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- Egenvall, M., et al.
(författare)
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Degree of blood loss during surgery for rectal cancer : a population-based epidemiologic study of surgical complications and survival
- 2014
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 16:9, s. 696-702
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Tidskriftsartikel (refereegranskat)abstract
- Aim The hypothesis tested in this study was that major blood loss during surgery for rectal cancer increases the risk for surgical complications and for small bowel obstruction (SBO) as a result of adhesions or tumour recurrence, and reduces overall survival. Method Data were retrieved from the Uppsala/Orebro Regional Rectal Cancer Registry for all patients undergoing radical resection for rectal cancer during 1997-2003 (n = 1843) and were matched against the Swedish National Patient Registry regarding surgery and admission for SBO. These patient records were scrutinized to determine the etiology of surgery for SBO. The registry was scrutinized for blood loss and other surgical complications associated with surgery. Uni- and multivariate Cox analysis and logistic regression were used. Results Ninety-four (5.1%) patients underwent surgery for SBO > 30 days after the index operation: 82 for adhesions and 12 for tumour recurrence. The volume of blood lost did not influence the risk of surgery for SBO as a result of adhesions, but blood loss above the median (>= 800 ml) increased the risk for surgery for SBO caused by tumour recurrence (hazard ratio = 10.52; 95% CI: 1.36-81.51). Increased blood loss increased the risk of surgical complications (OR = 1.78; 95% CI: 1.35-2.35 with blood loss of >= 450 ml) but did not reduce overall survival. Irradiation before surgery increased blood loss, complications and admission for SBO. Conclusion Major blood loss during surgery for rectal cancer increases the risk of later surgery for SBO caused by tumour recurrence and surgical complications, but overall survival is not affected.
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- Mörner, Malin E M, et al.
(författare)
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Preoperative anaemia and perioperative red blood cell transfusion as prognostic factors for recurrence and mortality in colorectal cancer-a Swedish cohort study
- 2017
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Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 32:2, s. 223-232
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The hypothesis in this study was that anaemia prior to surgery and perioperative red blood cell transfusion increases the risk for recurrence and overall mortality in patients with stages I-III colorectal cancer after abdominal resection with curative intent.METHODS: This is a Swedish single centre retrospective cohort study. Data on 496 consecutive radical abdominal resections stages I-III colorectal cancer performed at the Karolinska University Hospital 2007-2010 were extracted from the Swedish Colorectal Cancer Registry. Data were linked to local laboratory and transfusion databases to identify preoperative anaemia and perioperative transfusion. Disease recurrence was validated by scrutiny of patient records. A total of 496 stages I-III colorectal cancer patients were included in the analysis. Multivariate Cox regression analysis adjusted for tumour and patient characteristics were performed to assess risk for recurrence and overall mortality.RESULTS: Anaemia prior to surgery was associated with increased risk for overall mortality (HR 2.1, 95% CI 1.4-3.2). There was no association between anaemia and risk for recurrence (HR 1.6, 95% CI 0.97-2.6). Transfusion was not associated with increased risk of recurrence (HR 0.7, 95% CI 0.4-1.3) or overall mortality (HR 1.04, 95% CI 0.7-1.6).CONCLUSIONS: Anaemia prior to colorectal cancer surgery was associated with increased risk for overall mortality while a no increased risk was seen for recurrence. Previous findings indicating an association between blood transfusion and increased risk for recurrence could not be confirmed.
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- Persson-Sjodin, Emma, et al.
(författare)
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Withers vertical movement symmetry is useful for locating the primary lame limb in naturally occurring lameness
- 2024
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Ingår i: Equine Veterinary Journal. - : WILEY. - 0425-1644 .- 2042-3306. ; 56:1, s. 76-88
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDuring orthopaedic assessment of lame horses, a head nod is commonly present in both primary forelimb and hindlimb lame horses. Additional motion metrics that could assist clinicians in correctly differentiating between these two scenarios would be of great clinical value. ObjectivesThe primary objective of this study was to examine whether withers movement asymmetry can be used in a clinical setting to distinguish primary forelimb lameness from compensatory head movement asymmetry due to primary hindlimb lameness. Study designRetrospective, multicentre study. MethodsMovement asymmetry of head, withers and pelvis was measured using multi-camera optical motion capture, as part of routine lameness investigations at four European equine hospitals. Vertical movement asymmetry parameters from 317 horses trotting in a straight line were compared before and after successful diagnostic analgesia of a single limb. Descriptive statistics, t-tests and linear models were used to analyse the data. ResultsIn forelimb lame horses, 80%-81% showed head and withers asymmetry both indicating lameness in the same forelimb. In hindlimb lame horses, 69%-72% showed head asymmetry ipsilateral to the lame hindlimb and withers asymmetry diagonal to the lame hindlimb, thus, head and withers asymmetry indicated lameness in different forelimbs. A large (>15 mm) compensatory head nod was seen in 28%-31% of the hindlimb lame horses. In 89%-92% of these, head and withers asymmetry indicated lameness in different forelimbs. Withers asymmetry decreased linearly with reduced head or pelvic asymmetry for both forelimb and hindlimb lame horses. Main limitationsCompensatory strategies were evaluated on group level to identify common patterns, potentially ignoring uncommon individual strategies. ConclusionsWithers vertical movement asymmetry metrics can be useful in helping to locate the primary lame limb during quantitative lameness assessment. Head and withers movement asymmetry parameters generally indicate the same forelimb in forelimb lame horses, but different forelimbs in hindlimb lame horses.
