| 1. |
- Almquist, Martin, et al.
(author)
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Management of the exterior branch of the superior laryngeal nerve among thyroid surgeons - Results from a nationwide survey.
- 2015
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In: International Journal of Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1743-9159 .- 1743-9191. ; 20, s. 46-51
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Journal article (peer-reviewed)abstract
- The external branch of the superior laryngeal nerve is important for the voice. However, it is unknown how thyroid surgeons manage this nerve during operations. We hypothesised that this management is related to the surgeon's age, gender, the surgeons' annual number of thyroid operations, i.e volume, and surgical specialisation.
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| 2. |
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| 3. |
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| 4. |
- Björnsson, Bergthor, et al.
(author)
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Segment 4 occlusion in portal vein embolization increase future liver remnant hypertrophy : A Scandinavian cohort study
- 2020
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In: International Journal of Surgery. - : ELSEVIER. - 1743-9191 .- 1743-9159. ; 75, s. 60-65
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Journal article (peer-reviewed)abstract
- Background: The additional value of including segment 4 (S4) portal branches in right portal vein embolization (rPVE) is debated. The aim of the study was to explore this in a large multicenter cohort.Material and methods: A retrospective cohort study consisting of all patients subjected to rPVE from August 2012 to May 2017 at six Scandinavian university hospitals. PVE technique was essentially the same in all centers, except for the selection of main embolizing agent (particles or glue). All centers used coils or particles to embolize S4 branches. A subgroup analysis was performed after excluding patients with parts of or whole S4 included in the future liver remnant (FLR).Results: 232 patients were included in the study, of which 36 received embolization of the portal branches to S4 in addition to rPVE. The two groups (rPVE vs rPVE + S4) were similar (gender, age, co-morbidity, diagnosis, neoadjuvant chemotherapy, bilirubin levels prior to PVE and embolizing material), except for diabetes mellitus which was more frequent in the rPVE + S4 group (p = 0.02). Pre-PVE FLR was smaller in the S4 group (333 vs 380 ml, p = 0.01). rPVE + S4 resulted in a greater percentage increase of the FLR size compared to rPVE alone (47 vs 38%, p = 0.02). A subgroup analysis, excluding all patients with S4 included in the FLR, was done. There was no longer a difference in pre-PVE FLR between groups (333 vs 325 ml, p = 0.9), but still a greater percentage increase and also absolute increase of the FLR in the rPVE + S4 group (48 vs 38% and 155 vs 112 ml, p = 0.01 and 0.02).Conclusion: In this large multicenter cohort study, additional embolization of S4 did demonstrate superior growth of the FLR compared to standard right PVE.
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| 5. |
- Byrne, Guerard W, et al.
(author)
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Recent investigations into pig antigen and anti-pig antibody expression.
- 2015
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In: International journal of surgery (London, England). - : Ovid Technologies (Wolters Kluwer Health). - 1743-9159 .- 1743-9191. ; 23:Part B, s. 223-228
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Journal article (peer-reviewed)abstract
- Genetic engineering of donor pigs to eliminate expression of the dominant xenogeneic antigen galactose α1,3 galactose (Gal) has created a sea change in the immunobiology of xenograft rejection. Antibody mediated xenograft rejection of GGTA-1 α-galactosyltransferase (GTKO) deficient organs is now directed to a combination of non-Gal pig protein and carbohydrate antigens. Glycan analysis of GTKO tissues identified no new neo-antigens but detected high levels of N-acetylneuraminic acid (Neu5Gc) modified glycoproteins and glycolipids. Humans produce anti-Neu5Gc antibody and in very limited clinical studies sometimes show an induced anti-Neu5Gc antibody response after challenge with pig tissue. The pathogenicity of anti-Neu5Gc antibody in xenotransplantation is not clear however as non-human transplant models, critical for modelling anti-Gal immunity, do not produce anti-Neu5Gc antibody. Antibody induced after xenotransplantation in non-human primates is directed to an array of pig endothelial cells proteins and to a glycan produced by the pig B4GALNT2 gene. We anticipate that immune suppression will significantly affect the T-cell dependent and independent specificity of an induced antibody response and that donor pigs deficient in synthesis of multiple xenogeneic glycans will be important to future studies.
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| 6. |
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| 8. |
- Dahlberg, Karuna, 1979-, et al.
