is associated with the development of PCS in this cohort. Methods We conducted a retrospective review of all SRC (presenting 30 days or less postinjury) and PCS patients(3 or more symptoms for at least 1 month) referred to a multi-disciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and PostConcussion Symptom Scale assessment. Patients were also assessed for VOD defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision etc.) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex etc.). This study was approved by the local institutional ethics review board. Results 101 patients (mean age= 14.2 years, SD= 2.3; 63 male, 38 female) participated including 77(76.2%) SRC and 24(23.8%) PCS patients. 22/77 (28.6%) of SRC and 15/24 (62.5%) of PCS patients met the clinical criteria for VOD. The median duration of symptoms was 40 days (IQR: 28.5, 54) for SRC patients with VOD compared with 21 days (IQR: 13, 32) for those without VOD (p=0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among acute SRC patients with VOD compared with those without VOD (aOR: 4.10; 95% CI: 1.04, 16.16). Conclusion Evidence of VOD was detected in a significant proportion of children and adolescents with SRC and PCS referred to a multi-disciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric SRC cohort. 3 Comparison of left and right laparoscopic living donor nephrectomies: A Canadian single centre experience Clare Gardiner, Thomas McGregor (Section of Urology, Department of Surgery, University of Manitoba) Introduction Laparoscopic living donor nephrectomy is the standard of care at high volume renal transplant centres. There is still reticence to harvest the right kidney laparoscopically because of concerns regarding shorter right renal vein length, higher complexity of the dissection and potentially worse renal allograft outcomes and complication rates. We performed a retrospective analysis of our single centre laparoscopic donor nephrectomy series with regard to side harvested and outcomes of both donors and recipients. Methods Following ethics approval by the University of Manitoba, we retrospectively reviewed 72 consecutive living donor nephrectomies (LDN) between May 2011 and July 2014. There were a total of 144 patients when taking into account the donor and recipient pair. All donor nephrectomies were performed laparoscopically at a single centre by a single surgeon. Donor and recipient demographics, intra-operative data and graft outcomes were assessed comparing right to left donor side and differences analyzed utilizing appropriate statistics. Results Of the 72 LDN cases, 56 were left sided and 16 right sided. There was no significant difference in donor demographics, donor estimated blood loss, warm ischemic time, complications and length of stay between right and left LDN groups. Recipient mean serum creatinine levels were equivalent between the right and left laparoscopic donor groups at 0, 1 and 6 weeks post-operatively. Finally, rejection and delayed graft function rates in the recipients were no different whether the transplanted kidney was from a right or a left LDN. Conclusion This single centre study shows comparable donor operative parameters and recipient post-operative outcomes in left and right laparoscopic donor nephrectomies. Harvesting the right kidney laparoscopically is safe and does not have a negative impact on donor recovery or long term graft function in the recipient. 4 The DISCERN Study: Mid-term follow-up of post-operative health-related quality of life and mental health status in patients undergoing cardiac surgery Quyen Nguyen, Rakesh Arora1, Navdeep Tangri2 (1Section of Cardiac Surgery, 2Section of Nephrology, Department of Internal Medicine) Introduction Delirium is the most common neurological complication post cardiac surgery with incidence varying between 10-60%, but can be as high as 73% in the elderly. Our study objectives were to examine the effects of: 1) post-operative delirium on midterm (6-9 months) health-related quality of life (HRQoL), 2) post-operative delirium on mental health, 3) and to determine risk factors for each of these conditions. Methods A prospective observational cohort study was carried out in consecutive cardiac surgery patients between July 2013 and July 2014. 197 patients were interviewed via telephone 6-9 months post-cardiac surgery. HRQoL was assessed using the Short Form-12 (SF-12v2) and EuroQoL-5D (EQ-5D). Mood disorders were assessed using the Patient Health Questionnaire (PHQ-9). Cognition was assessed using the Memory Impairment Screen (MIS) and Category Fluency Test (CFT). Results The rate of post-operative delirium was 21.1% in elective and 30.8% in urgent or emergent cardiac surgery patients. Pre-operative predictors of delirium were higher EuroSCORE II, previous cardiovascular procedure, older age, less than high school education and left ventricular ejection fraction of <35%. Intra-operative predictors were increased cardiopulmonary pump time, acute kidney injury, returning to the OR due to post-operative bleeding and new cerebrovascular accident. Delirious patients remained in the ICU almost 4 times longer than non-delirious patients and were hospitalized 5 days longer. Patients who suffered from post-operative delirium were 2 times more likely to score below average in the physical health aspect of the SF-12v2 and were nearly 3 times more likely to report having anxiety or depression. Conclusion Post-operative delirium in cardiac surgery patients is associated with decreased midterm physical functions and mental health status. Pre-operative and intra-operative predictors could be utilized to identify patients at risk of post-operative delirium. 5 Targeting HMGA2-mediated chemoresistance in GB using DNA minor groove binding drugs Suchitra Natarajan,1 Amy Rommel2, Thatchawan Thanasupawat1, Marshall Pitz3,4, Jerry Kreck1,5, Inder M. Verma2, Sabine Hombach-Klonisch1,6, Thomas Klonisch1,7 (1Departments of Human Anatomy & Cell Science, 2Internal Medicine, 6Obstetrics, Gynecology & Reproductive Medicine, 7Medical Microbiology & Infectious Diseases, 5Surgery; 4CancerCare Manitoba; 2 Laboratory of Genetics, Salk Institute for Biological Studies) Introduction Temozolomide (TMZ) is an alkylating drug commonly used in glioblastoma (GB) treatment. TMZ-induced DNA damage is repaired by Base Excision Repair (BER) mechanism. We previously showed that stem cell factor and non-histone AT-rich chromatin binding HMGA2 (High Mobility Group AT-hook-2) plays important roles in BER and contributes to cancer chemoresistance. Methods We employed RT-PCR for mRNA detection, Western blot, immunofluorescence and immunohistochemistry for protein detection of HMGA2 in patient primary, mouse GB cells and human GB cell lines (U87 and U251). Patient cells were isolates from surgical GB tumor tissues and mouse cells were GFP positive NF53 cells derived from this mouse model of GB. WST and caspase assays were used to measure cell survival and cell death, respectively. Results We observed HMGA2 expression in patient and mouse GB (stem) cells, and in established human GB cell lines. HMGA2 was exclusively nuclear in GB cells. Presence of HMGA2 significantly decreased recruitment of DNA damage response marker γH2AX, indicating reduced TMZ-induced DNA damage in HMGA2-expressing human and mouse GB cells. HMGA2 knockdown increased the number of DNA strand breaks assessed by increased γH2AX nuclear foci, reduced the cell survival and increased the caspase 3/7-mediated GB cell death suggesting HMGA2 to reduce TMZinduced killing in GB cells. Netropsin, Pentamidine and Dovitinib, three known DNA minor groove binders were found to compete with and attenuate HMGA2-mediated chemoresistance. The combination of either netropsin or pentamidine or dovitinib with TMZ accelerated GB cell death when compared to individual treatment with TMZ. Conclusion We utilized the ability of DNA minor groove binders to compete with HMGA2 for DNA binding and knocking down its chemoresistive action. Our results point towards the development of a new combinatorial therapeutic strategy that significantly enhanced the ability of TMZ to induce GB cell death. 