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10 records – page 1 of 1.

Complications after hysterectomy. A Danish population based study 1978-1983.

https://arctichealth.org/en/permalink/ahliterature23911
Source
Acta Obstet Gynecol Scand. 1993 Oct;72(7):570-7
Publication Type
Article
Date
Oct-1993
Author
T F Andersen
A. Loft
H. Brønnum-Hansen
C. Roepstorff
M. Madsen
Author Affiliation
Institute of Social Medicine, University of Copenhagen, Denmark.
Source
Acta Obstet Gynecol Scand. 1993 Oct;72(7):570-7
Date
Oct-1993
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Denmark - epidemiology
Female
Humans
Hysterectomy - adverse effects
Hysterectomy, Vaginal - adverse effects
Logistic Models
Middle Aged
Multivariate Analysis
Patient Readmission - statistics & numerical data
Research Support, Non-U.S. Gov't
Abstract
We studied complications after hysterectomy among all women in the Danish population who had a simple hysterectomy in the period 1978-81 based on data obtained from the Danish National Hospital Registry. Among patients, with neither diagnosed cancer nor major co-surgery (n = 23,386), we identified all the complications which occurred during hospital admission from the time of surgery up to six years from that point. Within 30 days of hysterectomy 2.6% of the patients had been diagnosed in hospitals as having complications according to our definition. The corresponding figures at 90 days and two years after the operation were 3.7% and 9.4%. The most frequently observed complications were post operative wound infections and bleeding, each affecting about 2% of all operated women. Logistic regression and Cox regression were used to identify prognostic indicators of readmission with complications. The probability of readmission with complications within six years after hysterectomy was estimated at 8% among low risk patients. The most pronounced increase in risk of readmission with complication occurred among women who had been admitted to psychiatric or somatic hospitals 0-12 months before they had their uterus removed (OR in the range 1.59 to 1.83). We discuss the prevailing difficulties of comparing observational evidence from different clinical settings reported in the literature, and emphasize the importance of developing a coordinated international strategy for non-experimental assessment of medical technology.
PubMed ID
8213107 View in PubMed
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Coping with regional variations: the case of surgery in Denmark.

https://arctichealth.org/en/permalink/ahliterature74027
Source
Int J Health Plann Manage. 1987 Oct-Dec;2(4):253-64
Publication Type
Article
Author
T F Andersen
R. Blais
J. Bredesen
T. Jørgensen
A. Loft
M. Madsen
G. Mooney
T. Sejr
Source
Int J Health Plann Manage. 1987 Oct-Dec;2(4):253-64
Language
English
Publication Type
Article
Keywords
Cholecystectomy - utilization
Data Collection
Denmark
Female
Health Services Misuse
Health status
Humans
Hysterectomy - utilization
Male
Physician's Practice Patterns
Population Dynamics
Prostatectomy - utilization
Questionnaires
Surgical Procedures, Operative - utilization
Abstract
This article examines some of the key research and policy issues that are emerging as a result of recent analyses of regional variations in health care. The article presents a historical background to this important new field of health services' research, and indicates, using some Danish examples of research on hysterectomy, cholecystectomy, and prostatectomy, the relevance of this research to management and policy planning. Regional variations are not yet fully explained in terms of what causes them. What is clear and what is the primary focus of this article is that their very existence, whatever their explanation, creates a major challenge for the management and planning of future health services.
PubMed ID
10318049 View in PubMed
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Early postoperative mortality following cholecystectomy in the entire female population of Denmark, 1977-1981.

