| 1. |
- Dave, Nishi, et al.
(författare)
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Nosocomial SARS-CoV-2 infections and mortality during unique COVID-19 epidemic waves
- 2023
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 6:11
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Quantifying the burden of nosocomial SARS-CoV-2 infections and associated mortality is necessary to assess the need for infection prevention and control measures.Objective: To investigate the occurrence of nosocomial SARS-CoV-2 infections and associated 30-day mortality among patients admitted to hospitals in Region Stockholm, Sweden.Design, Setting, and Participants: A retrospective, matched cohort study divided the period from March 1, 2020, until September 15, 2022, into a prevaccination period, early vaccination and pre-Omicron (period 1), and late vaccination and Omicron (period 2). From among 303 898 patients 18 years or older living in Region Stockholm, 538 951 hospital admissions across all hospitals were included. Hospitalized admissions with nosocomial SARS-CoV-2 infections were matched to as many as 5 hospitalized admissions without nosocomial SARS-CoV-2 by age, sex, length of stay, admission time, and hospital unit.Exposure: Nosocomial SARS-CoV-2 infection defined as the first positive polymerase chain reaction test result at least 8 days after hospital admission or within 2 days after discharge.Main Outcomes and Measures: Primary outcome of 30-day mortality was analyzed using time-to-event analyses with a Cox proportional hazards regression model adjusted for age, sex, educational level, and comorbidities.Results: Among 2193 patients with SARS-CoV-2 infections or reinfections (1107 women [50.5%]; median age, 80 [IQR, 71-87] years), 2203 nosocomial SARS-CoV-2 infections were identified. The incidence rate of nosocomial SARS-CoV-2 infections was 1.57 (95% CI, 1.51-1.64) per 1000 patient-days. In the matched cohort, 1487 hospital admissions with nosocomial SARS-CoV-2 infections were matched to 5044 hospital admissions without nosocomial SARS-CoV-2 infections. Thirty-day mortality was higher in the prevaccination period (adjusted hazard ratio [AHR], 2.97 [95% CI, 2.50-3.53]) compared with period 1 (AHR, 2.08 [95% CI, 1.50-2.88]) or period 2 (AHR, 1.22 [95% CI, 0.92-1.60]). Among patients with nosocomial SARS-CoV-2 infections, 30-day AHR comparing those with 2 or more doses of SARS-CoV-2 vaccination and those with less than 2 doses was 0.64 (95% CI, 0.46-0.88).Conclusions and Relevance: In this matched cohort study, nosocomial SARS-CoV-2 infections were associated with higher 30-day mortality during the early phases of the pandemic and lower mortality during the Omicron variant wave and after the introduction of vaccinations. Mitigation of excess mortality risk from nosocomial transmission should be a strong focus when population immunity is low through implementation of adequate infection prevention and control measures.
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| 2. |
- Hedberg, Suzanne, et al.
(författare)
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BEST: Bypass equipoise sleeve trial; rationale and design of a randomized, registry-based, multicenter trial comparing Roux-en-Y gastric bypass with sleeve gastrectomy
- 2019
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Ingår i: Contemporary Clinical Trials. - : Elsevier BV. - 1551-7144 .- 1559-2030. ; 84
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Tidskriftsartikel (refereegranskat)abstract
- Background: Laparoscopic gastric bypass (LGBP) is a well-documented surgical intervention for severe obesity. Recently, laparoscopic sleeve gastrectomy (LSG) has gained increased popularity. Short-term follow-up in limited-sized randomized trials comparing LGBP and LSG show no major differences in weight-loss, adverse events, or effect on comorbidities; however, there is a lack of sufficiently powered, pragmatic, randomized controlled trials comparing the mid- and long-term results of the two methods. Method: BEST is a randomized, registry-based, multicenter trial comparing LGBP and LSG. The trial has two primary outcomes; rates of substantial complications (SC) and total body weight loss. We hypothesize that patients treated with LSG will experience 35% fewer substantial complications during the 5-year follow-up compared to patients treated with LGBP, and that the efficacy of LSG will remain within a non-inferiority margin of 5% in terms of weight loss. Our sample size calculation, using data from the Scandinavian Obesity Surgery Registry (SOReg), shows a power of 80% for SC and > 95% for weight loss at p < .025 with a total of 2100 included patients. The design of the trial will also enable comparisons within several relevant patient subgroups. Conclusions: As a large-sized, pragmatic, randomized trial, BEST will provide robust data comparing LGBP with LSG by generating long-term results on weight loss and SC's, as well as secondary outcomes and comparisons within patient subgroups. The use of a well-established registry for registration of all data facilitates a large multicenter trial, and combines the strengths of registry studies with those of a randomized trial. Clinical Trials registry: NCT 02767505. © 2019 Elsevier Inc.
