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[Commission of inquiry scrutinized complications of carotid surgery. Half of the complications could be explicable by errors or dubious indications]

https://arctichealth.org/en/permalink/ahliterature72168
Source
Lakartidningen. 2000 Apr 5;97(14):1673-6
Publication Type
Article
Date
Apr-5-2000
Author
D. Bergqvist
M. von Arbin
M L Hellénius
S. Holtås
T. Jogestrand
M. Lindqvist
B. Norrving
T. Troëng
N G Wahlgren
Author Affiliation
Akademiska sjukhuset, Uppsala. david.bergqvist@kirurgi.uu.se
Source
Lakartidningen. 2000 Apr 5;97(14):1673-6
Date
Apr-5-2000
Language
Swedish
Publication Type
Article
Keywords
Adult
Aged
Carotid Stenosis - pathology - surgery
Cerebrovascular Accident - prevention & control
Endarterectomy, Carotid - adverse effects - contraindications - mortality - standards
English Abstract
Female
Humans
Male
Medical Errors
Middle Aged
Postoperative Complications - diagnosis - epidemiology - mortality - prevention & control
Quality Assurance, Health Care
Registries
Sweden
Abstract
As carotid endarterectomy is a prophylactic procedure, it would seem particularly important to analyze complications with an aim to avoiding them. All carotid endarterectomies in Sweden are registered, and all serious complications (death and permanent neurological deficit) are analyzed in detail, classified and discussed within the profession. During the period 1994-1996 the frequency was 4.3 percent (technical causes in 17 percent, contraindications in 8 percent and dubious indications in 21 percent, but correct indication and surgery in 54 percent). Thus, even when conditions are optimal there is a certain price to pay for the prevention of ischemic stroke.
PubMed ID
10815393 View in PubMed
Less detail

Comparison of the cost of preventing postoperative deep vein thrombosis with either unfractionated or low molecular weight heparin.

https://arctichealth.org/en/permalink/ahliterature210651
Source
Br J Surg. 1996 Nov;83(11):1548-52
Publication Type
Article
Date
Nov-1996
Author
D. Bergqvist
B. Lindgren
T. Mätzsch
Author Affiliation
Department of Surgery, University Hospital, Uppsala, Sweden.
Source
Br J Surg. 1996 Nov;83(11):1548-52
Date
Nov-1996
Language
English
Publication Type
Article
Keywords
Blood Loss, Surgical - prevention & control
Cost-Benefit Analysis
Drug Costs
Heparin - economics - therapeutic use
Heparin, Low-Molecular-Weight - economics - therapeutic use
Humans
Sweden
Thromboembolism - economics - prevention & control
Thrombophlebitis - economics - prevention & control
Abstract
The relative costs were analysed of (1) no prophylaxis against deep vein thrombosis (DVT), (2) selective treatment of DVT after confirmation of diagnosis, (3) general prophylaxis with standard low-dose unfractionated heparin and (4) general prophylaxis with low molecular weight heparin (LMWH) in patients undergoing elective general abdominal surgery or elective hip surgery. The mean calculated costs per patient undergoing general abdominal surgery were: Swedish crowns (SEK) 1950 for no prophylaxis, SEK 5710 for selective treatment of DVT, SEK 735 for prophylaxis with unfractionated heparin and SEK 665 for prophylaxis with LMWH. The corresponding costs for hip surgery were SEK 3930, SEK 10790, SEK 1730 and SEK 1390 respectively. Thus, the least expensive management strategy in patients undergoing elective general abdominal or hip surgery would appear to be general prophylaxis with either unfractionated heparin or LMWH. Furthermore, general prophylaxis with LMWH would appear to be more cost-effective than general prophylaxis with unfractionated heparin.
Notes
Comment In: ACP J Club. 1997 Mar-Apr;126(2):51
PubMed ID
9014669 View in PubMed
Less detail

Concluding remarks and remaining problems on thromboprophylaxis.

https://arctichealth.org/en/permalink/ahliterature234148
Source
Acta Chir Scand Suppl. 1988;543:48-51
Publication Type
Article
Date
1988

Cost/benefit aspects on thromboprophylaxis.