https://arctichealth.org/en/permalink/ahliterature223854
Source
World J Surg. 1992 May-Jun;16(3):530-5
Publication Type
Article
Author
J. Bredesen
T. Jørgensen
T F Andersen
H. Brønnum-Hansen
C. Roepstorff
M. Madsen
P. Wille-Jørgensen
A. Loft
Author Affiliation
Department of Surgical Gastroenterology F, Bispebjerg Hospital, University of Copenhagen, Denmark.
Source
World J Surg. 1992 May-Jun;16(3):530-5
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cholecystectomy - mortality - statistics & numerical data
Denmark - epidemiology
Female
Humans
Hysterectomy - mortality - statistics & numerical data
Middle Aged
Risk
Time Factors
Abstract
This paper assesses the risk of dying within 30 days of admission among 13,854 women who had a cholecystectomy performed as the principal operation from 1977 to 1981. The overall crude mortality rate was 1.2%. Women who had a simple elective cholecystectomy performed had a mortality rate similar to women who had a simple hysterectomy. The mortality was significantly higher than in the general female population (p less than 0.05). Increased age, acute admission, admissions to hospital within 3 months prior to the index admission, the number of discharge diagnoses, and the geographical region were significantly associated with increased mortality. Exploration of the common bile duct was associated with higher mortality in the bivariate analysis, but the association disappeared when the number of discharge diagnoses was taken into account. Type of hospital and the population based cholecystectomy rate of the patient's residential area was not associated with mortality. As regards early mortality, it is concluded that simple elective cholecystectomy is a safe procedure before the age of 50 to 60 years. Acute admissions and more than one diagnosis at discharge were associated with an increased mortality, whereas exploration of the common bile duct may not be as important an independent factor as previously assumed.
PubMed ID
1589992 View in PubMed
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Early postoperative mortality following hysterectomy. A Danish population based study, 1977-1981.

https://arctichealth.org/en/permalink/ahliterature24908
Source
Br J Obstet Gynaecol. 1991 Feb;98(2):147-54
Publication Type
Article
Date
Feb-1991
Author
A. Loft
T F Andersen
H. Brønnum-Hansen
C. Roepstorff
M. Madsen
Author Affiliation
Department of Gynaecology and Obstetrics, Copenhagen County Hospital, Gentofte, Denmark.
Source
Br J Obstet Gynaecol. 1991 Feb;98(2):147-54
Date
Feb-1991
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Cause of Death
Cohort Studies
Comparative Study
Denmark - epidemiology
Emergencies
Female
Humans
Hysterectomy - mortality
Middle Aged
Postoperative Period
Research Support, Non-U.S. Gov't
Risk
Survival Analysis
Abstract
The main objective of this cohort study was to analyse the early postoperative mortality after 'simple' hysterectomy for benign indications and to compare it with that of a randomly selected reference group of women matched for age. Registry data covering the entire Danish female population were used. Included in the study were all patients operated in the period 1977-1981. Patients were only included if no cancer was diagnosed and if no major co-surgery was performed (29,192 patients). Cancer patients were also excluded in the reference group (16,182 women). Mortality was studied according to characteristics of patients, their residential area, the surgical approach and operating hospital. Overall 47 patients died within 30 days of admission for hysterectomy (overall mortality 16.1 per 10,000). Only seven deaths were expected on the basis of the population sample, and adjusted for age, the relative risk (RR) for hysterectomy patients was 6.38 (95% CI 4.33-9.39). Early postoperative mortality increased with age, and the risk was elevated among emergency patients (RR = 3.22; 1.72-6.04). Patients with more than one diagnosis at discharge (RR = 4.53; 2.12-9.70) were at high risk, but early postoperative mortality was independent of surgical approach. Causes of death are discussed. Compared to the general population, patients who undergo 'simple' hysterectomy are faced with a sixfold risk of dying within 30 days, but a complete assessment of the risks and benefits of hysterectomy requires prospective studies of survival and morbidity, including quality of life for longer periods of time following operations.
Notes
Comment In: Br J Obstet Gynaecol. 1992 Apr;99(4):350-11581286
PubMed ID
1822955 View in PubMed
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[Postoperative mortality after cholecystectomy. A survey of all cholecystectomies among women in 1977-1981].

