Kelly Fedoruk

All Publications

• Heterogeneity in Uterotonic Administration During Cesarean Delivery: Results From a Survey of Society of Obstetric Anesthesia and Perinatology Centers of Excellence Institutions. Anesthesia and analgesia Shah, S., Koons, N. J., Panigrahy, N., Squires, L., Ansari, J. R., Carvalho, B., Fedoruk, K. A. 2026; 143 (4): e68-e70

  View details for DOI 10.1213/ANE.0000000000008249

  View details for PubMedID 42743960

• Quality improvement methodology used in enhanced recovery after caesarean delivery implementation studies: a narrative review and author survey. BMJ open quality Fedoruk, K., Carvalho, B., Blake, L., Sultan, P. 2025; 14 (4)

  Abstract

  Enhanced recovery after caesarean delivery (ERAC) is gaining popularity and has been shown to improve maternal and neonatal outcomes. We aimed to identify the presence and type of quality improvement (QI) methodology used in ERAC studies through an exploratory analysis, including author surveys and literature review.We performed a literature search using four databases (MEDLINE through PubMed, Cumulative Index of Nursing and Allied Health Literature, Web of Science and Embase) to identify ERAC studies. Studies were considered if they compared an 'enhanced' or 'fast track' protocol to a control group and evaluated more than one system or outcome. The adopted QI methodology was evaluated through a standardised questionnaire developed by the authors which was sent to the authors of included studies.We identified 29 studies. A standardised questionnaire was applied to all included papers to evaluate the presence and type of QI methodology, and 24 authors were approached to complete the survey. We received results from 15 authors, yielding a response rate of 63%. 40% of authors reported use of defined QI methodology, the majority using the Model for Improvement. The QI components most used by those not reporting use of a defined methodology were engagement with multidisciplinary key stakeholders (80%), use of key drivers (87%) and process mapping (60%). Most authors reported use of traditional statistical methodology when analysing results (73%), and 60% reported use of Standards for Quality Improvement Reporting Excellence guidelines. The mean duration of baseline data collection by non-randomised controlled trial studies was 11 months and 9.9 months after implementation.There is a large variation in the QI practices used in protocol implementation and publication of ERAC studies. The minority of authors report the use of a defined QI methodology and very few report the use of standardised tools in their published works.CRD42023399418.

  View details for DOI 10.1136/bmjoq-2024-003013

  View details for PubMedID 41339001

• Comparison of Perioperative Temperature Monitoring Sites During Elective Cesarean Deliveries: A Quality Improvement Initiative. Cureus Ismaiel, N., Shah, S., Guo, N., Carvalho, B., Fedoruk, K. 2025; 17 (12): e99890

  Abstract

  Impaired thermoregulation secondary to neuraxial anesthesia during cesarean delivery (CD) can contribute to perioperative hypothermia and maternal morbidity. While temperature monitoring during CDs can detect hypothermia, the optimal temperature measurement modality for CDs under neuraxial anesthesia remains unclear. The aim of this quality improvement (QI) initiative was to compare perioperative temperature measurement modalities during CDs.Thirty patients undergoing scheduled CDs were selected for this Institutional Review Board (IRB)-exempt QI initiative. Patients received standard neuraxial anesthesia and intraoperative care including active warming. Temperature measurements were taken at three perioperative time points: at skin incision, within 15 minutes after delivery of the infant(s), and at skin closure. Three modalities were used to measure temperature each time: (1) temperature-sensing Foley catheter, (2) oral temperature probe, and (3) skin temperature probe. Temperature modalities were compared using mean differences ± SD, correlation coefficients, and Bland-Altman (BA) plots.The mean difference between oral vs. skin and oral vs. bladder temperatures was 0.238°C ± 0.380°C and 0.368°C ± 0.361°C, respectively. The overall temperature correlations between oral vs. skin, oral vs. bladder, and skin vs. bladder were 0.225, 0.588, and 0.198, respectively. In the end, the percentage of hypothermic temperatures (below 36°C) by modality were 0% (oral), 10% (skin), and 26.7% (bladder).The results suggest a weak correlation between oral and skin temperature measurements, and a moderate correlation between oral and bladder temperatures. These findings should be considered when evaluating hypothermia after CD to enhance patient safety and guide improvement efforts.

