The purpose of the study was to investigate the prognosis for patients treated for lung cancer by operative resection in the Copenhagen area. Ninety-four consecutively operated patients were followed prospectively for ten years. Seventy-one percent of the patients had been operated radically. The five- and ten-year survival for this group was respectively 46 and 27%. All non-radically operated patients were dead after four years. The postoperative mortality and long-term survival correspond to international results. Type of cancer and mode of operation did not affect survival in the radically operated patients.
European system for cardiac operative risk evaluation (EuroSCORE) is a valuable tool in control of the quality of cardiac surgery. However, the validity of the risk score for the individual patient may be questioned. The present study was carried out to investigate whether the continued fall in short-term mortality reflects an actual improvement in late mortality, and subsequently, to investigate EuroSCORE as predictor of 1-year mortality.
A population-based cohort study of 25,602 patients from a 12-year period from three public university hospitals undergoing coronary artery bypass grafting (CABG) or valve surgery. Analysis was carried out based on EuroSCORE, age and co-morbidity factors (residual EuroSCORE).
During the period the average age increased from 65.1 ± 10.0 years to 68.9 ± 10.7 years (P
Comment In: Ann Card Anaesth. 2015 Apr-Jun;18(2):143-425849680
During the period January 1985 to May 1993, 129 patients were hospitalized for abdominal aortic aneurysms at the hospital in Haugesund. Of these patients, 93 underwent surgery at our hospital. Acute operations were performed in 33 patients with a perioperative (30 days) mortality of 45%. 60 patients underwent elective surgery with no perioperative (30 days) mortality. 14 patients were sent to a regional/university hospital. For various reasons, 22 patients were not operated on.
A retrospective study was made of the management of abdominal aortic aneurysms in eight district general hospitals in Sweden in the period 1971-1980. The numbers of admitted cases rose steadily during these ten years, as did the numbers of operations. Most of the patients had ruptured aneurysm, though there was a manifold rise in the number of operations for asymptomatic aneurysm. The postoperative mortality increased with the level of emergency presented by the aneurysm symptoms, and was about 80% in patients with clinical shock. The results of operative treatment were essentially stable during the study period and they appeared to be similar to those obtained in patients referred to units specializing in vascular surgery. Patient age, preoperative recognition of the diagnosis, concomitance of complicating disease and magnitude of peroperative blood loss seemed to influence the results of surgery. Postoperative deaths tended to occur in the first few days and to be independent of the volume of transfused blood, although severe bleeding was a significant and often fatal postoperative complication.
Latest Russian publications about pathogenesis of acute appendicitis, surgical policy and new approaches to its treatment are discussed. Based on many-year experience of surgical treatment of abdominal diseases and literature data, the author gives his opinion about inexpedience of appendectomy for cataral and unchanged appendix. Unfounded proposals towards changed diagnosis formulation in various forms of destructive appendicitis are subjected to criticism. It is concluded that it is necessary to use traditional approaches to diagnosis and treatment of acute appendicitis.
An increasing number of octogenarians are being subjected to coronary artery bypass grafting (CABG). The purpose of this study was to examine age-dependent trends in postoperative mortality and preoperative comorbidity over time following CABG.
All patients who underwent isolated CABG surgery between January 1996 and December 2012 in Denmark were included. Patients were identified through nationwide administrative registers. Age was categorized into five different groups and time into three periods to see if mortality and preoperative comorbidity had changed over time. Predictors of 30-day mortality were analysed in a multivariable Cox proportional-hazard models and survival at 1 and 5 years was estimated by Kaplan-Meier curves.
A total of 38 830 patients were included; the median age was 65.4 ± 9.5 years, increasing over time to 66.6 ± 9.5 years. Males comprised 80%. The number of octogenarians was 1488 (4%). The median survival was 14.7 years (60-69 years), 10.7 years (70-74 years), 8.9 years (75-79 years) and 7.2 years (=80 years). The 30-day mortality rate was 3%, increasing with age (1% in patients 80 years), respectively. The proportion of patients >75 years increased from 10 to 20% during the study period as well as the proportion of patients undergoing urgent or emergency surgery. The burden of comorbidities increased over time, e.g. congestive heart failure 13-17%, diabetes 12-21%, stroke 9-11%, in all age groups. Age and emergency surgery were the main predictors of 30-day mortality: age >80 years [hazard ratio (HR): 5.75, 95% confidence interval (CI): 4.41-7.50], emergency surgery (HR: 5.23, 95% CI: 4.38-6.25).
Patients are getting older at the time of surgery and have a heavier burden of comorbidities than before. The proportion of patients undergoing urgent or emergency surgery increased with age and over time. Despite this, the 30-day mortality decreased over time and long-term survival increased, except in octogenarians where it was stable. Octogenarians had substantially higher 30-day mortality compared with younger patients but surgery can be performed with acceptable risks and good long-term outcomes.