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| 3. |
- Hedberg, Suzanne, et al.
(författare)
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Comparison of Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass : A Randomized Clinical Trial
- 2024
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: Laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB) are widely used bariatric procedures for which comparative efficacy and safety remain unclear.OBJECTIVE: To compare perioperative outcomes in SG and RYGB.DESIGN, SETTING, AND PARTICIPANTS: In this registry-based, multicenter randomized clinical trial (Bypass Equipoise Sleeve Trial), baseline and perioperative data for patients undergoing bariatric surgery from October 6, 2015, to March 31, 2022, were analyzed. Patients were from university, regional, county, and private hospitals in Sweden (n = 20) and Norway (n = 3). Adults (aged ≥18 years) eligible for bariatric surgery with body mass indexes (BMIs; calculated as weight in kilograms divided by height in meters squared) of 35 to 50 were studied.INTERVENTIONS: Laparoscopic SG or RYGB.MAIN OUTCOMES AND MEASURES: Perioperative complications were analyzed as all adverse events and serious adverse events (Clavien-Dindo grade >IIIb). Ninety-day mortality was also assessed.RESULTS: A total of 1735 of 14 182 eligible patients (12%; 1282 [73.9%] female; mean (SD) age, 42.9 [11.1] years; mean [SD] BMI, 40.8 [3.7]) were included in the study. Patients were randomized and underwent SG (n = 878) or RYGB (n = 857). The mean (SD) operating time was shorter in those undergoing SG vs RYGB (47 [18] vs 68 [25] minutes; P < .001). The median (IQR) postoperative hospital stay was 1 (1-1) day in both groups. The 30-day readmission rate was 3.1% after SG and 4.0% after RYGB (P = .33). There was no 90-day mortality. The 30-day incidence of any adverse event was 40 (4.6%) and 54 (6.3%) in the SG and RYGB groups, respectively (odds ratio, 0.71; 95% CI, 0.47-1.08; P = .11). Corresponding figures for serious adverse events were 15 (1.7%) for the SG group and 23 (2.7%) for the RYGB group (odds ratio, 0.63; 95% CI, 0.33-1.22; P = .19).CONCLUSIONS AND RELEVANCE: This randomized clinical trial of 1735 patients undergoing primary bariatric surgery found that both SG and RYGB were performed with a low perioperative risk without clinically significant differences between groups.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02767505.
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| 4. |
- Hedberg, Suzanne
(författare)
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lmproving Procedure Selection and Surgical Technique in Bariatric Surgery
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bariatric surgery is currently the most effective treatment for obesity and its metabolic comorbidities. There are, however, unexplored differences between surgical methods regarding outcomes and suitability for the individual patient. There are also variations in surgical techniques, where the association between differences in outcomes are not fully explored. The overall aim of this thesis is to improve outcomes in bariatric surgery by optimizing procedure selection and refining surgical technique. Paper I describes the design and rationale of the Bypass Equipoise Sleeve Trial (BEST), a large registry-based randomized multicenter trial comparing sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB). In Paper II, the perioperative outcome of BEST is presented. Paper III is a retrospective study identifying, describing, and proposing a treatment option for postprandial symptoms due to a dysfunctional jejunojejunostomy after RYGB. Paper IV is a large observational registry study comparing surgical variations in the construction of the jejunojejunostomy regarding the association with post-operative small bowel obstruction. In this thesis it is concluded that: 1) Sleeve gastrectomy and RYGB can both be performed safely and with low perioperative risk in adult patients undergoing primary bariatric surgery; 2) Many patients having postprandial pain, nausea, and/or vomiting after RYGB, improve or become symptom-free after surgical revision of the jejunojejunostomy; and 3) The risk of small bowel obstruction varies with the type of surgical technique used for the jejunojejunostomy, both in the short and long term.
