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Adverse events in spine surgery in Sweden: a comparison of patient claims data and national quality register (Swespine) data .

https://arctichealth.org/en/permalink/ahliterature129817
Source
Acta Orthop. 2011 Dec;82(6):727-31
Publication Type
Article
Date
Dec-2011
Author
Annica Ohrn
Anders Olai
Hans Rutberg
Per Nilsen
Hans Tropp
Author Affiliation
Department of Medical and Health Sciences, Linköping University, Sweden. annica.ohrn@lio.se
Source
Acta Orthop. 2011 Dec;82(6):727-31
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Disability Evaluation
Dura Mater - injuries
Female
Humans
Insurance Claim Review
Male
Orthopedic Procedures - adverse effects - methods - standards
Outcome Assessment (Health Care)
Prosthesis Failure
Quality Assurance, Health Care
Registries
Reoperation
Spinal Diseases - surgery
Spinal Nerves - injuries
Spine - surgery
Surgical Wound Infection - etiology
Sweden
Abstract
Our knowledge of complications and adverse events in spinal surgery is limited, especially concerning incidence and consequences. We therefore investigated adverse events in spine surgery in Sweden by comparing patient claims data from the County Councils' Mutual Insurance Company register with data from the National Swedish Spine Register (Swespine).
We analyzed patient claims (n = 182) to the insurance company after spine surgery performed between 2003 and 2005. The medical records of the patients filing these claims were reviewed and compared with Swespine data for the same period.
Two-thirds (119/182, 65%) of patients who claimed economic compensation from the insurance company were registered in Swespine. Of the 210 complications associated with these 182 claims, only 74 were listed in Swespine. The most common causes of compensated injuries (n = 139) were dural lesions (n = 40) and wound infections (n = 30). Clinical outcome based on global assessment, leg pain, disability, and quality of health was worse for patients who claimed economic compensation than for the total group of Swespine patients.
We found considerable under-reporting of complications in Swespine. Dural lesions and infections were not well recorded, although they were important reasons for problems and contributed to high levels of disability. By analyzing data from more than one source, we obtained a better understanding of the patterns of adverse events and outcomes after spine surgery.
Notes
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Cites: BMJ. 2007 Jan 13;334(7584):7917175566
PubMed ID
22066564 View in PubMed
Less detail

[ASSESSMENT OF ENERGY NEEDS AND THE ROLE OF NUTRITIONAL SUPPORT IN SENILE PATIENTS WITH INTESTINAL FAILURE IN ORTHOPEDIC SURGERY OF HIGH RISK].

https://arctichealth.org/en/permalink/ahliterature270137
Source
Adv Gerontol. 2015;28(2):316-20
Publication Type
Article
Date
2015
Author
S I Kirilina
V S Sirota
S A Pervukhin
V M Prokhorenko
V V Pavlov
V S Baitov
Source
Adv Gerontol. 2015;28(2):316-20
Date
2015
Language
Russian
Publication Type
Article
Keywords
Aged, 80 and over
Female
Follow-Up Studies
Humans
Incidence
Intestinal Diseases - epidemiology - etiology - therapy
Male
Nutritional Support - methods
Orthopedic Procedures - adverse effects
Retrospective Studies
Risk assessment
Risk factors
Siberia - epidemiology
Abstract
The study of anamnestic, clinical, laboratory, endoscopic, morphological parallels of senile patients in knee and hip joints prosthesis shows the presence of intestinal failure while perioperative period. A direct connection between a natural intestinal and immune dysfunction and nutritional deficiency was diagnosed. The use of nutritional-metabolic correction of comorbid pathology and determination of basal metabolism in the perioperative period enabled to normalize indicators of homeostasis, microflora of the colon, indicators of immune status, and get a reduction in the number of early postoperative complications.
PubMed ID
26856094 View in PubMed
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Deep venous thrombosis after surgery for Achilles tendon rupture: a provoked transient event with minor long-term sequelae.