https://arctichealth.org/en/permalink/ahliterature218608
Source
Ugeskr Laeger. 1994 Mar 7;156(10):1470-4
Publication Type
Article
Date
Mar-7-1994
Author
J. Bredesen
T. Jørgensen
T F Andersen
H. Brønnum-Hansen
C. Roepstorff
M. Madsen
P A Wille-Jørgensen
A. Loft
Author Affiliation
Kirurgisk afdeling K, Bispebjerg Hospital, København.
Source
Ugeskr Laeger. 1994 Mar 7;156(10):1470-4
Date
Mar-7-1994
Language
Danish
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Cholecystectomy - mortality
Denmark - epidemiology
Female
Humans
Middle Aged
Postoperative Complications - mortality
Risk factors
Abstract
This paper assesses the risk of dying within thirty days of admission among 13,854 women who had a cholecystectomy performed as the principal operation during the period 1977-81. The overall crude mortality rate was 1.2%. Women who had a simple elective cholecystectomy performed had a mortality rate (0.2%) similar to women who had a simple hysterectomy, but significantly higher than in the general female population. High age, acute admission, admission to hospital in the three months prior to the index admission, the number of discharge diagnoses, and the geographical region were significantly associated with increased mortality. The higher mortality associated with exploration of the common bile duct disappeared when number of discharge diagnoses was taken into account. As regards early mortality, it is concluded that simple elective cholecystectomy is a safe procedure before the age of 50-60 years. Exploration of the common bile duct may not be as important an independent factor as previous assumed.
PubMed ID
8016934 View in PubMed
Less detail

A quasi-experimental design based on regional variations: discussion of a method for evaluating outcomes of medical practice.

https://arctichealth.org/en/permalink/ahliterature73902
Source
Soc Sci Med. 1989;28(2):147-54
Publication Type
Article
Date
1989
Author
A. Loft
T F Andersen
M. Madsen
Author Affiliation
Institute of Social Medicine, University of Copenhagen, Panum Institute, Denmark.
Source
Soc Sci Med. 1989;28(2):147-54
Date
1989
Language
English
Publication Type
Article
Keywords
Adult
Aged
Denmark
Diffusion of Innovation
Female
Humans
Hysterectomy
Middle Aged
Outcome and Process Assessment (Health Care)
Research Design
Research Support, Non-U.S. Gov't
Abstract
A large proportion of common medical practices are subject to substantial regional variation resulting in numerous natural experiments. Opportunities are thereby provided for outcome evaluation through quasi-experimental design. If patients treated in different regions were comparable a natural experiment involving alternative treatments could be regarded as 'pseudo randomised', but empirical investigations are needed to verify this prerequisite. This paper discusses the role of quasi-experimental designs in assessment of medical care with evaluation of outcomes after hysterectomy in Denmark as an example. The design is developed and the comparability of selected groups of patients is elucidated from administrative data, while the outcome results are not presented in this context. One indication for hysterectomy is carcinoma in situ of the cervix uteri which may be treated with either hysterectomy, or conisation. A study group of patients was selected from departments where hysterectomy was the treatment of choice for this indication while the reference group was drawn from departments in which conisation was generally preferred. The comparability of the populations, effects and information for the two groups are elicited from administrative data. We conclude that it is possible to establish a quasi-experimental design based on regional variations and that the comparability of the groups included may be assessed through registry data. The importance of technology diffusion for the prospects of performing quasi randomised studies is emphasised. In this attempt to evaluate hysterectomy, it was not possible to identify groups of patients, which were sufficiently comparable to justify a study of soft outcomes.
PubMed ID
2928824 View in PubMed
Less detail

[Regional differences in the use of cholecystectomy in Denmark during the period 1977-1985].

https://arctichealth.org/en/permalink/ahliterature231267
Source
Ugeskr Laeger. 1989 Feb 13;151(7):426-30
Publication Type
Article
Date
Feb-13-1989
Author
J. Bredesen
M. Madsen
T F Andersen
A. Loft
C. Roepstorff
T. Jørgensen
Source
Ugeskr Laeger. 1989 Feb 13;151(7):426-30
Date
Feb-13-1989
Language
Danish
Publication Type
Article
Keywords
Adult
Aged
Cholecystectomy - trends - utilization
Denmark
Female
Humans
Male
Middle Aged
Abstract
In a register-based study of all cholecystectomized patients in Denmark during the period from 1977-85 (37,048 patients) an account is given of the regional variations observed in connection with the intervention. The cholecystectomy operation is sub-divided into four types of operation dependent on whether the intervention is merely a matter of cholecystectomy or it involves the choledocus, the duodenum, the small intestine or other organs. The variation analysis is based on a division of the country into 75 areas, each primarily served by a single hospital. The method highly reflects the differences in clinical treatment strategies. The summarized rate of cholecystectomy for this period of time was 8.2 per 10,000 persons. In areas with the highest and the lowest rates of operation the figures were 12.3 per 10,000 and 5.1 per 10,000, respectively. In 18 areas, the rates of operation were significantly higher than average and in 18 other areas significantly higher than average and in 18 other areas significantly below average. SCV-score (X100) 2.19. There is no systematic correlation between the degree of specialisation in the operating department and the frequency in employing the operation. Areas with an operation index significantly above average had the same rate of more complicated operations than simple cholecystectomy as the other areas. Possible causes of national as well as international variations in the use of cholecystectomy are discussed, and the need for a radical evaluation of this kind of treatment is emphasized.
PubMed ID
2919465 View in PubMed
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Survival until 6 years after cholecystectomy: female population of Denmark, 1977-1983.