6 The AVATAR Trial: Applying VAcuum To Accomplish Reduced wound infections in laparoscopic pediatric surgery Robin Visser, Kris Milbrandt, Suyin Lum Min, Nathan Wiseman, BJ Hancock, Melanie Morris, Richard Keijzer (Department of Surgery, Division of Pediatric Surgery, University of Manitoba; and Children’s Hospital Research Institute of Manitoba) Introduction Surgical site infections are the most common complication of surgery yet very little literature has addressed their prevention in pediatrics. Negative pressure wound therapy is used to treat complex wounds by removing local edema, improving vascular and lymphatic flow, decreasing bacterial density, and promoting angiogenesis and formation of granulation tissue. We hypothesized that this principle may also be applied to simple uncomplicated wounds in a prophylactic manner to reduce the incidence of wound infections following laparoscopic surgery. The aim of this study was to test this in a randomized controlled clinical trial. Methods In this randomized controlled trial, pediatric patients undergoing emergent or elective laparoscopic surgery requiring an umbilical port site were recruited and divided into 2 treatment arms: standard dressing vs simple vacuum dressing. Umbilical port site wounds were inspected between post-operative days 7-10 by a research nurse unaware of the treatment arm. A surgical site infection was diagnosed using the American Center for Disease Control criteria. Data comparison was performed using a Fisher exact test with P<0.05 being set as significant. Results Ninety patients were recruited over 2 years; 35 were assigned to the vacuum or treatment arm and 30 assigned to the control arm. We observed a 2.8% (N=1) infection rate in the vacuum study group and 3.3% (N=1) in the control group. (p = 1.0) . Conclusion Due to its limited numbers, this study was unable to prove that our simple vacuum dressing reduces postoperative wound infections in uncomplicated surgical wounds. A fully powered investigation using our validated methodology is needed to definitively answer this question. To achieve this, a multi-institutional approach would be required. We believe this is warranted, despite the relatively low rates of infection (~3%) since SSIs continue to be one of the leading causes of morbidity and mortality following surgery. 7 Avoidance of profound hypothermia during initial reperfusion improves the functional recovery of DCD hearts Christopher W. White, Yun Li, Alison Müller, Emma Ambrose, Hoa Le, James Thliveris, Trevor W. Lee, Rakesh C. Arora, Ganghong Tian, Jayan Nagendran, Larry Hryshko, Darren H. Freed (Section of Cardiac Surgery, Department of Surgery, University of Manitoba) Introduction Donor hearts following circulatory death (DCD) have been proposed as an alternative source of organs for transplant. DCD hearts experience significant ischemia during the hypoxemic cardiac arrest and warm-ischemic standoff period that ethically define death. Subsequent initial reperfusion (IR) causes intracellular calcium overload and ischemia-reperfusion injury. IR with an oxygenated cardioplegia may facilitate restoration of energy stores and calcium homeostasis prior to myocardial contraction, and minimize ischemia-reperfusion injury. These reparative processes may be inhibited under hypothermic conditions; therefore, we investigated the impact of IR temperature on the functional of DCD hearts. Methods Eighteen pigs sustained a hypoxemic cardiac arrest and 15-minute warm-ischemic standoff period. Hearts were then procured and reperfused with a cardioplegic solution for 3 minutes at 3 different temperatures (5°C; N=6, 25°C; N=5, and 35°C; N=7). Myocardial function was then assessed ex vivo by measuring the cardiac index (mL/ minute/gram heart tissue) achieved at a left atrial pressure of 8 mmHg. Results Hearts sustained an equivalent period of warm ischemia (5°C=28±1, 25°C=29±1, 35° C=27±1 minutes, p=0.50) prior to IR. During IR coronary blood flow (5°C=483±53, 25°C=722±60, 35°C=906±36 mL/min, p<0.01) differed among treatment groups. Greater preservation of endothelial cell integrity (electron microscopy endothelial injury score: 5°C=3.2±0.5, 25°C=1.8±0.2, 35°C=1.7±0.3, p=0.01) and less myocardial injury (troponin I: 5°C=91±6, 25°C=64±16, 35°C=57±7 pg/mL/gram, p=0.04) were evident in hearts reperfused at warmer temperatures. IR under profoundly hypothermic conditions impaired the recovery of indexed cardiac output (5°C=3.9±0.8, 25°C=6.2±0.4, 35°C=6.5±0.0.6 mL/min/gram, p<0.01). Conclusion Avoidance of profound hypothermia during IR minimizes injury and improves the functional recovery of DCD hearts. 8 Normalizing miR-200b expression in vivo improves nitrofen-induced lung hypoplasia in the rat model of congenital diaphragmatic hernia Naghmeh, Khoshgoo1,2,3, Patricia Terra1,2, Barbara Iwasiow1,2, Fuqin Zhu1,2, Robin Visser1,2, Vinaya Siragam1,2, Richard Keijzer1,2,3 (1Children’s Hospital Research Institute of Manitoba, 2Department of Surgery, 3 Department of Physiology & Pathophysiology) Introduction We have previously discovered that microRNA miR-200b expression is lower in nitrofen-induced hypoplastic lungs. In this study we test the hypothesis that normalizing miR-200b expression improves lung development in the nitrofen rat model for congenital diaphragmatic hernia (CDH). Methods We induced pulmonary hypoplasia and CDH by gavaging five pregnant SpragueDawley rats with 100 mg/ml nitrofen in olive oil. Two control rats were treated with olive oil alone. Immediately after this treatment, we injected the pregnant nitrofentreated rats with 5 mg/kg miR-200b mimics in normal saline (three) or normal saline alone (two). Newborn rats were euthanized when in distress or one hour after birth. Lungs were insufflation-fixated with 4% PFA and processed for morphometry and immunohistochemistry. Statistical comparisons were done using a one-way ANOVABonferroni test (p<0.05 was significant). Results We observed a 70% CDH incidence in the nitrofen pups treated with normal saline. This was reduced to 15% in the nitrofen rats treated with miR-200b mimics. The majority of the nitrofen pups treated with saline were suffering from severe respiratory distress and euthanized within 10 minutes, whereas all pups treated with miR200b mimics displayed no respiratory distress and were euthanized after 10 minutes. Histology and morphology of lungs in nitrofen pups treated with miR-200b mimics improved. Radial alveolar count was significantly higher (p=0.016) after miR200b treatment. Conclusion Normalizing miR-200b expression in pregnant rats treated with nitrofen improves lung development in the offspring clinically and morphologically. Translational studies in larger animal models should reveal if these promising results could eventually be extrapolated to human clinical trials. 9 Microsurgical reconstruction with ambulation preservation following lower extremity sarcoma resection Colin McInnes, I. MacArthur, Edward W. Buchel, Thomas Hayakawa (Section of Plastic Surgery, Department of Surgery, University of Manitoba) Introduction Lower extremity sarcoma treatment has evolved from primarily amputation towards limb salvage when possible to preserve ambulation. Sarcoma resections frequently result in massive soft tissue defects which usually require microsurgical reconstruction. Traditionally, success has been defined as having flap survival in the hostile conditions of a radiated surgical field. This series investigates whether these tissue defects can be reliably reconstructed with preservation of ambulation, and moreover, if immediate functional muscle free-flap reconstructions can be successful when required to preserve ambulation. Methods A 5-year retrospective review of microsurgical reconstruction for limb salvage in lower extremity sarcoma patients was conducted at the University of Manitoba. Outcome measures included limb salvage rates, type of flap(s) utilized, ambulation preservation and patient function utilizing the Toronto Extremity Salvage Score (TESS), and complications, among others. Results Over a five-year period, 22 patients (average age 52 years) underwent free flap reconstruction following lower extremity sarcoma resection with an average follow-up of 14 months. Of those, 85% underwent neo-adjuvant radiation therapy. The thigh was the most common tumour site (57%) and 3 different muscles were resected on average. Perforator flaps were used in the majority of reconstructions (68%), and functional muscle transfers or immediate tendon transfers were used in 3 patients. The average TESS scores was 84. There were no flap failures, and all patients achieved ambulation. Two patients in the series died from metastatic disease (not local recurrence). Conclusion Microsurgical reconstruction of lower extremity sarcoma defects enabling preservation of ambulation is usually successful and must be considered the gold standard, replacing the traditional goal of achieving adequate soft tissue coverage alone. Preservation of function utilizing functional microsurgical reconstructions should now be considered safe, effective, and as first line treatment in limb salvage procedures. These results may expand the indications for limb salvage in otherwise borderline cases. 