(author)
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“Let the patient decide” – person-centered postoperative follow-up contacts, initiated via a phone app after day surgery : secondary analysis of a randomized controlled trial
- 2019
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In: International Journal of Surgery. - : Elsevier. - 1743-9191 .- 1743-9159. ; , s. 33-37
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Journal article (peer-reviewed)abstract
- BACKGROUND: Patients undergoing day surgery are expected to manage their recovery on their own. Follow-up routines differ, but many patients have expressed a need for more professional support during recovery. The aim of this study was to describe how many follow-up contacts were initiated, and when and why, via a digital solution. Also, we wanted to compare postoperative recovery and characteristics between patients requesting, and patients not requesting, contact.MATERIALS AND METHODS: This was a secondary analysis of a multicenter, two-group, parallel randomized controlled trial. Participants used a digital solution called "Recovery Assessment by Phone Points (RAPP)" for initiating follow-up contacts after day surgery. The quality of postoperative recovery was measured with the Swedish web-version of Quality of Recovery.RESULTS: Of 494 patients, 84 (17%) initiated contact via RAPP. The most common reasons for initiating contact were related to the surgical wound and pain. Contacts were initiated across the 14-day assessment period, with 62% (62/100) in the first postoperative week. The RAPP contact group had significantly poorer postoperative recovery on days 1-14 compared to those not requesting contact via RAPP (p < 0.001). There was a significantly higher proportion of patients who had undergone general anesthesia in the RAPP contact group (85% [71/84]) compared to the non-RAPP contact group (71% [291/410]), p = 0.003.CONCLUSION: Letting the patient decide him/herself whether, and when, contact and support is needed during the postoperative period, is possible and does not increase the frequency of contacts. This study investigates a digital solution, RAPP, as one example of a person-centered approach that can be implemented in day surgery follow-up.
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| 9. |
- Dev, HS, et al.
(author)
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Letter to the editor of IJS
- 2010
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In: International journal of surgery (London, England). - : Elsevier BV. - 1743-9159 .- 1743-9191. ; 8:5, s. 411-411
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Journal article (other academic/artistic)
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| 10. |
- El Boghdady, Michael, et al.
(author)
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The influence of music on the surgical task performance : A systematic review
- 2020
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In: International Journal of Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1743-9191 .- 1743-9159. ; 73, s. 101-112
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Research review (peer-reviewed)abstract
- Introduction: Music is commonly played in operating theatres. Music was shown to diminish stress of the surgical team along with reducing the patients anxiety before surgery. On the other hand, it has been revealed that music might give rise to negative effects of divided attention causing distraction in surgical routines. Therefore, we aimed to systematically review the effect of music on the surgeon's task performance.Methods: A systematic review was performed in compliance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines. A literature search using PubMed/Medline, ScienceDirect and Google Scholar, was performed by means of the search terms: music and operating theatre, as well as music and surgery. The search was limited to citations in English from year 2009-2018. Search items were considered from the nature of the articles, date of publication, forum of publication, aims and main findings in relation to use of music in operating theatres. Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were applied. Studies were included based on predetermined inclusion criteria where after the papers' quality assessments and evidence grading were completed by two independent reviewers. The protocol was registered with the PROSPERO register of systematic reviews.Results: Out of 18 studies that formed the base for evidence evaluations, 6 studies were assessed as having high quality and 8 studies of moderate quality. Five studies, provided both strong and moderate scientific evidence for a positive effect of music on surgeon's task performance. In contrast, strong scientific evidence for a negative effect of music on surgeon's task performance also was revealed in 2 high-quality studies. Nevertheless, the positive effect of music on the surgical task performance was significantly higher when compared to its negative effect (p < 0.0001).Conclusion: Certain music elements affect the surgical task performance in a positive or negative way. The total and significant outcome of the present study was that the positive effect of music on surgeon's task performance, overrides its negative effect. Classic music when played with a low to medium volume can improve the surgical task performance by increasing both accuracy and speed. The distracting effect of music should also be put in consideration when playing a loud or high-beat type of music in the operating theatres.
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| 11. |
- Falk, Peter, 1962, et al.
(author)
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TGF-β1 promotes transition of mesothelial cells into fibroblast phenotype in response to peritoneal injury in a cell culture model.
- 2013
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In: International journal of surgery (London, England). - : Ovid Technologies (Wolters Kluwer Health). - 1743-9159 .- 1743-9191. ; 11:9, s. 977-982
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Journal article (peer-reviewed)abstract
- Peritoneal adhesions are a clinical problem. A key to the understanding of peritoneal adhesions is to study the healing of mesothelial cells within the peritoneal cavity following surgery. Transforming growth factor beta (TGF-βs) affects this healing process. The aim of this study was to investigate the effects of different concentrations of TGF-β1 on the healing rate and healing properties of mesothelial cells.
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| 12. |
- Hernandez-Alejandro, Roberto, et al.