https://arctichealth.org/en/permalink/ahliterature134163
Source
J Thromb Haemost. 2011 Aug;9(8):1493-9
Publication Type
Article
Date
Aug-2011
Author
L M Persson
L J Lapidus
G. Lärfars
S. Rosfors
Author Affiliation
Section of Clinical Physiology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Sweden. lena.m.persson@sodersjukhuset.se
Source
J Thromb Haemost. 2011 Aug;9(8):1493-9
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Achilles Tendon - injuries - surgery
Adult
Analysis of Variance
Asymptomatic Diseases
Female
Humans
Incidence
Male
Middle Aged
Orthopedic Procedures - adverse effects
Physical Examination
Plethysmography
Postthrombotic Syndrome - etiology
Quality of Life
Questionnaires
Recurrence
Risk assessment
Risk factors
Severity of Illness Index
Sweden
Tendon Injuries - surgery
Time Factors
Ultrasonography, Doppler, Color
Venous Thrombosis - diagnosis - epidemiology - etiology
Abstract
Deep venous thrombosis (DVT) occurs frequently in patients undergoing orthopedic surgery, but there is a lack of knowledge regarding long-term sequelae of DVT after different types of surgical procedures.
To describe the long-term effect of symptomatic (SDVT) and asymptomatic (ADVT) deep venous thrombosis on venous function and subsequent incidence of post-thrombotic syndrome (PTS) in patients who have undergone surgery for Achilles tendon rupture.
This observational follow-up study includes 83 patients with postoperative DVT, examined after a mean of 7 years. There were two series of patients: 45 with SDVT and 38 with ADVT. In both series, more than 90% of the DVTs were limited to calf veins. Follow-up examinations comprised color duplex ultrasonography (CDU), strain-gauge plethysmography (SGP), clinical examination including scoring for venous disease and questionnaires for quality of life (QOL).
A mild degree of PTS was found in 11% of the patients: 13% in SDVT and 8% in ADVT patients. The rate of recurrent ipsilateral DVT was 2%. Deep venous reflux was more common in patients with SDVT than in ADVT patients (84% vs. 55%, P
PubMed ID
21615680 View in PubMed
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Early treatment with the von Rosen splint for neonatal instability of the hip is safe regarding avascular necrosis of the femoral head: 229 consecutive children observed for 6.5 years.

https://arctichealth.org/en/permalink/ahliterature274814
Source
Acta Orthop. 2016;87(2):169-75
Publication Type
Article
Date
2016
Author
Daniel Wenger
Hanna Samuelsson
Henrik Düppe
Carl Johan Tiderius
Source
Acta Orthop. 2016;87(2):169-75
Date
2016
Language
English
Publication Type
Article
Keywords
Child
Child, Preschool
Female
Femur Head Necrosis - epidemiology - etiology - radiography
Follow-Up Studies
Hip Dislocation, Congenital - surgery
Humans
Infant
Infant, Newborn
Male
Orthopedic Procedures - adverse effects - methods
Osteogenesis - physiology
Postoperative Complications - epidemiology - etiology
Splints - adverse effects
Sweden - epidemiology
Treatment Outcome
Abstract
Avascular necrosis of the femoral head (AVN) is a complication in treatment of developmental dysplasia of the hip (DDH). We evaluated the risk of AVN after early treatment in the von Rosen splint and measured the diameter of the ossific nucleus at 1 year of age.
All children born in Malm?, Sweden, undergo clinical screening for neonatal instability of the hip (NIH). We reviewed 1-year radiographs of all children treated early for NIH in our department from 2003 through 2010. The diameter of the ossific nucleus was measured, and signs of AVN were classified according to Kalamchi-MacEwen. Subsequent radiographs, taken for any reason, were reviewed and a local registry of diagnoses was used to identify subsequent AVN.