10 Ultrasound assessment of optic nerve sheath diameter (ONSD) in healthy volunteers Patrick Goeres1, Frederick A. Zeiler2, Bertram Unger,3 Lawrence M. Gillman4 (1UGME-University of Manitoba, 2Section of Neurosurgery, 3Department of Medical Education, 4 Section of General Surgery) Introduction Ultrasonic assessment of optic nerve sheath diameter (ONSD) has been suggested as a potential non-invasive technique for the measurement of intracranial pressure (ICP). Numerous small studies exist defining its validity as a means to quickly determine elevated ICP. However, discrepancy exists around what a normal value is for ONSD due to a lack of standardized measurement technique, and only a small number of studies mostly in unhealthy patients with normal invasive ICP measurements. In this study we sought to define a normal value range for ONSD in a large population of healthy adult volunteers using a standardized measurement technique. Methods ONSD was measured using a standardized technique in healthy adult volunteers and a normal range was defined using descriptive statistics. Pearson’s correlation was used to determine relationship between ONSD measurements and sex, age, height and weight. Results 62 adults were recruited ranging in age from 19 to 65 (mean 29.5) with 50% being male. Mean ONSD was 38.3 (33.1-45.8 95% confidence Interval (CI)) in the left eye, and 38.0 (31.8-44.4 95% CI) in the right eye. Mean ONSD did not vary with age but did vary significantly with weight, height and sex. However, when controlling for sex, weight and height no longer contributed to ONSD measurements. Mean ONSD measurements for males were 39.8 (34.9-45.8 95% CI) compared with 36.5 (28.641.0 95% CI) for females. Conclusion This study has defined the range of ONSD in a healthy cohort of volunteers. The determined range and lack of relationship to age, weight and height is similar to other studies in the literature but this is the first study to find a difference in sex amongst ONSD measurements suggesting the possible need for modified reference ranges for males and females. 11 Renal nephrometry score and predictors of pathologic upstaging in patients undergoing partial and radical nephrectomies Deepak Pruthi1, Ruchi Chhibba2, Darrel E. Drachenberg1, Thomas B. McGregor1 (1Section of Urology-Department of Surgery and 2UGME-College of Medicine, University of Manitoba) Introduction To examine the predictive capability of pre-operative anatomic imaging characterization using the R.E.N.A.L. Nephrometry Score (RNS) in assessing pathologic upstaging of clinical T1 (cT1) lesions to pathologic T3 (pT3) in partial and radical nephrectomy specimens. Methods A retrospective review of all patients undergoing radical and partial nephrectomies between January 1, 2011 and May 31, 2014 for cT1 renal masses. All pre-operative imaging scans were reviewed and the R.E.N.AL. Nephrometry score (radius for tumor size as maximal diameter, exophytic/endophytic tumor properties, nearness of deepest portion of tumor to collecting system or sinus, anterior/posterior descriptor and location relative to polar line) was applied to each scan. Chi-square, Fisher exact test, and Student t test were utilized to examine associations. Results Of the 229 patients who underwent partial or radical nephrectomy for cT1, 124 (54%) underwent partial nephrectomy. On pathologic evaluation 195 (85%) patients had malignancy. Of all tumors 26 (13%) were pathologically upstaged to pT3 with the majority attributable to renal sinus/fat (35%) or perinephric fat (31%) involvement. High RNS (>10) was significant in predicting pathologic T3 upstaging (p=0.039) but did not predict high grade (Furhman grade 3-4) disease (p=0.803). While a high nephrometry score trended toward predicting malignancy vs benign disease (p=0.086), a higher mean nephrometry score (7.81 vs 6.84) significantly predicted malignancy (p=0.015). When controlled for cT1a lesions, tumor location relative to polar lines (L=3 vs L1+2) was predictive of pT3 upstaging (24 vs 6%, p=0.03). Age >65 was significantly associated with upstaging (26 vs 7%, p=0.0001). Conclusion Surveillance of small renal masses is common but high RNS and age >65 significantly predicted upstaging. Mean nephrometry score was also useful in predicting malignancy. Nephrometry score may aid in deciding on early surgical intervention. 12 Comparison of percutaneous fixation versus open reduction and internal plate fixation for the treatment of calcaneal fractures Ricky Muller Moran, Ted Tufescu, Allan Hammond (Section of Orthopedic Surgery, Department of Surgery, University of Manitoba) Introduction Although calcaneal fractures are common and often associated with significant morbidity, there is a controversy between open reduction and internal fixation using a calcaneal plate (ORIF), versus minimally invasive techniques of percutaneous fixation (PF) as the superior operative treatment method. The primary objective of this study was to measure the rate of post-operative complications with both types of treatment. Secondary objectives included measuring the quality and maintenance of fracture reduction with each technique, and clinical outcome of patients who received each type of treatment. Methods A retrospective review of 82 consecutive patients treated for calcaneal fractures at a level I trauma centre during the years of 2011 to 2014 was conducted. Radiographic outcomes were measured pre-operatively, peri-operatively (defined as either intraoperatively or up to three weeks post-operatively), and at last follow-up. This included measuring Böhler’s angle at all three time points and assessment of the subtalar joint at the latter two time points. Functional outcomes were measured using the Short-Form 12, Foot Function Index, and Foot & Ankle Ability Measure health surveys. Results Of the 82 consecutive patients, three did not meet the inclusion criteria. 87 calcaneal fractures were identified in the remaining 79 patients (ORIF n = 18, PF n = 69). No significant difference was found between the two operative groups in terms of either radiographic or functional outcome. Time to surgery was significantly higher in the ORIF group (10.6 days ORIF versus 3.27 days PF, P = 0.0002). Post-operative complication rates were 40% with ORIF versus 7.41% with PF; this was not a statistically significant difference (P = 0.11). Conclusion The trend that we have identified supports the hypothesis that PF is associated with a lower complication rate. This study was limited by the small ORIF group; further investigation with a larger sample size is warranted. 13 Genesis II SPC / Legion mid-term survivorship Alistair Ross Demcoe, Thomas Turgeon, Colin Burnell, Eric Bohm (Concordia Hip & Knee Institute, Section of Orthopedic Surgery, Department of Surgery, University of Manitoba) Introduction The Genesis II total knee implant system was released to the general market in 1996 and experienced good overall performance. Design variations were introduced into the system in 2005, which utilized a symmetrical posterior condyle design. This system, initially known as the Genesis II SPC, and later as the Legion Primary, has not been evaluated for implant performance and survival. The aim of this study was to report on the mid term survivalship of the Genesis II SPC/Legion primary TKA at a single institution. Methods The institution’s ethics review board approved the study. Legion/Genesis II SPC TKAs implanted at the study centre from March 2007 to August 2012 by four fellowship trained arthroplasty surgeons were included. Patients were consented and enrolled into a prospective database. Patient’s age at time of surgery, height and weight were all recorded. The database was retrospectively reviewed and survival analysis was undertaken using Kaplan-Meier techniques. Results There were 2170 patients with 2814 primary total knee arthroplasties with a minimum of 2 year follow up available in the database for analysis. The mean age was 64.6 (19.2-102.0) years, average BMI was 34.9 (14.8-75.7), and 63.0% of the knees were performed in female patients. The Kaplan-Meier analysis demonstrated a 2year survival of 98.2% (95 % CI 97.7-98.6%) for failure for any reason, and a 5 year survival rate of 97.0% (95% CI 96.2-97.7%). Conclusion The Genesis II SPC/Legion Primary system offers excellent midterm survivorship. Confirmation of these findings using registry data is warranted. 14 The effect of rater training on trainee assessments in medical education: A systematic review Reagan Maniar, Ashley Vergis, Lawrence Gillman, Krista Hardy, Jason Park (Section of General Surgery, Department of Surgery, University of Manitoba) Introduction Rater training is commonly used in non-medical disciplines to improve the reliability and accuracy of assessments. Many standardized assessment tools have been developed for medical education purposes but the benefit of rater training in this context is unclear. We conducted a systemic review to examine the effect of rater training on trainee assessments in the medical education literature. Methods We searched PubMed, MEDLINE, EMBASE, The Cochrane Library, CINHL, ERIC and PsychInfo for original publications until March 2014. Inclusion criteria were: prospective studies with rater training for physicians as a primary intervention compared to some type of controls. Results Eleven studies met the inclusion criteria. The studies evaluated rater training on a wide variety of skills and assessment tools, with marked heterogeneity in the methods and type of rater training. Five studies examined inter-rater reliability, four examined accuracy, one examined construct validity, and two examined evaluation quality. Four studies showed a significant effect of rater training on reliability, accuracy and quality (two studies). Most studies were of low to moderate quality, but one high quality RCT showed a significant effect of rater training on the inter-rater reliability of clinical skill evaluations that persisted for eight months. Conclusion The effect of rater training on assessments of medical trainees remains unclear given the current evidence. Additional high quality studies are warranted to determine if rater training can improve assessments in medical and surgical education, such as those for technical skills assessments. 