https://arctichealth.org/en/permalink/ahliterature23157
Source
World J Surg. 1995 Jul-Aug;19(4):609-15
Publication Type
Article
Author
T F Andersen
H. Brønnum-Hansen
T. Jørgensen
C. Roepstorff
A. Loft
M. Madsen
Author Affiliation
Department of Social Medicine, Faculty of Health Sciences, University of Copenhagen, Panum, Denmark.
Source
World J Surg. 1995 Jul-Aug;19(4):609-15
Language
English
Publication Type
Article
Keywords
Adult
Cause of Death
Cholecystectomy - mortality
Denmark - epidemiology
Female
Humans
Multivariate Analysis
Research Support, Non-U.S. Gov't
Survival Analysis
Abstract
It has been a prevailing assumption that cholecystectomy patients by and large follow a pattern of survival similar to that of the normal population. This paper presents a population-based study of the long-term survival after cholecystectomy in order to reassess this assumption. Based on data available in the Danish National Hospital Register the records of all Danish women who were operated between 1977 and 1981 were examined and studied up to 6 years subsequent to surgery. Cholecystectomy patients who were free of diagnosed cancer and who had no major co-surgery (n = 11,123) were compared to both hysterectomy patients and a sample of the female population. Adjusting for age and other covariates, patients with psychiatric hospital admissions prior to surgery experienced a threefold risk of dying within 6 years after surgery. Patients with prior somatic admissions and patient with acute admissions had a relative risk (RR) of about 1.5. Cholecystectomy patients had a significantly increased mortality when compared to hysterectomy patients, RR = 1.3 (1.1-1.6), and to the population sample. Heart diseases and cancer occurred significantly more often as causes of death among cholecystectomy patients when compared to hysterectomy patients, but our data suggest that the occurrence of many other causes of death may be increased among cholecystectomy patients as well. The authors concluded that cholecystectomy patients are subject to relatively higher levels of mortality than previously assumed in parts of the literature. Furthermore, the increase seems to be attributable to a multitude of causes of death. The most likely explanation of the excess mortality among cholecystectomy patients is that gallbladder patients are relatively fragile.(ABSTRACT TRUNCATED AT 250 WORDS)
PubMed ID
7676708 View in PubMed
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[The prevalence of women with hysterectomies among the Danish population in 1983].

https://arctichealth.org/en/permalink/ahliterature235557
Source
Ugeskr Laeger. 1987 Feb 23;149(9):615-9
Publication Type
Article
Date
Feb-23-1987
Author
T F Andersen
M. Madsen
A. Loft
Source
Ugeskr Laeger. 1987 Feb 23;149(9):615-9
Date
Feb-23-1987
Language
Danish
Publication Type
Article
Keywords
Adult
Aged
Denmark
Female
Humans
Hysterectomy
Middle Aged
PubMed ID
3824674 View in PubMed
Less detail

[Validity of surgical information from the Danish National Patient Registry with special attention to the analysis of regional variations in hysterectomy rates].

https://arctichealth.org/en/permalink/ahliterature234848
Source
Ugeskr Laeger. 1987 Aug 31;149(36):2420-2
Publication Type
Article
Date
Aug-31-1987
Author
T F Andersen
M. Madsen
A. Loft
Source
Ugeskr Laeger. 1987 Aug 31;149(36):2420-2
Date
Aug-31-1987
Language
Danish
Publication Type
Article
Keywords
Denmark
Female
Humans
Hysterectomy - utilization
Registries
PubMed ID
3450055 View in PubMed
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10 records – page 1 of 1.