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Broholm M, Vogelsang R, Bulut M, Gögenur M, Stigaard T, Orhan A, Schefte X, Fiehn AMK, Gehl J, Gögenur I. Neoadjuvant calcium electroporation for potentially curable colorectal cancer. Surg Endosc 2024; 38:697-705. [PMID: 38017160 DOI: 10.1007/s00464-023-10557-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/22/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The development of new perioperative treatment modalities to activate the immune system in colorectal cancer might have a beneficial effect on reducing the risk of recurrence after surgery. Calcium electroporation is a promising treatment modality that potentially modulates the tumor microenvironment. The aim of this study was to evaluate the safety of the procedure in the neoadjuvant setting in localized left-sided colorectal cancer (CRC). METHODS The study included patients with potentially curable sigmoid or rectal cancer with no indication for other neoadjuvant treatment. Patients were offered calcium electroporation as a neoadjuvant treatment before elective surgery. Follow-up visits were conducted on the preoperative day before elective surgery, POD2, POD14, and POD30, with an evaluation of adverse events, impact on elective surgery, clinical examination, and quality of recovery. RESULTS Endoscopic calcium electroporation was performed as an outpatient procedure in all 21 cases, with no procedure-related complications reported. At follow-up, five adverse events were registered, two of which were classified as serious adverse events. Surgery was performed as planned in 19 patients (median time to surgery, 8 days), and the final two patients underwent surgery with a delay due to adverse events (14 and 33 days). No significant impact on the quality of recovery scores nor inflammatory markers were seen before and after calcium electroporation, nor baseline and POD30. CONCLUSIONS Endoscopic calcium electroporation is a safe and feasible procedure in patients with potentially curable CRC. The study showed limited side effects and limited impact on the following elective surgical resection.
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Affiliation(s)
- M Broholm
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark.
| | - R Vogelsang
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
| | - M Bulut
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - M Gögenur
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
| | - T Stigaard
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
| | - A Orhan
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - X Schefte
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
| | - A M K Fiehn
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - J Gehl
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - I Gögenur
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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2
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Bjoern MX, Clausen FB, Seiersen M, Bulut O, Bech-Knudsen F, Jansen JE, Gögenur I, Klein MF. Quality of life and functional outcomes after transanal total mesorectal excision for rectal cancer-results from the implementation period in Denmark. Int J Colorectal Dis 2022; 37:1997-2011. [PMID: 35960389 DOI: 10.1007/s00384-022-04219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The standard operation for mid- and low rectal cancer total mesorectal excision (TME) is routinely performed as minimally invasive surgery. TME is associated with temporary or permanent functional impairment of pelvic organs, causing reduced quality of life (QoL). Concerns have been raised that the newest minimally invasive approach, transanal TME (TaTME), may further reduce urogenital and anorectal functions. OBJECTIVE To determine if functional outcomes affecting QoL are altered after TaTME. Primary end-point is the impact of TaTME on QoL and functional outcomes. Secondary end-point is assessing differences in QoL and functional outcomes after TME surgery from below (TaTME) or above (transabdominal TME). DESIGN, SETTING, AND PARTICIPANTS Observational study consisting of prospectively registered self-reported questionnaire data collected at baseline and follow-ups after TaTME. All patients who underwent TaTME during the Danish national implementation phase were included. Central surveillance of the implementation included questionnaires concerning QoL and functional outcomes. Analyses of functional results from the Danish cohort of the ROLARR trial (Jayne et al. in JAMA 318:1569-1580, (2017) are reported separately for perspective, representing the transabdominal approach to TME, i.e., laparoscopic- or robotic-assisted TME (LaTME/RoTME). Applied questionnaires include EORTC QLQ-C30, SF-36, LARS, ICIQ-MLUTS, ICIQ-FLUTS, IPSS, IIEF, SVQ, and FSFI. RESULTS A total of 115 TaTME procedures were registered August 2016 to April 2019. LaTME/RoTME patients (n = 92) were operated on January 2011 to September 2014. A temporary postoperative decrease of QoL (global health status and functional scales) was observed, yet long-term results were unaffected by surgery in both groups. In TaTME patients, the anorectal dysfunction increased significantly (p < 0.001) from preoperative baseline to 13.5 months follow-up, where 67.5% (n = 52) reported major LARS symptoms. Urinary function was not significantly impaired after TME regardless of technique. The paucity of responses concerning sexual function precludes conclusions. CONCLUSIONS Although an initial reduction in QoL after TME occurs, it normalizes within the first year postoperatively. In concurrence with international results, we found that significant anorectal dysfunction is common after TaTME. No data on anorectal function was available for LaTME/RoTME patients for comparison. We found no indications that transanal TME is inferior to transabdominal TME surgery concerning urogenital functions or health-related QoL.