(author)
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Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure for colorectal liver metastasis
- 2020
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In: International Journal of Surgery. - : ELSEVIER. - 1743-9191 .- 1743-9159. ; 82, s. 103-108
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Research review (peer-reviewed)abstract
- Since first described, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) has garnered boisterous praise and fervent criticism. Its rapid adoption and employment for a variety of indications resulted in high perioperative morbidity and mortality. However recent risk stratification, refinement of technique to reduce the impact of stage I and progression along the learning curve have resulted in improved outcomes. The first randomized trial comparing ALPPS to two stage hepatectomy (TSH) for colorectal liver metastases (CRLM) was recently published demonstrating comparable perioperative morbidity and mortality with improved resectability and survival following ALPPS. In this review, as ALPPS enters the thirteenth year since conception, the current status of this contentious two stage technique is presented and best practices for deployment in the treatment of CRLM is codified.
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| 13. |
- Jildenstål, Pether K., 1970-, et al.
(author)
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AAI-guided anaesthesia is associated with lower incidence of 24-h MMSE < 25 and may impact the IL-6 response
- 2014
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In: International Journal of Surgery. - : Elsevier. - 1743-9191 .- 1743-9159. ; 12:4, s. 290-295
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Journal article (peer-reviewed)abstract
- Introduction: Trauma stress and neuro-inflammation caused by surgery/anaesthesia releases cytokines. This study analysed impact of Auditory Evoked Potential Index (AAI) depth-of-anaesthesia titration on the early plasma IL-6 release after eye surgery under general anaesthesia.Method: This is a subgroup analysis of a prospective randomized study on the effect of auditory evoked potential guided anaesthesia for eye surgery. Plasma IL-6 levels taken before, 5 and 24 h after end of surgery from 450 patients undergoing elective ophthalmic surgery under desflurane anaesthesia were analysed. Minimal mental state examination (MMSE) was also tested at 24-h.Results: IL-6 increased significantly at both 5 and further at 24 h after surgery (3.2, 4.5 and 5.1 base-line, 5 and 24-h respectively), the IL-6 increase showed different patterns between the 2 groups; IL-6 was significantly increased in the control group of patients between preoperative baseline and 24 h after surgery (p = 0.008) also between 5 h and 24 h, (p = 0.006) after surgery while the AAI-group had only minor non-significant changes. The 18 patients that showed a 24-h MMSE score less than 25 had a significant higher 24-h IL-6 compared to the 390 patients with a MMSE score > 24 (p = 0.002).Conclusion: The IL-6 increase after surgery was less pronounced in patients where anaesthesia was titrated by AAI compared to anaesthesia adjusted on clinical signs only. IL-6 were also found to be higher in patients with a MMSE < 25 at 24-h. Further studies are warranted evaluating the role of depth of anaesthesia monitoring on the risk for early cognitive impairment and neuro-inflammation.
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| 14. |
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| 15. |
- Klopf, Johannes, et al.
(author)
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MetAAA trial patients show superior quality of life compared to patients under regular surveillance for small AAA : a single-center retrospective cohort study
- 2023
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In: International Journal of Surgery. - : LIPPINCOTT WILLIAMS & WILKINS. - 1743-9191 .- 1743-9159. ; 109:4, s. 861-869
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Journal article (peer-reviewed)abstract
- Background: Abdominal aortic aneurysm (AAA) is a multifactorial vascular disease associated with high morbidity and mortality. Currently, surgical intervention is the only treatment option, and there is no drug therapy available for AAA. Hence, surveillance of AAA until indication for surgery may impact patient quality of life (QoL). There is a paucity of high-quality observational data on health status and QoL, particularly among AAA patients participating in randomized controlled trials. The objective of this study was to compare the QoL scores of AAA patients on surveillance to those of AAA patients enrolled in the MetAAA trial.Material and methods: Overall, 54 MetAAA trial patients and 23 AAA patients under regular surveillance for small AAA (part of a longitudinal monitoring study) were asked to complete three established and validated (in total 561 longitudinally collected) QoL questionnaires: the 36-Item Short Form Health Survey (SF-36), the Aneurysm Symptom Rating Questionnaire (ASRQ), and the Aneurysm-Dependent Quality of Life questionnaire (ADQoL).Results: A superior health status and QoL was found in AAA patients participating in the MetAAA trial compared to AAA patients under regular surveillance. In detail, MetAAA trial patients showed superior general health perception (P=0.012), higher energy level (P=0.036) as well as enhanced emotional well-being (P=0.044) and fewer limitations due to general malaise (P=0.021), which was subsequently reflected in an overall superior current QoL score (P=0.039) compared to AAA patients under regular surveillance.Conclusion: AAA patients enrolled in the MetAAA trial showed superior health status and QoL compared to AAA patients under regular surveillance.
