| 1. |
- Currie, Andrew, et al.
(författare)
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The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection Results From an International Registry
- 2015
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Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 261:6, s. 1153-1159
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Tidskriftsartikel (refereegranskat)abstract
- Background: The ERAS (enhanced recovery after surgery) care has been shown in randomized clinical trials to improve outcome after colorectal surgery compared to traditional care. The impact of different levels of compliance and specific elements, particularly out with a trial setting, is poorly understood.Objective: This study evaluated the individual impact of specific patient factors and perioperative enhanced recovery protocol compliance on postoperative outcome after elective primary colorectal cancer resection.Methods: The international, multicenter ERAS registry data, collected between November 2008 and March 2013, was reviewed. Patient demographics, disease characteristics, and perioperative ERAS protocol compliance were assessed. Linear regression was undertaken for primary admission duration and logistic regression for the development of any postoperative complication.Findings: A total of 1509 colonic and 843 rectal resections were undertaken in 13 centers from 6 countries. Median length of stay for colorectal resections was 6 days, with readmissions in 216 (9.2%), complications in 948 (40%), and reoperation in 167 (7.1%) of 2352 patients. Laparoscopic surgery was associated with reduced complications [odds ratio (OR) = 0.68; P < 0.001] and length of stay (OR = 0.83, P < 0.001). Increasing ERAS compliance was correlated with fewer complications (OR = 0.69, P < 0.001) and shorter primary hospital admission (OR = 0.88, P < 0.001). Shorter hospital stay was associated with preoperative carbohydrate and fluid loading (OR = 0.89, P = 0.001), and totally intravenous anesthesia (OR= 0.86, P < 0.001); longer stay was associated with intraoperative epidural analgesia (OR = 1.07, P = 0.019). Reduced postoperative complications were associated with restrictive perioperative intravenous fluids (OR = 0.35, P < 0.001).Conclusions: This analysis has demonstrated that in a large, international cohort of patients, increasing compliance with an ERAS program and the use of laparoscopic surgery independently improve outcome.
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| 2. |
- Djureinovic, Tatjana, et al.
(författare)
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The CHEK2 1100delC variant in Swedish colorectal cancer
- 2006
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Ingår i: Anticancer Research. - 0250-7005 .- 1791-7530. ; 26:6C, s. 4885-4888
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The cell cycle checkpoint kinase 2 (CHEK2) 1100delC variant has recently been identified at high frequency in families with both breast and colorectal cancer, suggesting the possible role of this variant in colorectal cancer predisposition. PATIENTS AND METHODS: To evaluate the role of CHEK2 ll00delC among Swedish colorectal cancer patients, the variant frequency was determined in 174 selected familial cases, 644 unselected cases and 760 controls, as well as in l8 families used in the genome-wide linkage analysis, where weak linkage was seen for the region harboring the CHEK2 gene. RESULTS: CHEK2 l100delC was found in 1.15% of familial and in 0.93% of unselected cases, compared to 0.66% of controls, showing no significant difference between groups. One out of 45 familial cases with a family history of breast cancer was shown to be a carrier. The variant was not identified in the 18 families included in the linkage analysis. CONCLUSION: The CHEK2 1100delC was not significantly increased in Swedish colorectal cancer patients, however, in order to determine the role of the variant in colorectal cancer families with the history of breast cancer a larger sample size is needed.
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| 3. |
- Erlandsson, Johan, et al.