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| 5. |
- Hedberg, Suzanne, et al.
(författare)
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Surgical technique in constructing the jejunojejunostomy and the risk of small bowel obstruction after Roux-en-Y gastric bypass
- 2022
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289 .- 1878-7533. ; 18:9, s. 1151-1159
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mechanical problems at the level of the jejunojejunostomy (JJ) have been identified as a cause of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (RYGB). Objectives: The objective of the study was to investigate associations between specific surgical techniques used to construct the JJ and the subsequent risk of SBO. Setting: Nationwide Registry, Sweden. Methods: The risk of SBO after primary RYGB surgery during 2012-2019 was assessed using data from the Scandinavian Obesity Surgery Registry and the Swedish National Patient Register. The impact of unidirectional or bidirectional stapling and length of the mesenteric division (0, 1-4, or >= 5 cm) at the JJ was analyzed with adjustments for known covariates. Results: We analyzed outcomes from 23,448 patients (mean follow-up = 4.3 +/- 2.2 yr). In multivar-iate analysis, bidirectional stapling of the JJ was associated with a reduced 30-day risk of SBO (hazard ratio [HR] = .52, 95% confidence interval [CI] = .29-.95, P < .05), whereas limited mesenteric division (1-4 cm) increased the risk of SBO (HR = 1.66, 95% CI = 1.14-2.42, P < .01). The long-term incidence of SBO was increased by bidirectional stapling but unaffected by mesenteric division. However, mesenteric division decreased the long-term risk of SBO in patients with a bidirectionally stapled JJ (1-4 cm, HR = .59, 95% CI = .38-.90, P < .05; >= 5 cm, HR = .30, 95% CI = .14-.65, P < .005). Conclusions: The surgical technique for construction of the JJ may affect the incidence of SBO after RYGB surgery. (C) 2022 American Society for Bariatric Surgery. Published by Elsevier Inc.
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| 6. |
- Hedberg, Suzanne, et al.
(författare)
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The Jejunojejunostomy: an Achilles Heel of the Roux-en-Y Gastric Bypass Construction
- 2021
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 31, s. 5141-5147
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Tidskriftsartikel (refereegranskat)abstract
- Background Laparoscopic Roux-en-Y gastric bypass (RYGB) has for long been the gold standard technique in bariatric surgery, especially in the Scandinavian countries. In a tertiary hospital setting, we observed an increasing number of patients with postprandial abdominal pain and nausea, often associated with complex hypoglycemia. Objectives The present study aimed to characterize the clinical patterns, patient characteristics, and clinical outcomes after surgical revision of dysfunctional RYGB at Sahlgrenska University Hospital in Gothenburg, Sweden. Methods This cohort study included patients with RYGB who underwent revision of the jejunojejunostomy (JJ) after 2013. Information was obtained by reviewing medical records and performing complementary interviews. Results Laparoscopic revisional surgery was performed in 115 cases with either adhesiolysis or total revision of the JJ (mean age 41 years, range 19-67 years; 90% women). The median time to assessment after the last revision was 33 months (range 12-75 months). Forty-four (38%) patients reported that they were symptom-free long-term after the intervention, and 32 (28%) patients experienced an improvement in the symptoms that were the indication for revision. However, 31 (27%) patients reported no long-term improvement, and half of them (n = 16) subsequently had a reversal of the anatomy. Eight (7%) patients were lost to follow-up. Conclusions Dysfunction of the JJ appears to be a relatively common cause of postprandial pain and nausea after ante-colic/ante-gastric RYGB. Most patients with symptoms of dysfunction experienced partial or total relief following revisional surgery, but a substantial minority had persistent problems, with one in five eventually undergoing reversal of the anatomy.
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| 7. |
- Hellström, Micaela, et al.