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| 16. |
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| 17. |
- Lluis, Nuria, et al.
(author)
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Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study)
- 2023
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In: International Journal of Surgery. - : LIPPINCOTT WILLIAMS & WILKINS. - 1743-9191 .- 1743-9159. ; 109:4, s. 760-771
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Journal article (peer-reviewed)abstract
- Background/Purpose:Intraductal papillary neoplasm of the bile duct (IPNB) is a rare disease in Western countries. The main aim of this study was to characterize current surgical strategies and outcomes in the mainly European participating centers. Methods:A multi-institutional retrospective series of patients with a diagnosis of IPNB undergoing surgery between 1 January 2010 and 31 December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association. The textbook outcome (TO) was defined as a non-prolonged length of hospital stay plus the absence of any Clavien-Dindo grade at least III complications, readmission, or mortality within 90 postoperative days. Results:A total of 28 centers contributed 85 patients who underwent surgery for IPNB. The median age was 66 years (55-72), 49.4% were women, and 87.1% were Caucasian. Open surgery was performed in 72 patients (84.7%) and laparoscopic in 13 (15.3%). TO was achieved in 54.1% of patients, reaching 63.8% after liver resection and 32.0% after pancreas resection. Median overall survival was 5.72 years, with 5-year overall survival of 63% (95% CI: 50-82). Overall survival was better in patients with Charlson comorbidity score 4 or less versus more than 4 (P=0.016), intrahepatic versus extrahepatic tumor (P=0.027), single versus multiple tumors (P=0.007), those who underwent hepatic versus pancreatic resection (P=0.017), or achieved versus failed TO (P=0.029). Multivariable Cox regression analysis showed that not achieving TO (HR: 4.20; 95% CI: 1.11-15.94; P=0.03) was an independent prognostic factor of poor overall survival. Conclusions:Patients undergoing liver resection for IPNB were more likely to achieve a TO outcome than those requiring a pancreatic resection. Comorbidity, tumor location, and tumor multiplicity influenced overall survival. TO was an independent prognostic factor of overall survival.
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| 18. |
- Lovely, Jenna K., et al.
(author)
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Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS (R)) programs
- 2019
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In: International Journal of Surgery. - : Elsevier. - 1743-9191 .- 1743-9159. ; 63, s. 58-62
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Research review (peer-reviewed)abstract
- One of the most durable approaches to perioperative enhanced recovery programming has culminated in the formation of perioperative organizations devoted to improvements in the quality of the surgical patient experience, such as the Enhanced Recovery After Surgery (ERAS (R)) Society. Members of the American College of Clinical Pharmacy (ACCP) Perioperative Care Practice and Research Network (PRN) and officials from the ERAS (R) Society present an opinion that: (1) identifies therapeutic options within each pharmacotherapy-intensive area of ERAS (R); (2) generates applied research questions that would allow for comparative analyses of pharmacotherapy options within ERAS (R) programs; (3) proposes collaborative practice opportunities between key stakeholders in the surgical journey and clinical pharmacists to manage drug therapy problems and research questions; and (4) highlights examples of pharmacist-led cost savings attributed to ERAS (R) implementation. Clinical pharmacists, working in this manner with the perioperative team across the care continuum, have optimized pharmacotherapy towards measurable outcomes improvements, and stand ready to partner with inter-professional stakeholders and organizations to advance the care of our mutual patients.
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| 19. |
- Meier, RPH, et al.
(author)
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Current status of hepatocyte xenotransplantation
- 2015
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In: International journal of surgery (London, England). - : Ovid Technologies (Wolters Kluwer Health). - 1743-9159 .- 1743-9191. ; 23:Pt B, s. 273-279
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Journal article (peer-reviewed)
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| 20. |
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| 21. |
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| 23. |
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| 24. |
- Onerup, Aron, 1983, et al.
(author)
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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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In: International Journal of Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1743-9191 .- 1743-9159. ; 19:July, s. 35-41
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Journal article (peer-reviewed)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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| 25. |
- Pantiora, Eirini, et al.
