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| 3. |
- Angenete, Eva, 1972, et al.
(författare)
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Physical activity before radical prostatectomy reduces sick leave after surgery : results from a prospective, non-randomized controlled clinical trial (LAPPRO)
- 2016
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Ingår i: BMC Urology. - : Springer Science and Business Media LLC. - 1471-2490. ; 16:1, s. 50-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Studies have reported that early physical rehabilitation after surgical procedures is associated with improved outcome measured as shorter hospital stay and enhanced recovery. The aim of this study was to explore the relationship between the preoperative physical activity level and subsequent postoperative complications, sick-leave and hospital stay after radical prostatectomy for prostate cancer in the setting of the LAPPRO trial (LAParoscopic Prostatectomy Robot Open). METHODS: LAPPRO is a prospective controlled trial, comparing robot-assisted laparoscopic and open surgery for localized prostate cancer between 2008 and 2011. 1569 patients aged 64 or less with an occupation were included in this sub-study. The Gleason score was <7 in 52 % of the patients. Demographics and the level of self-assessed preoperative physical activity, length of hospital stay, complications, quality of life, recovery and sick-leave were extracted from clinical record forms and questionnaires. Multivariable logistic regression, with log-link and logit-link functions, was used to adjust for potential confounding variables. RESULTS: The patients were divided into four groups based on their level of activity. As the group with lowest engagement of physical activity was found to be significantly different in base line characteristics from the other groups they were excluded from further analysis. Among patients that were physically active preoperativelly (n = 1467) there was no significant difference between the physical activity-groups regarding hospital stay, recovery or complications. However, in the group with the highest self-assessed level of physical activity, 5-7 times per week, 13 % required no sick leave, compared to 6.3 % in the group with a physical activity level of 1-2 times per week only (p < 0.0001). CONCLUSIONS: In our study of med operated with radical prostatectomy, a high level of physical activity preoperatively was associated with reduced need for sick leave after radical prostatectomy compared to men with lower physical activity. TRIAL REGISTRATION: The trial is registered at the ISCRTN register. ISRCTN06393679 .
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- Correa-Marinez, Adiela, et al.
(författare)
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Stoma-Const - the technical aspects of stoma construction: study protocol for a randomised controlled trial.
- 2014
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- The construction of a colostomy is a common procedure, but the evidence for the different parts of the construction of the colostomy is lacking. Parastomal hernia is a common complication of colostomy formation. The aim of this study is to standardise the colostomy formation and to compare three types of colostomy formation (one including a mesh) regarding the development of parastomal hernia.
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| 7. |
- Nilsson, Hanna, et al.
(författare)
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Is preoperative physical activity related to post-surgery recovery? : A cohort study of patients with breast cancer
- 2016
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of our study is to assess the association between preoperative level of activity and recovery after breast cancer surgery measured as hospital stay, length of sick leave and self-assessed physical and mental recovery. Design: A prospective cohort study. Setting: Patients included were those scheduled to undergo breast cancer surgery, between February and November 2013, at two participating hospitals in the Western Region of Sweden. Participants: Patients planned for breast cancer surgery filled out a questionnaire before, as well as at 3 and 6 weeks after the operation. The preoperative level of activity was self-assessed and categorised into four categories by the participants using the 4-level SaltinGrimby Physical Activity Level Scale (SGPALS). Main outcome measure: Our main outcome was postoperative recovery measured as length of sick leave, in-hospital stay and self-assessed physical and mental recovery. Results: 220 patients were included. Preoperatively, 14% (31/220) of participants assessed themselves to be physically inactive, 61% (135/220) to exert some light physical activity (PA) and 20% (43/220) to be more active (level 3+4). Patients operated with mastectomy versus partial mastectomy and axillary lymph node dissection versus sentinel node biopsy were less likely to have a short hospital stay, relative risk (RR) 0.88 (0.78 to 1.00) and 0.82 (0.70 to 0.96). More active participants (level 3 or 4) had an 85% increased chance of feeling physically recovered at 3 weeks after the operation, RR 1.85 (1.20 to 2.85). No difference was seen after 6 weeks. Conclusions: The above study shows that a higher preoperative level of PA is associated with a faster physical recovery as reported by the patients 3 weeks post breast cancer surgery. After 6 weeks, most patients felt physically recovered, diminishing the association above. No difference was seen in length of sick leave or self-assessed mental recovery between inactive or more active patients.
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| 8. |
- Nilsson, Hanna, 1979-, et al.
