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Abdominal injuries in a low trauma volume hospital--a descriptive study from northern Sweden.

https://arctichealth.org/en/permalink/ahliterature264480
Source
Scand J Trauma Resusc Emerg Med. 2014;22:48
Publication Type
Article
Date
2014
Author
Patrik Pekkari
Per-Olof Bylund
Hans Lindgren
Mikael Öman
Source
Scand J Trauma Resusc Emerg Med. 2014;22:48
Date
2014
Language
English
Publication Type
Article
Keywords
Abdominal Injuries - diagnosis - epidemiology - therapy
Adolescent
Adult
Disease Management
Female
Follow-Up Studies
Hospital Mortality - trends
Hospitals, Low-Volume - statistics & numerical data
Humans
Incidence
Injury Severity Score
Length of Stay - trends
Male
Middle Aged
Prognosis
Retrospective Studies
Survival Rate - trends
Sweden - epidemiology
Tomography, X-Ray Computed
Trauma Centers - statistics & numerical data
Young Adult
Abstract
Abdominal injuries occur relatively infrequently during trauma, and they rarely require surgical intervention. In this era of non-operative management of abdominal injuries, surgeons are seldom exposed to these patients. Consequently, surgeons may misinterpret the mechanism of injury, underestimate symptoms and radiologic findings, and delay definite treatment. Here, we determined the incidence, diagnosis, and treatment of traumatic abdominal injuries at our hospital to provide a basis for identifying potential hazards in non-operative management of patients with these injuries in a low trauma volume hospital.
This retrospective study included prehospital and in-hospital assessments of 110 patients that received 147 abdominal injuries from an isolated abdominal trauma (n = 70 patients) or during multiple trauma (n = 40 patients). Patients were primarily treated at the University Hospital of Umeå from January 2000 to December 2009.
The median New Injury Severity Score was 9 (range: 1-57) for 147 abdominal injuries. Most patients (94%) received computed tomography (CT), but only 38% of patients with multiple trauma were diagnosed with CT
Notes
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PubMed ID
25124882 View in PubMed
Less detail

Higher revision risk for unicompartmental knee arthroplasty in low-volume hospitals.

https://arctichealth.org/en/permalink/ahliterature102993
Source
Acta Orthop. 2014 Aug;85(4):342-7
Publication Type
Article
Date
Aug-2014
Author
Mona Badawy
Birgitte Espehaug
Kari Indrekvam
Leif I Havelin
Ove Furnes
Author Affiliation
Kysthospital in Hagevik , Hagavik.
Source
Acta Orthop. 2014 Aug;85(4):342-7
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee - statistics & numerical data
Female
Hospitals, Low-Volume - statistics & numerical data
Humans
Knee Prosthesis - statistics & numerical data
Male
Middle Aged
Norway - epidemiology
Postoperative Complications - epidemiology - surgery
Proportional Hazards Models
Prosthesis Failure
Reoperation - statistics & numerical data
Risk factors
Abstract
Some studies have found high complication rates and others have found low complication rates after unicompartmental knee arthroplasty (UKA). We evaluated whether hospital procedure volume influences the risk of revision using data from the Norwegian Arthroplasty Register (NAR).
5,791 UKAs have been registered in the Norwegian Arthroplasty Register. We analyzed the 4,460 cemented medial Oxford III implants that were used from 1999 to 2012; this is the most commonly used UKA implant in Norway. Cox regression (adjusted for age, sex, and diagnosis) was used to estimate risk ratios (RRs) for revision. 4 different volume groups were compared: 1-10, 11-20, 21-40, and > 40 UKA procedures annually per hospital. We also analyzed the reasons for revision.
We found a lower risk of revision in hospitals performing more than 40 procedures a year than in those with less than 10 UKAs a year, with an unadjusted RR of 0.53 (95% CI: 0.35-0.81) and adjusted RR of 0.59 (95% CI: 0.39-0.90). Low-volume hospitals appeared to have a higher risk of revision due to dislocation, instability, malalignment, and fracture than high-volume hospitals.
Notes
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PubMed ID
24847789 View in PubMed
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Hospital teaching status and volume related to mortality after pancreatic cancer surgery in a national cohort.