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Affiliation(s)
- M X Bjoern
- Copenhagen University Hospital Hvidovre, Hvidovre, Denmark. .,Centre for Surgical Science, Zealand University Hospital Køge, Køge, Denmark.
| | - F B Clausen
- Centre for Surgical Science, Zealand University Hospital Køge, Køge, Denmark
| | - M Seiersen
- Zealand University Hospital Køge, Køge, Denmark
| | - O Bulut
- Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - F Bech-Knudsen
- Colorectal Cancer Centre South, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - J E Jansen
- Copenhagen University Hospital North Zealand, Hillerød, Denmark
| | - I Gögenur
- Centre for Surgical Science, Zealand University Hospital Køge, Køge, Denmark.,Danish Colorectal Cancer Group (DCCG.Dk), Copenhagen, Denmark
| | - M F Klein
- Danish Colorectal Cancer Group (DCCG.Dk), Copenhagen, Denmark.,Copenhagen University Hospital Herlev, Herlev, Denmark
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3
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Lin V, Tsouchnika A, Allakhverdiiev E, Rosen AW, Gögenur M, Clausen JSR, Bräuner KB, Walbech JS, Rijnbeek P, Drakos I, Gögenur I. Training prediction models for individual risk assessment of postoperative complications after surgery for colorectal cancer. Tech Coloproctol 2022; 26:665-675. [PMID: 35593971 DOI: 10.1007/s10151-022-02624-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/20/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The occurrence of postoperative complications and anastomotic leakage are major drivers of mortality in the immediate phase after colorectal cancer surgery. We trained prediction models for calculating patients' individual risk of complications based only on preoperatively available data in a multidisciplinary team setting. Knowing prior to surgery the probability of developing a complication could aid in improving informed decision-making by surgeon and patient and individualize surgical treatment trajectories. METHODS All patients over 18 years of age undergoing any resection for colorectal cancer between January 1, 2014 and December 31, 2019 from the nationwide Danish Colorectal Cancer Group database were included. Data from the database were converted into Observational Medical Outcomes Partnership Common Data Model maintained by the Observation Health Data Science and Informatics initiative. Multiple machine learning models were trained to predict postoperative complications of Clavien-Dindo grade ≥ 3B and anastomotic leakage within 30 days after surgery. RESULTS Between 2014 and 2019, 23,907 patients underwent resection for colorectal cancer in Denmark. A Clavien-Dindo complication grade ≥ 3B occurred in 2,958 patients (12.4%). Of 17,190 patients that received an anastomosis, 929 experienced anastomotic leakage (5.4%). Among the compared machine learning models, Lasso Logistic Regression performed best. The predictive model for complications had an area under the receiver operating characteristic curve (AUROC) of 0.704 (95%CI 0.683-0.724) and an AUROC of 0.690 (95%CI 0.655-0.724) for anastomotic leakage. CONCLUSIONS The prediction of postoperative complications based only on preoperative variables using a national quality assurance colorectal cancer database shows promise for calculating patient's individual risk. Future work will focus on assessing the value of adding laboratory parameters and drug exposure as candidate predictors. Furthermore, we plan to assess the external validity of our proposed model.
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Affiliation(s)
- V Lin
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark.
| | - A Tsouchnika
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - E Allakhverdiiev
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - A W Rosen
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - M Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - J S R Clausen
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - K B Bräuner
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - J S Walbech
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - P Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - I Drakos
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - I Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
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Bojesen RD, Jørgensen LB, Grube C, Skou ST, Johansen C, Dalton SO, Gögenur I. Fit for Surgery—feasibility of short-course multimodal individualized prehabilitation in high-risk frail colon cancer patients prior to surgery. Pilot Feasibility Stud 2022; 8:11. [PMID: 35063042 PMCID: PMC8781359 DOI: 10.1186/s40814-022-00967-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/05/2022] [Indexed: 12/18/2022] Open
Abstract
Background Prehabilitation is a promising modality for improving patient-related outcomes after major surgery; however, very little research has been done for those who may need it the most: the elderly and the frail. This study aimed to investigate the feasibility of a short course multimodal prehabilitation prior to primary surgery in high-risk, frail patients with colorectal cancer and WHO performance status I and II. Methods The study was conducted as a single-center, prospective one-arm feasibility study of eight patients with colon cancer between October 4, 2018, and January 14, 2019. The intervention consisted of a physical training program tailored to the patients with both high-intensity interval training and resistance training three times a week in sessions of approximately 1 h in length, for a duration of at least 4 weeks, nutritional support with protein and vitamins, a consultation with a dietician, and medical optimization prior to surgery. Feasibility was evaluated regarding recruitment, retention, compliance and adherence, acceptability, and safety. Retention was evaluated as the number of patients that completed the intervention, with a feasibility goal of 75% completing the intervention. Compliance with the high-intensity training was evaluated as the number of sessions in which the patient achieved a minimum of 4 min > 90% of their maximum heart rate and adherence as the attended out of the offered training sessions. Results During the study period, 64 patients were screened for eligibility, and out of nine eligible patients, eight patients were included and seven completed the intervention (mean age 80, range 66–88). Compliance to the high-intensity interval training using 90% of maximum heart rate as the monitor of intensity was difficult to measure in several patients; however, adherence to the training sessions was 87%. Compliance with nutritional support was 57%. Half the patients felt somewhat overwhelmed by the multiple appointments and six out of seven reported difficulties with the dosage of protein. Conclusions This one-arm feasibility study indicates that multimodal prehabilitation including high-intensity interval training can be performed by patients with colorectal cancer and WHO performance status I and II. Trial registration Clinicaltrials.gov: the study current feasibility study was conducted prior to the initiation of a full ongoing randomized trial registered by NCT04167436; date of registration: November 18, 2019. Retrospectively registered. No separate prospectively registration of the feasibility trial was conducted but outlined by the approved study protocol (Danish Scientific Ethical Committee SJ-607). Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-00967-8.
