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- Derogar, M., et al.
(author)
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Hospital teaching status and volume related to mortality after pancreatic cancer surgery in a national cohort
- 2015
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In: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 102:5, s. 548-557
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Journal article (peer-reviewed)abstract
- Background: The association between hospital teaching status and mortality after pancreatic resection is not well explored. Although hospital volume is related to short-term mortality, the effect on long-term survival needs investigation, taking into account hospital teaching status and selective referral patterns. Methods: This was a nationwide retrospective register-based cohort study of patients undergoing pancreatic resection between 1990 and 2010. Follow-up for survival was carried out until 31 December 2011. The associations between hospital teaching status and annual hospital volume and short-, intermediate- and long-term mortality were determined by use of multivariable Cox regression models, which provided hazard ratios (HRs) with 95 per cent c.i. The analyses were mutually adjusted for hospital teaching status and volume, as well as for patients' sex, age, education, co-morbidity, type of resection, tumour site and histology, time interval, referral and hospital clustering. Results: A total of 3298 patients were identified during the study interval. Hospital teaching status was associated with a decrease in overall mortality during the latest interval (years 2005-2010) (university versus non-university hospitals: HR 0.72, 95 per cent c.i. 0.56 to 0.91; P = 0.007). During all time periods, hospital teaching status was associated with decreased mortality more than 2 years after surgery (university versus non-university hospitals: HR 0.86, 0.75 to 0.98; P = 0.026). Lower annual hospital volume increased the risk of short-term mortality (HR for 3 or fewer compared with 4-6 pancreatic cancer resections annually: 1.60, 1.04 to 2.48; P = 0.034), but not long-term mortality. Sensitivity analyses with adjustment for tumour stage did not change the results. Conclusion: Hospital teaching status was strongly related to decreased mortality in both the short and long term. This may relate to processes of care rather than volume per se. Very low-volume hospitals had the highest short-term mortality risk.
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- Sadr-Azodi, O., et al.
(author)
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Pattern of increasing HbA(1c) levels in patients with diabetes mellitus before clinical detection of pancreatic cancer - a population-based nationwide case-control study
- 2015
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In: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 54:7, s. 986-992
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Journal article (peer-reviewed)abstract
- Background. Diabetes mellitus is a risk factor for pancreatic cancer. Impaired insulin resistance might precede the clinical detection of this cancer by several years. Methods. This was a nested case-control population-based study assessing the pattern of glycated hemoglobin (HbA(1c)) change before clinical detection of pancreatic cancer in a population of individuals with diabetes mellitus. All patients registered in the Swedish National Diabetes Register with a prescription of an anti-diabetic drug between 2005 and 2011 were identified. For each case of pancreatic cancer, 10 controls were randomly selected, matched for age, sex, and factors related to diabetes mellitus. Multivariable conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between HbA(1c) and pancreatic cancer. Results. In total, 391 cases and 3910 matched controls were identified. The risk of pancreatic cancer was increased more than two-fold in individuals with the highest HbA(1c) quartile compared with the lowest (OR 1.96, 95% CI 1.40-2.75). The risk of pancreatic cancer remained elevated when comparing the highest HbA(1c) quartile measured within five years from the clinical detection of pancreatic cancer to the lowest HbA(1c) quartile (p-value for trend < 0.05). No association was found between HbA(1c) and pancreatic cancer if HbA(1c) was measured > 5 years before the clinical detection of pancreatic cancer. Conclusions. The pattern of increasing HbA(1c) in patients with diabetes mellitus preceded the clinical detection of pancreatic cancer by up to five years. These findings indicate that there is a lead time of several years during which the development of pancreatic cancer might be detectable through screening in patients with diabetes mellitus.
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- Stromberg, J, et al.
(author)
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Cholecystectomy in Patients with Liver Cirrhosis
- 2015
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In: Gastroenterology research and practice. - : Hindawi Limited. - 1687-6121 .- 1687-630X. ; 2015, s. 783823-
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Journal article (peer-reviewed)abstract
- Background. The aim of this population-based study was to describe characteristics of patients with liver cirrhosis undergoing cholecystectomy and evaluate the risk for perioperative and postoperative complications during the 30-day postoperative period.Method. All laparoscopic and open cholecystectomy procedures registered between 2006 and 2011 in the Swedish Registry for Gallstone Surgery and ERCP (GallRiks) were included. Patients with liver cirrhosis were identified by linking data to the Swedish National Patient Registry (NPR).Results. Of 62,488 patients undergoing cholecystectomy, 77 (0.12%) had cirrhosis, of which 29 patients (37.7%) had decompensated cirrhosis. Patients with cirrhosis were older and had more often gallstone complications at the time for surgery. Postoperative complications were registered in 13 (16.9%) patients with liver cirrhosis and in 5,738 (9.2%) patients in the noncirrhotic group(P<0.05). Univariable analysis showed that patients with liver cirrhosis are more likely to receive postoperative blood transfusion (OR = 4.4, CI 1.08–18.0,P<0.05) and antibiotic treatment >1 day (OR = 2.3, CI 1.11–4.84,P<0.05) than noncirrhotic patients.Conclusion. Patients with cirrhosis undergoing cholecystectomy have a higher incidence of postoperative complications than patients without cirrhosis. However, cholecystectomy is safe and if presented with adequate indication, surgery should not be delayed due to fears of surgical complications.
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