229 of 586 children referred because of suspected NIH received early treatment (age?=?1 week) for NIH during the study period. 2 of the 229 treated children (0.9%, 95% CI: 0.1-3.1) had grade-1 AVN. Both had spontaneous resolution and were asymptomatic during the observation time (6 and 8 years). 466 children met the inclusion criteria for measurement of the ossific nucleus. Neonatally dislocated hips had significantly smaller ossific nuclei than neonatally stable hips: mean 9.4 mm (95% CI: 9.1-9.8) vs. 11.1 mm (95% CI: 10.9-11.3) at 1 year (p?
Notes
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PubMed ID
26730503 View in PubMed
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The Effect of Local Anesthetic Volume Within the Adductor Canal on Quadriceps Femoris Function Evaluated by Electromyography: A Randomized, Observer- and Subject-Blinded, Placebo-Controlled Study in Volunteers.

https://arctichealth.org/en/permalink/ahliterature283722
Source
Anesth Analg. 2016 Aug;123(2):493-500
Publication Type
Article
Date
Aug-2016
Author
Ulrik Grevstad
Pia Jæger
Johan Kløvgaard Sørensen
Bo Gottschau
Brian Ilfeld
Martin Ballegaard
Mike Hagelskjaer
Jørgen Berg Dahl
Source
Anesth Analg. 2016 Aug;123(2):493-500
Date
Aug-2016
Language
English
Publication Type
Article
Keywords
Action Potentials - drug effects
Anesthetics, Local - administration & dosage - adverse effects
Denmark
Double-Blind Method
Electromyography
Femoral Nerve - drug effects
Humans
Injections
Isometric Contraction - drug effects
Knee - innervation - surgery
Lidocaine - administration & dosage - adverse effects
Male
Muscle Strength - drug effects
Muscle Strength Dynamometer
Nerve Block - adverse effects - methods
Orthopedic Procedures - adverse effects
Pain Measurement
Pain Threshold - drug effects
Pain, Postoperative - diagnosis - etiology - physiopathology - prevention & control
Predictive value of tests
Quadriceps Muscle - innervation
Time Factors
Treatment Outcome
Abstract
Single-injection adductor canal block (ACB) provides analgesia after knee surgery. Which nerves that are blocked by an ACB and what influence-if any-local anesthetic volume has on the effects remain undetermined. We hypothesized that effects on the nerve to the vastus medialis muscle (which besides being a motor nerve innervates portions of the knee) are volume-dependent.
In this assessor- and subject-blinded randomized trial, 20 volunteers were included. On 3 separate days, subjects received an ACB with different volumes (10, 20, and 30 mL) of lidocaine 1%. In addition, they received a femoral nerve block and a placebo ACB. The effect on the vastus medialis (primary endpoint) and the vastus lateralis was evaluated using noninvasive electromyography (EMG). Quadriceps femoris muscle strength was evaluated using a dynamometer.
There was a statistically significant difference in EMG response from the vastus medialis, dependent on volume. Thirty-five percent (95% confidence interval [CI], 18-57) of the subjects had an affected vastus medialis after an ACB with 10 mL compared with 84% (95% CI, 62-94) following 20 mL (P = 0.03) and 100% (95% CI, 84-100) when 30 mL was used (P = 0.0001). No statistically significant differences were found between volume and effect on the vastus lateralis (P = 0.81) or in muscle strength (P = 0.15).
For ACB, there is a positive correlation between local anesthetic volume and effect on the vastus medialis muscle. Despite the rather large differences in EMG recordings, there were no statistically significant differences in quadriceps femoris muscle strength. Subsequent clinical studies comparing different volumes in a surgical setting, powered to show differences not only in analgesic efficacy, but also in adverse events, are required.
PubMed ID
27159069 View in PubMed
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The effects of local anesthetic concentration and dose on continuous infraclavicular nerve blocks: a multicenter, randomized, observer-masked, controlled study.