15 Computational fluid dynamics analysis of pulsatile flow in non-ruptured abdominal aortic aneurysms: A correlation between aortic hemodynamics and aortic matrix metallopreteinases Annie Ducas1, Richard Lozowy2, David Kuhn,3 Thomas Klonisch4, April Boyd1 (1Section of Vascular Surgery, Department of Surgery, 2PhD candidate, 3Faculty of Engineering, 4 Department of Human anatomy & Cell Sciences) Introduction Currently, there is no truly reliable way to evaluate the susceptibility of particular abdominal aortic aneurysms (AAA) to rupture. In order to elucidate the pathogenesis of AAA, a correlation of aortic blood flow with aortic wall composition might vastly improve understanding the development, growth and rupture of AAA. Methods We numerically simulated aortic blood flow in non-ruptured AAA using Open-Foam computational fluid dynamics software. Intra-aortic areas of high and low wall shear stress (WSS) were identified in laminar and pulsatile flow states. At the time of open repair, redundant aortic tissue and thrombus samples were harvested throughout the aorta. Tissue was assessed histologically for inflammatory cell content, as well as collagen and elastin content. Immunohistochemistry was used to identify Matrix Metalloproteinase—9 (MMP-9) levels active and non-active forms. Colorimetric and Western-blot analysis was used to quantify MMP-9 enzymes at different locations in the aorta. The composition of the AAA wall at sampling sites was correlated with WSS at each location. Results To date, 16 patients have been enrolled in the study and aortic tissue samples have been collected. Analysis of histological changes and MMP-9 levels are underway. The computational fluid dynamics models have been generated for each AAA demonstrating the regions of high and low WSS under pulsatile flow conditions. Conclusion This work may improve our understanding of the interaction between the mechanical effect of shear and the local biological factors responsible for AAA wall de-generation and rupture. 16 Utility of pre-operative magnetic resonance imaging in the prediction of prostate adenocarcinoma disease burden Jennifer Bjazevic, Kamaljot Singh Kaler, Rebekah Rittberg, Jeffery Walter Saranchuk, Darrel E. Drachenberg (Section of Urology, Department of Surgery, University of Manitoba) Introduction Magnetic resonance imaging (MRI) of the prostate is becoming increasingly utilized in the preoperative assessment of patients prior to radical prostatectomy (RP) for prostate adenocarcinoma. However, the predictive ability of prostate MRI to detect disease extent varies significantly in the published literature. Following its introduction at a single institution, we evaluated the predictive capability of MRI prostate to determine burden of disease. Methods 24 patients who underwent preoperative MRI prostate imaging prior to RP were retrospectively reviewed. Imaging was completed at the discretion of the surgeon based on clinical and pathological features. All MRIs were reviewed for positive findings and correlated with final pathologic specimens. Sensitivity and specificity of MRI in predicting tumor location, extracapsular extension (ECE), seminal vesicle invasion (SVI), and lymphadenopathy was calculated. Results 21 (87.5%) patients had carcinoma of the prostate present on MRI imaging. MRI correctly predicted positive lymphadenopathy in a single patient; however, 10 (41.7%) patients with no lymphadenopathy on MRI had positive pelvic lymph nodes. MRI predicted 4 (16.7%) patients had SVI, and 2 (50%) of these patients had positive SVI on pathology. 7 (29.2%) patients were not predicted to have SVI on MRI and had positive seminal vesicles. For SVI, preoperative MRI had a sensitivity and specificity of 22.2% and 86.7% respectively. 6 (25.0%) patients had ECE present on MRI and 5 (83.3%) of these patients were confirmed to have ECE on final pathology. 10 (41.7%) patients with no evidence of ECE on MRI had positive ECE. MRI imaging has a sensitivity of 33.3% and a specificity of 88.9% for predicting ECE. Conclusion Preoperative prostate MRI can provide valuable information for treatment decisions and operative planning. However, the ability of MRI to accurately predict ECE, SVI, and lymphadenopathy is still limited. 17 Ultrasound imaging of nodal metastases in the central compartment in differentiated thyroid cancer: Is it possible to increase sensitivity? Mohamed Sharaf Eldin1, Ahmed Tawfik2, Shady Awny3, Fayez Shahatto3, Sherif Kotb3 (1Head & Neck Surgical Oncology Fellowship Program, 2Mansoura University, 3Mansoura Oncology Centre) Introduction Ultrasound imaging criteria for cervical lymph nodes were set mainly to increase sensitivity. However, unlike the lateral neck compartment, the challenge in the central compartment is the low sensitivity of Ultrasonography. We performed this study to evaluate whether the sensitivity of Ultrasonography could be increased by considering any detected lymph node in the central compartment as malignant. Methods Forty one patients with differentiated thyroid cancer underwent dedicated preoperative Ultrasonography by one radiologist for detection of metastatic lymph nodes in the central compartment. Any lymph node detected was considered positive regardless of Ultrasound morphologic criteria. All patients underwent thyroidectomy with central node dissection (CND), unilateral in 31 and bilateral in 10 cases, based on tumor size and laterality. Ultrasound imaging results were compared to hitopathologic results. Results The number of true positive cases by Ultrasonography was 13, false negative cases 8, true negative 15 and false positive 5 cases. The sensitivity of US was 61.9%, the specificity 75%, the positive predictive value 72.2% and the negative predictive value 65.2%. Conclusion The sensitivity of Ultrasonography for detection of metastatic lymph nodes in the central compartment in patients with DTC may be increased, compared to previously published data, by considering every detected node as positive rather than using the routine criteria for lymph node metastases in other neck levels. 18 Impact of necrotizing fasciitis on quality of life Robert Strazar1, Justin Gawaziuk2, Sarvesh Logsetty1,2 (1Section of Plastic Surgery, Department of Surgery, University of Manitoba and 2Manitoba Firefighters’ Burn Unit) Introduction Improved management of necrotizing fasciitis (NF) has resulted in prolonged survival. However long-term outcomes in survivors of NF are not well studied. The goal of this study is to assess self-reported mental and physical health, and self-perceived appearance in NF patients using existing self-reported surveys. Methods Surveys include: Short Form (SF)-36 examines physical (PCS) and mental well-being (MCS) and Derriford Appearance Scale (DAS)-24 for concern of appearance. Following ethics approval, surveys were mailed to NF patients who survived discharge from our hospital between 2004-2014 (n=200). Results Forty five (26 male, 19 female) completed the study. Age was 46.8 yr ± 14.2, TBSA was 6% ± 7.6, number of surgeries was 2.8 ± 1.3, length of hospital stay (LOS) 40 days ± 48, and days since NF was 1945 ± 933. Overall, NF resulted in worse PCS 36.3 vs. MCS 46.6. Both are worse than normative data for age 45-54 (PCS 49.62, MCS 50.54). Mean DAS-24 score of 43 ± 18 indicates distress over appearance. Age was inversely correlated with DAS-24 score (p = 0.03) and MCS (p < 0.01), but not PCS. There was a significant difference between men and women (p =0.01) for MCS, but not PCS. DAS-24 trended towards a difference (p = 0.067). There was no significant correlation with number of surgeries or days since NF. PCS was negatively correlated with %TBSA (p < 0.01) and LOS (p = 0.02), whereas MCS was not. Conclusion Our results indicate that NF has an impact on long-term mental and physical health, and distress regarding self-perceived appearance. Compared to older, younger patients tended to have worse mental well-being, although better physical. Severity related factors, %TBSA and LOS, are related to worse physical well-being but surprising not a worse mental well-being. This study highlights the need for a holistic approach for NF rehabilitation irrespective of disease severity, taking into account age and both mental and physical health of the NF patient. 