(författare)
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Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial
- 2017
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Ingår i: The Lancet Oncology. - : ELSEVIER SCIENCE INC. - 1470-2045 .- 1474-5488. ; 18:3, s. 336-346
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Tidskriftsartikel (refereegranskat)abstract
- Background Radiotherapy reduces the risk of local recurrence in rectal cancer. However, the optimal radiotherapy fractionation and interval between radiotherapy and surgery is still under debate. We aimed to study recurrence in patients randomised between three different radiotherapy regimens with respect to fractionation and time to surgery. Methods In this multicentre, randomised, non-blinded, phase 3, non-inferiority trial (Stockholm III), all patients with a biopsy-proven adenocarcinoma of the rectum, without signs of non-resectability or distant metastases, without severe cardiovascular comorbidity, and planned for an abdominal resection from 18 Swedish hospitals were eligible. Participants were randomly assigned with permuted blocks, stratified by participating centre, to receive either 5 x 5 Gy radiation dose with surgery within 1 week (short-course radiotherapy) or after 4-8 weeks (short-course radiotherapy with delay) or 25 x 2 Gy radiation dose with surgery after 4-8 weeks (long-course radiotherapy with delay). After a protocol amendment, randomisation could include all three treatments or just the two short-course radiotherapy treatments, per hospital preference. The primary endpoint was time to local recurrence calculated from the date of randomisation to the date of local recurrence. Comparisons between treatment groups were deemed non-inferior if the upper limit of a double-sided 90% CI for the hazard ratio (HR) did not exceed 1.7. Patients were analysed according to intention to treat for all endpoints. This study is registered with ClinicalTrials.gov, number NCT00904813. Findings Between Oct 5, 1998, and Jan 31, 2013, 840 patients were recruited and randomised; 385 patients in the three-arm randomisation, of whom 129 patients were randomly assigned to short-course radiotherapy, 128 to short-course radiotherapy with delay, and 128 to long-course radiotherapy with delay, and 455 patients in the two-arm randomisation, of whom 228 were randomly assigned to short-course radiotherapy and 227 to short-course radiotherapy with delay. In patients with any local recurrence, median time from date of randomisation to local recurrence in the pooled short-course radiotherapy comparison was 33.4 months (range 18.2-62.2) in the short-course radiotherapy group and 19.3 months (8.5-39.5) in the short-course radiotherapy with delay group. Median time to local recurrence in the long-course radiotherapy with delay group was 33.3 months (range 17.8-114.3). Cumulative incidence of local recurrence in the whole trial was eight of 357 patients who received short-course radiotherapy, ten of 355 who received short-course radiotherapy with delay, and seven of 128 who received long-course radiotherapy (HR vs short-course radiotherapy: short-course radiotherapy with delay 1.44 [95% CI 0.41-5.11]; long-course radiotherapy with delay 2.24 [0.71-7.10]; p=0.48; both deemed non-inferior). Acute radiation-induced toxicity was recorded in one patient (amp;lt;1%) of 357 after short-course radiotherapy, 23 (7%) of 355 after short-course radiotherapy with delay, and six (5%) of 128 patients after long-course radiotherapy with delay. Frequency of postoperative complications was similar between all arms when the three-arm randomisation was analysed (65 [50%] of 129 patients in the short-course radiotherapy group; 48 [38%] of 128 patients in the short-course radiotherapy with delay group; 50 [39%] of 128 patients in the long-course radiotherapy with delay group; odds ratio [OR] vs short-course radiotherapy: short-course radiotherapy with delay 0.59 [95% CI 0.36-0.97], long-course radiotherapy with delay 0.63 [0.38-1.04], p=0.075). However, in a pooled analysis of the two short-course radiotherapy regimens, the risk of postoperative complications was significantly lower after short-course radiotherapy with delay than after short-course radiotherapy (144 [53%] of 355 vs 188 [41%] of 357; OR 0.61 [95% CI 0.45-0.83] p=0.001). Interpretation Delaying surgery after short-course radiotherapy gives similar oncological results compared with short-course radiotherapy with immediate surgery. Long-course radiotherapy with delay is similar to both short-course radiotherapy regimens, but prolongs the treatment time substantially. Although radiation-induced toxicity was seen after short-course radiotherapy with delay, postoperative complications were significantly reduced compared with short-course radiotherapy. Based on these findings, we suggest that short-course radiotherapy with delay to surgery is a useful alternative to conventional short-course radiotherapy with immediate surgery.
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| 4. |
- Granlund, Johan, et al.
(författare)
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Mortality in patients hospitalised for diverticulitis in Sweden—A national population‐based cohort study
- 2021
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Ingår i: GastroHep. - : John Wiley & Sons. - 1478-1239 .- 1478-1239. ; 3:3, s. 131-140
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMortality in diverticulitis patients is poorly documented.AimsTo determine short- and long-term mortality in diverticulitis patients compared to matched disease-free individuals.MethodsBy use of nation-wide registers, mortality among all individuals with a first-time hospital admission for diverticulitis 1990-2010 was compared to a disease-free cohort, matched for gender and age, with up to 21 years of follow-up. Hazard ratios (HR) for death within 0-100 days and 101 days–5 years from admission, respectively, were calculated using Cox regression, adjusting for prior comorbidity and social factors. Separate analyses were performed on diverticulitis treated conservatively and surgically.Results83 461 diverticulitis and 812 942 disease-free individuals were included. Among all diverticulitis patients, mortality within 100 days was four times higher than in disease-free individuals, HR 4.44 (95% confidence interval 4.26-4.63), and in surgically treated patients, a HR of 12.13 (11.03-13.34) was observed. Within 100 days, 11.4% of patients receiving surgical treatment died, compared to 3.2% after conservative treatment. From day 101 to 5 years, the HR was 1.40 (1.32-1.47) after surgical treatment and 1.08 (1.05-1.10) after conservative treatment. Relative mortality within 100 days was slightly more pronounced in females than males, whereas in the 101 days–5 years interval, HRs were similar between genders.ConclusionsIn patients initially admitted for diverticulitis, survival is significantly reduced, both in the short and the long-term. This highlights the need of further efforts for prevention and optimised treatment.