https://arctichealth.org/en/permalink/ahliterature221595
Source
Haemostasis. 1993 Mar;23 Suppl 1:15-9
Publication Type
Article
Date
Mar-1993
Author
D. Bergqvist
T. Mätzsch
Author Affiliation
Department of Surgery, Lund University, Malmö General Hospital, Sweden.
Source
Haemostasis. 1993 Mar;23 Suppl 1:15-9
Date
Mar-1993
Language
English
Publication Type
Article
Keywords
Abdomen - surgery
Cost-Benefit Analysis
Heparin - economics - therapeutic use
Heparin, Low-Molecular-Weight - economics - therapeutic use
Hip Prosthesis
Humans
Postoperative Care - economics
Postoperative Complications - economics - prevention & control
Prospective Studies
Risk
Sweden
Thromboembolism - economics - prevention & control
Abstract
Several studies have shown thromboprophylaxis of any kind to be more cost-effective than no prophylaxis or general diagnostic surveillance and selective treatment. Little has been written on low molecular weight heparins from the cost-effectiveness point of view. This preliminary study shows low molecular weight heparin to be more cost-effective than standard low-dose heparin in most situations of prophylaxis.
PubMed ID
8388349 View in PubMed
Less detail

Cost-effectiveness of prolonged out-of-hospital prophylaxis with low-molecular-weight heparin following total hip replacement.

https://arctichealth.org/en/permalink/ahliterature195379
Source
Haemostasis. 2000;30 Suppl 2:130-5; discussion 128-9
Publication Type
Article
Date
2000
Author
D. Bergqvist
B. Jönsson
Author Affiliation
Department of Surgical Sciences, University Hospital, Uppsala, Sweden. david.berqvist@kirurgi.uu.se
Source
Haemostasis. 2000;30 Suppl 2:130-5; discussion 128-9
Date
2000
Language
English
Publication Type
Article
Keywords
Anticoagulants - administration & dosage - economics - therapeutic use
Arthroplasty, Replacement, Hip - nursing
Cost-Benefit Analysis
Drug Costs
Enoxaparin - administration & dosage - economics - therapeutic use
Home Care Services - economics
Hospital Costs
Hospitalization - economics
Humans
Outpatients
Phlebography
Postoperative Complications - epidemiology - prevention & control - radiography
Postoperative Period
Self Care - economics
Sweden
Thrombophlebitis - epidemiology - etiology - prevention & control - radiography
Treatment Outcome
Venous Thrombosis - epidemiology - etiology - prevention & control - radiography
Abstract
Several studies have demonstrated that prolongation of thromboprophylaxis after elective hip replacement significantly reduces the frequency of venographically demonstrated deep vein thrombosis. This paper reports an economic evaluation of prolonged prophylaxis with low-molecular-weight heparin (LMWH), based on outcome data from one of these trials. Analysis showed a net saving per patient of 3,400 Swedish kronor. Consequently, if the costs of administering the LMWH -- which includes the cost of teaching the patient to self-administer whilst in hospital and the cost of a follow-up visit by a district nurse to ensure compliance -- are below this amount, the intervention will prove to be cost saving.
PubMed ID
11251357 View in PubMed
Less detail

Cost-effectiveness of venous thromboembolism prophylaxis in surgery.

https://arctichealth.org/en/permalink/ahliterature219579
Source
Eur J Surg Suppl. 1994;(571):49-53
Publication Type
Article
Date
1994

Current use of thromboembolism prophylaxis for laparoscopic cholecystectomy patients in Sweden.

https://arctichealth.org/en/permalink/ahliterature177145
Source
Surg Endosc. 2005 Mar;19(3):386-8
Publication Type
Article
Date
Mar-2005
Author
F. Lindberg
M. Bjorck
I. Rasmussen
D. Bergqvist
Author Affiliation
Department of Surgery, Uppsala University Hospital, Sweden. 0910.51345@telia.com
Source
Surg Endosc. 2005 Mar;19(3):386-8
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Cholecystectomy, Laparoscopic
Humans
Postoperative Complications - prevention & control
Questionnaires
Sweden
Thromboembolism - prevention & control
Thrombolytic Therapy
Abstract
The need for thromboembolism (TE) prophylaxis during laparoscopic surgery is not well established. The aim of this study was to investigate current TE prophylaxis in patients undergoing laparoscopic cholecystectomy (LC) in Sweden.
Mail questionnaire to all Surgical Departments in Sweden about the current use of thromboembolism prophylaxis in patients undergoing laparoscopic cholecystectomy.
The response rate was 78 of 80 departments of surgery (98%). Seventy reported performing LC. Thirty-six percent used thromboembolism prophylaxis in all patients, 17% in most, 9% in half their patients and 39% only rarely. The current use of thromboembolism prophylaxis ranged from low-molecular-weight heparin for 7 days + stockings in all patients to no prophylaxis at all in the majority of patients.
The use of thromboembolism prophylaxis in LC patients is highly variable, even in the small and homogenous country of Sweden. Further studies concerning the risk of TE complications after laparoscopic surgery are warranted.
PubMed ID
15573240 View in PubMed
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Economic evaluation of desirudin vs heparin in deep vein thrombosis prevention after hip replacement surgery.