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Wilhelmsen M, Njor SH, Roikjær O, Rasmussen M, Gögenur I. IMPACT OF SCREENING ON SHORT-TERM MORTALITY AND MORBIDITY FOLLOWING TREATMENT FOR COLORECTAL CANCER. Scand J Surg 2021; 110:465-471. [PMID: 34098830 DOI: 10.1177/14574969211019824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to describe short-term changes in morbidity and mortality associated with the implementation of screening for colorectal cancer in Denmark. MATERIALS AND METHODS Prospective cohort study with inclusion of all patients aged 50-75 years treated for colorectal cancer between 1 March 2014 and 31 December 2015 in Denmark. Adjusted hazard ratios were calculated for 30 and 90 days mortality using Cox Regression. We made two adjusted models-a "basic" adjusted for screening status, sex, age, smoking, alcohol consumption, and cancer type and an "advanced" that also included body mass index and American society of Anesthesiologists score in analyses. Relative risks were calculated for postoperative surgical and medical complications. RESULTS In total, 5348 patients were included. In the "basic model," adjusted risk of 30 and 90 days total mortality was reduced in the screen-detected group (p < 0.01, HR = 0.43, CI = 0.24-0.76) and (p < 0.01, HR = 0.45, CI = 0.30-0.69). In the "advanced model," only 90 days total mortality was significantly reduced in the screen-detected group (p = 0.01, HR 0.59, CI = 0.39-0.90). No significant changes were found with regard to surgical and medical complications, respectively, (p = 0.05 (CI = 0.76-1.00) and p = 0.47(CI = 0.74-1.15)). CONCLUSION This nationwide study showed that screening for colorectal cancer was associated with a lower 90 days total mortality although no significant improvements were seen with regard to morbidity.
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Affiliation(s)
- M Wilhelmsen
- Gastrounit, Surgical Division, Hvidovre Hospital, Hvidovre, Denmark
| | - S H Njor
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.,Danish Bowel Cancer Screening Database, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - O Roikjær
- Danish Bowel Cancer Screening Database, Aarhus N, Denmark.,Department of Surgery, Zealand University Hospital, Køge, Denmark.,University of Copenhagen, Copenhagen, Denmark.,Danish Colorectal Cancer Group (DCCG), Copenhagen, Denmark
| | - M Rasmussen
- Danish Bowel Cancer Screening Database, Aarhus N, Denmark.,University of Copenhagen, Copenhagen, Denmark.,Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - I Gögenur
- Department of Surgery, Zealand University Hospital, Køge, Denmark.,University of Copenhagen, Copenhagen, Denmark.,Danish Colorectal Cancer Group (DCCG), Copenhagen, Denmark
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6
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Vogelsang RP, Bojesen RD, Hoelmich ER, Orhan A, Buzquurz F, Cai L, Grube C, Zahid JA, Allakhverdiiev E, Raskov HH, Drakos I, Derian N, Ryan PB, Rijnbeek PR, Gögenur I. Prediction of 90-day mortality after surgery for colorectal cancer using standardized nationwide quality-assurance data. BJS Open 2021; 5:6272169. [PMID: 33963368 PMCID: PMC8105588 DOI: 10.1093/bjsopen/zrab023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background Personalized risk assessment provides opportunities for tailoring treatment, optimizing healthcare resources and improving outcome. The aim of this study was to develop a 90-day mortality-risk prediction model for identification of high- and low-risk patients undergoing surgery for colorectal cancer. Methods This was a nationwide cohort study using records from the Danish Colorectal Cancer Group database that included all patients undergoing surgery for colorectal cancer between 1 January 2004 and 31 December 2015. A least absolute shrinkage and selection operator logistic regression prediction model was developed using 121 pre- and intraoperative variables and internally validated in a hold-out test data set. The accuracy of the model was assessed in terms of discrimination and calibration. Results In total, 49 607 patients were registered in the database. After exclusion of 16 680 individuals, 32 927 patients were included in the analysis. Overall, 1754 (5.3 per cent) deaths were recorded. Targeting high-risk individuals, the model identified 5.5 per cent of all patients facing a risk of 90-day mortality exceeding 35 per cent, corresponding to a 6.7 times greater risk than the average population. Targeting low-risk individuals, the model identified 20.9 per cent of patients facing a risk less than 0.3 per cent, corresponding to a 17.7 times lower risk compared with the average population. The model exhibited discriminatory power with an area under the receiver operating characteristics curve of 85.3 per cent (95 per cent c.i. 83.6 to 87.0) and excellent calibration with a Brier score of 0.04 and 32 per cent average precision. Conclusion Pre- and intraoperative data, as captured in national health registries, can be used to predict 90-day mortality accurately after colorectal cancer surgery.
