A retrospective study was undertaken of all surgical patients in Malmö, Sweden, during the period 1951-1980, in whom pulmonary emboli were found at autopsy. The autopsy rate was high throughout the period, ranging from 73 to 100 per cent. Of 5477 patients who died during the period, 1274 had pulmonary emboli (23.6 per cent), 349 of which were considered fatal, 353 contributory to death and 572 incidental. Fifty-one per cent of the patients were not operated upon. The number of contributory and incidental emboli increased over the period, to some extent probably reflecting greater thoroughness in postmortems. The frequency of fatal pulmonary emboli decreased in the last 5 year period. Pulmonary embolism was more rare in patients under 50 years of age. The proportion of females increased. In 24 cases major embolism emanated from thrombi around central venous catheters. This retrospective analysis of a large number of patients shows that pulmonary embolism continues to be a major cause of death in surgical patients, and in Malmö as common a cause of death in operated as in nonoperated patients.
AIMS: The purpose of this study was to evaluate the safety and efficacy of cryoablation in a large series of patients with typical (slow-fast) atrioventricular nodal reentrant tachycardia (AVNRT). METHODS AND RESULTS: Between 2003 and 2007, 312 patients with typical AVNRT--median age of 53 years (range 10-92), 200 women (64%)--underwent cryoablation, using exclusively a 6 mm tip catheter tip. Acute success was achieved in 309 of 312 patients (99%). The overall recurrence rate was 18 of 309 (5.8%) during a mean follow-up of 673 +/- 381 days. Sixteen of these patients (89%) were successfully reablated. The recurrence rate was 9% in patients with residual dual atrioventricular (AV) nodal pathway post-ablation compared with 4% in those with complete elimination of slow pathway conduction (P = 0.05). No patient developed permanent AV block. CONCLUSION: Cryoablation of AVNRT can be achieved with a high acute success rate and a reasonable recurrence rate at long-term follow-up. Complete abolition of slow pathway conduction seems to predict better late outcome.
Malmö General Hospital is the single referral unit for 240000 people living in Malmö, Sweden. In order to assess the influence of age on annual risk and clinical course in acute appendicitis we reviewed hospital records of 673 randomly selected patients operated on 1972-1978. Annual incidence in 20-year-olds 4/1000 was four times higher than in the 59-70-year-olds. Perforation was more common in old than in young patients. Fifty-four percent of all cases above 60 were perforated. Patients older than 60 with perforation had the longest duration of symptoms. Age above 60 and perforation were both associated with an increased body temperature at arrival an increased risk of wound infection and other complications and a longer period of hospitalization.
Data from patients undergoing acute mastoidectomy were examined retrospectively to evaluate if the nature of acute mastoiditis (AM) treated surgically has changed during the last 20 years (1977-97). Moreover, a prevalence study was conducted to clarify the otological and audiological course following acute mastoidectomy. Patients with cholesteatoma and intracranial complications were excluded. Thus, 79 patients with a median age of 16 months were included. Thirty-seven percent had a history of middle ear disease, and the mean duration from onset of symptoms to admission was 9 days. Well-being was affected in 46%, and 82% had fever. The clinical picture was dominated by auricular protrusion (77%) and pathological tympanic membrane (94%). Postauricular oedema, hyperaemia and tenderness were demonstrated in 89%, 78% and 49% of cases, respectively. Peroperatively, purulent middle ear effusion was recognized in 92%, subperiosteal abscess in 66% and pus in the mastoid in 90%. Specimens revealed growth of pathogens in 58%, predominantly Gram-positive bacteria. The observation period was 1-20 years. The findings in operated ears were not significantly different from the contralateral non-operated ears concerning incidence of otitis media, hearing and ear canal volume. Conclusively, acute mastoidectomy is a safe and effective treatment to eliminate infection. The operation can be done with negligible risk and does not leave long-term sequelae.
The objective of the study was to evaluate the risk of asthma in children who had undergone an adenoidectomy, an operation frequently performed on children with glue ear or recurrent otitis media. Two surveys were carried out, a nation-wide questionnaire returned by 483 individuals (survey A) and a survey of hospital discharge records involving 1616 children who had undergone an adenoidectomy and 161 control children who had undergone probing of the nasolacrimal duct due to congenital obstruction (survey B). The questionnaire (survey A) showed that an adenoidectomy before the age of 4 years was associated with asthma (OR 3.19, 95% CI 1.25; 8.13) and with allergy to animal dust (OR 2.50, 95% CI 1.27; 4.95). In survey B, asthma diagnosis was retrieved from the national asthma register. It showed also that adenoidectomy at an early age was associated with an increased risk of asthma (OR 6.74, 95% CI 2.99; 15.2). There was an association between asthma and adenoidectomy, even before adenoidectomy had actually been performed. The risk of asthma was highest among children who had had adenoidectomy because of recurrent otitis media. The observed association between an adenoidectomy and asthma may be explained by an underlying factor predisposing to both recurrent otitis media and asthma.
