Validity and reliability of the diagnostic codes for hypochondriasis and dysmorphophobia in the Swedish National Patient Register: a retrospective chart review

ObjectivesIn the International Classification of Diseases, Tenth Edition (ICD-10), hypochondriasis (illness anxiety disorder) and dysmorphophobia (body dysmorphic disorder) share the same diagnostic code (F45.2). However, the Swedish ICD-10 allows for these disorders to be coded separately (F45.2 and F45.2A, respectively), potentially offering unique opportunities for register-based research on these conditions. We assessed the validity and reliability of their ICD-10 codes in the Swedish National Patient Register (NPR).DesignRetrospective chart review.MethodsSix hundred individuals with a diagnosis of hypochondriasis or dysmorphophobia (300 each) were randomly selected from the NPR. Their medical files were requested from the corresponding clinics, located anywhere in Sweden. Two independent raters assessed each file according to ICD-10 definitions and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and Fifth Edition criteria. Raters also completed the Clinical Global Impression–Severity (CGI-S) and the Global Assessment of Functioning (GAF).Primary outcome measurePer cent between-rater agreement and positive predictive value (PPV). Intraclass correlation coefficients for the CGI-S and the GAF.ResultsEighty-four hypochondriasis and 122 dysmorphophobia files were received and analysed. The inter-rater agreement rate regarding the presence or absence of a diagnosis was 95.2% for hypochondriasis and 92.6% for dysmorphophobia. Sixty-seven hypochondriasis files (79.8%) and 111 dysmorphophobia files (91.0%) were considered ‘true positive’ cases (PPV=0.80 and PPV=0.91, respectively). CGI-S scores indicated that symptoms were moderately to markedly severe, while GAF scores suggested moderate impairment for hypochondriasis cases and moderate to serious impairment for dysmorphophobia cases. CGI-S and GAF inter-rater agreement were good for hypochondriasis and moderate for dysmorphophobia.ConclusionsThe Swedish ICD-10 codes for hypochondriasis and dysmorphophobia are sufficiently valid and reliable for register-based studies. The results of such studies should be interpreted in the context of a possible over-representation of severe and highly impaired cases in the register, particularly for dysmorphophobia.

O23 SURGICAL REPAIR OF PARASTOMAL BULGING - A REGISTER-BASED STUDY

Aim To examine the incidence of primary and recurrent repair and types of repair performed in patients with parastomal bulging. Material and Methods We linked prospectively collected data on parastomal bulging from the Danish Stoma Database to surgical data on repair of parastomal bulging from the Danish National Patient Register. Survival statistics provided cumulative incidences and time until primary and recurrent repair Results Of 1016 patients, registered from 2010-2017 with a permanent stoma and a parastomal bulge, 180 (18%) underwent surgical repair. The cumulative incidence of a primary repair was 9% (95% CI [8%; 11%]) within 1 year and 19% (95% CI [17%; 22%]) within 5 years after the occurrence of a parastomal bulge. For colostomies and ileostomies, we found similar probability of undergoing primary repair. For recurrent repair, the 5-year cumulative incidence was 5% (95% CI [3%; 7%]). The probability of undergoing further recurrent repair was 33% (95% CI [21%; 46%]) within 5 years. For primary repair, open or laparoscopic repair with mesh (43%) and stoma revision (39%) were performed almost equally frequent. Stoma revision and repair with mesh could precede and follow one another as primary and recurrent repair. Stoma reversal was performed in 17% of patients. Conclusions Our data offered a new and comprehensive view of the course of surgical treatment of parastomal bulging. Five years after the occurrence of a parastomal bulge the estimated probability of undergoing a repair was 19%. The probability of undergoing recurrent repair was high and stoma reversal more common than expected.

Moving from an era of open Appendectomy to an era of Laparoscopic Appendectomy: A Nationwide Cohort Study of Adult Patients Undergoing Surgery for Appendicitis

Background and Aims: During the last decades, laparoscopic surgery has been introduced as an alternative to open surgery. We aimed to examine to what extent laparoscopic surgery has replaced open surgery for appendicitis in an entire nation during the last two decades. Second, we examined the effects of shifting to laparoscopic surgery for appendicitis on different quality indicators such as length of postoperative stay and mortality. We also examined age as a predictor of 30-day mortality. Materials and Methods: During the period 2000 to 2015, all adult patients with appendicitis and surgical removal of the appendix were identified in the Danish National Patient Register. Demographics, type of surgery, time of surgery, and duration of postoperative stay were retrieved form Danish National Patient Register. Vital status was retrieved from the Danish Civil Registration System. Results: A total of 58,093 patients underwent surgery for appendicitis. In 2000, a total of 274 out of 3717 (7.4%) had a laparoscopic appendectomy, and the postoperative stay was 55 (iqr: 35–88) h and 30-day mortality was 0.91%. In 2015, a total of 3995 out of 4296 (93.0%) had a laparoscopic appendectomy, and the postoperative stay was 16 (iqr: 9–56) h and 30-day mortality was 0.40%. Age as a predictor of 30-day postoperative mortality had an area under the curve of 0.93 (95% confidence interval: 0.92; 0.94). Conclusion: In Denmark, the standard surgical procedure for appendicitis has changed from open surgery to laparoscopic surgery during the period 2000–2015. At the same time, duration of postoperative stay and 30-day mortality has decreased.