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Affiliation(s)
- R P Vogelsang
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - R D Bojesen
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark.,Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - E R Hoelmich
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - A Orhan
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - F Buzquurz
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - L Cai
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - C Grube
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - J A Zahid
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - E Allakhverdiiev
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark.,Odysseus Data Services Inc., Cambridge, Massachusetts, USA
| | - H H Raskov
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - I Drakos
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - N Derian
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - P B Ryan
- Department of Medical Informatics, Janssen Research & Development LLC, Raritan, New Jersey, USA.,Columbia University, New York, New York, USA
| | - P R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - I Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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7
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Wahlstrøm KL, Bjerrum E, Gögenur I, Burcharth J, Ekeloef S. Effect of remote ischaemic preconditioning on mortality and morbidity after non-cardiac surgery: meta-analysis. BJS Open 2021; 5:6176672. [PMID: 33733660 PMCID: PMC7970092 DOI: 10.1093/bjsopen/zraa026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/16/2020] [Indexed: 01/22/2023] Open
Abstract
Background Remote ischaemic preconditioning (RIPC) has been shown to have a protective role on vital organs exposed to reperfusion injury. The aim of this systematic review was to evaluate the effects of non-invasive RIPC on clinical and biochemical outcomes in patients undergoing non-cardiac surgery Methods A systematic literature search of PubMed, EMBASE, Scopus, and Cochrane databases was carried out in February 2020. RCTs investigating the effect of non-invasive RIPC in adults undergoing non-cardiac surgery were included. Meta-analyses and trial sequential analyses (TSAs) were performed on cardiovascular events, acute kidney injury, and short- and long-term mortality. Results Some 43 RCTs including 3660 patients were included. The surgical areas comprised orthopaedic, vascular, abdominal, pulmonary, neurological, and urological surgery. Meta-analysis showed RIPC to be associated with fewer cardiovascular events in non-cardiac surgery (13 trials, 1968 patients, 421 events; odds ratio (OR) 0.68, 95 per cent c.i. 0.47 to 0.96; P = 0.03). Meta-analyses of the effect of RIPC on acute kidney injury (12 trials, 1208 patients, 211 events; OR 1.14, 0.78 to 1.69; P = 0.50; I2 = 9 per cent), short-term mortality (7 trials, 1239 patients, 65 events; OR 0.65, 0.37 to 1.12; P = 0.12; I2 = 0 per cent), and long-term mortality (4 trials, 1167 patients, 9 events; OR 0.67, 0.18 to 2.55; P = 0.56; I2 = 0 per cent) showed no significant differences for RIPC compared with standard perioperative care in non-cardiac surgery. However, TSAs showed that the required information sizes have not yet been reached. Conclusion Application of RIPC to non-cardiac surgery might reduce cardiovascular events, but not acute kidney injury or all-cause mortality, but currently available data are inadequate to confirm or reject an assumed intervention effect.
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Affiliation(s)
- K L Wahlstrøm
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital, Koege, Denmark
| | - E Bjerrum
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital, Koege, Denmark
| | - I Gögenur
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital, Koege, Denmark
| | - J Burcharth
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital, Koege, Denmark
| | - S Ekeloef
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital, Koege, Denmark
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8
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Kleif J, Thygesen LC, Gögenur I. Moving from an era of open Appendectomy to an era of Laparoscopic Appendectomy: A Nationwide Cohort Study of Adult Patients Undergoing Surgery for Appendicitis. Scand J Surg 2021; 110:512-519. [PMID: 33563095 DOI: 10.1177/1457496921992615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS During the last decades, laparoscopic surgery has been introduced as an alternative to open surgery. We aimed to examine to what extent laparoscopic surgery has replaced open surgery for appendicitis in an entire nation during the last two decades. Second, we examined the effects of shifting to laparoscopic surgery for appendicitis on different quality indicators such as length of postoperative stay and mortality. We also examined age as a predictor of 30-day mortality. MATERIALS AND METHODS During the period 2000 to 2015, all adult patients with appendicitis and surgical removal of the appendix were identified in the Danish National Patient Register. Demographics, type of surgery, time of surgery, and duration of postoperative stay were retrieved form Danish National Patient Register. Vital status was retrieved from the Danish Civil Registration System. RESULTS A total of 58,093 patients underwent surgery for appendicitis. In 2000, a total of 274 out of 3717 (7.4%) had a laparoscopic appendectomy, and the postoperative stay was 55 (iqr: 35-88) h and 30-day mortality was 0.91%. In 2015, a total of 3995 out of 4296 (93.0%) had a laparoscopic appendectomy, and the postoperative stay was 16 (iqr: 9-56) h and 30-day mortality was 0.40%. Age as a predictor of 30-day postoperative mortality had an area under the curve of 0.93 (95% confidence interval: 0.92; 0.94). CONCLUSION In Denmark, the standard surgical procedure for appendicitis has changed from open surgery to laparoscopic surgery during the period 2000-2015. At the same time, duration of postoperative stay and 30-day mortality has decreased.
