The primary objective was to describe 30-day outcomes after primary inguinal paediatric hernia repair.
Prospectively collected data from the National Patient Registry covering a 2-year study period 1 January 2005 to 31 December 2006 were collected. Unexpected outcomes were defined as either/or hospital stay for >1 day (i.e. 2 nights at hospital or more), readmission within 30 days, reoperations within 12 months after repair including repair for recurrence, and death within 30 days after repair.
The study cohort comprised 2,476 patients, and unexpected outcome was found in 267 patients/repairs (10.8 %). Prolonged hospital stay was by far the most prevalent indicator of unexpected outcome. Prolonged hospital stay was in 8.2 %, readmission in 2.1 %, reoperation in 0.7 %, and complications were observed in 1.1 %. One patient died within 30 days after repair, but death was not associated with the inguinal hernia repair. The usual technique was a simple sutured plasty (96.5 %). Emergency repair was performed in 54 patients (2.2 %) mainly in children between 0 and 2 years (79.6 %). During the 1 year follow-up, reoperation for recurrent inguinal hernia was performed in 8 children after elective repair (recurrence rate 0.3 %). Paediatric repairs were for most parts performed in surgical public hospitals, and most departments performed less than 10 inguinal hernia repairs within the 2 years study period.
These nationwide results are acceptable with low numbers of patients staying more than one night at hospital, low morbidity, and no procedure-related mortality.
A previous study on the incidence of cancer in a cohort of 286 asbestos-exposed electrochemical industry workers observed from 1953 through 1980 has been extended with another 8 years of follow-up. The incidence of cancer was derived from the Cancer Registry of Norway, and the expected figures were calculated by a life table method. During the extended follow-up period from 1981 through 1988, among the cohort members there were 12 new cancer cases versus 14.2 expected (SIR 85, 95% CI 44-158). In a lightly exposed sub-cohort, the extended follow-up revealed 4 cases of lung cancer or pleural mesothelioma (ICD, 7th revision 162-163) versus 1.6 cases expected (SIR 256, 95% CI71-654). In a heavily exposed sub-cohort, the corresponding figures were 3 and 0.5 (SIR 588, 95% CI 118-1,725).
Unexpected deaths still occur following major surgical procedures. The cause is often unknown but may be cardiac or thromboembolic in nature. Postoperative ischaemia, infarction and sudden cardiac death may be triggered by episodic or constant arterial hypoxaemia, which increases during the night. This study examined the circadian variation of sudden unexpected death following abdominal surgery between 1985 and 1989 inclusive. Deaths were divided into those occurring during the day (08.00-16.00 hours), evening (16.00-24.00 hours) and night (24.00-08.00 hours). Twenty-three deaths were considered to have been totally unexpected. Of 16 such patients undergoing autopsy, pulmonary embolism was the cause of death in five. In the remaining 11 patients, death occurred at night in eight (P
Laparoscopic inguinal hernia repair is becoming more common in many countries, but the quality of care, experience of the operating surgeon, and details of the surgical technique are not known in detail on a national level in Denmark. In a period of expanding surgical volume for laparoscopic inguinal hernia repair, it is important to know the typical indications for surgery, re-operation rates, details of surgical technique, and status of surgical training on a national level in order to rationalize interventions to improve outcome.
Data from the National Hernia Database for the last 8 years regarding laparoscopic inguinal hernia repair were used in combination with questionnaire data obtained from all surgical units in Denmark. The questionnaire included issues such as the number of operating surgeons in the department, number of residents training in the laparoscopic technique, and the experience level of the most experienced surgeon in the department regarding laparoscopic inguinal hernia repair. The questionnaire also included details of the surgical technique.
The frequency of laparoscopic repair has been increasing over the last 8 years and now accounts for about 16% of the total number of inguinal herniorrhaphies with the main indication nationwide being bilateral hernias and recurrent hernias. We found slight variations in surgical technique although all departments used the TAPP repair. The majority used adequate mesh sizes at or above 10 x 15 cm, and most departments used coils or tacks for mesh fixation and peritoneal closure. Fifteen of 25 departments had only one or two surgeons performing laparoscopic inguinal hernia repair and 12 of 25 departments did not have any young surgeons in training for laparoscopic inguinal hernia repair. Ten departments had one surgeon in training, and three departments had two surgeons in training.
Laparoscopic inguinal hernia repair in Denmark is increasing in prevalence. Indications for surgery as well as operative techniques differ although all departments use the TAPP technique. Few surgeons are currently learning the laparoscopic technique, and it is therefore important to initiate meetings and courses to ensure uniform indications for surgery and operative techniques throughout the country.