https://arctichealth.org/en/permalink/ahliterature262534
Source
Br J Surg. 2015 Apr;102(5):548-57; discussion 557
Publication Type
Article
Date
Apr-2015
Author
M. Derogar
J. Blomberg
O. Sadr-Azodi
Source
Br J Surg. 2015 Apr;102(5):548-57; discussion 557
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Epidemiologic Methods
Female
Hospitals, High-Volume - statistics & numerical data
Hospitals, Low-Volume - statistics & numerical data
Hospitals, Teaching - statistics & numerical data
Humans
Male
Middle Aged
Pancreatic Neoplasms - mortality - surgery
Sweden - epidemiology
Young Adult
Abstract
The association between hospital teaching status and mortality after pancreatic resection is not well explored. Although hospital volume is related to short-term mortality, the effect on long-term survival needs investigation, taking into account hospital teaching status and selective referral patterns.
This was a nationwide retrospective register-based cohort study of patients undergoing pancreatic resection between 1990 and 2010. Follow-up for survival was carried out until 31 December 2011. The associations between hospital teaching status and annual hospital volume and short-, intermediate- and long-term mortality were determined by use of multivariable Cox regression models, which provided hazard ratios (HRs) with 95 per cent c.i. The analyses were mutually adjusted for hospital teaching status and volume, as well as for patients' sex, age, education, co-morbidity, type of resection, tumour site and histology, time interval, referral and hospital clustering.
A total of 3298 patients were identified during the study interval. Hospital teaching status was associated with a decrease in overall mortality during the latest interval (years 2005-2010) (university versus non-university hospitals: HR 0·72, 95 per cent c.i. 0·56 to 0·91; P?=?0·007). During all time periods, hospital teaching status was associated with decreased mortality more than 2?years after surgery (university versus non-university hospitals: HR 0·86, 0·75 to 0·98; P?=?0·026). Lower annual hospital volume increased the risk of short-term mortality (HR for 3 or fewer compared with 4-6 pancreatic cancer resections annually: 1·60, 1·04 to 2·48; P?=?0·034), but not long-term mortality. Sensitivity analyses with adjustment for tumour stage did not change the results.
Hospital teaching status was strongly related to decreased mortality in both the short and long term. This may relate to processes of care rather than volume per se. Very low-volume hospitals had the highest short-term mortality risk.
PubMed ID
25711855 View in PubMed
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Impact of hospital volume on local recurrence and distant metastasis in bladder cancer patients treated with radical cystectomy in Sweden.

https://arctichealth.org/en/permalink/ahliterature114691
Source
Scand J Urol. 2013 Dec;47(6):483-90
Publication Type
Article
Date
Dec-2013
Author
Emad F Sabir
Sten Holmäng
Fredrik Liedberg
Börje Ljungberg
Per-Uno Malmström
Wiking Månsson
Hans Wijkström
Staffan Jahnson
Author Affiliation
Department of Urology, Institution for Medical Sciences, Linköping University , Linköping , Sweden.
Source
Scand J Urol. 2013 Dec;47(6):483-90
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cystectomy - mortality
Female
Hospitals, High-Volume - statistics & numerical data
Hospitals, Low-Volume - statistics & numerical data
Humans
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Recurrence, Local - mortality - pathology
Neoplasm Staging
Neoplasm, Residual
Sweden
Urinary Bladder Neoplasms - mortality - pathology - surgery
Abstract
This study evaluated the impact of hospital volume on local recurrence and distant metastasis in a population-based series of radical cystectomy patients in Sweden.
All patients who underwent cystectomy for bladder cancer in 1997-2002 in Sweden and were reported to the National Bladder Cancer Registry were included. A high-volume hospital (HVH) was defined as one with =10 cystectomies/year and a low-volume hospital (LVH) as one with pT2 and 69 (11%) were microscopic non-radical. Corresponding figures for the 516 (46%) LVH patients were 35 (7%), 68 (13%), 191 (37%), 222 (43%) and 96 (19%). Local recurrence was observed in 245 patients (22%): 113 (19%) at HVHs and 132 (26%) at LVHs. Distant metastasis was found in 363 (32%): 203 (33%) at HVHs and 160 (31%) at LVHs. Perioperative chemotherapy was given to 193 (17%). Multivariate Cox proportional hazards analysis showed that local recurrence was associated with LVHs and non-organ-confined disease, whereas distant metastasis was correlated with non-organ-confined disease and lymph-node metastases.
In this retrospective analysis, local tumour recurrence after cystectomy was common, particularly in patients with non-organ-confined disease. Furthermore, local recurrence was more frequent at LVHs than HVHs, and overall survival was better at HVHs. These findings suggest that concentrating cystectomies in HVHs may improve outcomes such as local recurrence and overall survival.
PubMed ID
23590830 View in PubMed
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Multidisciplinary team conferences promote treatment according to guidelines in rectal cancer.