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Affiliation(s)
- J Kleif
- Department of Surgery, North Zealand Hospital, Copenhagen University Hospital, Hillerød, Denmark
| | - L C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - I Gögenur
- Department of Surgery, Zealand University Hospital, Center for Surgical Science, Køge, Denmark
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9
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Ekeloef S, Koyuncu S, Holst-Knudsen J, Gundel O, Meyhoff CS, Homilius M, Stilling M, Ekeloef P, Münster AMB, Mathiesen O, Gögenur I. Cardiovascular events in patients undergoing hip fracture surgery treated with remote ischaemic preconditioning: 1-year follow-up of a randomised clinical trial. Anaesthesia 2021; 76:1042-1050. [PMID: 33440017 DOI: 10.1111/anae.15357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 12/17/2022]
Abstract
Remote ischaemic preconditioning reduces the risk of myocardial injury within 4 days of hip fracture surgery. We aimed to investigate the effect of remote ischaemic preconditioning on the incidence of major adverse cardiovascular events 1 year after hip fracture surgery. We performed a phase-2, multicentre, randomised, observer-blinded, clinical trial between February 2015 and September 2017. We studied patients aged ≥ 45 years with a hip fracture and a minimum of one cardiovascular risk factor. Patients were allocated randomly to remote ischaemic preconditioning applied just before surgery or no treatment (control group). Remote ischaemic preconditioning was performed on the upper arm with a tourniquet in four cycles of 5 min ischaemia and 5 min reperfusion. Primary outcome was the occurrence of major adverse cardiovascular events within 1 year of surgery. A total of 316 patients were allocated randomly to the remote ischaemic preconditioning group and 309 patients to the control group. Major adverse cardiovascular events occurred in 43 patients (13.6%) in the remote ischaemic preconditioning group compared with 51 patients (16.5%) in the control group (adjusted hazard ratio (95%CI) 0.83 (0.55-1.25); p = 0.37). Fewer patients in the remote ischaemic preconditioning group had a myocardial infarction (11 (3.5%) vs. 22 (7.1%); hazard ratio (95%CI) 0.48 (CI 0.23-1.00); p = 0.04). Remote ischaemic preconditioning did not reduce the occurrence of major adverse cardiovascular events within 1 year of hip fracture surgery. The effect of remote ischaemic preconditioning on clinical cardiovascular outcomes in non-cardiac surgery needs confirmation in appropriately powered randomised clinical trials.
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Affiliation(s)
- S Ekeloef
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - S Koyuncu
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koege, Denmark
| | - J Holst-Knudsen
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koege, Denmark
| | - O Gundel
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C S Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Homilius
- Department of Orthopaedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro, Denmark
| | - M Stilling
- Department of Orthopaedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro, Denmark
| | - P Ekeloef
- Department of Anaesthesiology, Regional Hospital West Jutland, Holstebro, Denmark
| | - A M B Münster
- Unit for Thrombosis Research, Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark
| | - O Mathiesen
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koege, Denmark
| | - I Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
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10
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Klein MF, Gögenur I, Ingeholm P, Njor SH, Iversen LH, Emmertsen KJ. Validation of the Danish Colorectal Cancer Group (DCCG.dk) database - on behalf of the Danish Colorectal Cancer Group. Colorectal Dis 2020; 22:2057-2067. [PMID: 32894818 DOI: 10.1111/codi.15352] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022]
Abstract
AIM The aim of this study was to validate the clinical quality database of the Danish Colorectal Cancer Group. The validation is meant to focus on core data regarding staging of the disease, treatment provided, patient-related factors and key complications. METHOD This was a database validation study assessing the completeness of the database and the accuracy of the data by re-entering core variables into an online module in a blinded fashion and comparing re-entered data with the original database data. A sample of 5% of patients from the years 2014-2017 was randomly selected. RESULTS The sample of 936 patients was identified and data were re-entered. The completeness of the data retrieved was a median of 96%, 100% and 99% for preoperative, intra-operative and postoperative variables, respectively. The overall accuracy was a median of 95%. The least accurate variable was date of diagnosis (50% perfect agreement), with agreement rising to 96% when near matches defined as correct date ± 30 days were included. Intra-operative variables were of high quality, as were data on surgical complications including anastomotic leakage, where agreement was 97%. CONCLUSION This was the first major validation of the Danish Colorectal Cancer Group's database. Overall, the completeness and quality of data were high, but the validation process also identified weaknesses, which can be crucial for future users to acknowledge and consider.