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| 5. |
- Hjern, Fredrik
(författare)
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Aspects on diverticular disease
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: The aims of this thesis were to evaluate the influence of ethnicity and other sociodemographic factors on the rate of diverticular disease (DD) (Paper I), to compare findings specific for DD and acceptance of CT Colonography (CTC) and conventional Colonoscopy (CC) in patients examined after diverticulitis (AD) (Paper II), to evaluate the value of antibiotics in conservative treatment of patients with mild AD (Paper III) and to study patients with diverticular fistulas to the female genital tract (Paper IV). Methods: In paper I, Swedish national registers with information about health and socio-demographic indicators were used to study ethnicity and other socio-demographic factors and the risk of hospital admission due to DD in a national cohort (4.4 millions) followed prospectively over a period of ten years. Paper II was a prospective comparative study of 57 patients examined with CTC and CC respectively. Paper III was an observational study of 311 patients; all treated for AD and included mailed questionnaires. Paper IV reviewed evaluation, management, morbidity and outcome in 60 women treated for DD fistulas to the genital tract. Results: In all 25,123 patients were hospitalized because of DD during 1991-2000. The risk ratio (RR) of DD, after adjustment for age, sex and socio-economic indicators, was lower in non-western immigrants (RRs 0.5-0.7) compared with indigenous patients. The risk increased with time after settlement in Sweden. Women had a higher risk compared with men (R-R 1.50, CI 95% 1.46-1.54, p<0.001) and the difference increased with age. (Paper I) DD was found in 96 % of patients at CTC and in 90 % at colonoscopy. Eight suspected polyps sized ¡Ý5 mm were found in six patients. Patients experienced colonoscopy more discomforting (p<0.03), painful (p<0.001) and difficult (p<0.01) than CTC. Seventy-four % of patients preferred CTC. (Paper II) During first hospitalisation, patients treated with antibiotics had a more pronounced inflammation compared with patients treated without antibiotics. If initially treated with antibiotics three patients (3 %) failed to respond to medical management and had surgery. Seven patients (4 %) treated without antibiotics failed to respond and antibiotics were then added. In all, 29 % of patients treated with antibiotics had further events (recurrent AD and/or subsequent surgery) during EU (mean 30 months, range 16-45), compared with 28 % (N.S.), if treated without antibiotics. In a multivariate analysis, antibiotics did not influence the risk for a further event (OR 1.03, Cl 95 % 0.61-1.74). (Paper III) The most common presenting symptoms in women with a DD fistula to the genital tract were vaginal discharge of faeces or gas (95 %) and 75 % of them had previously had a hysterectomy. 57/60 patients had surgery, sigmoid resection and anastomosis was performed in 51 and a Hartmann's procedure with colostomy in six patients. In all, 26 % of the patients experienced morbidity after surgery, including anastomotic dehiscence (n=4) and ureteric injury (n=3). All operated patients were cured from their fistulas and outcome was satisfactory in 86 %. (Paper IV) Conclusions: DD appears to be an acquired disorder and acculturation to a Western lifestyle has an impact on the risk for DD. Potential socio-demographic confounders, such as socio-economic status, residency and housing situation don't influence the risk. The diagnostic findings of CTC are comparable to colonoscopy in patients investigated after AD. CTC is less discomforting and preferred by a majority of patients. Thus, CTC seems to be a good alter-native in the follow-up of patients after AD. To omit antibiotics in the treatment of mild AD appears safe and does not influence the rate of further events. DD fistulas to the female genital tract mostly occur in elderly patients with a prior hysterectomy. Sigmoid resection and primary anastomosis is done safely in the majority of patients.
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| 6. |
- Hjern, Fredrik, et al.