19 Classification of facial pain: A 13-year population-based longitudinal study Lyra de Fatima Barchet1, Anthony M Kaufmann2 (1BSc Med Student Program and Section of Neurosurgery, Department of Surgery, University of Manitoba) 2 Introduction Accurate diagnosis of facial pain (FP) is critical for appropriate assignment of potential surgical treatments, avoidance of misdirected interventions and study of outcomes. There are, however, inconsistencies between commonly applied diagnostic criteria, particularly for trigeminal neuralgia. Our aim was to compare various FP classification schemes applied to patients presenting to neurosurgery. Methods All residents of Manitoba (population 1.25 million) presenting to neurosurgery with a primary complaint of FP were assigned to a diagnostic category: typical trigeminal neuralgia (tTN), atypical trigeminal (aTN), idiopathic painful trigeminal neuropathy (iTn), MS- or tumor-related trigeminal neuropathy, idiopathic or atypical facial pain (IFP), and a variety of other craniofacial pain conditions. For this study we reviewed clinical records and further assigned diagnoses according to published classification schemes for comparisons. Results A total of 544 FP patients were assessed. The most common diagnosis was tTN in 301 patients (55%) with diagnostic criteria equivalent to IHS-III classical trigeminal neuralgia, purely paroxysmal (13.1.1.1) and IASP trigeminal neuralgia (tic douloureux) (II-1). An additional 24 patients (4%) had aTN, equivalent to IHS-III classical trigeminal neuralgia with concomitant persistent facial pain (13.1.1.2). Additional 39 patients (7%) had iTn without corresponding criteria in IHS-III or IASP. The Burchiel classifications of TN-1and TN-2 had criteria encompassing but not differentiating tTN, aTN and iTn. Other diagnoses included MS-related trigeminal neuralgia in 5% (not differentiated from tTN in IASP), tumor-related trigeminal neuralgia in 1%, IFP in 10% and other craniofacial pain diagnoses in 18%. Conclusion Classification of FP is optimally based upon the underlying pathophysiology. The IHSIII is closest to achieving this aim among the published criteria, although does not account for iTn. Neurosurgeons offering trigeminal neuralgia treatment must be well versed in the differential diagnoses of FP, as only two-thirds of referred patients had conditions potentially amenable to surgical intervention. 20 In vivo micromotion comparison of a keeled versus pegged glenoid in a total shoulder replacement: A two-year radiostereometric analysis study Peter MacDonald1, Sheila Mcrae1, Trevor Gascoyne2, Jeff Leiter1, Martin Petrak2, Eric Bohm2 (1Section of Orthopedic Surgery—Pan Am Clinic, Department of Surgery, University of Manitoba and 2Concordia Hip & Knee Institute) Introduction Our primary objectives were: - To establish the validity and reliability of RSA to measure glenoid micromotion; -To measure the translational and rotational micromotion of the glenoid components of the pegged and keeled design as measured by RSA; - Compare the two groups with respect to patient reported quality of life. Methods An RSA phantom study was performed prior to the clinical trial to determine appropriate marker placement and accuracy of the system. Then, fifteen participants (1 bilateral) were randomized to receive either the pre-marked pegged or keeled glenoid design (Biomet Orthopaedics, Warsaw, IN). Five to ten tantalum markers were inserted during surgery. RSA exams, physical assessment, and three subjective outcome scores were completed at 6 weeks, 6-, 12-, and 24-months post-surgery. Significance was set as p < 0.05. Results From the TSA phantom, the translational precision and accuracy was better than 20 microns in any direction and the precision (zero-displacement between glenoid component and scapula) was better than 10 microns in any direction. Ten men (one bilateral) and five women with mean age of 64 years participated. No differences were detected between the pegged versus keeled designs in terms of rotation or translation. Some patients showed high early migration of the glenoid component; however, this may be a result of a lack of visible markers causing large errors in motion. All subjective outcome scores (WOOS, ASES, SST), improved significantly for both study groups from pre- to post-surgery. No differences in subjective measures between groups were detected at any post-surgery time points. Conclusion No statistical differences were found between the pegged versus keeled glenoid fixation styles in patient quality of life, which is consistent with one previous study, but not another. Overall, we were not able to infer any trends or patterns in vivo motion for either component. 21 Transanal endoscopic microsurgery for giant rectal polyps Courtney Chernos1, Elise Crocker2, David J. Hochman1 (1Section of General Surgery, Department of Surgery, University of Manitoba and 2BSC Med Student Program) Introduction Historically, patients with complex rectal lesions not amenable to complete endoscopic resections required radical surgical excision. Giant polyps, defined in the literature as lesions greater than 4 x 4 cm in dimension, are a particularly difficult subset of polyps. With the advent of Transanal Endoscopic Microsurgery (TEM) surgery we are now able to achieve full curative resection with a minimally invasive surgical technique. This case series examines the outcomes of patients with giant rectal polyps following TEM resection. Methods Between May 2009, and February 2014, 164 patients underwent TEM surgery for rectal lesions in Manitoba. All patients who met the criteria of a giant rectal lesion, defined as lesions greater than 16 cm² in area were included in the analysis, focusing on completeness of resection, quality of specimen excision and recurrence rates. Results 80 patients (48.8%) underwent TEM surgery for a giant rectal lesion. The average size of the lesions was 31.1 cm2 in area (16.2 - 73.5). The average height of the lesion from the anal verge was 9.6 cm. Lesions were removed with full thickness excision in 77 (96%) cases and had negative resection margins in 67 (84%). Pathology identified unanticipated malignancy in 16 patients (20%). Recurrences were noted in 7 (8.8%) cases, mean time to recurrence was 17 months (8-25). The mean follow-up interval was 8 months (0-34). Procedural complications occurred in a total of 3 patients (3.8%), and consisted of postoperative bleeding. Conclusion Compared to current literature, we demonstrate a higher rate of TEM resections of giant rectal polyps. In spite of their size, these lesions were successfully removed with clear margins in the majority of cases. These large polyps also contained a high percentage of unrecognized malignancies. Overall, TEM has been found to be a safe alternative to radical surgical excision of giant rectal polyps, with both low complication and recurrence rates. 22 Early and late continence after bladder neck sparing radical prostatectomy Chun Huang, Jennifer Bjazevic, Darrel Drachenberg (Section of Urology, Department of Surgery, University of Manitoba) Introduction Urinary incontinence is a well-recognized side effect of radical prostatectomy. It has been demonstrated that laparoscopic and robotic prostatectomy result in improved early return to continence with a bladder neck sparing (BNS) technique. Methods A retrospective chart review was performed, looking at early and late continence results of BNS surgery in open radical prostatectomy compared to non-BNS surgery between April 2013 and Dec 2014. 42 patients have been reviewed and 12 BNS cases identified. Data reviewed include age, stage, grade of tumour, pathologic stage, positive margin rate, immediate, early, and late continence, measured by use of incontinence pads. Tumor pathology and surgical margins were observed and correlated to margin positivity rates. Results BNS patients had improved early return to continence at 3 and 6-month follow up (66% vs. 26%) but no change in over-all continence at 1-year with 75% of BNS patients achieving one pad or less per day and 80% of the non-BNS patients achieving similar levels of continence. There were 3 positive margins identified in the BNS group while 1 positive margin was identified in the non-BNS cohort. Conclusion This study demonstrates return to early continence associated with bladder neck sparing surgery. There does not appear to be a long-term benefit. While there is a suggested higher rate of positive margins with the BNS approach, other studies have not shown significant effect of margin positivity on over-all survival in organconfined disease. Thus, BNS approach to radical prostatectomy can be considered for select patients. 