https://arctichealth.org/en/permalink/ahliterature273070
Source
Acta Oncol. 2015 Apr;54(4):447-53
Publication Type
Article
Date
Apr-2015
Author
Fredrik Brännström
Jon K Bjerregaard
Anders Winbladh
Mef Nilbert
Arthur Revhaug
Gunnar Wagenius
Malin Mörner
Source
Acta Oncol. 2015 Apr;54(4):447-53
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Congresses as Topic - statistics & numerical data
Female
Hospitals, High-Volume - statistics & numerical data
Hospitals, Low-Volume - statistics & numerical data
Humans
Interdisciplinary Communication
Male
Odds Ratio
Practice Guidelines as Topic
Preoperative Care
Rectal Neoplasms - pathology - radiotherapy - surgery
Registries
Sweden
Abstract
Multidisciplinary team (MDT) conferences have been introduced into standard cancer care, though evidence that it benefits the patient is weak. We used the national Swedish Rectal Cancer Register to evaluate predictors for case discussion at a MDT conference and its impact on treatment.
Of the 6760 patients diagnosed with rectal cancer in Sweden between 2007 and 2010, 78% were evaluated at a MDT. Factors that influenced whether a patient was discussed at a preoperative MDT conference were evaluated in 4883 patients, and the impact of MDT evaluation on the implementation of preoperative radiotherapy was evaluated in 1043 patients with pT3c-pT4 M0 tumours, and in 1991 patients with pN+ M0 tumours.
Hospital volume, i.e. the number of rectal cancer surgical procedures performed per year, was the major predictor for MDT evaluation. Patients treated at hospitals with
PubMed ID
25291075 View in PubMed
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Pancreaticoduodenectomy--the transition from a low- to a high-volume center.

https://arctichealth.org/en/permalink/ahliterature258345
Source
Scand J Gastroenterol. 2014 Apr;49(4):481-4
Publication Type
Article
Date
Apr-2014
Author
Daniel Ansari
Caroline Williamsson
Bobby Tingstedt
Bodil Andersson
Gert Lindell
Roland Andersson
Author Affiliation
Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital , Lund , Sweden.
Source
Scand J Gastroenterol. 2014 Apr;49(4):481-4
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Female
Gastrectomy
Hospitals, High-Volume - statistics & numerical data
Hospitals, Low-Volume - statistics & numerical data
Humans
Male
Pancreaticoduodenectomy - statistics & numerical data
Physician's Practice Patterns - statistics & numerical data
Reoperation - statistics & numerical data
Retrospective Studies
Sweden
Treatment Outcome
Abstract
Previous studies have identified a significant volume-outcome relationship for hospitals performing pancreaticoduodenectomy (PD). However, scant information exists concerning the effects of increased caseload of PD within the same hospital. Here, we describe the effects of becoming a high-volume provider of PD.
The study group comprised 221 patients who underwent PD between 2000 and 2012. Hospital volume was allocated into three groups: low-volume (
PubMed ID
24255988 View in PubMed
Less detail

Postoperative 30-day Mortality Rates for Kidney Cancer Are Dependent on Hospital Surgical Volume: Results from a Norwegian Population-based Study.

https://arctichealth.org/en/permalink/ahliterature292703
Source
Eur Urol Focus. 2017 04; 3(2-3):300-307
Publication Type
Journal Article
Date
04-2017
Author
Karin M Hjelle
Tom B Johannesen
Christian Beisland
Author Affiliation
Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Source
Eur Urol Focus. 2017 04; 3(2-3):300-307
Date
04-2017
Language
English
Publication Type
Journal Article
Keywords
Age Factors
Aged
Aged, 80 and over
Female
Hospitals, High-Volume - statistics & numerical data
Hospitals, Low-Volume - statistics & numerical data
Humans
Kidney Neoplasms - mortality - pathology - surgery
Male
Middle Aged
Neoplasm Metastasis
Neoplasm Staging
Nephrectomy - mortality - statistics & numerical data
Norway - epidemiology
Registries
Risk factors
Abstract
To improve cancer care in Norway, the government introduced surgical volume requirements for hospitals in 2015. To treat kidney cancer (KC) in Norway, the lower limit is 20 surgical procedures per year.
To compare the impact of hospital volume on outcome with regard to 30-d mortality (TDM) following KC surgery.
We identified all KC patients from the Cancer Registry of Norway diagnosed during 2008-2013 whose surgical treatment involved partial or radical nephrectomy. Hospitals were divided into three volume groups: low (LVH), intermediate (IVH), and high (HVH) volume.
Relationships with outcome were analysed using multivariate logistic regression.
In total, 3273 patients were identified. The TDM rate was 0.89% overall, 0.73% for localised KC, and 2.6% for metastatic KC. The mean (median, interquartile range) numbers of procedures for LVH, IVH and HVH were 5.2 /yr (3, 1.3-8.7), 27 /yr (26, 23-30) and 53 /yr (53, 48-58), with TDM rates of 2.2%, 0.83%, and 0.39%, respectively (p=0.001). In a multivariate logistic regression model, tumour stage, age, and hospital volume remained independent TDM predictors. The odds ratio for TDM was 4.98 (confidence interval 1.72-14.4) for LVH compared to HVH (p=0.003). Study limitations include a lack of data for surgical complications and other possible confounders.
TDM is associated with age, stage, and hospital volume. The study supports the new regulation for hospital volume introduced in Norway.
The risk of dying within 30 d following kidney cancer surgery is low. Advanced disease and older age are risk factors for higher mortality. In this study, we also showed that more patients die within 30 d in hospitals performing fewer operations per year than in hospitals performing many operations.
PubMed ID
28753795 View in PubMed
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Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study.