https://arctichealth.org/en/permalink/ahliterature153581
Source
Anesth Analg. 2009 Jan;108(1):345-50
Publication Type
Article
Date
Jan-2009
Author
Brian M Ilfeld
Linda T Le
Joanne Ramjohn
Vanessa J Loland
Anupama N Wadhwa
J C Gerancher
Elizabeth M Renehan
Daniel I Sessler
Jonathan J Shuster
Douglas W Theriaque
Rosalita C Maldonado
Edward R Mariano
Author Affiliation
Department of Anesthesiology, University of California San Diego, San Diego, California 92037-7651, USA. bilfeld@ucsd.ed
Source
Anesth Analg. 2009 Jan;108(1):345-50
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Adult
Amides - administration & dosage - adverse effects
Anesthetics, Local - administration & dosage - adverse effects
Brachial Plexus - drug effects
Clavicle - innervation
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Humans
Infusion Pumps
Infusions, Parenteral
Male
Middle Aged
Nerve Block - methods
Ontario
Orthopedic Procedures - adverse effects
Pain Measurement
Pain Threshold - drug effects
Pain, Postoperative - etiology - prevention & control
Patient satisfaction
Single-Blind Method
Touch - drug effects
United States
Abstract
It remains unclear whether local anesthetic concentration or total drug dose is the primary determinant of continuous peripheral nerve block effects. The only previous investigation, involving continuous popliteal-sciatic nerve blocks, specifically addressing this issue reported that insensate limbs were far more common with higher volumes of relatively dilute ropivacaine compared with lower volumes of relatively concentrated ropivacaine. However, it remains unknown if this relationship is specific to the sciatic nerve in the popliteal fossa or whether it varies depending on anatomic location. We therefore tested the null hypothesis that providing ropivacaine at different concentrations and rates, but at an equal total basal dose, produces comparable effects when used in a continuous infraclavicular brachial plexus block.
Preoperatively, an infraclavicular catheter was inserted using the coracoid approach in patients undergoing moderately painful orthopedic surgery distal to the elbow. Patients were randomly assigned to receive a postoperative perineural ropivacaine infusion of either 0.2% (basal 8 mL/h, bolus 4 mL) or 0.4% (basal 4 mL/h, bolus 2 mL) through the second postoperative day. Both groups, therefore, received 16 mg of ropivacaine each hour with a possible addition of 8 mg every 30 min via a patient-controlled bolus dose. Our primary end point was the incidence of an insensate limb during the 24-h period beginning the morning after surgery. Secondary end points included analgesia and patient satisfaction.
Patients given 0.4% ropivacaine (n = 27) experienced an insensate limb, a mean (sd) of 1.8 (1.6) times, compared with 0.6 (0.9) times for subjects receiving 0.2% ropivacaine (n = 23; estimated difference = 1.2 episodes, 95% confidence interval, 0.5-1.9 episodes; P = 0.001). Satisfaction with postoperative analgesia (scale 0-10, 10 = highest) was scored a median (25th-75th percentiles) of 10.0 (8.0-10.0) in Group 0.2% and 7.0 (5.3-8.9) in Group 0.4% (P = 0.018). Analgesia was similar in each group.
For continuous infraclavicular nerve blocks, local anesthetic concentration and volume influence perineural infusion effects in addition to the total mass of local anesthetic administered. Insensate limbs were far more common with smaller volumes of relatively concentrated ropivacaine. This is the opposite of the relationship previously reported for continuous popliteal-sciatic nerve blocks. The interaction between local anesthetic concentration and volume is thus complex and varies among catheter locations.
Notes
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Comment In: Anesth Analg. 2009 Oct;109(4):1347-8; author reply 1348-919762771
PubMed ID
19095871 View in PubMed
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Extended dalteparin prophylaxis for venous thromboembolic events: cost-utility analysis in patients undergoing major orthopedic surgery.

