scholarly journals Regional variations in the treatment of gallstone disease may affect patient outcome: A large, population-based register study in sweden

2020 ◽  
pp. 145749692096801
Author(s):  
L. Lindqvist ◽  
G. Sandblom ◽  
P. Nordin ◽  
O. Hemmingsson ◽  
L. Enochsson
Keyword(s):  
Population Density ◽  
Gallstone Disease ◽  
Large Population ◽  
Treatment Strategies ◽  
Population Based ◽  
Standards Of Care ◽  
Geographical Regions ◽  
Operative Complications ◽  
American Society ◽  
Post Operative Complications

Background: The lack of studies showing benefit from surgery in patients with symptoms of gallstone disease has led to a divergence in local practices and standards of care. This study aimed to explore regional differences in management and complications in Sweden. Furthermore, to study whether population density had an impact on management. Methods: Data were collected from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). Cholecystectomies undertaken for gallstone disease between January 2006 and December 2017 were included. Age, sex, American Society of Anesthesiologists (ASA) classification, intra- and post-operative complications, and the proportion of patients with acute cholecystitis who underwent surgery within 2 days of hospital admission were analyzed. The 21 different geographical regions in Sweden were compared, and each variable was analyzed according to population density. Results: A total of 139,444 cholecystectomies cases were included in this study. There were large differences between regions regarding indications for surgery and intra- and post-operative complications. In the analyses, there were greater divergences than would be expected by chance for most of the variables analyzed. Age of the cholecystectomized patients correlated with population density of the regions (R2 = 0.310; p = 0.0088). Conclusion: There are major differences between the different regions in Sweden in terms of the treatment of gallstone disease and outcome, but these did not correlate to population density, suggesting that local routines are more likely to have an impact on treatment strategies rather than demographic factors. These differences need further investigation to reveal the underlying causes.

Post-operative complications in elderly onset inflammatory bowel disease: a population-based study

2018 ◽  
Vol 47 (12) ◽  
pp. 1652-1660 ◽  
Author(s):  
S.-C. Sacleux ◽  
H. Sarter ◽  
M. Fumery ◽  
C. Charpentier ◽  
N. Guillon-Dellac ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Population Based ◽  
Population Based Study ◽  
Operative Complications ◽  
Elderly Onset ◽  
Inflammatory Bowel ◽  
Post Operative Complications

scholarly journals Sex differences and temporal trends in aortic dissection: a population-based study of incidence, treatment strategies, and outcome in Swedish patients during 15 years

2020 ◽  
Vol 41 (26) ◽  
pp. 2430-2438 ◽  
Author(s):  
Christian Smedberg ◽  
Johnny Steuer ◽  
Karin Leander ◽  
Rebecka Hultgren
Keyword(s):  
Sex Differences ◽  
Aortic Dissection ◽  
Large Population ◽  
Temporal Trends ◽  
Treatment Strategies ◽  
Population Based ◽  
Favourable Outcome ◽  
Hospitalized Patients ◽  
Population Based Study ◽  
National Patient

Abstract Aims As large population-based studies of aortic dissection are lacking, the incidence numbers and knowledge about time-trends and sex differences are uncertain. The objective was to describe incidence, temporal trends and outcome of aortic dissection with particular emphasis on sex differences. Methods and results During the study period 2002–2016, 8057 patients in Sweden were diagnosed with aortic dissection, identified from the National Patient Register and the Cause of Death Register. A total of 5757 (71%) patients were hospitalized, whereas 2300 (29%) patients were deceased without concurrent hospital stay. The annual incidence was 7.2 per 100 000 (9.1 in men and 5.4 in women), decreasing over time in men (P = 0.005). Mean age in the hospitalized patients was 68 years (SD 13), 2080 (36%) were women. Within the first 14 days after onset, 1807 patients (32%) underwent surgical repair. The proportion of surgically treated increased from the 5-year period 2002–2006 to 2012–2016 [27% vs. 35%, odds ratio (OR) 1.61, 95% confidence interval (CI) 1.39–1.86; P < 0.001]. In hospitalized patients, 30-day mortality decreased between the same periods (26% vs. 21%, OR 0.68, 95% CI 0.59–0.80; P < 0.001). Long-term mortality decreased as well (hazard ratio 0.74, 95% CI 0.67–0.82; P < 0.001). Women had higher 30-day mortality than men after acute repair, a sex difference that remained after age adjustment (17% vs. 12%, OR 1.38, 95% CI 1.04–1.82; P = 0.006). Conclusion This population-based study detected a higher incidence of aortic dissection than prior reports, but a decreasing incidence in men. Surgical therapy was increasingly used and with more favourable outcome but was less frequently offered to elderly patients. The sustained sex differences regarding both incidence and outcome require further attention.