(författare)
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Mortality after groin hernia surgery : delay of treatment and cause of death
- 2011
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Ingår i: Hernia. - Paris : Springer. - 1265-4906 .- 1248-9204. ; 15:3, s. 301-307
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Emergency hernia surgery, in contrast to elective hernia surgery, is associated with appreciable mortality. Incarcerated hernia is the second most common cause of small bowel obstruction after adhesions, and the leading cause of bowel strangulation.METHODS: Information on patients who died within 30 days of groin hernia surgery was retrieved from the Swedish Hernia Register, from the Cause-of-Death Register, and from hospital notes.RESULTS: Of 103,710 groin hernia operations between 1992 and 2004, 292 patients died within 30 days of surgery. Hospital notes and cause of death were retrieved for 242 cases (82%). In 5 of these patients, the hernia operation was done in addition to more urgent surgery and therefore excluded from further analyses; 152 patients were admitted as emergency cases and 55 of these patients underwent bowel resection. A total of 107 patients had signs of bowel obstruction when admitted. For 37% of these patients, physical examination of the groin was not documented. Patients with bowel obstruction without a note on a palpable groin lump were more likely to undergo imaging investigation preoperatively (P < 0.001) and they had an increased time to surgery compared to patients with a palpable lump. Women and patients with femoral hernia were significantly less likely to undergo a groin examination compared to other patients. Local anaesthesia was used in 7% of all patients who died postoperatively, and in 3% of emergency cases. Pulmonary disease, sepsis and malignant disease were more common as causes of death after emergency surgery than after elective surgery.CONCLUSIONS: Groin examination of patients presenting with bowel obstruction is of utmost importance in order to minimise delay to hernia surgery.
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- Onerup, Aron, 1983, et al.
(författare)
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The preoperative level of physical activity is associated to the postoperative recovery after elective cholecystectomy : A cohort study
- 2015
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Ingår i: International Journal of Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1743-9191 .- 1743-9159. ; 19:July, s. 35-41
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Tidskriftsartikel (refereegranskat)abstract
- Introduction There is an increasing interest in the role of preoperative physical activity for postoperative recovery. The effect of preoperative physical activity and recovery after cholecystectomy is unknown. The aim of this study was to evaluate the association of self-reported leisure-time preoperative physical activity with postoperative recovery and complications after elective cholecystectomy due to gallstone disease. Methods Prospective observational cohort study with 200 patients scheduled to undergo elective cholecystectomy. Level of self-assessed leisure-time physical activity was compared with recovery. Results Regular physical activity was associated with a higher degree of return to work within three weeks post-operatively (relative chance (RC) 1.26, p = 0.040); with a higher chance of leaving hospital within one day post-op (RC 1.23, p = 0.001), as well as with better mental recovery (RC 1.18, p = 0.049), compared to physically inactive. No statistically significant association was seen with return to work within one week or with self-assessed physical recovery. Discussion In clinical practice, evaluating the patients’ level of physical activity is feasible, and may potentially be used to identify patients being more suitable for same-day surgery. Given the study design, the results from this study cannot prove causality. Conclusion The present study shows that the preoperative leisure-time physical activity-level, is positively associated with less sick leave, a shorter hospital stay and with better mental recovery, three weeks post-elective cholecystectomy. We recommend assessing the physical activity-level preoperatively for prognostic reasons. If preoperative/postoperative physical training will increase recovery remains to be shown in a randomized controlled study.
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| 10. |
- Rosemar, Anders, 1958, et al.
(författare)
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Body mass index and diverticular disease: a 28-year follow-up study in men.
- 2008
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Ingår i: Diseases of the colon and rectum. - : Ovid Technologies (Wolters Kluwer Health). - 0012-3706. ; 51:4, s. 450-5
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Diverticular disease increased steadily concomitant with elevated rates of overweight and obesity during the 20th century. Therefore, the objective of this study was to investigate whether overweight and obesity in midlife predict future diverticular disease in men. METHODS: This was a prospective cohort study of a general population of men living in Göteborg, Sweden. A community-based sample of 7,494 men, investigated when aged 47 to 55 years, were followed from baseline in 1970 to 1973 for a maximum of 28 years. Hospitalization with a discharge diagnosis of diverticular disease according to the Swedish hospital discharge register was measured. RESULTS: Totally, 112 men (1.5 percent) were hospitalized with diverticular disease. A relationship between body mass index and diverticular disease was demonstrated; men with a body mass index between 20 and 22.5 kg/m(2) had the lowest risk. After adjustment for covariates, the risk increased linearly in men who had a body mass index of 22.5 to 25 (multiple-adjusted hazard ratio, 2.3; 95 percent confidence interval, 0.9-6; 25-27.5 (hazard ratio, 3 (1.2-7.6)), 27.5-30 (hazard ratio 3.2, (1.2-8.6)), and 30 or greater (hazard ratio 4.4, (1.6-12.3)) kg/m(2) (P for linear trend = 0.004). Men with a body mass index of
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| 11. |
- Rosemar, Anders, 1958, et al.