https://arctichealth.org/en/permalink/ahliterature152900
Source
Am J Cardiovasc Drugs. 2009;9(1):45-58
Publication Type
Article
Date
2009
Author
George Dranitsaris
Carmine Stumpo
Reginald Smith
William Bartle
Author Affiliation
Augmentium Pharma Consulting, Toronto, Ontario, Canada. goerge@augmentium.com
Source
Am J Cardiovasc Drugs. 2009;9(1):45-58
Date
2009
Language
English
Publication Type
Article
Keywords
Anticoagulants - administration & dosage - economics - therapeutic use
Canada - epidemiology
Cost-Benefit Analysis
Dalteparin - administration & dosage - economics - therapeutic use
Drug Administration Schedule
Humans
Meta-Analysis as Topic
Models, Economic
Orthopedic Procedures - adverse effects - economics
Postoperative Complications - economics - etiology - prevention & control
Prevalence
Quality-Adjusted Life Years
Venous Thromboembolism - economics - epidemiology - etiology - prevention & control
Warfarin - administration & dosage - therapeutic use
Abstract
Deep vein thrombosis (DVT) and pulmonary embolism (PE) are manifestations of venous thromboembolic events (VTEs). Patients undergoing major surgical procedures such as total hip replacement (THR), total knee replacement (TKR), and hip fracture surgery (HFS) are at an elevated risk for VTEs. The American College of Chest Physicians' (ACCP) guidelines recommend that such patients receive thromboprophylaxis for at least 10 days. In patients undergoing THR or HFS, extended prophylaxis for up to 28-35 days is the recommended approach for those at high risk of thromboembolic events. The NAFT (North American Fragmin Trial) compared the prophylactic efficacy of dalteparin with that of warfarin during the in-hospital period, and with that of placebo during the period of hospital discharge until day 35 postsurgery, in patients who underwent total hip arthroplasty. During both the in-hospital and the postdischarge time periods, dalteparin significantly reduced the occurrence of DVT. Given the clinical relevance of these results, the low specificity of the ACCP recommendations regarding optimal prophylaxis duration, and the importance of optimizing the efficiency of DVT prophylaxis in the practice setting, a cost-utility analysis was conducted comparing dalteparin 10-day and 35-day (extended) with a warfarin 10-day protocol, in patients undergoing major orthopedic surgeries such as THR, TKR, or HFS.
A three-arm decision model was developed using the prevalence of symptomatic DVT from NAFT publications, epidemiologic studies, and published meta-analyses. Healthcare resource use was abstracted from a survey of clinicians and from the economic literature. Utility estimates were obtained by interviewing a sample of 24 people from the general public using the time trade-off technique. The clinical, economic and utility data were then used to estimate the cost per quality-adjusted life-year (QALY) gained with dalteparin for 10 or 35 days relative to 10 days of warfarin.
Canadian provincial healthcare system.
The cost per QALY gained with 10 days of dalteparin was below $Can1000 for all the surgeries evaluated (all costs are reported in 2007 Canadian dollars [$Can1 = $US1, as of December 2007]). In the case of extended prophylaxis, the incremental cost per QALY gained with 35 days of dalteparin over warfarin was $Can40 100, $Can46 500, and $Can31 200 for patients undergoing THR, TKR, and HFS, respectively. Reducing the duration of prophylaxis from 35 to 28 days generated ratios that were below $Can35 000 for all three surgeries evaluated.
Ten days of dalteparin following major orthopedic surgery is a clinically and economically attractive alternative to warfarin for DVT prophylaxis. In the case of the 35-day dalteparin protocol, the results also indicated acceptable economic value to a publicly funded healthcare system, particularly in the settings of HFS and THR. In addition, reducing the duration of prophylaxis to 28 days postsurgery would be associated with a more favorable return on public healthcare expenditures.
PubMed ID
19178131 View in PubMed
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Healthcare processes must be improved to reduce the occurrence of orthopaedic adverse events.