https://arctichealth.org/en/permalink/ahliterature104278
Source
BMJ. 2014;348:g3284
Publication Type
Article
Date
2014
Author
Bheeshma Ravi
Richard Jenkinson
Peter C Austin
Ruth Croxford
David Wasserstein
Benjamin Escott
J Michael Paterson
Hans Kreder
Gillian A Hawker
Author Affiliation
Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada bheeshma.ravi@mail.utoronto.ca.
Source
BMJ. 2014;348:g3284
Date
2014
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Hip - adverse effects - mortality - statistics & numerical data
Canada - epidemiology
Clinical Competence
Cohort Studies
Female
Health Services Research
Hospital Mortality
Hospitals, Low-Volume - statistics & numerical data
Humans
Male
Middle Aged
Multivariate Analysis
Outcome and Process Assessment (Health Care)
Physician's Practice Patterns - statistics & numerical data
Postoperative Complications - epidemiology - etiology
Abstract
To identify a cut point in annual surgeon volume associated with increased risk of complications after primary elective total hip arthroplasty and to quantify any risk identified.
Propensity score matched cohort study.
Ontario, Canada.
37,881 people who received their first primary total hip arthroplasty during 2002-09 and were followed for at least two years after their surgery.
The rates of various surgical complications within 90 days (venous thromboembolism, death) and within two years (infection, dislocation, periprosthetic fracture, revision) of surgery.
Multivariate splines were developed to visualize the relation between surgeon volume and the risk for various complications. A threshold of 35 cases a year was identified, under which there was an increased risk of dislocation and revision. 6716 patients whose total hip arthroplasty was carried out by surgeons who had done = 35 such procedure in the previous year were successfully matched to patients whose surgeon had carried out more than 35 procedures. Patients in the former group had higher rates of dislocation (1.9% v 1.3%, P=0.006; NNH 172) and revision (1.5% v 1.0%, P=0.03; NNH 204).
In a cohort of first time recipients of total hip arthroplasty, patients whose operation was carried by surgeons who had performed 35 or fewer such procedures in the year before the index procedure were at increased risk for dislocation and early revision. Surgeons should consider performing 35 cases or more a year to minimize the risk for complications. Furthermore, the methods used to visualize the relationship between surgeon volume and the occurrence of complications can be easily applied in any jurisdiction, to help inform and optimize local healthcare delivery.
Notes
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Comment In: BMJ. 2014;348:g343324859903
PubMed ID
24859902 View in PubMed
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Results of a national population-based study of outcomes of surgery for renal tumors associated with inferior vena cava thrombus.