(författare)
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Obesity, Physical Inactivity, and Colonic Diverticular Disease Requiring Hospitalization in Women : A Prospective Cohort Study
- 2012
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Ingår i: American Journal of Gastroenterology. - : NATURE PUBLISHING GROUP. - 0002-9270 .- 1572-0241. ; 107:2, s. 296-302
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Lifestyle factors other than dietary fiber intake and risk for colonic diverticular disease have only been examined in few studies. The objective of this study was to investigate the association between obesity and physical inactivity and diverticular disease in a population-based cohort of women. METHODS: This was a prospective population-based cohort study. In all, 36,592 women, born 1914-1948, in the Swedish Mammography Cohort were followed 1997-2009. Body mass index (BMI; kg/m(2)), physical activity, diet, smoking, and other lifestyle factors were collected at baseline through questionnaires. Cases of diverticular disease were identified from the Swedish Patient and Death Registers. Relative risks (RRs) of diverticular disease requiring hospitalization (or being the cause of death) according to BMI and physical activity were estimated using Cox proportional hazards models. The multivariable models were adjusted for age; intake of dietary fiber; diabetes; hypertension; use of acetylsalicylate acid, non-steroid anti-inflammatory drug, or steroid medication; alcohol consumption; smoking; and educational level. RESULTS: During 12 years, 626 cases of incident diverticular disease requiring hospitalization were found. Two women were registered in the National Death Register only. In multivariable analysis, women with BMI 25-29.99 had 29% increased risk (RR=1.29; 95% confidence interval (CI): 1.08, 1.54) and obese women (BMI >= 30) had 33% (1.33; 95% CI: 1.03-1.72) increased risk of diverticular disease compared to women with BMI 20-24.99. Exercise <= 30 min/day increased the risk for disease with 42% (1.42; 95% CI: 1.18-1.69) compared with exercise >30 min/day in multivariable analysis. Ninety-eight subjects were hospitalized due to complications; perforation or abscess. Women with BMI >= 30 had a twofold (RR=2.00; 95% CI: 1.08-3.73; P=0.028) increased risk for complicated disease. CONCLUSIONS: Overweight, obesity, and physical inactivity among women increase diverticular disease requiring hospitalization.
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| 7. |
- Isacson, Daniel
(författare)
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Treatment of Acute Uncomplicated Colonic Diverticulitis
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to evaluate the clinical management of AUD with regard to the no-antibiotic policy and its long-term effect, treatment on an outpatient basis and the potential health-care cost savingsStudy I: a retrospective study at Västmanlands Hospital that evaluated and confirmed the adherence to the no-antibiotic policy in patients with AUD and its safety regarding complications and recurrences. A total of 246 patients with acute diverticulitis were identified, of which 195 had computed tomography (CT) confirmed AUD. In total, 91.3% of these patients did not receive any antibiotics and only two developed complications.Study II: a retrospective study with the aim to conduct a long-term follow-up of all Swedish patients who participated in the AVOD trial in terms of recurrences, complications, surgery and quality of life. The medical records of 96% of the patients were reviewed with a mean follow up of 11 years. Quality of life questionnaires were sent out to all patients. There were no differences regarding the rates of recurrence, complications or surgery for diverticulitis. There were no differences in the quality of life between groups according to the EQ-5D questionnaire.Study III: a prospective study where 155 patients with CT-verified AUD as were treated as outpatients without antibiotics. On day 3, patients reported an average pain score of 1.8 of 10 on the VAS scale and only 30% of patients were using analgesia. Four patients returned to hospital because of treatment failure.Study IV: a retrospective cohort study at Västmanland’s Hospital evaluated the impact on admissions, complication rates and health-care costs of the policy of outpatient treatment without using antibiotics. Medical records of all patients diagnosed with AUD in the year before (2011) and after (2014) the implementation of outpatient management without antibiotics were reviewed. Overall 494 episodes of AUD were identified: 254 in 2011 and 240 in 2014. Three patients developed complications in 2011 and four in 2014. The proportion of patients managed as outpatients was 20% in 2011 compared with 61% in 2014. The hospital admissions, total length of stay of and total health-care costs were almost halved.In conclusion, these studies confirm the low complication and recurrence rates of AUD and strengthens findings that antibiotics have no benefit in the treatment of this disease. The no-antibiotic policy had no impact on short- or long-term outcomes regarding the rates of recurrence, complications, surgery or quality of life. Outpatient management was found to be feasible and safe, and significantly reduced admissions, which led to large health-care cost savings.
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| 8. |
- Mahmood, Mahmood W., et al.
(författare)
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High intake of dietary fibre from fruit and vegetables reduces the risk of hospitalisation for diverticular disease.