(författare)
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Symbiodinium spp. diversity in a single host species, Galaxea fascicularis, Vietnam : Impact of environmental factors, host traits, and diversity hot spots
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- We determined the distribution of zooxanthellate ITS2 types within one broadcast spawning coral species,Galaxea fascicularis with horizontal symbiont uptake, in both inshore and offshore reef habitats over a 3200 km range along the coast of Vietnam, covering 11 degrees of latitude. Host traits (mtDNA genotype) and environmental factors (visibility, sea surface temperatures and Chlorophyll a derived from satellite data, regional measures of coral species diversity and distance from land (inshore/offshore)) were measured to test whether symbiont type distribution was determined by host characteristics or by environmental factors. The G. fascicularis and their associated symbionts were not genetically coupled to each other but to environmental factors The host displayed an inshore-offshore zonation, with higher diversity offshore. The D1a symbiont exhibited an inshore- offshore zonation. In contrast; the 5 different C symbiont types showed a latitudinal distribution gradient, which shifted in dominance north to south. We found regional differences in symbiont type; these were related to environmental differences and not to genetic characteristics in the coral G. fascicularis.
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| 8. |
- Laurenius, Anna, et al.
(författare)
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Possible relation between partial small bowel obstruction and severe postprandial reactive hypoglycemia after Roux-en-Y gastric bypass.
- 2019
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Ingår i: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. - : Elsevier BV. - 1878-7533 .- 1550-7289. ; 15:6, s. 1024-1028
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Tidskriftsartikel (refereegranskat)abstract
- Although dietary treatment ameliorates symptoms in most patients with postbariatric hypoglycemia (PBH), there is a subgroup with severe symptoms that do not respond sufficiently to either diet or drugs. A clinical observation showed that those patients additionally experienced postprandial abdominal discomfort or pain.This report describes patients with severe PBH following laparoscopic Roux-en Y gastric bypass undergoing corrective surgery to alleviate partial small bowel obstruction (kink, adhesions, dysfunctional anastomosis) and the subsequent outcome regarding symptoms of PBH.Sahlgrenska University Hospital, Sweden.Retrospective analysis regarding hypoglycemic symptoms from medical records and a complementary telephone interview.Out of 80 patients treated for severe PBH at our tertiary academic surgical unit over the last 4 years, 38 underwent corrective surgery (adhesiolysis and/or a reconstructed jejuno-jejunostomy). Out of 21 patients using medications to control hypoglycemia before corrective surgery, 19 (90.5%) discontinued the medication, and 5 of 19 (26%) no longer needed to use a blood glucometer or a continuous glucose monitor. Although patients after surgical correction still could experience PBH, symptoms were less frequent and less severe. Postprandial abdominal symptoms decreased, and patients reported improved eating quality. Patient interviews revealed that 8% became entirely free of PBH symptoms after surgery and 71% experienced significant relief.We propose a possible association between severe hypoglycemic symptoms after laparoscopic Roux-en Y gastric bypass and partial small bowel obstruction. Patients with PBH not responding adequately to diet and drug treatment may benefit from assessment and intervention for partial small bowel obstruction.
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| 9. |
- Olbers, Torsten, et al.
(författare)
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Resolution of Comorbidities Following Bariatric Surgery: Diabetes, Hypertension, Sleep Apnea, and Metabolic Syndrome
- 2023
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Ingår i: Obesity, Bariatric and Metabolic Surgery: A Comprehensive Guide: Second Edition. - Cham : Springer International Publishing. - 9783030605964 ; , s. 997-1004
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- One of the most exciting and unexpected findings in modern medicine is that a number of metabolic diseases appear to be effectively treated with gastrointestinal surgery. Over the last decades, several publications have demonstrated profound effects with improvement and even resolution of comorbidities in patients with obesity, following bariatric surgery. Further investigation revealed that substantial improvement of comorbidities can be achieved even in patients with mild obesity. This suggests, at least to some extent, the presence of weight loss independent mechanisms, and that the gut is a valid target for treatment of metabolic disorders. By using the term “metabolic surgery, " aims beyond weight loss are addressed for patients suffering from diseases such as type 2 diabetes mellitus (T2DM), sleep apnea, hypertension, and dyslipidemia. Interestingly, some recent data demonstrated a favorable impact, following bariatric surgery, on other comorbidities such as asthma, gout, and psoriasis, as well as cancer in women. This chapter aimed to summarize the current evidence regarding the positive effects of bariatric and metabolic surgery on the metabolic comorbidities such as T2DM, hypertension, sleep apnea, and the metabolic syndrome.
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