https://arctichealth.org/en/permalink/ahliterature144070
Source
Scand J Caring Sci. 2010 Dec;24(4):671-7
Publication Type
Article
Date
Dec-2010
Author
Maria Unbeck
Nils Dalen
Olav Muren
Ulf Lillkrona
Karin Pukk Härenstam
Author Affiliation
Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden. maria.unbeck@ds.se
Source
Scand J Caring Sci. 2010 Dec;24(4):671-7
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Humans
Orthopedic Procedures - adverse effects
Retrospective Studies
Risk factors
Sweden
Abstract
Many nonhealth industries have decades of experiences working with safety systems. Similar systems are also needed in healthcare to improve patient safety. Clinical incident reporting systems in healthcare identify adverse events but seriously underestimate the incidence of adverse events. A wide range of information sources and monitoring techniques are needed to understand and mitigate healthcare risks.
The purpose of this study was to identify patient safety risk factors that can lead to adverse events in adult orthopaedic inpatients.
A three-stage structured retrospective patient record review of consecutively admitted patients to the inpatient service of a large, urban Swedish hospital.
Records for all orthopaedic inpatients admitted during a 2-month period (n = 395) were screened using 12 criteria. Positive records were then reviewed in two stages by orthopaedic surgeons using a standardized protocol. Data were collected from the index admission and from subsequent visits or readmissions within 28 days of discharge.
Sixty patients experienced 65 healthcare associated adverse events. Affected patients had a length of hospital stay double that of patients without adverse events. Adverse events were more common in patients undergoing surgical procedures and patients with risk factors for anaesthesia. Although 59 of the adverse events occurred in patients who underwent surgery, only nine of the adverse events were due to deficiencies in surgical/anaesthesia technique. The others were related to deficiencies in healthcare processes. The most common adverse events were hospital acquired infections (n = 20) and delayed detection of urinary retention (n = 13). Six adverse drug events involved elderly patients (=65 years).
Orthopaedic care is a high risk activity for its typically elderly, often debilitated patients. Reducing adverse events in orthopaedic patients will require more multidisciplinary, interdepartmental teamwork strategies that focus on healthcare processes outside the operating room.
PubMed ID
20409063 View in PubMed
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The incidence of symptomatic venous thromboembolic events in orthopaedic surgery when using routine thromboprophylaxis.

https://arctichealth.org/en/permalink/ahliterature154302
Source
Vasa. 2008 Nov;37(4):353-7
Publication Type
Article
Date
Nov-2008
Author
J. Milbrink
D. Bergqvist
Author Affiliation
Department of Orthopaedics, University Hospital, Uppsala, Sweden.
Source
Vasa. 2008 Nov;37(4):353-7
Date
Nov-2008
Language
English
Publication Type
Article
Keywords
Fibrinolytic Agents - therapeutic use
Heparin, Low-Molecular-Weight - therapeutic use
Humans
Incidence
Orthopedic Procedures - adverse effects
Pulmonary Embolism - epidemiology - etiology - prevention & control
Retrospective Studies
Sweden - epidemiology
Time Factors
Venous Thromboembolism - epidemiology - etiology - prevention & control
Abstract
Few studies have shown the effect of thromboprophylactic regimen with low molecular weight heparin (LMWH) on the incidence of clinical venous thromboembolism (VTE) in common practice. The aim was to study the three-year incidence of clinically overt VTE events at a university based orthopaedic department with some 3300 operations performed and 15 000 patients treated annually.
Since all Swedish citizens have an individual identification number it was possible tp follow up all patients operated during a 3 year period (2000-2002) for a period of four months.
The incidence of VTE in the classical high-risk groups of hip fracture surgery, total hip arthroplasty (THA) and total knee arthroplasty (TKA) was low - about 0.6 %, while the Pulmonary embolism (PE) incidence in the hip fracture group was 0.27%, with two cases of fatal PE occurring 72 and 109 days after surgery. Patients with ankle fractures had more VTE. The majority of clinical VTE occurred after discharge from hospital.
When using routine thrombopropylaxis with LMWH in orthopaedic surgery the rate of symptomatic VTE is low.
PubMed ID
19003746 View in PubMed
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