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Affiliation(s)
- M F Klein
- Department of Surgery, Copenhagen University Hospital Herlev, Herlev, Denmark.,Scientific Council of the Danish Colorectal Cancer Group, Copenhagen, Denmark
| | - I Gögenur
- Scientific Council of the Danish Colorectal Cancer Group, Copenhagen, Denmark.,Department of Surgery, Center for Surgical Science, Zealand University Hospital Køge, Køge, Denmark
| | - P Ingeholm
- Department of Pathology, Copenhagen University Hospital Herlev, Herlev, Denmark.,Steering Committee of the Danish Colorectal Cancer Group's database, Copenhagen, Denmark
| | - S H Njor
- Steering Committee of the Danish Colorectal Cancer Group's database, Copenhagen, Denmark.,Department for Cancer and Cancer Screening, Danish Clinical Registries, Copenhagen, Denmark
| | - L H Iversen
- Scientific Council of the Danish Colorectal Cancer Group, Copenhagen, Denmark.,Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - K J Emmertsen
- Scientific Council of the Danish Colorectal Cancer Group, Copenhagen, Denmark.,Department of Surgery, Aarhus University Hospital Randers, Randers, Denmark
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11
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Krogsgaard M, Gögenur I, Helgstrand F, Andersen RM, Danielsen AK, Vinther A, Klausen TW, Hillingsø J, Christensen BM, Thomsen T. Surgical repair of parastomal bulging: a retrospective register-based study on prospectively collected data. Colorectal Dis 2020; 22:1704-1713. [PMID: 32548884 DOI: 10.1111/codi.15197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/13/2020] [Indexed: 12/16/2022]
Abstract
AIM The aim of this work was to examine (1) the incidence of primary repair, (2) the incidence of recurrent repair and (3) the types of repair performed in patients with parastomal bulging. METHOD Prospectively collected data on parastomal bulging from the Danish Stoma Database were linked to surgical data on repair of parastomal bulging from the Danish National Patient Register. Survival statistics provided cumulative incidences and time until primary and recurrent repair. RESULTS In the study sample of 1016 patients with a permanent stoma and a parastomal bulge, 180 (18%) underwent surgical repair. The cumulative incidence of a primary repair was 9% [95% CI (8%; 11%)] within 1 year and 19% [95% CI (17%; 22%)] within 5 years after the occurrence of a parastomal bulge. We found a similar probability of undergoing primary repair in patients with ileostomy and colostomy. For recurrent repair, the 5-year cumulative incidence was 5% [95% CI (3%; 7%)]. In patients undergoing repair, the probability was 33% [95% CI (21%; 46%)] of having a recurrence requiring repair within 5 years. The main primary repair was open or laparoscopic repair with mesh (43%) followed by stoma revision (39%). Stoma revision and repair with mesh could precede or follow one another as primary and recurrent repair. Stoma reversal was performed in 17% of patients. CONCLUSION Five years after the occurrence of a parastomal bulge the estimated probability of undergoing a repair was 19%. Having undergone a primary repair, the probability of recurrent repair was high. Stoma reversal was more common than expected.
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Affiliation(s)
- M Krogsgaard
- Department of Surgical Gastroenterology, Clinic C Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - I Gögenur
- Department of Surgery, Centre for Surgical Sciences, Zealand University Hospital, Koege, Denmark
| | - F Helgstrand
- Department of Surgery, Centre for Surgical Sciences, Zealand University Hospital, Koege, Denmark
| | - R M Andersen
- Department of Surgical Gastroenterology, Clinic C Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A K Danielsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital in Herlev and Gentofte, Copenhagen, Denmark.,QD-Research Unit, Copenhagen University Hospital in Herlev and Gentofte, Denmark
| | - T W Klausen
- Department of Haematology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Hillingsø
- Department of Surgical Gastroenterology, Clinic C Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B M Christensen
- Department of Surgical Gastroenterology, Clinic C Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - T Thomsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Herlev Acute, Critical and Emergency Care Science Group, Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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12
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Søby JH, Watt SK, Vogelsang RP, Servant F, Lelouvier B, Raskov H, Knop FK, Gögenur I. Alterations in blood microbiota after colonic cancer surgery. BJS Open 2020; 4:1227-1237. [PMID: 33022149 PMCID: PMC7709364 DOI: 10.1002/bjs5.50357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/18/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mechanisms contributing to the perioperative stress response remain poorly understood. This study investigated changes in the amount of bacterial DNA in blood and the diversity of blood microbiota in the perioperative period in patients undergoing minimally invasive surgery for colonic cancer in an enhanced recovery after surgery setting. METHODS DNA encoding the bacterial 16S ribosomal RNA gene (16S rDNA) in whole blood obtained the day before surgery, and on postoperative day (POD) 1 and POD 10-14 was amplified and quantified by PCR before sequencing for taxonomic assignment. Richness, evenness and similarity measures were calculated to compare microbiota between days. Differences in relative abundance were analysed using the linear discriminant analysis effect size (LEfSe) algorithm. RESULTS Thirty patients were included between January and July 2016. The concentration of bacterial 16S rDNA in blood increased between the day before surgery and POD 1 (P = 0.025). Bacterial richness was lower on POD 10-14 than on the day before surgery and POD 1 (both P < 0·001). LEfSe analysis comparing the day before surgery and POD 10-14 identified changes in the abundance of several bacteria, including Fusobacterium nucleatum, which was relatively enriched on POD 10-14. CONCLUSION These findings suggest that the blood of patients with colonic cancer harbours bacterial 16S rDNA, which increases in concentration after surgery.