OBJECTIVE: To evaluate the effect of supplemental oxygen on postoperative cardiovascular response to submaximal exercise. DESIGN: Randomised, controlled study. SETTING: University hospital, Denmark. SUBJECTS: 16 patients having major abdominal operations. INTERVENTIONS: A submaximal exercise test (heart rate up to 120 min(-1)) done twice on the third day after operation. Patients were given either 100% oxygen (4 L min(-1)) or air (21% oxygen, 4 L min(-1)) 30 minutes before and during the test in randomised order. During the tests they were monitored with a Holter tape recorder and a pulse oximeter. MAIN OUTCOME MEASURES: Heart rate during exercise. RESULTS: At similar workloads there were significantly lower heart rates (median decrease 3 min(-1)) during exercise tests with oxygen compared with air (p
OBJECTIVE: To evaluate the effect of supplementary oxygen on heart rate and arterial oxygen saturation during colonoscopy. DESIGN: Controlled study. SETTING: Two university hospitals, Denmark. SUBJECTS: 40 patients having colonoscopy. INTERVENTIONS: 20 patients were given supplementary oxygen through nasal prongs (2 L/min), and 20 patients breathed room air during colonoscopy. All patients were given conscious sedation and were monitored with a pulse oximeter during colonoscopy. MAIN OUTCOME MEASURES: Tachycardia (pulse rate>100 min(-1)) and arterial oxygen desaturation (SpO2
OBJECTIVE: To evaluate the influence of preoperative abstinence on postoperative outcome in alcohol misusers with no symptoms who were drinking the equivalent of at least 60 g ethanol/day. DESIGN: Randomised controlled trial. Setting: Copenhagen, Denmark. SUBJECTS: 42 alcoholic patients without liver disease admitted for elective colorectal surgery. INTERVENTIONS: Withdrawal from alcohol consumption for 1 month before operation (disulfiram controlled) compared with continuous drinking. MAIN OUTCOME MEASURES: Postoperative complications requiring treatment within the first month after surgery. Perioperative immunosuppression measured by delayed type hypersensitivity; myocardial ischaemia and arrhythmias measured by Holter tape recording; episodes of hypoxaemia measured by pulse oximetry. Response to stress during the operation were assessed by heart rate, blood pressure, serum concentration of cortisol, and plasma concentrations of glucose, interleukin 6, and catecholamines. RESULTS: The intervention group developed significantly fewer postoperative complications than the continuous drinkers (31% v 74%, P=0.02). Delayed type hypersensitivity responses were better in the intervention group before (37 mm2 v 12 mm2, P=0.04), but not after surgery (3 mm2 v 3 mm2). Development of postoperative myocardial ischaemia (23% v 85%) and arrhythmias (33% v 86%) on the second postoperative day as well as nightly hypoxaemic episodes (4 v 18 on the second postoperative night) occurred significantly less often in the intervention group. Surgical stress responses were lower in the intervention group (P
Outcome after ventral hernia repair is not optimal. The surgical technique relies on personal preferences or evidence from small-scale studies, rather than large-scale prospective data with high external validity. The purpose of this paper was to describe the establishment and potential of the Danish Ventral Hernia Database (DVHD). Furthermore, the first 2-year data from 2007 to 2008 are presented.
Registrations were based on surgeons' web registrations and validated by cross checking with data from the Danish National Patient Register.
The DVHD was established in June 2006 and is based on prospective online web-registration of perioperative data, and individualised tracking of follow up data. During the first 2 years (2007-2008) data showed a large variation in almost all aspects of ventral hernia repair regarding surgical technique, use of open versus laparoscopic technique, use of mesh or no mesh, type of suture material, and placement of the mesh. A total of 5,629 elective and 661 acute ventral hernia repairs were registered. After the first 2 years the registration rate was 70%.
The first national ventral hernia database has been established. Preliminary results call for large-scale prospective and randomised studies to improve outcomes. Overall, the DVHD may facilitate identification of surgical technical problems and contribute to improved outcomes. The initial registration rate of 70% is inadequate and initiatives have been undertaken to reach >95% of all hernia repairs as in the Danish Inguinal Hernia Database.
Prevalence of disease related to previous exposure to asbestos was investigated in a cohort of 394 men who had worked for more than a year at a magnesium plant before 1970. Radiography showed lung fibrosis in nine men (2.3%) and pleural plaques in 40 men (9.5%). Prevalence rates varied considerably between sub-groups subjected to different modes of exposure. For the whole cohort there was a positive correlation between prevalence rate of radiographic changes and duration of work entailing exposure to asbestos. Subjects with pleural changes had more dyspnoea than found in an external reference material. Vital capacity and forced expiratory volume in one second was significantly reduced for the whole cohort. A significant reduction in lung function was found among a larger proportion of subjects with pleural changes than among subjects with no radiographic indications of such changes. The results unveil a need for similar surveys among workers in other energy-intensive industries where a similar mode of exposure to asbestos may be assumed.
BACKGROUND AND OBJECTIVES: Normally, the gallbladder is sent routinely for histological examination after cholecystectomy. From a cost-benefit point of view this may not be optimal. METHODS: Computerised records were used to identify patients with gallbladder carcinoma over a 20-year period, from 1979 to 1999, and these patient records were evaluated manually. RESULTS: The estimated cost for one histological examination was $37. During the period, 4,614 cholecystectomies were performed and 33 patients had gallbladder carcinoma. In 29 of the 33 patients, there was evident preoperative and/or peroperative suspicion of cancer, but no such suspicion in four patients. These four patients had other peroperative macroscopic abnormal findings, besides gallbladder stones. CONCLUSION: This retrospective series indicates that in the case of normal preoperative and/or peroperative macroscopic conditions (except for gallbladder stones) there is no need for histological examination of the gallbladder.