23 Comparison of physical fitness between surgical and non-surgical residents David Perrin1, Dean Cordingley2, Jeff Leiter2 (1Section of Plastic Surgery, Department of Surgery, University of Manitoba, 2 Pan Am Clinic) Introduction Although every residency program can be physically, emotionally and intellectually challenging, it is well known that the demands of surgical residency training offer strenuous working hours, sleep deprivation and poor eating. Given the nature of surgical residency training, physical deconditioning would be expected to be greater amongst surgical residents than non-surgical residents. The purpose of this study is to evaluate and compare physical fitness levels between surgical and non-surgical residents. The hypothesis is that surgical residents would have inferior physical fitness scores compared to non-surgical residents. Methods This was a comparative study. Residents of all programs at the University of Manitoba were invited to participate. Participant gender, age, weekly work hours, and year of residency were obtained. Maximal VO2 testing was used to evaluate aerobic capacity. Anthropometric and strength testing were performed including BMI, body composition, resting blood pressure, resting heart rate, grip strength and a sit-up test. Differences in scores between both groups were evaluated using a t-test. Correlation analysis was used to identify any association between Maximal VO2 scores and year of residency. Results A total of 45 residents volunteered to participate in this study and were grouped into surgical (n=21) and non-surgical (n=24) groups. Surgical residents demonstrated longer working hours (p<0.05), lower aerobic fitness levels (p<0.02) and higher BMI (p<0.02) compared to the non-surgical residents. No additional differences were found between the groups in other anthropometric or strength measures. No correlation was found between year of residency and aerobic capacity. Conclusion Surgical residents have longer working hours, inferior aerobic fitness levels and higher BMI compared to non-surgical residents. 24 A randomized clinical trail comparing the breast and abdominal related morbidity of DIEP and DIEA flaps Blair Peters, Leif Sigurdson, Edward Buchel, Kimberly Dalke (Section of Plastic Surgery, Department of Surgery, University of Manitoba) Introduction The DIEP flap is the current standard of care in abdominal-based breast reconstruction. The SIEA flap is felt to be an improvement as it does not damage the abdominal wall. The SIEA flap is reported to be a more difficult dissection with smaller vessels which put the flap at higher risk of complication. Due to this uncertainty, we aimed to evaluate the abdominal and breast related morbidity associated with DIEP and SIEA flaps. Methods A double blinded, randomized clinical trial is being performed involving breast cancer patients undergoing autologous tissue reconstruction. Women are randomized to either receive the DIEP or SIEA flap procedure. Objective isokinetic abdominal testing is done pre-operatively and 3, 6 and 12 months post-operatively. A validated questionnaire is administered pre-operatively and at 3 and 12 months post. Secondary outcomes include flap and donor site complications. Results 109 patients have enrolled in the study. Preliminary analyses shows post-operative decreases in abdominal strength in both groups at 3 months. This decrease initially appears larger in the DIEP group and is trending towards significance. There is preliminary evidence that this strength deficit returns to normal at 1 year. There are no significant differences in all flap and abdominal complications. There is also no difference in post-operative pain. There are no significant differences in the intraoperative findings between groups with an adequate SIEA present in over 60% of patients. Conclusion We have gone further than others in determining the risks and benefits of each procedure. The frequency and size of the SIEA vessels found as well as the absence of increased complication rates challenge the assumption that the superficial vessels are too small to support a tissue flap and suggest that more patients are candidates for the SIEA flap than once thought. 25 Neuro-imaging findings in pediatric sports-related concussions: A clinical study Thomas Hall4, Jeff Leiter4, Patrick J. McDonald1, Scott Sawyer2,4, Norm Silver2,4, Martin Bunge3, Marco Essig3, Michael J. Ellis1,4 (1Section of Neurosurgery, Department of Surgery, University of Manitoba; 2Department of Pediatric & Child Health; 3Diagnostic Imaging; 4Pan Am Clinic, Canada North Concussion Network) Introduction The objective of this study was to summarize the results of clinical neuroimaging studies performed in sports-related concussion patients referred to a multidisciplinary pediatric concussion program. Methods We conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multi-disciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria included: 1.) age ≤ 19 years of age, 2.) physician-diagnosed SRC. All patients underwent evaluation by one neurosurgeon. The two outcomes examined in this study were the frequency of neuroimaging studies performed in this population, including computerized tomography (CT) and magnetic resonance (MRI) studies, and the findings of those studies. Clinical indications for neuroimaging were summarized. This study was approved by the local institutional ethics review board. Results 151 patients (mean age=14 years, 59% female) were included this study. Overall, 24% of patients underwent neuroimaging studies of which 78% were normal. 16% of patients underwent CT imaging which was normal in 79% of cases. Abnormal CT findings included: arachnoid cyst(1 patient), skull fracture(2 patients), suspected intracranial hemorrhage(1 patient), suspected hemorrhage into an arachnoid cyst(1 patient). 11% of patients underwent MRI, which was normal in 75% of cases. Abnormal MRI findings included: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst(1 patient), non-hemorrhagic contusion(1 patient), demyelinating disease(1 patient), posterior fossa arachnoid cyst, cerebellar volume loss, and non-specific white matter changes(1 patient). Conclusion Clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts return to play and retirement decision-making. 26 The impact of body position and walking on neurophysiological outcome measure Mina Aziz1, Michael Johnson1, Michael Goytan1, Jeff Leiter2, Jeanmarie Burke3, Mary Balliett3, Paul Dogherty3, Steven Passmore3 (1Section of Orthopedic Surgery, Department of Surgery, University of Manitoba; 2Pan Am Clinic; 3 New York Chiropractic College) Introduction Lumbar spinal stenosis is a common condition that is characterized by activity induced neurological symptoms which are influenced by body position.The purpose of the study was to establish whether a change in body position or exercise impacts the integrity of the descending motor pathway or spinal reflexes in a healthy population as assessed by Transcranial magnetic stimulation (TMS) and H-reflex. Acute exercise will reduce latencies and amplitudes of central and peripheral neurophysiological outcome measures.Body position changes may impact the amplitudes and latencies of neurophysiological outcome measures. Methods Healthy participants were recruited (N=16),8 of whom were female.Single TMS pulses to evoke motor evoked potentials (MEPs) were presented and MEPs were recorded using surface EMG collected from the abductor hallucis.The tibial nerve H-reflex methodology outlined by Hugon (1973) was used to record H-reflex responses from the soleus muscle of the right leg.A progressive exercise treadmill test was used to induce the effects of acute exercise.Both MEPs and H-reflexes were collected in the supine, and seated positions,pre- and post-walking.Data analyzed included the mean amplitude and latency for both MEPs and H-reflexes.The statistical approach used was a repeated measures ANOVA. Results TMS data yielded no statistically significant changes in amplitude and latency with exercise or changes in position.H-reflex data yielded no statistically significant changes in amplitude with changes in position. A statistically significant decrease in H-reflex amplitude was noted post exercise F(1,12)=4.880,p=0.047.H-reflex latency was noted to be longer in the seated position F(1,12)=5.633,p=0.035 and pre exercise F(1,12)=14.141,p=0.003 respectively. Conclusion Neurophysiological outcome differences attributed to acute exercise in a healthy population are due to peripheral factors. Position changes only impacted peripheral reflex latency. 