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Affiliation(s)
- J. H. Søby
- Department of Surgery, Centre for Surgical ScienceZealand University Hospital, University of CopenhagenKøgeDenmark
- The Danish Cancer SocietyCopenhagenDenmark
| | - S. K. Watt
- Department of Surgery, Centre for Surgical ScienceZealand University Hospital, University of CopenhagenKøgeDenmark
| | - R. P. Vogelsang
- Department of Surgery, Centre for Surgical ScienceZealand University Hospital, University of CopenhagenKøgeDenmark
| | | | | | - H. Raskov
- Department of Surgery, Centre for Surgical ScienceZealand University Hospital, University of CopenhagenKøgeDenmark
| | - F. K. Knop
- Department of Clinical MedicineCopenhagenDenmark
- Novo Nordisk Centre for Basic Metabolic Research, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Centre for Clinical Metabolic ResearchGentofte Hospital, University of CopenhagenHellerupDenmark
- Steno Diabetes Centre CopenhagenGentofteDenmark
| | - I. Gögenur
- Department of Surgery, Centre for Surgical ScienceZealand University Hospital, University of CopenhagenKøgeDenmark
- Department of Clinical MedicineCopenhagenDenmark
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13
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Buzquurz F, Bojesen RD, Grube C, Madsen MT, Gögenur I. Impact of oral preoperative and perioperative immunonutrition on postoperative infection and mortality in patients undergoing cancer surgery: systematic review and meta-analysis with trial sequential analysis. BJS Open 2020; 4:764-775. [PMID: 32573977 PMCID: PMC7528521 DOI: 10.1002/bjs5.50314] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background Infectious complications occur in 4–22 per cent of patients undergoing surgical resection of malignant solid tumours. Improving the patient's immune system in relation to oncological surgery with immunonutrition may play an important role in reducing postoperative infections. A meta‐analysis was undertaken to evaluate the potential clinical benefits of immunonutrition on postoperative infections and 30‐day mortality in patients undergoing oncological surgery. Methods PubMed, Embase and Cochrane Library databases were searched to identify eligible studies. Eligible studies had to include patients undergoing elective curative surgery for a solid malignant tumour and receiving immunonutrition orally before surgery, including patients who continued immunonutrition into the postoperative period. The main outcome was overall infectious complications; secondary outcomes were surgical‐site infection (SSI) and 30‐day mortality, described by relative risk (RR) with trial sequential analysis (TSA). Risk of bias was assessed according to Cochrane methodology. Results Some 22 RCTs with 2159 participants were eligible for meta‐analysis. Compared with the control group, immunonutrition reduced overall infectious complications (RR 0·58, 95 per cent c.i. 0·48 to 0·70; I2 = 7 per cent; TSA‐adjusted 95 per cent c.i. 0·28 to 1·21) and SSI (RR 0·65, 95 per cent c.i. 0·50 to 0·85; I2 = 0 per cent; TSA‐adjusted 95 per cent c.i. 0·21 to 2·04). Thirty‐day mortality was not altered by immunonutrition (RR 0·69, 0·33 to 1·40; I2 = 0 per cent). Conclusion Immunonutrition reduced overall infectious complications, even after controlling for random error, and also reduced SSI. The quality of evidence was moderate, and mortality was not affected by immunonutrition (low quality). Oral immunonutrition merits consideration as a means of reducing overall infectious complications after cancer surgery.