(författare)
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Body mass index and groin hernia: a 34-year follow-up study in Swedish men
- 2008
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Ingår i: Annals of Surgery. - 1528-1140. ; 247:6, s. 1064-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Inguinal hernias are very common disorders, especially in men, with inguinal herniorrhaphy being one of the most frequently performed general surgical procedures in men. Theoretically, obesity might increase the risk of groin hernia by increasing intra-abdominal pressure. The objective of the present study was to investigate whether overweight and obesity in middle age could significantly predict future groin hernia in men. SUMMARY BACKGROUND DATA: Design: Prospective cohort study; Setting: General population of men living in Gothenburg, Sweden; Participants: A community-based sample of 7483 men aged 47 to 55 years were followed-up from baseline (1970-1973) for a maximum of 34 years. MAIN OUTCOME MEASURES: A diagnosis of groin hernia according to the Swedish hospital discharge register. RESULTS: A total of 1017 men (13.6%) were diagnosed with groin hernia. An inverse relationship was found between body mass index (BMI) and risk of groin hernia. With each BMI unit (3-4 kg), the relative risk for groin hernia decreased by 4% (P < 0.0001). Compared with men of normal weight, obese men had a 43% lower risk (P = 0.0008, 95% confidence interval 21%-59%). Heavy smokers demonstrated a 26% lower risk for groin hernia (P = 0.003, 95% confidence interval 10%-39%). Diabetes, high physical activity, and blood pressure were not associated with groin hernia. Entering other variables potentially associated with groin hernia, as age, BMI, smoking, and serum cholesterol, in a multivariable analysis left the risk estimates for BMI and smoking virtually unchanged. CONCLUSIONS: In a large community-based sample of middle-aged men overweight and obesity were associated with a lower risk for groin hernia during an extended follow-up. Obesity, in comparison with normal weight, reduced the risk of groin hernia by 43%. A reduced risk of groin hernia was also noted in heavy smokers. Obviously, hernia may be more easily detected in lean men but a true protective effect cannot be excluded.
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| 12. |
- Rosemar, Anders, 1958, et al.
(författare)
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Effect of body mass index on groin hernia surgery.
- 2010
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Ingår i: Annals of Surgery. - : Lippincott, Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 252:2, s. 397-401
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyze the effect of underweight, overweight, and obesity in relation to clinical characteristics, the risk of postoperative complications, 30-day mortality, and reoperations for recurrence after groin hernia surgery. SUMMARY OF BACKGROUND DATA: Groin hernia surgery is one of the most frequent operations performed in general surgery. Several studies have demonstrated a protective effect of overweight and obesity on the risk of developing primary groin hernia. However, obesity has also been suggested to increase the risk for recurrence of groin hernia. METHODS: Through the Swedish Hernia Register, 49,094 primary groin hernia operations were identified between January 1, 2003 and December 31, 2007. Patients were divided into 4 body mass index (BMI) groups: BMI 1, <20 kg/m2; BMI 2, 20 to 25 kg/m2; BMI 3, 25-30 kg/m2; and BMI 4, >30 kg/m2. RESULTS: Of the 49,094 patients, 3.5% had a BMI <20 kg/m2 and 5.2% were obese. Altogether, women constituted only 7.7% of the studied group, but among patients with BMI <20 kg/m2 that had surgical procedures for femoral hernia, 81.4% were women. The relation between BMI and postoperative complications was U-shaped and after adjustment for age, gender, and emergency procedure, patients with BMI <20 and >25 had a significant increased risk when compared with patients with BMI from 20 to 25. Reoperation for recurrence of groin hernia has an increased hazard ratio of 1.20 (95% confidence interval, 1.00-1.40) in overweight, which was particularly evident after open suture and preperitoneal mesh techniques. CONCLUSIONS: In this large and unselected population of patients with a first surgical procedure for groin hernia a relative dominance of female and femoral hernias presented as an emergency condition was observed in the low BMI group. The prevalence of obesity was markedly low. Both lean and obese patients had an increased risk for postoperative complications.
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| 13. |
- Schulman, S., et al.