(author)
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Effect of mode of delivery of patient reported outcomes in patients with breast disease : a randomised controlled trial
- 2024
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In: International Journal of Surgery. - : Lippincott Williams & Wilkins. - 1743-9191 .- 1743-9159. ; 110:1, s. 176-182
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Journal article (peer-reviewed)abstract
- Background: Patient reported outcomes (PROs) have an integral role on how to improve patients' overall experience. The optimal PROs delivery in patients with breast disease is an important issue since PROs are steadily integrated in routine care.Methods: An institutional phase 3 randomised controlled, open-label trial. Eligible candidates were adult women with perceived or confirmed breast disease. Computer generated randomization was used to allocate interventions: collection of PROs in electronic or paper form. Our objective was the effectiveness of electronic versus paper form of PROs. The main outcome measures were: response rate, reported experience, administrative resources, and carbon dioxide emissions.Results: Two hundred thirty-eight patients were randomised. After loss-to-follow-up and consent withdrawals, 218 participants (median age, IQR=55, 21; n=110/n=108) were included in the per-intention-to-treat analysis. Response rate was 61.8% for electronic patient reported outcomes (ePROs) and 63.9% for paper patient reported outcomes (pPROs) (difference=-2.1%, 95% CI: -15.8-11.7%). Only known breast cancer at recruitment was predictive for response in multivariable analysis. ePROs were associated with a 57% reduction in administrative time required, a 95% reduction in incremental costs, and 84% reduction in carbon dioxide emissions, all differences being significant. No difference was detected in perception of PRO significance or ease of completion, but participants experienced that they needed less time to complete ePROs [median, (IQR) 10 (9) respectively 15(10)]. Finally, respondents would prefer ePROs over pPROs (difference 48.1%, 95% CI: 32.8-63.4%).Conclusion: ePROs do not increase the response rate in patients with perceived or confirmed breast disease. However, they can enhance patient experience, reduce incremental costs, facilitate administrative logistics, and are more sustainable. On the basis of these findings, both modalities should continue to be available.
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| 26. |
- Parker, Mike, et al.
(author)
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A historical perspective on the introduction of laparoscopic basic surgical training in the Caribbean and factors that contribute to sustainability of such training
- 2019
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In: International Journal of Surgery. - : ELSEVIER. - 1743-9191 .- 1743-9159. ; 72, s. 6-12
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Research review (peer-reviewed)abstract
- Objective: To report the development of minimally invasive training courses and workshops in the Caribbean and specifically the establishment of the Basic Surgical Skills Course of the Royal College of Surgeons of England (RCSEng) in Trinidad with respect to their value toward Surgical laparoscopic or minimally invasive training in the Caribbean. Design: & Methods: The literature written on laparoscopy in the region was reviewed and in particular that related to the minimally invasive training courses provided over the period 2004 to 2019 and the development of laparoscopic surgical training described from a historic perspective. The factors that contribute to sustainability of courses were identified. Results: Laparoscopic surgical training courses were sporadically introduced into the Caribbean over the period 2004 to 2019 in countries including Barbados, Curacao, Guyana, St. Lucia, Jamaica and Trinidad & Tobago. These were timed and closely related to the establishment of the Caribbean College of Surgeons (CCOS) with the help of the Royal College of Surgeons of England. However, the only certified course introduced was the Basic Surgical Skills (BSS) course of the RCSEng into Trinidad in 2012. This has now been established as a recognised overseas centre by the RCSEng and provides the Intercollegiate BSS course annually forming a solid basis for trainees to learn safe surgical and laparoscopic skills prior to commencing formal surgical training. This has resulted in the sustainable development of minimally invasive training in Trinidad in particular. Conclusion: Laparoscopic skills courses and workshops have been established in the Caribbean for 15 years beginning circa. 2004 to 2019 and have grown in number and locations throughout the Caribbean. The RCSEng and the CCOS have been instrumental in the development process. Of note, the only recognised overseas training centre for Basic Surgical Skills Course was established in Trinidad & Tobago with the support of the RCSEng and seems to be the main contributor to the successful, regular maintenance of these and other minimally invasive courses in General Surgery, ENT, Gynaecology and other fields on an annual, sustainable basis.
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| 27. |
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| 28. |
- Ristl, Robin, et al.