To study the impact of different adherence levels to the enhanced recovery after surgery (ERAS) protocol and the effect of various ERAS elements on outcomes following major surgery.
Single-center prospective cohort study before and after reinforcement of an ERAS protocol. Comparisons were made both between and across periods using multivariate logistic regression. All clinical data (114 variables) were prospectively recorded.
Ersta Hospital, Stockholm, Sweden.
Nine hundred fifty-three consecutive patients with colorectal cancer: 464 patients treated in 2002 to 2004 and 489 in 2005 to 2007.
The association between improved adherence to the ERAS protocol and the incidence of postoperative symptoms, complications, and length of stay following major colorectal cancer surgery was analyzed.
Following an overall increase in preoperative and perioperative adherence to the ERAS protocol from 43.3% in 2002 to 2004 to 70.6% in 2005 to 2007, both postoperative complications (odds ratio, 0.73; 95% confidence interval, 0.55-0.98) and symptoms (odds ratio, 0.53; 95% confidence interval, 0.40-0.70) declined significantly. Restriction of intravenous fluid and use of a preoperative carbohydrate drink were major independent predictors. Across periods, the proportion of adverse postoperative outcomes (30-day morbidity, symptoms, and readmissions) was significantly reduced with increasing adherence to the ERAS protocol (>70%, >80%, and >90%) compared with low ERAS adherence (
to study the influence of the patients adherence to the recommended therapy after coronary artery bypass grafting (CABG) on prognosis of postoperative period.
We examined 197 consecutive patients with stable coronary artery disease (CAD) who had undergone CABG. Age of patients was 38-75 years.
Assessment of modifiable cardiovascular risk factors showed that about half of patients had smoked before CABG and only a few gave up smoking after surgery. Number of patients with abdominal obesity increased by 8% after surgery. Number of patients involved in physical trainings remained unchanged. Adherence to drug therapy before CABG was low. Less than half of the patients took antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors, only 25% took statins. One year after CABG number of patients taking appropriate medications significantly increased. However, only half of patients managed to achieve the main objectives of secondary prevention.
Laparoscopic adrenalectomy is replacing open adrenalectomy. The advantages are reduced mortality and morbidity, and shorter postoperative hospitalisation. The organization and short-term outcomes of adrenalectomy in Denmark are largely unknown.
Extraction, review, and analysis of data from the National Patient Register and discharge notes from 2002-2006.
A total of 297 adrenalectomies, of which 161 were laparoscopic, were identified. Discharge notes were reviewed in 221 of these cases (2002-2005). All except three were performed in a university hospital setting. The laparoscopic to open conversion rate was 7.6%, mortality 1%, and complication rates for open/laparoscopic adrenalectomy 25%/16%. The mean postoperative hospital stays on surgical/urological wards were 6.0/2.9 days for open and laparoscopic procedures, respectively.
In Denmark, the share of adrenalectomies performed laparoscopically is growing, currently reaching about 65%. Laparoscopic adrenalectomies are only performed at departments with a high frequency of laparoscopic surgery and specialized endocrinological and anaesthesiological support. For educational and research purposes, adrenalectomy should be performed at an even smaller number of departments. Postoperative hospital stay and mortality are at par with internationally reported levels, but the conversion rate of laparoscopic adrenalectomies should be reduced.
The authors assessed the consequences of delayed treatment for ulcer perforation with regard to short-term and long-term survival, complication rates, and length of hospital stay.
Important adverse effects of delayed treatment have not been studied previously. Conflicting results have been given with regard to short-term survival.
One thousand two hundred ninety-two patients operated on for perforated peptic ulcer in the Bergen area between 1935 and 1990 were studied. The effect of delay on postoperative lethality and complications adjusted for age, sex, ulcer site, and year of perforation was analyzed by stepwise logistic regression. The effect of delay on duration of hospital stay adjusted for potential confounding factors was analyzed by Cox proportional hazards regression. Observed survival was estimated by the Kaplan-Meier method, and expected survival was calculated from population mortality data.
Adverse effects increased markedly when delay exceeded 12 hours. Delay of more than 24 hours increased lethality sevenfold to eightfold, complication rate to threefold, and length of hospital stay to twofold, compared with delay of 6 hours or less. The reduced long-term survival for patients treated more than 12 hours after perforation could be attributed entirely to high postoperative mortality.
Delayed treatment after peptic ulcer perforation reduced survival, increased complication rates, and caused prolonged hospital stay. To improve outcome after ulcer perforation, an effort should be made to keep delay at less 12 hours, particularly in elderly patients.
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