https://arctichealth.org/en/permalink/ahliterature207267
Source
Pharmacoeconomics. 1998 Jan;13(1 Pt 2):111-8
Publication Type
Article
Date
Jan-1998
Author
L A Levin
M. Horst
D. Bergqvist
Author Affiliation
Department of Health and Society, Tema Research, Linköping University, Sweden.
Source
Pharmacoeconomics. 1998 Jan;13(1 Pt 2):111-8
Date
Jan-1998
Language
English
Publication Type
Article
Keywords
Anticoagulants - economics - therapeutic use
Arthroplasty, Replacement, Hip - adverse effects - economics
Clinical Trials as Topic
Cost-Benefit Analysis
Heparin - economics - therapeutic use
Hirudin Therapy
Hirudins - analogs & derivatives - economics
Humans
Models, Economic
Recombinant Proteins - economics - therapeutic use
Sweden
Thrombosis - economics - prevention & control
Abstract
Deep vein thrombosis is a serious complication of orthopaedic surgery and can lead to pulmonary embolism and long term post-thrombotic syndrome. A simulation model based on both epidemiological data and data from clinical trials was used to compare the long term cost effectiveness of standard prophylaxis with subcutaneous unfractionated heparin with that of desirudin (recombinant hirudin), in patients undergoing elective hip replacement. The analysis, which was performed before the price of desirudin was set, showed that prophylactic treatment with desirudin saved 4.5 life-years per 100 patients treated, compared with unfractionated heparin. Desirudin prophylaxis was dominant up to a total drug cost of 4400 Swedish kronor (SEK) per treatment. The results were robust against changes in the parameters used in several sensitivity analyses. This study showed that prophylactic therapy with desirudin compared with unfractionated heparin was more cost effective and potentially cost saving under a wide range of assumptions concerning the future price of desirudin in preventing deep vein thrombosis following elective hip surgery.
PubMed ID
10176145 View in PubMed
Less detail

Fatal pulmonary embolism in an unselected series: the possible role of caval filters in prevention.

https://arctichealth.org/en/permalink/ahliterature23525
Source
Eur J Surg. 1994 Oct;160(10):553-9
Publication Type
Article
Date
Oct-1994
Author
M B Thomsen
B. Lindblad
D. Bergqvist
Author Affiliation
Department of Surgery, County Hospital, Kristianstad, Sweden.
Source
Eur J Surg. 1994 Oct;160(10):553-9
Date
Oct-1994
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Cadaver
Female
Femoral Vein
Hip Fractures - complications
Humans
Iliac Vein
Lung - radionuclide imaging
Male
Middle Aged
Neoplasms - complications
Phlebography
Prospective Studies
Pulmonary Embolism - complications - diagnosis - mortality - prevention & control
Thrombosis - complications - diagnosis - mortality - prevention & control
Vena Cava Filters
Vena Cava, Inferior
Vena Cava, Superior
Abstract
OBJECTIVE: To evaluate the possible benefit of inserting a caval filter for the prevention of pulmonary embolism (PE) in an unselected group of patients admitted to hospital. DESIGN: Analysis of clinical data collected prospectively. SETTING: University hospital, Sweden. SUBJECTS: 1391 patients who presented during 1987 435 with deep vein thrombosis (DVT), thrombus in the right atrium or the right ventricle or PE at necropsy; 366 patients shown to have DVT on phlebography; 44 shown to have PE on pulmonary scintigraphy; and 546 patients operated on for hip fractures. OUTCOME MEASURES: Clinical description of patients and groups of patients who died of PE who could possibly have benefitted from insertion of a filter. RESULTS: Of the 435 patients with DVT or PE or both, 141 had DVT in the femoral or iliac veins or in the inferior vena cava together with PE which contributed to the cause of death. Only 11 of these had been suspected clinically of having DVT in or below the inferior vena cava and only 1 of these was less than 80 years old and did not have malignant disease with distant metastases. Of the 366 patients with phlebographically confirmed DVT 8 died with PE that had contributed to the cause of death; 6 had incurable cancer and the remaining two were over 85 years. Of the 44 patients with scintigraphically confirmed PE 2 patients (aged 78 and 89) died of PE that had already been diagnosed clinically and none would have benefited from insertion of a filter after diagnosis. There were 9 PE deaths related to PE among 546 patients operated on for hip fractures, and all but one had potentially lethal coexisting disease or were over 80 years old. CONCLUSION: In this epidemiological survey only a few patients would have benefited from insertion of a caval filter. The results call for a restricted use of caval filters until benefit has been confirmed by prospective studies.
PubMed ID
7849157 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
Less detail

22 records – page 1 of 3.