Richard Garfinkle

August 2020

  • Residency Program: McGill University
  • Supervisors: Dr. Marylise Boutros,

Richard is currently a clinical PGY-3 in General Surgery at McGill University. He spent the last three years enrolled in the Surgical Scientist Program and Clinician Investigator Program, during which he completed an MSc in Epidemiology and pursued a PhD in Experimental Surgery. He was supported by both provincial (FRQS) and national (CIHR) salary awards throughout his dedicated research time. He completed his medical school at McGill University in 2015.

Research Summary

Richard’s research focuses on the surgical outcomes of Colorectal Surgery patients, making use of large administrative databases, institutional data, and prospective trials to answer various clinical questions. His areas of interest include rectal cancer and diverticulitis, both of which make up a large component of any Colorectal Surgeon’s practice.

During his MSc, he performed a systematic review and meta-analysis evaluating bowel recovery after loop ileostomy closure. His meta-analysis reported a pooled incidence of postoperative ileus nearing 10%, and identified several factors associated with this outcome. He then studied institutional data to develop a prediction model and web-based calculator for estimating ileus after loop ileostomy closure, which can be used in practice to select patients suitable for day-surgery ileostomy closure. This model was externally validated in collaboration with the Colorectal Surgery team at St. Paul’s Hospital, UBC. Richard is currently leading a SAGES and CAGS-funded multicenter trial evaluating preoperative bowel stimulation to reduce ileus after ileostomy closure. The trial has been running since 2017, and is set to close in the next 6-12 months.

Richard has also published on the management of patients with acute diverticulitis. His work in 2016, supported by a 2014 ASCRS medical student grant, demonstrated the safety of long-term nonoperative management in patients with diverticular abscess. He recently took part in the SAGES/EAES consensus guidelines on the management of acute diverticulitis, and was tasked with recommendations for the management of uncomplicated diverticulitis. As a follow-up study, Richard led a North American Delphi study including patients and physicians, to better understand their willingness and acceptance of non-antibiotic therapy for acute uncomplicated diverticulitis.

His PhD thesis is focusing on increasing patient engagement and support in the management of Low Anterior Resection Syndrome (LARS), a long-term sequela of rectal cancer treatment following restorative proctectomy. He has developed a patient-centric supportive intervention, including educational resources and specialized nursing care, to better care for patients with postoperative bowel dysfunction. His PhD thesis will be submitted at the end of August, and the individual manuscripts will be submitted for publication shortly after. His work is generously supported by an operating grant from CSCRS.

Selected Publications

Garfinkle R, Almalki T, Pelsser V, et al. Conditional Recurrence-Free Survival After an Episode of Diverticulitis Managed Nonoperatively. Br J Surg. Accepted May-30-2020.

Garfinkle R
, Sabboobeh S, Demian M, et al. Patient and Physician Preferences for Antibiotics in Acute Uncomplicated Diverticulitis: A Modified Delphi Consensus Process to Generate Non-Inferiority Margins. Dis Colon Rectum. Accepted Apr-29-2020.

Garfinkle R, Vasilevsky CA, Ghitulescu G, et al. Compliance with Preoperative Elements of the American Society of Colon and Rectal Surgeons Rectal Cancer Surgery Checklist Improves Pathologic and Postoperative Outcomes. Dis Colon Rectum. 2020;63(1):30-38.

Garfinkle R, Filion KB, Bhatnagar S, et al. Prediction Model and Web-Based Risk Calculator for Postoperative Ileus after Loop Ileostomy Closure. Br J Surg. 2019;106(12);1676-1684.

Garfinkle R, Savage P, Boutros M, et al. Incidence and Predictors of Postoperative Ileus After Loop Ileostomy Closure: A Systematic Review and Meta-Analysis. Surg Endosc. 2019;33(8):2430-2443.

Garfinkle R, Wong-Chong N, Petrucci A, et al. Assessing the Readability, Quality and Accuracy of Online Health Information for Patients with Low Anterior Resection Syndrome Following Surgery for Rectal Cancer. Colorectal Dis. 2019;21(5):523-531.