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- Samuelsson, K. S., et al.
(författare)
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Inappropriate drug use in elderly patients is associated with prolonged hospital stay and increased postoperative mortality after colorectal cancer surgery : a population-based study
- 2016
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 18:2, s. 155-162
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Tidskriftsartikel (refereegranskat)abstract
- Aim The study aimed to investigate whether continuing potentially inappropriate medication (PIM) is associated with length of hospital stay (LOS) and postoperative mortality in elderly people undergoing colorectal cancer surgery.Method The Swedish National Colorectal Cancer Register and the Swedish Prescribed Drug Register provided matched data on 7279 patients aged 75 years or more who had undergone bowel resection for colorectal cancer between 2007 and 2010. Patients were divided into two groups depending on whether or not they were taking PIM at the time of surgery. The primary efficacy variables were the LOS and 30-day postoperative mortality.Results Of the 7279 patients, 22.5% (1641) of the patients were exposed to at least one PIM and the total number of drugs taken in this group was six, compared with three in the non-PIM group (P<0.001). Postoperative mortality was higher in the PIM group (7.1% vs 4.5%, P<0.001), and LOS was longer (10days vs 9, P=0.001). When adjusted for independent predictors, the differences in LOS (odds ratio 1.14; 95% confidence interval 1.00-1.29, P=0.046) and postoperative mortality (odds ratio 1.43; 95% confidence interval 1.11-1.85, P=0.006) remained significant.Conclusion The use of PIM prior to surgery is associated with increased postoperative mortality and prolonged hospital stay. Although no causal relationship is proved, the results add a further aspect to preoperative optimization of elderly patients about to have major colorectal surgery.What does this paper add to the literature? The study shows an association between the exposure to potentially inappropriate medication and increased length of stay and postoperative mortality in elderly patients undergoing colorectal cancer surgery. The finding adds an additional factor to take into account during the preoperative optimization of elderly people.
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- Samuelsson, Katja Schubert, et al.
(författare)
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The older patient's experience of the healthcare chain and information when undergoing colorectal cancer surgery according to the ERAS concept
- 2018
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 27:7-8, s. e1580-e1588
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: To describe how older patients experience the healthcare chain and information given before, during and after colorectal cancer surgery.BACKGROUND: Most persons with colorectal cancer are older than 70 years and undergo surgery with subsequent enhanced recovery programmes aiming to quickly restore preoperative function. However, adaptation of such programmes to suit the older patient has not been made.DESIGN: Qualitative descriptive study.METHOD: Semi-structured interviews were conducted on 16 patients undergoing colorectal cancer surgery at a Swedish University Hospital. Inductive content analysis was employed.RESULTS: During the period of primary investigation and diagnosis, a paucity of information regarding the disease and management, and lack of help in coping with the diagnosis of cancer and its impact on future life, leads to a feeling of vulnerability. During their stay in hospital, the patient's negative perception of the hospital environment, their need for support, and uncertainty and anxiety about the future are evident. After discharge, rehabilitation is perceived as lacking in structure and individual adaptation, leading to disappointment. Persistent difficulty with nutrition delays recovery, and confusion regarding division of responsibility between primary and specialist care leads to increased anxiety and feelings of vulnerability. Information on self-care is perceived as inadequate. Furthermore, provided information is not always understood and therefore not useful.CONCLUSION: Information before and after surgery must be tailored to meet the needs of older persons, considering the patient's knowledge and ability to understand. Furthermore, individual nutritional requirements and preoperative physical activity and status must be taken into account when planning rehabilitation. This article is protected by copyright. All rights reserved.
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