https://arctichealth.org/en/permalink/ahliterature107649
Source
Urology. 2013 Sep;82(3):572-7
Publication Type
Article
Date
Sep-2013
Author
Paul Toren
Robert Abouassaly
Narhari Timilshina
Girish Kulkarni
Shabbir Alibhai
Antonio Finelli
Author Affiliation
Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Source
Urology. 2013 Sep;82(3):572-7
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Age Factors
Canada - epidemiology
Carcinoma, Renal Cell - complications - surgery
Clinical Competence - statistics & numerical data
Comorbidity
Coronary Artery Bypass - adverse effects
Female
Hospital Mortality
Hospitals, High-Volume - statistics & numerical data
Hospitals, Low-Volume - statistics & numerical data
Humans
Kidney Neoplasms - complications - surgery
Length of Stay
Male
Middle Aged
Nephrectomy - adverse effects - mortality
Retrospective Studies
Thrombectomy - adverse effects - mortality
Treatment Outcome
Vena Cava, Inferior
Venous Thrombosis - complications - surgery
Abstract
To determine whether surgeon or hospital volume effects in-hospital mortality or complications of radical nephrectomy with concomitant removal of inferior vena cava (IVC) thrombus, we examine a national population-based cohort. Radical nephrectomy with removal of IVC thrombus is a complex urologic operation, which, similar to other major surgical procedures, may have an association between provider volume and outcomes.
Canadian Institute for Health Information administrative codes were used to identify nephrectomies associated with IVC manipulation in Canada from 1998 to 2007. Canadian Institute for Health Information databases yielded information on in-hospital mortality and complications for the hospital admission at surgery. Multivariate regression analysis was performed to assess the effect of surgeon and hospital volume on in-hospital mortality and complications, adjusting for age, sex, comorbidity, year of surgery, and region.
During the study period, 816 radical nephrectomies with associated IVC thrombectomy were performed on 521 men and 295 women. The in-hospital mortality rate was 7%. Notably, 75% of deaths occurred in the first 2 cases of surgeon experience. Median length of stay was 10 days. Complications were noted in 633 patients (78%). Fifty-eight patients with concomitant cardiac bypass had increased in-hospital mortality and complications. Age, comorbidity, and cardiac bypass were the strongest predictors of in-hospital mortality. Increasing surgeon volume, but not hospital volume, was associated with lower in-hospital mortality on multivariate regression analysis; however, this was not statistically significant.
Radical nephrectomy with associated IVC thrombectomy has significant complications and mortality. Surgeon but not hospital volume may affect outcomes.
Notes
Comment In: Urology. 2013 Sep;82(3):577; discussion 577-823987151
PubMed ID
23987150 View in PubMed
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Short and long-term mortality after appendectomy in Sweden 1987 to 2006. Influence of appendectomy diagnosis, sex, age, co-morbidity, surgical method, hospital volume, and time period. A national population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature118568
Source
World J Surg. 2013 May;37(5):974-81
Publication Type
Article
Date
May-2013
Author
Roland E Andersson
Author Affiliation
Department of Surgery, Ryhov County Hospital, SE-551 85 Jönköping, Sweden. roland.andersson@lj.se
Source
World J Surg. 2013 May;37(5):974-81
Date
May-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Appendectomy - methods - mortality
Appendicitis - complications - diagnosis - mortality - surgery
Child
Child, Preschool
Cohort Studies
Female
Hospitals, High-Volume - statistics & numerical data
Hospitals, Low-Volume - statistics & numerical data
Humans
Infant
Laparoscopy - mortality
Male
Middle Aged
Proportional Hazards Models
Registries
Sweden - epidemiology
Treatment Outcome
Unnecessary Procedures - mortality
Young Adult
Abstract
Avoiding mortality is the ultimate goal when managing patients with suspected appendicitis. Previous studies have shown high mortality after negative appendectomy. This national cohort study analyzes short- and long-term mortality after appendectomy in relation to appendectomy diagnosis, age, co-morbidity, surgical method, hospital volume, and time period.
A total of 223,543 appendectomy patients treated from 1987 to 2006 were identified from the Swedish National Patient Register and followed up via the Swedish Cause of Death Register. Analysis of mortality was conducted as Standardized Mortality Ratio (SMR) and by Cox multivariate regression.
Negative appendectomy was followed by a higher mortality in the short term (30-day Standardized Mortality Ratio (SMR30d) 8.95, confidence interval (CI) 6.68-12.61) than after perforated appendicitis (SMR30d 6.39, CI 5.44-7.48), and remained increased for up to 5 years (SMR5yr 1.31, CI 1.16-1.47). Non-perforated appendicitis had a lower than expected long-term mortality (SMR5yr 0.72, CI 0.68-0.76). These differences remained after adjustment for covariates. Laparoscopic appendectomy had similar short-term mortality as open appendectomy but lower than expected long-term morality (SMR5yr 0.70, CI 0.62-0.78). Mortality was decreasing during the study period. Hospital volume had no influence on mortality.
Negative appendectomy is associated with excess short- and long-term mortality that remains after adjustment for known confounders, suggesting an association with underlying undetected morbidity. This motivates an improved preoperative diagnosis to avoid the additional trauma from unnecessary surgical interventions, but further studies are needed to investigate the cause of the increased long-term mortality and if this can be prevented by an improved follow-up of patients with negative appendectomy. Laparoscopic and open appendectomy have similar short-term mortality. The lower long-term mortality after non-perforated appendicitis and laparoscopic appendectomy suggest selection of healthier patients for these interventions. This possibility should be taken into account when comparing mortality after open and laparoscopic appendectomy.
Notes
Comment In: World J Surg. 2013 May;37(5):982-323456224
PubMed ID
23192168 View in PubMed
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