(författare)
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Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients
- 2010
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Ingår i: Journal of Thrombosis and Haemostasis. - : Elsevier BV. - 1538-7933 .- 1538-7836. ; 8:1, s. 202-204
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Tidskriftsartikel (refereegranskat)abstract
- The definition of major bleeding varies between studies on surgical patients, particularly regarding the criteria for surgical wound-related bleeding. This diversity contributes to the difficulties in comparing data between trials. The Scientific and Standardization Committee (SSC), through its subcommittee on Control of Anticoagulation, of the International Society on Thrombosis and Haemostasis has previously published a recommendation for a harmonized definition of major bleeding in non-surgical studies. That definition has been adopted by the European Medicines Agency and is currently used in several non-surgical trials. A preliminary proposal for a parallel definition for surgical studies was presented at the 54(th) Annual Meeting of the SSC in Vienna, July 2008. Based on those discussions and further consultations with European and North American surgeons with experience from clinical trials a definition has been developed that should be applicable to all agents that interfere with hemostasis. The definition and the text that follows have been reviewed and approved by relevant co-chairs of the subcommittee and by the Executive Committee of the SSC. The intention is to seek approval of this definition from the regulatory authorities to enhance its incorporation into future clinical trial protocols.
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| 14. |
- Schulman, S, et al.
(författare)
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Response to rebuttal, definition of major bleeding in surgery: an anaesthesiologist's point of view.
- 2010
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Ingår i: Journal of thrombosis and haemostasis. - : Elsevier BV. - 1538-7836 .- 1538-7933. ; 8:6, s. 1443-1444
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Tidskriftsartikel (refereegranskat)abstract
- See also Schulman S, Angeras U, Bergqvist D, Eriksson B, Lassen MR, Fisher W. Definition of major bleeding in clinical investigations of anti-hemostatic medicinal products in surgical patients. J Thromb Haemost 2010; 8: 202–4; Rosencher N, Zufferey P, Samama C-M. Definition of major bleeding in surgery: an anesthesiologist's point of view: a rebuttal. This issue, pp 1442–3. We read with interest the comments by Rosencher et al. about our definition of major bleeding in surgical patients. The component of our definition that is the focus of this discussion is criterion 5, i.e. the unexpected bleeding with some additional requirements [1]. We are aware that anesthesiologists frequently make use of more detailed calculations of blood loss. Their way of calculating blood loss is certainly more accurate than the criterion of a defined drop in hemoglobin or the need for 2 or more units of blood transfusion. In theory, such calculations are physiologically relevant for the decision to give a blood transfusion and may, therefore, result in more appropriate and hopefully reduced use of blood transfusions as indicated in the OSTHEO study [2]. However, criteria that are based on blood loss calculations have never been used for recognition of major bleeding. One of us (B.E.) evaluated blood loss, transfusion requirement and delta-hemoglobin in phase II studies on desirudin and melagatran. These variables had a lower sensitivity than the surgeon’s subjective view of ’serious bleeding‘ or ’overt bleeding‘ in the dose response of these anticoagulants. There is thus insufficient evidence to propose that calculated blood loss could be superior to differentiate between drug-induced and surgical bleeding. The European Medicines Agency (EMEA) guideline from 2007 (printed 2008) [3] is the one we want to improve and correct with our set of definitions. That guideline primarily uses the criteria defined by ISTH for medical patients. As additional support, calculated blood loss is in the middle of a long list of examples. In our work with the ISTH guidelines, we have tried to consider the important factors for both the surgeon and the patient. At the same time, it was necessary to create a definition that could not only be applied to most types of surgery represented in clinical trials using new anticoagulants, but also to keep it comparatively simple. The fact that both European and North American orthopedic and general surgeons could agree on these criteria was a big step forward. Although we admit that criterion no. 5 remains partly subjective, we find that the criterion suggested by Rosencher et al., ’all abnormal bleeding notified by the local investigator‘ is highly subjective and susceptible to influence by the knowledge that the patient is taking part in a trial with a new hemostatic agent. In trials, the local investigator is frequently not the operating surgeon. Who better than the surgeon present in the operating theatre, can assess what is unexpected (for the circumstances) and what represents prolonged bleeding? Some of us have been members of multiple committees for central event-adjudication for these studies, and we have often found that advice from the surgeon is the most helpful for gauging the seriousness of the wound bleeding and any likely association to study drug rather than to other bleeding risk factors. We, therefore, feel that the ISTH guideline for surgical patients is workable, in line with standard clinical practice and acceptable in any multicenter trial. A completely scientific and evidence-based process to develop ideal guidelines should select different strict criteria and prospectively evaluate their sensitivity for clinically important outcomes, including long-term function.
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