Morbidity and mortality following major large bowel resection for colorectal cancer detected by a population-based screening program

2020 ◽  
pp. 096914132095736
Author(s):  
Lawrence F Paszat ◽  
Rinku Sutradhar ◽  
Elyse Corn ◽  
Jin Luo ◽  
Nancy N Baxter ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Large Bowel ◽  
Bowel Resection ◽  
Screening Program ◽  
Occult Blood ◽  
Population Based ◽  
Fecal Occult Blood ◽  
Operative Complications ◽  
Large Bowel Resection ◽  
Post Operative Complications

Background and aims In 2008, Ontario initiated a population-based colorectal screening program using guaiac fecal occult blood testing. This work was undertaken to fill a major gap in knowledge by estimating serious post-operative complications and mortality following major large bowel resection of colorectal cancer detected by a population-based screening program. Methods We identified persons with a first positive fecal occult blood result between 2008 and 2016, at the age of 50–74 years, who underwent a colonoscopy within 6 months, and proceeded to major large bowel resection for colon cancer within 6 months or rectosigmoid/rectal cancer within 12 months, and identified an unscreened cohort of resected cases diagnosed during the same years at the age of 50–74 years. We identified serious postoperative complications and readmissions ≤30 days following resection, and postoperative mortality ≤30 days, and between 31 and 90 days among the screen-detected and the unscreened cohorts. Results Serious post-operative complications or readmissions within 30 days were observed among 1476/4999 (29.5%) cases in the screen-detected cohort, and among 3060/8848 (34.6%) unscreened cases. Mortality within 30 days was 43/4999 (0.9%) among the screen-detected cohort, and 208/8848 (2.4%) among the unscreened cohort. Among 30 day survivors, mortality between 31 and 90 days was 28/4956 (0.6%) and 111/8640 (1.3%), respectively. Conclusion Serious post-operative complications, readmissions, and mortality may be more common following major large bowel resection for colorectal cancer between the ages of 50 and 74 among unscreened compared to screen-detected cases.

Post-Operative Complications in Elderly-Onset Inflammatory Bowel Disease: A Population-Based Study

2017 ◽  
Vol 152 (5) ◽  
pp. S777-S778
Author(s):  
Sophie-Caroline Sacleux ◽  
Helene Sarter ◽  
Cloé Charpentier ◽  
Mathurin Fumery ◽  
Nathalie Guillon-Dellac ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Population Based ◽  
Population Based Study ◽  
Operative Complications ◽  
Elderly Onset ◽  
Inflammatory Bowel ◽  
Post Operative Complications

scholarly journals Do standards of care and early outcomes of periprosthetic fractures change during the COVID-19 pandemic? A multicentre study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Luigi Zagra ◽  
Rocco D’Apolito ◽  
Nicola Guindani ◽  
Giovanni Zatti ◽  
Fabrizio Rivera ◽  
...  
Keyword(s):  
Periprosthetic Fractures ◽  
Standards Of Care ◽  
Pain Visual Analogue Scale ◽  
Level Of Evidence ◽  
Clinical Frailty Scale ◽  
Asa Score ◽  
Operative Complications ◽  
American Society ◽  
Surgical Treatments ◽  
Unified Classification System

Abstract Background Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. Materials and methods Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien–Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. Results Median age was 81 years (range 70–96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1–4), median VAS score on admission was 3 (range, 0–6), median CFS was 4 (range, 1–8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1–5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1–5). The median LOS was 12.8 days (range 2–36 days), and 21 patients (55.3%) were discharged home. Conclusions The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. Level of evidence IV.

scholarly journals The Mystery of the Z-Score

Aorta ◽  
2016 ◽  
Vol 04 (04) ◽  
pp. 124-130 ◽  
Author(s):  
Alexander Curtis ◽  
Tanya Smith ◽  
Bulat Ziganshin ◽  
John Elefteriades
Keyword(s):  
Thoracic Aorta ◽  
Normal Population ◽  
Pediatric Population ◽  
Treatment Strategies ◽  
Z Score ◽  
Web Based ◽  
Geographical Regions ◽  
Z Scores ◽  
American Society ◽  
Size Limits

AbstractReliable methods for measuring the thoracic aorta are critical for determining treatment strategies in aneurysmal disease. Z-scores are a pragmatic alternative to raw diameter sizes commonly used in adult medicine. They are particularly valuable in the pediatric population, who undergo rapid changes in physical development. The advantage of the Z-score is its inclusion of body surface area (BSA) in determining whether an aorta is within normal size limits. Therefore, Z-scores allow us to determine whether true pathology exists, which can be challenging in growing children. In addition, Z-scores allow for thoughtful interpretation of aortic size in different genders, ethnicities, and geographical regions. Despite the advantages of using Z-scores, there are limitations. These include intra- and inter-observer bias, measurement error, and variations between alternative Z-score nomograms and BSA equations. Furthermore, it is unclear how Z-scores change in the normal population over time, which is essential when interpreting serial values. Guidelines for measuring aortic parameters have been developed by the American Society of Echocardiography Pediatric and Congenital Heart Disease Council, which may reduce measurement bias when calculating Z-scores for the aortic root. In addition, web-based Z-score calculators have been developed to aid in efficient Z-score calculations. Despite these advances, clinicians must be mindful of the limitations of Z-scores, especially when used to demonstrate beneficial treatment effect. This review looks to unravel the mystery of the Z-score, with a focus on the thoracic aorta. Here, we will discuss how Z-scores are calculated and the limitations of their use.

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