(author)
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Comparing maximum diameter and volume when assessing the growth of small abdominal aortic aneurysms using longitudinal CTA data : cohort study
- 2023
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In: International Journal of Surgery. - : Wolters Kluwer. - 1743-9191 .- 1743-9159. ; 109:8, s. 2249-2257
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Journal article (peer-reviewed)abstract
- Background: Monitoring of abdominal aortic aneurysms (AAAs) is currently based on serial measurements of maximum aortic diameter. Additional assessment of aneurysm volume has previously been proposed to possibly improve growth prediction and treatment decisions. To evaluate the use of supplementing volume measurements, the authors aimed to characterise the growth distribution of AAA volume and to compare the growth rates of the maximum diameter and volume at the patient level.Methods: Maximum diameter and volume were monitored every 6 months in 84 patients with small AAAs, with a total of 331 computed tomographic angiographies (with initial maximum diameters of 30-68 mm). A previously developed statistical growth model for AAAs was applied to assess the growth distribution of volume and to compare individual growth rates for volume and for maximum diameter.Results: The median (25-75% quantile) expansion in volume was 13.4 (6.5-24.7) % per year. Cube root transformed volume and maximum diameter showed a closely linear association with a within-subject correlation of 0.77. At the surgery threshold maximum diameter of 55 mm, the median (25-75% quantile) volume was 132 (103-167) ml. In 39% of subjects, growth rates for volume and maximum diameter were equivalent, in 33% growth was faster in volume and in 27% growth was faster in maximum diameter.Conclusion: At the population level, volume and maximum diameter show a substantial association such that the average volume is approximately proportional to the average maximum diameter raised to a power of three. At the individual level, however, in the majority of patient's AAAs grow at different pace in different dimensions. Hence, closer monitoring of aneurysms with sub-critical diameter but suspicious morphology may benefit from complementing maximum diameter by volume or related measurements.
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| 29. |
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| 30. |
- Sellbrant, I, et al.
(author)
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Anaesthetics and analgesics; neurocognitive effects, organ protection and cancer reoccurrence an update.
- 2016
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In: International journal of surgery (London, England). - : Ovid Technologies (Wolters Kluwer Health). - 1743-9159 .- 1743-9191. ; 34, s. 41-46
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Journal article (peer-reviewed)abstract
- Available general and local anaesthetics, third generation inhaled anaesthetics, propofol and amide class local anaesthetics are effective and reassuringly safe. They are all associated to low incidence of toxicology and or adverse-effects. There is however a debate whether anaesthetic drug and technique could exhibit effects beyond the primary effects; fully reversible depression of the central nervous system, dose dependent anaesthesia. Anaesthetics may be involved in the progression of neurocognitive side effects seen especially in the elderly after major surgery, so called Postoperative Cognitive Dysfunction. On the other hand anaesthetics may exhibit organ protective potential, reducing ischemia reperfusion injury and improving survival after cardiac surgery. Anaesthetics and anaesthetic technique may also have effects of cancer reoccurrence and risk for metastasis. The present paper provides an update around the evidence base around anaesthesia potential contributing effect on the occurrence of postoperative cognitive adverse-effects, organ protective properties and influence on cancer re-occurrence/metastasis.
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| 35. |
- Sooriakumaran, P
(author)
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Surgery-induced angiogenesis
- 2005
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In: International journal of surgery (London, England). - : Elsevier BV. - 1743-9159 .- 1743-9191. ; 3:4, s. 289-90
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Journal article (other academic/artistic)
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| 36. |
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| 37. |
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| 38. |
- Suleiman, Adeiza S., et al.
(author)
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Impact of antibiotic-coated sutures on surgical site infections : a second-order meta-analysis
- 2024
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In: International Journal of Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1743-9191 .- 1743-9159. ; 110:1, s. 507-519
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Journal article (peer-reviewed)abstract
- Background:Surgical site infections (SSIs) pose a global challenge, impacting patients and healthcare expenditures. This second-order meta-analysis endeavors to assess the efficacy of antibiotic sutures in averting SSIs by amalgamating data from various meta-studies.Materials and methods:This research adhered to the PRISMA 2020 guidelines. The quality and comprehensiveness of the encompassed meta-analyses were assessed through the QUOROM checklist and AMSTAR techniques. The primary study overlap was evaluated via measures such as pairwise intersection heat maps, corrected covered area, and the citation matrix of evidence. The statistical power at the study-level was determined utilizing the meta-meta package. Data synthesis employed random and fixed effects models at a 95% CI. A meta-regression analysis was conducted to explore potential correlations between the CDC classification of SSIs, trial types, and the observed effect sizes in the studies.Results:This investigation revealed a significant reduction in SSI rates due to antimicrobial-coated sutures, evidenced by a relative risk (RR) of 0.68 (95% CI: 0.59-0.76), with a prediction interval of 0.38-1.19. The analysis encompassed 18 studies with 22 meta-analyses, demonstrating a median QUOROM score of 13.6 out of 18 and an AMSTAR score of 9.1 out of 11. The presence of moderate heterogeneity was noted (Q=106.611, I2=54.038%), with nonrandomized controlled trials exhibiting an RR of 0.56 (95% CI: 0.39-0.80), and RCTs displaying an RR of 0.71 (95% CI: 0.63-0.81). Subgroup analysis unveiled variable RR reductions for specific surgical procedures.Conclusion:Antimicrobial-coated sutures offer a promising approach to mitigating SSIs risk. However, their efficacy is optimally realized when employed in conjunction with other robust practices.
