CAGS Recommendations

How the list was created
The Canadian Association of General Surgeons (CAGS) established its Choosing Wisely Canada Top 5 recommendations by first having its Clinical Practice Committee review the American College of Surgeons (ACS) Choosing Wisely® list. Feeling confident that the American list reflected general surgery issues in Canada (addressing breast cancer diagnostics and treatment, colon cancer screening, trauma diagnostics and screening, admission and preoperative chest X-rays, and appendicitis diagnostics in children), the CAGS Clinical Practice Committee approved the list in principle. The list was then circulated to the CAGS Board and surgeons that specialized in each area were consulted. Ultimately, the first five items were adopted with permission from the Five Things Physicians and Patients Should Question, © 2013 American College of Surgeons. The CAGS Board also felt strongly about adding a sixth item to the list about the treatment of asymptomatic hernia and six items were then submitted for publication.

Recommendations:
1: Don’t perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy.
2
: Avoid the routine use of “whole-body” diagnostic computed tomography (CT) scanning in patients with minor or single system trauma.
3: Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than 10 years and no family history of colorectal neoplasia.
4: Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam.
5:Don’t do computed tomography (CT) for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option.
6:Avoid repair of minimally symptomatic inguinal hernias where appropriate by offering an option of watchful waiting for up to two years.