  View details for DOI 10.7759/cureus.99890

  View details for PubMedID 41583327

  View details for PubMedCentralID PMC12828851

• Comparative efficacy of intravenous treatments for perioperative shivering in patients undergoing caesarean delivery under neuraxial anaesthesia: A systematic review and Bayesian network meta-analysis of randomised-controlled trials. Journal of clinical anesthesia Ferrea, G., Monks, D. T., Singh, P. M., Fedoruk, K., Singh, N. P., Blake, L., Carvalho, B., Sultan, P. 2024; 100: 111680

  Abstract

  Shivering affects 52 % of patients undergoing caesarean delivery under neuraxial anaesthesia. Despite extensive research focused on its prevention, there is still no consensus regarding optimal pharmacological treatment. This systematic review and network meta-analysis aims to compare available intravenous treatments of perioperative shivering in patients undergoing caesarean delivery under neuraxial anaesthesia.We searched seven databases (PubMed MEDLINE, Scopus, Web of Science, Embase, LILACS, Cochrane CRCT and clinicaltrials.gov) for randomised controlled trials comparing intravenous treatments of perioperative shivering during caesarean delivery and performed a Bayesian model network meta-analysis. We assessed study quality using the Cochrane risk of bias assessment tool. The primary outcome evaluated in this meta-analysis was shivering control (cessation or significant reduction in intensity), and secondary outcomes included time to shivering control, shivering recurrence, and incidence of maternal nausea.Twenty randomised controlled trials, with a total of 1983 patients, were included in this analysis. Network estimates of odds ratios (OR [95 % Credible Interval]) of effective treatment of shivering compared with saline were: dexmedetomidine (38.1 [14.2 to 111.5]), tramadol (33.6 [15.1 to 81.8]), nalbuphine (26.2 [10.8 to 80.2]), meperidine (20.9 [6.2 to 73.1]), ondansetron (6.6 [2.2 to 23.2]), and clonidine (3.2 [0.6 to 14.9]). The rank order of interventions by surface area under the cumulative ranking curve scores (in parenthesis) for shivering control was dexmedetomidine (0.87) > tramadol (0.85) > nalbuphine (0.74) > meperidine (0.66) > ondansetron (0.41) > clonidine (0.3) > amitriptyline (0.03). Dexmedetomidine was also the top-ranked intervention for time to shivering control, shivering recurrence and maternal nausea. We judged the certainty in the evidence to be moderate for dexmedetomidine and nalbuphine, and low for all other interventions.This network meta-analysis identified four effective intravenous treatments for shivering in patients undergoing caesarean delivery under neuraxial anaesthesia: dexmedetomidine, tramadol, nalbuphine and meperidine. Dexmedetomidine was the top-ranked intervention for all outcomes.

  View details for DOI 10.1016/j.jclinane.2024.111680

  View details for PubMedID 39608094

• Obstetric Anesthesia Quality Metrics: Performance, Pitfalls, and Potential. Anesthesia and analgesia Fedoruk, K. A., Sultan, P. 2024

  View details for DOI 10.1213/ANE.0000000000007054

  View details for PubMedID 39316517

• Effect of an electronic medical record nudge to improve quality improvement program tracking of neuraxial catheter replacements in obstetric patients. BMJ open quality Fedoruk, K., Xie, J., Wang, E., Fowler, C., Riley, E., Carvalho, B. 2023; 12 (4)

  Abstract

  Monitoring complications associated with medical procedures requires reliable and accurate record keeping. Nudge reminders executed by way of electronic medical record (EMR) alerts influence clinician behaviour. We hypothesised that the introduction of an EMR nudge would improve documentation of replaced neuraxial blocks by obstetric anaesthesiologists at our institution.We developed an EMR nudge that would alert the physician to a replaced neuraxial block if two or more neuraxial procedure notes in a single patient encounter were detected. The nudge encouraged physicians to document neuraxial block replacements in our institution's quality improvement database. We assessed the rate of physician adherence to replaced neuraxial block charting prior to the introduction of the nudge (January 2019-September 2019) and after the implementation (October 2019-December 2020).494 encounters during the chart review period, January 2019-December 2020, required a neuraxial block replacement, representing an actual neuraxial replacement rate of 6.3% prior to the introduction of the nudge in October 2019. This rate was largely unchanged (6.2%) after the introduction of the nudge (0.1% difference, 95% CI: -0.0119 to 0.0099). Prior to the introduction of the nudge, the proportion of correctly charted failed/replaced blocks in our quality improvement database was 80.0%, and after nudge introduction, the rate was 96.2% (p value <0.00001, OR=6.32, 95% CI: 3.15 to 12.66). A p-chart of the monthly adherence rate demonstrated sustained improvement over time.EMR nudge technology significantly improved adherence with quality metric monitoring of neuraxial catheter replacement in obstetric patients. The results imply that data collection for quality metric databases of neuraxial block failures and replacements that rely on clinician memory without a nudge are likely under-reporting neuraxial block failures and replacements. This study supports widespread implementation of nudges in EMRs to improve quality metric reporting.