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| 42. |
- Warrén Stomberg, Margareta, et al.
(author)
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Day surgery, variations in routines and practices a questionnaire survey.
- 2013
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In: International journal of surgery (London, England). - : Ovid Technologies (Wolters Kluwer Health). - 1743-9159 .- 1743-9191. ; 11:2, s. 178-182
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Journal article (peer-reviewed)abstract
- BACKGROUND: Day surgery is expanding however little is known about every day practice and routines. METHODS: A web-based questionnaire including 34 questions with fixed multiple choice responses around routine and practice for the perioperative handling of patients scheduled for day case surgery was send to 100 hospitals. RESULTS: There was an overall response rate of 70%. Most centres had a dedicated day surgery unit (87%). Preoperative assessment routines, when, how and by whom varied. Patient self-assessment questionnaires were common practice (87%). Upper age limit was uncommon (10%), lower age limit common (77%), and fixed high body mass index-limitation showed a mixed pattern, mean 40%. Postoperative nauseas and vomiting-risk stratification varied mean 46%. Anxiolytic premedication was uncommon. Administration of oral analgesics varied, mean 70%; paracetamol (94%), NSAIDs (80%) and opioid (28%). Preferred general anaesthesia technique varied considerable. Laryngeal mask airway was consistently used. Management of pain while in hospital was consistently performed. A majority centres provided take-home analgesics "tablet-package" (69%) or as prescription (80%). Strong opioids to be taken at home were given or prescribed by 59% of units. Written information about the postoperative care was common practice (90%), written instruction about management of pain was less frequently provided (69%). Most hospitals (93%) had standardised discharge criteria, including demand of an escort (75%) and not being alone first postoperative night (81%). CONCLUSIONS: We found that regime for day surgical anaesthesia practice varied between as well as within countries. There is obvious room for further research on how to achieve safe and cost-effective logistics and practice for day case surgery.
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| 43. |
- Warrén Stomberg, Margareta, et al.
(author)
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Preoperative centre improving patients' satisfaction?
- 2013
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In: International journal of surgery (London, England). - : Ovid Technologies (Wolters Kluwer Health). - 1743-9159 .- 1743-9191. ; 11:5, s. 430-431
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Journal article (peer-reviewed)
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| 44. |
- Wefer, Agnes, et al.
(author)
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Patient-reported adverse events after hernia surgery and socio-economic status : A register-based cohort study
- 2016
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In: International Journal of Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1743-9191 .- 1743-9159. ; 35, s. 100-103
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Journal article (peer-reviewed)abstract
- BACKGROUND: The aim of the present study was to assess how socio-economic background influences perception of an adverse postoperative event after hernia surgery, and to see if this affects the pattern of seeking healthcare advice during the early postoperative period.MATERIALS AND METHODS: All patients aged 15 years or older with a primary unilateral inguinal or femoral hernia repair recorded in the Swedish Hernia Register (SHR) between November 1 and December 31, 2002 were sent a questionnaire inquiring about adverse events. Data on civil status, income, level of education and ethnic background were obtained from Statistics Sweden.RESULTS: Of the 1643 patients contacted, 1440 (87.6%) responded: 1333 (92.6%) were men and 107 (7.4%) women, mean age was 59 years. There were 203 (12.4%) non-responders. Adverse events were reported in the questionnaire by 390 (27.1%) patients. Patients born in Sweden and patients with high income levels reported a significantly higher incidence of perceived adverse events (p < 0.05). Patients born in Sweden and females reported more events requiring healthcare contact. There was no association between registered and self-reported outcome and civil status or level of education.CONCLUSION: We detected inequalities related to income level, gender and ethnic background. Even if healthcare utilization is influenced by socio-economic background, careful information of what may be expected in the postoperative period and how adverse events should be managed could lead to reduced disparity and improved quality of care in the community at large.
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| 45. |
- Öbrink, Emma, et al.