27 Characteristics, long-term survival and predictors of mortality of patients needing prolonged intensive unit care stay post cardiac surgery Rizwan A. Manji1, Brett M. Hiebert2, Rakesh C. Arora1, Michael C. Moon1, Darren H. Freed1, Alan H. Menkis1 (1Section of Cardiac Surgery, Department of Surgery, University of Manitoba and 2Cardiac Sciences Program, WRHA) Introduction Long term survival and predictors of mortality for patients needing prolonged length of stay in the ICU (prLOSICU) - defined as stay ≥ 5 days post cardiac surgery (CS) – are not well defined. Methods Data of patients with prLOSICU from Jan 1, 2000 - Sept 30, 2011 was extracted from clinical and provincial databases. Cox proportional regression analysis was done to determine predictors of mortality post discharge home. Results There were 862 out of a total 9711 CS patients (8.9%) who had prLOSICU and 790/862 (91.6%) patients survived to ICU discharge. The patients had many comorbidities (including mental illness), were acutely ill (high risk score), came from lower income quintile neighborhoods within the province, and primarily had CABG or CABG + Valve procedures done. Post ICU hospital survival rate was 88.5%, and 1, 3 and 5 year post discharge home survival rates were 88.6%, 78.7% and 72.6% respectively. Cox proportional hazard regression analysis revealed factors associated with mortality post discharge home were (n=699): preoperative cardiac arrest (OR=2.52, 95% CI [1.53-4.16], p<0.001), preoperative social assistance requirement (OR=2.22, 95% CI [1.13-4.34], p=0.021), preoperative infection (OR=1.80, 95% CI [1.18-2.76], p=0.007), diabetes mellitus (OR=1.49, 95% CI [1.12-1.99], p=0.006), COPD (OR=1.47, 95% CI [1.03-2.11], p=0.036), congestive heart failure (OR=1.41, 95% CI [1.02-1.94], p=0.036), and age (OR=1.02, 95% CI [1.01-1.04], p=0.005 for each year of age since surgery). Conclusion Following cardiac surgery, 8.9% of patients have prLOSICU with reasonable long term survival rates. Long term mortality is related more to co-morbidities, initial presentation (eg. preoperative cardiac arrest) and socioeconomic status rather than having a complex cardiac operation. This information may prove useful in determining goals of care in “sick” cardiac surgery patients “struggling” in the ICU. 28 Shits happens: Integrated knowledge translation to identify and prioritize knowledge needs faced by Hirschsprung’s Disease families Kendall Hobbs-Murison1,2,3, M. Morris2,3,8, K. Wittmeier3,7,8, C. Holland1, E. Crawford4, J. Elson5, C. Beauchamp5, B. Milne5, H. Loewen6, A. Abou-Setta7, R. Keijzer2,3.8 (1Child Health Program, Health Science Centre, 2Department of Surgery, University of Manitoba, 3Children’s Hospital Research Institute of Manitoba, 4Swish Productions Ltd., 5Direct Focus Marketing Communications Inc., 6NJ Maclean Health Sciences Library and 7Centre for Healthcare Innovation, University of Manitoba) Introduction Collaboration between knowledge users and providers is fundamental to integrated Knowledge Translation (iKT). We hypothesized that iKT can be used to guide research questions in rare diseases. Our primary aim was to use social media to prioritize information needs of Hirschsprung’s Disease (HD) families and our secondary aim to compare congruency between information needs of HD families and pediatric surgeons. Methods Partnering with a parent-created social media campaign (Facebook, Twitter and blog) titled “Shit Happens,” we surveyed families and patients to prioritize information needs. Concurrently, using an online tool we surveyed the Canadian Association of Paediatric Surgeons (CAPS) to understand i) the most common problems encountered in their HD practice, and subsequently ii) what information methods are used to guide clinical management. Surveys were independently analyzed to determine themes and to rank priorities. We used a modified Delphi approach to combine results and achieve consensus on a prioritized list of knowledge needs. Results 89 HD family participants responded to the survey; 66.3% of these within 7 days. 23.9% of CAPS members responded to the survey. Overlapping priorities included bowel management issues, treating perineal irritation, recognition and management of enterocolitis. Discordant priorities between families and surgeons included nutrition/growth and diagnostics. Of 21.1% of CAPS survey respondents; 84% use their expert opinion to guide management, 81% use collegial expert opinion, 76% indicate guidance from HD literature, and 54% in the literature related to HD while 32% rely on practice guidelines. Conclusion iKT research combining a parent research partner with social media can identify and prioritize knowledge needs for families dealing with rare diseases such as HD in an efficient manner. Results of this study are currently guiding knowledge synthesis and where sufficient, resource development to assist parents. 29 Mental and physical health outcomes in parents of children with burn injuries as compared to matched controls Jessica Enns1, J.P. Gawaziuk23, S. Khan4, D. Chateau4, J. Bolton5, J. Sareen5, J. Stone1, M. Doupe4, S. Logsetty2,3 (1BSc Med Program, College of Medicine, University of Manitoba, 2Manitoba Firefighters Burn Unit, 3 Department of Surgery, University of Manitoba, 4Manitoba Centre for Health Policy and 5Department of Psychiatry, University of Manitoba0 Introduction Pediatric burn-injuries are common and the stress of caring for them can affect caregiver’s health. The objective of this study was to examine the rates of mental and physical disorders of parents of burn-injured children (Cases) compared to matched controls (Controls). Methods This population-based study links the Winnipeg Children’s Hospital Pediatric burn registry with health information at the Manitoba Centre for Health Policy. Pediatric burn cases were matched 1:5 with control children from the general population based on age, sex and geographical location. 1029 parental Cases and 4923 Controls were identified. ICD codes were used to identify diagnoses of common mental and physical disorders, comparing rates of disease 2 years prior to and 2 years following the date of burn. The changes in the relative rates of health outcomes (pre-injury to post-injury) were compared between the cases and the controls. This methodology is an important strength of this study as this allows for correction of changes in rates due to aging or other factors. Results The prevalence of substance abuse disorder 2 years prior to burn date was 3.0% among cases rising to 10.4% postburn; in controls this change was from 2.11% to 6.03%. There was an absolute rate increase of 7.38% for cases compared to 3.92% for the controls (a relative increase of over 20%). Similarly there was an absolute increase of 3.5% and a relative increase of 36% more fractures in the Cases. There were no significant differences found in other Axis one mental, or physical disorders. Conclusion Increased rates of substance use disorder and fractures in the parents of burninjured children compared to the matched controls has important clinical implications for the care of parents who have a burn-injured child. 30 The impact of lumbar spinal stenosis on lower extremity motor control: A pre-surgical study Austin Enright, Michael Johnson, Valerie Pelleck, Dean Kriellaars, Cheryl Glazebrook Steven Passmore (Section of Orthopedic Surgery, Department of Surgery, University of Manitoba) Introduction Objective outcome measures are lacking for the progression, impairment and management of degenerative lumbar spinal stenosis (LSS). The most common reason for adults over 65 to proceed to spine surgery is LSS. Fitts’ Law is an established motor paradigm that may provide a novel approach to outcome measurement since task difficulty is easily manipulated, and performance on Fitts’ Law tasks are resistant to learning. Hypothesis: We predict that pre-surgical LSS patients will be demonstrate performance that is more adversely impacted than healthy control participants when measuring their physical ability to perform a motor task. Study Design: Crosssectional between groups experimental design. Method Participants with degenerative LSS (N=12) and healthy controls (N=12) performed pointing movements with their great toe to a series of squares that appeared on a touchscreen monitor. Three dimensional motion analysis recorded movement. Behavioural measures included reaction time and movement time (MT), kinematic performance measures were also recorded. The Health Research Ethics Board approved all protocols and procedures. Results Significant interactions for MT [F(5,110) = 3.17, p<.05] and kinematic variables time to peak velocity [F(5,110) = 5.51 p<.05] and peak velocity [F(5,110) = 9.61 p<.05 ] respectively revealed that the LSS group’s movements were more adversely impacted by increasing task ID. Conclusion A lower extremity Fitts’ Law task is useful in measuring differences between healthy and pre-surgical LSS populations. In the future it may be applied in LSS surgical intervention studies considering motor performance measurement as a quantitative outcome measure. 