  View details for DOI 10.1136/bmjoq-2022-002240

  View details for PubMedID 37903567

• Virtual Compared to In-Person Obstetric Anesthesiology Trainee Education During the COVID-19 Pandemic: A Short Report. Cureus Fedoruk, K., Abir, G., Carvalho, B. 2022; 14 (6): e26423

  Abstract

  BACKGROUND: The COVID-19 pandemic brought many changes to medical training, including in-person education platforms being disbanded and replaced with virtual education. At our institution, dedicated obstetric anesthesiology teaching for residents and fellows occurs daily and is highly valued and rated. In March 2020 due to the COVID-19 pandemic, we changed the teaching platform from in-person to virtual teaching (via video communication). We subsequently surveyed residents, fellows, and attendings to determine the impact of virtual compared with in-person teaching.METHODS: To assess the impact of this change, an electronic survey was sent to 10 anesthesiology residents on their 2nd obstetric anesthesiology rotation, and 10 residents on their 1st rotation, respectively. The electronic survey was also sent to three fellows and eight obstetric anesthesiology attendings. Answers were based on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree).RESULTS: The results for 1st rotation residents were higher in all domains compared with 2nd rotation residents and fellows, where "quality" achieved statistical significance (p=0.009) between 1st and 2nd rotation residents. "Engagement" was overall the most impacted domain for trainees. Attendings did not feel that virtual teaching impacted their ability to provide adequate education, however, learner engagement was again the lowest rated domain, and teachers strongly favored resuming in-person teaching.CONCLUSIONS: Virtual teaching is an appropriate alternative when in-person teaching is not possible. Future initiatives are needed to improve engagement and better facilitate virtual teaching.

  View details for DOI 10.7759/cureus.26423

  View details for PubMedID 35915679

• Assessing the Association Between Blood Loss and Postoperative Hemoglobin After Cesarean Delivery: A Prospective Study of 4 Blood Loss Measurement Modalities. Anesthesia and analgesia Fedoruk, K., Seligman, K. M., Carvalho, B., Butwick, A. J. 2018

  Abstract

  BACKGROUND: Visual estimation and gravimetric methods are commonly used to quantify the volume of blood loss during cesarean delivery (CD). However, the correlation between blood loss and post-CD hemoglobin (Hb) is poorly studied, and it is unclear whether the correlation varies according to how blood loss is measured.METHODS: After obtaining Institutional Review Board approval, we performed a prospective study of 61 women undergoing CD to assess the relations between post-CD Hb and blood loss measured using 4 modalities: gravimetric blood loss measurement (gBL), visual blood loss estimation by a blinded obstetrician (oBL) and anesthesiologist (aBL), and the Triton System (tBL). Hb was measured preoperatively and within 10 minutes after CD. gBL was quantified as blood volume in a suction canister in addition to the weight of blood-soaked sponges. tBL was measured with the Triton System by photographing blood-soaked sponges and suction canister contents. To assess the relation between blood loss and post-CD Hb, we performed correlation analyses and compared the magnitude of the correlations across the 4 measurement modalities using William t test. A Bonferroni correction was set to identify a statistically significant correlation (P < .0125) and statistically significant differences between correlation coefficients (P < .008).RESULTS: The mean (standard deviation) preoperative Hb was 12 (1.1) g/dL and post-CD Hb was 11.3 (1.0) g/dL. Median (interquartile range) values for gBL, oBL, aBL, and tBL were 672 mL (266-970), 700 mL (600-800), 750 mL (600-1000), and 496 mL (374-729), respectively. A statistically significant but weak correlation was observed between tBL and post-CD Hb (r = -0.33; P = .01). No statistically significant correlations were observed among aBL (r = -0.25; P = .06), oBL (r = -0.2; P = .13), and gBL (r = -0.3; P = .03) with post-CD Hb. We did not detect any significant differences between any 2 correlation coefficients across the 4 modalities.CONCLUSIONS: Given that we observed only weak correlations between each modality with post-CD Hb and no significant differences in the magnitude of the correlations across the 4 modalities, there may be limited clinical utility in estimating post-CD Hb from blood loss values measured with any of the 4 modalities.

  View details for PubMedID 29847380