Incidence of extra-articular manifestations in ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis: results from a national register-based cohort study

Objectives To estimate the incidence and strength of association of extra-articular manifestations [EAMs, here: anterior uveitis (AU), IBD and psoriasis] in patients with AS, undifferentiated SpA (uSpA) and PsA, compared with controls. Methods Three mutually exclusive cohorts of patients aged 18–69 years with AS (n = 8517), uSpA (n = 10 245) and PsA (n = 22 667) were identified in the Swedish National Patient Register 2001–2015. Age-, sex- and geography-matched controls were identified from the Swedish Population Register. Follow-up began 1 January 2006, or six months after the first SpA diagnosis, whichever occurred later, and ended at the first date of the EAM under study, death, emigration, 70 years of age, and 31 December 2016. Incidence rates (IRs) and incidence rate ratios were calculated for each EAM, and stratified by sex and age. Results Incidence rate ratios for incident AU, IBD and psoriasis were significantly increased in AS (20.2, 6.2, 2.5), uSpA (13.6, 5.7, 3.8) and PsA (2.5, 2.3, n.a) vs controls. Men with AS and uSpA had significantly higher IRs per 1000 person-years at risk for incident AU than women with AS (IR 15.8 vs 11.2) and uSpA (IR 10.1 vs 6.0), whereas no such sex difference was demonstrated in PsA or for the other EAMs. Conclusions AU, followed by IBD and psoriasis, is the EAM most strongly associated with AS and uSpA. Among the SpA subtypes, AS and uSpA display a largely similar pattern of EAMs, whereas PsA has a considerably weaker association with AU and IBD.

Late cardiac interventions in adults with congenital ventricular septal defects

Introduction Ventricular septal defect (VSD) is one of the most common congenital heart lesions. Shunts with hemodynamic significance are usually closed early in life whereas small shunts are left without intervention. The need for late cardiac interventions in these populations is essentially unknown. The aim was to study the late cardiac interventions in adults with VSD. Methods The national register on congenital heart disease was searched for patients with VSD with or without associated simple cardiac defects but without complex lesions. For these patients, the last 10 years (over the age of 18) in the national patient register was searched for cardiac interventions. Results 774 patients (mean age 39.0±14.7 years, women =50.6%), 224 (28.9%) with previous closure of VSD, were identified. The total observed time was 6920 patient years. There were 43 interventions in 41 patients (5.3%) of whom 12 had a previous closure of VSD. Twelve patients had isolated closure of VSD, 18 closure of VSD together with other cardiac surgery (one of these had repeated cardiac surgery) and 8 had only other cardiac surgery. In 4 cases, a pacemaker was implanted, of whom one together with cardiac surgery. Conclusion The need for cardiac interventions is relatively common in adults with a VSD, also in those without previous closure of their shunt. Our data suggests that most patients with a VSD, closed or not, should be offered periodic follow-up as approximately one out of 20 patients may encounter a complication within 10 years. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Swedish Heart-Lung Foundation

Disease trajectory browser for exploring temporal, population-wide disease progression patterns in 7.2 million Danish patients

We present the Danish Disease Trajectory Browser (DTB), a tool for exploring almost 25 years of data from the Danish National Patient Register. In the dataset comprising 7.2 million patients and 122 million admissions, users can identify diagnosis pairs with statistically significant directionality and combine them to linear disease trajectories. Users can search for one or more disease codes (ICD-10 classification) and explore disease progression patterns via an array of functionalities. For example, a set of linear trajectories can be merged into a disease trajectory network displaying the entire multimorbidity spectrum of a disease in a single connected graph. Using data from the Danish Register for Causes of Death mortality is also included. The tool is disease-agnostic across both rare and common diseases and is showcased by exploring multimorbidity in Down syndrome (ICD-10 code Q90) and hypertension (ICD-10 code I10). Finally, we show how search results can be customized and exported from the browser in a format of choice (i.e. JSON, PNG, JPEG and CSV).