- 2019
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Ingår i: European Journal of Nutrition. - : Springer Nature. - 1436-6207 .- 1436-6215. ; 58, s. 2393-2400
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDS AND AIMS: High intake of dietary fibres has been associated with a reduced risk of DD. However, reports on which type of dietary fibre intake that is most beneficial have been conflicting. The aim of this study was to investigate the association between different dietary fibres and hospitalisation due to diverticular disease (DD) of the colon.METHODS: This was a major cohort study. The Swedish Mammography Cohort and the Cohort of Swedish Men were linked to the Swedish Inpatient Register and the Causes of Death Register. Data on the intake of dietary fibre were collected through questionnaires. The effect of intake (in quartiles) of different types of dietary fibre on the incidence of hospitalisation due to DD was investigated using multivariable Cox regression. Estimates were adjusted according to age, BMI, physical activity, co-morbidity, intake of corticosteroids, smoking, alcohol intake and education level.RESULTS: Women with intake of fruit and vegetable fibres in the highest quartile (median 12.6 g/day) had a 30% decreased risk of hospitalisation compared to those with the lowest intake (4.1 g/day). Men within the highest quartile (10.3 g/day) had a 32% decreased risk compared to those with a low intake (2.9 g/day). High intake of fibres from cereals did not affect the risk.CONCLUSION: A high intake of fruits and vegetables may reduce the risk of hospitalisation due to DD. Intake of cereals did not influence the risk.
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| 9. |
- Mahmood, Mahmood Wael, et al.
(författare)
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Identification of diverticular disease in Swedish healthcare registers : a validation study
- 2024
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Ingår i: Scandinavian Journal of Gastroenterology. - : Taylor & Francis. - 0036-5521 .- 1502-7708. ; 59:2, s. 176-182
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The Swedish National Patient Register (SNPR) is frequently used in studies of colonic diverticular disease (DD). Despite this, the validity of the coding for this specific disease in the register has not been studied.Methods: From SNPR, 650 admissions were randomly identified encoded with ICD 10, K572-K579. From the years 2002 and 2010, 323 and 327 patients respectively were included in the validation study. Patients were excluded prior to, or up to 2 years after a diagnosis with IBD, Celiac disease, IBS, all forms of colorectal cancer (primary and secondary), and anal cancer. Medical records were collected and data on clinical findings with assessments, X-ray examinations, endoscopies and laboratory results were reviewed. The basis of coding was compared with internationally accepted definitions for colonic diverticular disease. Positive predictive values (PPV) were calculated.Results: The overall PPV for all diagnoses and both years was 95% (95% CI: 93-96). The PPV for the year 2010 was slightly higher 98% (95% CI: 95-99) than in the year 2002, 91% (95% CI: (87-94) which may be due to the increasing use of computed tomography (CT).Conclusion: The validity of DD in SNPR is high, making the SNPR a good source for population-based studies on DD.
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| 10. |
- Manhica, Hélio, 1981-
(författare)
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Mental health, substance misuse and labour market participation in teenage refugees in Sweden – A longitudinal perspective
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To fill the knowledge gap about the importance of contextual factors after resettlement on mental health, substance misuse and labour market participation among young refugees who immigrate to Sweden as teenagers. Methods: Register studies in national registers of national cohorts of young refugees, unaccompanied and accompanied, who settled in Sweden as teenagers. Studies 1-4 used Cox regression models to study the risks of psychiatric care consumption and substance misuse, while Study 5 used multinomial regression to study position on the labour. These findings were compared with peers from the same birth cohorts in the general Swedish population and non-European intercountry adoptees (Studies 2 and 5). Results: The overall results suggest that young accompanied and unaccompanied refugees were more likely to be admitted to psychiatric inpatient and compulsory hospital care, but not outpatient care, with refugees born in the Horn of Africa and Iran having the highest risk (Study 1). Young accompanied and unaccompanied refugees also had higher risk of hospitalization and criminal conviction associated with substance misuse (Study 3). Longer duration of residence in Sweden was associated with increased risks of outpatient care (Study 1) and hospitalization related to substance misuse (studies 3 and 4). These increase risks of young refugees were associated with their socioeconomic living conditions (Studies 3 and 4), but risk factors associated with the country of origin of the refugee population and the intercountry adoptees were more important determinants of schizophrenia than socioeconomic conditions in Sweden (Study 2). Young accompanied and unaccompanied refugees and intercountry adoptees had a lower likelihood of being in full employment than native Swedes with comparable levels of education. Secondary education, however, increased employment chances and reduced the risk of being neither employed nor in education or training (Study 5). Conclusion: Evidence suggests that several groups of young refugees are at higher risk of mental health problems and substance misuse. They also face employment disadvantages and barriers to psychiatric care in the early stages of developing a psychiatric disorder.
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