(author)
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Post-operative nausea and vomiting : Update on predicting the probability and ways to minimize its occurrence, with focus on ambulatory surgery
- 2015
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In: International Journal of Surgery. - : Elsevier. - 1743-9191 .- 1743-9159. ; 15, s. 100-106
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Research review (peer-reviewed)abstract
- Postoperative nausea and vomiting "the little big problem" after surgery/anaesthesia is still a common side-effect compromising quality of care, delaying discharge and resumption of activities of daily living. A huge number of studies have been conducted in order to identify risk factors, preventive and therapeutic strategies. The Apfel risk score and a risk based multi-modal PONV prophylaxis is advocated by evidence based guidelines as standards of care but is not always followed. Tailored anaesthesia and pain management avoiding too liberal dosing of anaesthetics and opioid analgesics is also essential in order to reduce risk. Thus multi-modal opioid sparing analgesia and a risk based PONV prophylaxis should be provided in order to minimise the occurrence. There is however still no way to guarantee an individual patient that he or she should not experience any PONV. Further studies are needed trying to identify risk factors and ways to tailor the individual patient prevention/therapy are warranted.The present paper provides a review around prediction, factors influencing the occurrence and the management of PONV with a focus on the ambulatory surgical patient.
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| 46. |
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| 47. |
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| 48. |
- Ekström, Eva, et al.
(author)
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Hyperglycemia and insulin infusion in pancreatoduodenectomy : a prospective cohort study on feasibility and impact on complications
- 2023
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In: International journal of surgery (London, England). - 1743-9159. ; 109:12, s. 3770-3777
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Journal article (peer-reviewed)abstract
- BACKGROUND: Hyperglycemia is a risk factor for postoperative complications but its impact on outcome after pancreatoduodenectomy (PD) is scarcely studied. This prospective cohort study aimed to assess the effect of continuous insulin infusion on postoperative complications and blood glucose, as well as to evaluate the impact of hyperglycemia on complications, after PD. MATERIALS AND METHODS: One hundred patients planned for PD at Skåne University Hospital, Sweden were prospectively included for perioperative continuous insulin infusion and a historic cohort of 100 patients was included retrospectively. Median blood glucose levels were calculated and data on complications were analyzed and compared between the historic cohort and the intervention group as well as between normo- and hyperglycemic patients. RESULTS: Median glucose levels were significantly lower in the intervention group compared to the historic cohort up to 30 days postoperatively (median glucose 8.5 mmol/l (interquartile range 6.4-11) vs. 9.1 mmol/l (interquartile range 6.8-17) ( P =0.007)). No significant differences in complication rates were recorded between these two groups. The incidence of complications classified as Clavien ≥3 was higher in hyperglycemic patients (100 vs. 27%, P =0.024). Among hyperglycemic patients the prevalence of preoperative diabetes was higher compared to normoglycemic patients (52 vs.12%, P <0.001). In patients with a known diagnosis of diabetes, a trend, although not statistically significant, towards a lower incidence of postoperative pancreatic fistula grade B and C, as well as postpancreatectomy hemorrhage grade B and C, was seen compared to those without preoperative diabetes (6.8 vs. 14%, P =0.231 and 2.3 vs. 7.0%, P =0.238, respectively). CONCLUSION: Insulin infusion in the early postoperative phase after PD is feasible in a non-ICU setting and significantly decreased blood glucose levels. The influence on complications was limited. Preoperative diabetes was a significant predictor of postoperative hyperglycemia and was associated with a lower incidence of clinically significant postoperative pancreatic fistula.
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| 49. |
- Hedström, Jonas, et al.
(author)
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Cholecystectomy and ERCP in pregnancy : a nationwide register-based study
- 2024
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In: International journal of surgery (London, England). - 1743-9159. ; 110:1, s. 324-331
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The objective was to examine the outcomes of cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy and compare these outcomes with those in nonpregnant women of fertile age. SUMMARY BACKGROUND DATA: Although both laparoscopic cholecystectomy and ERCP are considered safe and feasible in pregnant patients, there is still concern and uncertainty regarding gallstone intervention during pregnancy. This study aimed to investigate outcomes in pregnant patients compared to outcomes in nonpregnant patients. METHODS: Data on all female patients aged 18-45 years were retrieved from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The patients were divided into groups according to intervention: cholecystectomy, ERCP, or a combination thereof. Differences between pregnant and nonpregnant patients were analyzed. RESULTS: A total of 21 328 patients were included, with 291 cholecystectomy and 63 ERCP procedures performed in pregnant patients. At the 30-day follow-up, more complications after cholecystectomy were registered for pregnant patients. However, pregnancy was not a significant risk factor for adverse events when adjusting for previous complicated gallstone disease, intraoperative complications, emergency surgery, and common bile duct stones. There were no differences in outcomes when comparing cholecystectomy among the different trimesters. ERCP had no significant effect on outcomes at the 30-day follow-up. CONCLUSION: Cholecystectomy, ERCP, and combinations thereof are safe during pregnancy.
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| 50. |
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