31 Non-neoplastic kidney and predictors of post-operative renal insufficiency in radical nephrectomies Ruchi Chhibba1, Deepak K. Pruthi2, Thomas B. McGregor2 (1UGME-College of Medicine, University of Manitoba, and 2Section of Urology, Department of Surgery, University of Manitoba) Introduction To identify predictors of post-operative renal insufficiency by analyzing clinical comorbidities and the pathologic changes in the non-neoplastic kidney (NNK) specimens of patients undergoing radical nephrectomy (RN). Methods We retrospectively reviewed all patients undergoing RN for suspected RCC from January 2011-May 2014. Estimated glomerular filtration rate (eGFR) was calculated employing the modified diet in renal disease (MDRD) formula using the 6 month creatinine value. Pathologic reports were reviewed to assess for any glomerular, tubulointerstitial and arterial/arteriolar (GTA) changes. Univariant analysis was employed. Results Of the 147 patients undergoing RN, 57 (39%) had changes in the NNK, 57 (39%) had unremarkable changes and 33 (22%) had no specific comments on the NNK. Fourtytwo patients had specific changes to the GTA architecture; of these 42, 51% had more than one GTA change. Patients with GTA changes were not more likely to have declines in post-operative (PsO) renal function compared to those with unremarkable findings (p=0.15). However, those with pre-operative (PrO) eGFR > 60/ml/ min/1.73m2 had a greater decrease in PsO renal function than those with PrO eGFR of <60 (-26 vs -6ml/min/1.73m2, p<0.0001). Overall, patients with GTA changes were more likely to have a lower PrO eGFR (<60 vs >60 ml/min/1.73m2, p=0.009) than those with unremarkable changes. Patients with a tumor size < 10 cm had a greater decrease in PsO renal function compared with a tumor size >10 cm (-25 vs -14 ml/ min/1.73m2, p=0.011). New onset stage 3 CKD or greater occurred in 65% of patients. Diabetes, hypertension, smoking status, and age (>60) were not statistically significant in predicting PsO renal function. Conclusion Smaller tumor size and higher PrO eGFR were associated with greater decline in PsO renal function. NNK changes did not predict renal functional outcome in this series. New CKDIII occurred in over half of all patients. 32 Arthroscopic versus open lateral release for the treatment of lateral epicondylitis; A prospective randomized controlled trial Jamie Dubberley1, Tod Clark1, Sheila Mcrae2, Jeff Leiter2, Peter MacDonald1 (1Section of Orthopedic Surgery—Pan Am Clinic, Department of Surgery, University of Manitoba; and 2Pan Am Clinic Foundation) Introduction The primary objective of this study was to determine if quality of life and function are different following arthroscopic versus open tennis elbow release surgery. Based on retrospective studies, both approaches have been found to be beneficial, but no prospective randomized comparison has been conducted to date. Methods Following a minimum six-months of conservative treatment, seventy-one patients (>16 yrs old) were randomized intraoperatively to undergo either arthroscopic or open lateral release. Outcome measures were the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), a 5-question VAS Pain Scale, and grip strength. Study assessments took place pre-, and 6-week, 3-, 6-, and 12-months post-surgery. Comparisons between groups and within groups over time were conducted with p<0.05. Results No pre-surgery differences were found between groups based on age, sex, DASH or VAS scores. Fifteen women and 19 men underwent the open procedure with mean age 47.1 years (6.7) and 13 women and 21 men were in the arthroscopic group with mean age of 45.0 (6.9). Both groups demonstrated a significant improvement in all measures following surgery, and no significant differences were found between groups at any time point. The DASH, our primary outcome, decreased from a mean (SD) of 47.5 (14.5) pre-surgery to 21.9 (21.8) at 12-months post-surgery in the Open group and from 52.7 (16.0) to 22.6 (21.1) in the Arthroscopic group. VAS-pain scores followed a similar pattern. Grip strength increased on the affected side from 23.6 (14.9) kg to 29.3 (16.3) and 21.4 (15.4) kg to 29.8 (15.4) for Open and Arthroscopic groups, respectively. Conclusion Based on this study, there is no difference in patient quality of life and function between arthroscopic and open tennis elbow release surgery. More detailed analysis of the impact of third party claims, sex, and smoking status would be beneficial. 33 Participant’s Abstract Index Aziz, Mina ........................................................................................................................... 27 Barchet, Lyra de Fatima ..................................................................................................... 20 Bjazevic, Jennifer ................................................................................................................ 17 Chernos, Courtney ............................................................................................................. 22 Chhibba, Ruchi ................................................................................................................... 32 Demcoe, Alistair Ross ......................................................................................................... 14 Dubberley, Jamie ............................................................................................................... 33 Ducas, Annie ...................................................................................................................... 16 Eldin, Mohamed Sharaf ...................................................................................................... 18 Ellis, Michael ...................................................................................................................... 3 Enns, Jessica ....................................................................................................................... 30 Enright, Austin ................................................................................................................... 31 Gardiner, Claire .................................................................................................................. 4 Goeres, Patrick ................................................................................................................... 11 Hall, Thomas ...................................................................................................................... 26 Hobbs-Murison, Kendall ..................................................................................................... 29 Huang, Chun ....................................................................................................................... 23 Khoshgoo, Naghmeh .......................................................................................................... 9 MacDonald, Peter ............................................................................................................... 21 Maniar, Reagan .................................................................................................................. 15 Manji, Rizwan ..................................................................................................................... 28 McInnes, Colin ................................................................................................................... 10 Muller-Moran, Ricky .......................................................................................................... 13 Natarajan, Suchitra ............................................................................................................. 6 Nguyen, Quyen .................................................................................................................. 5 Perrin, David ...................................................................................................................... 24 Peters, Blair ........................................................................................................................ 25 Pruthi, Deepak ................................................................................................................... 12 Steigerwald, Sarah .............................................................................................................. 1 Stone, James ...................................................................................................................... 2 Strazar, Robert ................................................................................................................... 19 Visser, Robin ....................................................................................................................... 7 White, Christopher ............................................................................................................. 8 34 Annual Department of Surgery Research Day 2015