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Affiliation(s)
- F Buzquurz
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.,Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - R D Bojesen
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.,Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - C Grube
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.,Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - M T Madsen
- Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - I Gögenur
- Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
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14
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Bojesen RD, Fitzgerald P, Munk-Madsen P, Eriksen JR, Kehlet H, Gögenur I. The clinical implication of the association between hypoxaemia and postoperative troponin I: a reply. Anaesthesia 2019; 75:128-129. [PMID: 31794643 DOI: 10.1111/anae.14917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - H Kehlet
- Zealand University Hospital, Køge, Denmark
| | - I Gögenur
- Zealand University Hospital, Køge, Denmark
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15
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Munk-Madsen P, Eriksen JR, Kehlet H, Gögenur I. Why still in hospital after laparoscopic colorectal surgery within an enhanced recovery programme? Colorectal Dis 2019; 21:1438-1444. [PMID: 31309661 DOI: 10.1111/codi.14762] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/03/2019] [Indexed: 02/08/2023]
Abstract
AIM Enhanced recovery after surgery programmes in elective colorectal surgery have been developed and implemented widely, but a subgroup of patients may still require longer hospital stays than expected. The aim of this study was to identify and describe factors compromising early postoperative recovery by asking 'why is the patient still in hospital today?' after laparoscopic colorectal cancer surgery within an enhanced recovery after surgery programme. METHOD Patients undergoing elective laparoscopic colorectal cancer resection were evaluated postoperatively with predefined potential reasons for still being in hospital. The primary outcome was 'reason for still being in hospital' on postoperative day 0-4 and secondarily length of stay with a focus on differences between patients with and without a stoma. RESULTS Ninety-six patients having colorectal cancer surgery were included. The median length of stay for the whole group was 3 days (range 1-14). The four dominant causes for patients without a stoma to be in hospital were lack of gastrointestinal function, lack of early mobilization, lack of normal micturition and nausea. Patients with a stoma stayed in hospital due to stoma training, lack of gastrointestinal function, lack of free micturition and a miscellaneous 'others' group. CONCLUSION Delayed gastrointestinal function, insufficient mobilization, poor urinary function and stoma care training have been characterized as dominant compromising factors for postoperative recovery. Together with a focus on frailty, future studies should focus on improving early mobilization, prevention and treatment of postoperative urinary retention and improved stoma care training, in order to minimize delay in postoperative recovery and discharge.
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Affiliation(s)
- P Munk-Madsen
- Centre for Surgical Science, Department of Surgery, Zealand University Hospital, Roskilde, Denmark
| | - J R Eriksen
- Centre for Surgical Science, Department of Surgery, Zealand University Hospital, Roskilde, Denmark
| | - H Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, København N, Denmark
| | - I Gögenur
- Centre for Surgical Science, Department of Surgery, Zealand University Hospital, Roskilde, Denmark
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16
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Orhan A, Vogelsang R, Andersen M, Madsen M, Hölmich E, Raskov H, Gögenur I. The prognostic value of tumour-infiltrating lymphocytes (TILs) in pancreatic cancer: A systematic review and meta-analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz447.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Watt SK, Fransgaard T, Degett TH, Thygesen LC, Benfield T, Knudsen JD, Fuursted K, Jensen TG, Dessau RB, Schønheyder HC, Møller JK, Gögenur I. Associations between blood cultures after surgery for colorectal cancer and long-term oncological outcomes. Br J Surg 2019; 107:310-315. [PMID: 31755092 DOI: 10.1002/bjs.11372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/11/2019] [Accepted: 08/27/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Systemic inflammation following curative surgery for colorectal cancer may be associated with increased risk of recurrence. [Correction added on 29 November 2019, after first online publication: text amended for accuracy.] This study investigated whether a clinically suspected infection, for which blood cultures were sent within 30 days after surgery for colorectal cancer, was associated with long-term oncological outcomes. METHODS This register-based national cohort study included all Danish residents undergoing surgery with curative intent for colorectal cancer between January 2003 and December 2013. Patients who developed recurrence or died within 180 days after surgery were not included. Associations between blood cultures taken within 30 days after primary surgery and overall survival, disease-free survival and recurrence-free survival were analysed using Cox regression models adjusted for relevant clinical confounders, including demographic data, cancer stage, co-morbidity, blood transfusion, postoperative complications and adjuvant chemotherapy. RESULTS The study included 21 349 patients, of whom 3390 (15·9 per cent) had blood cultures taken within 30 days after surgery. Median follow-up was 5·6 years. Patients who had blood cultures taken had an increased risk of all-cause mortality (hazard ratio (HR) 1·27, 95 per cent c.i. 1·20 to 1·35; P < 0·001), poorer disease-free survival (HR 1·22, 1·16 to 1·29; P < 0·001) and higher risk of recurrence (HR 1·15, 1·07 to 1·23; P < 0·001) than patients who did not have blood cultures taken. CONCLUSION A clinically suspected infection requiring blood cultures within 30 days of surgery for colorectal cancer was associated with poorer oncological outcomes.
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Affiliation(s)
- S K Watt
- Department of Surgery, Zealand University Hospital Køge/Roskilde, Køge, Denmark
| | - T Fransgaard
- Department of Surgery, Zealand University Hospital Køge/Roskilde, Køge, Denmark
| | - T H Degett
- Department of Surgery, Zealand University Hospital Køge/Roskilde, Køge, Denmark
| | - L C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - T Benfield
- Department of Infectious Diseases, Copenhagen University Hospital, Amager/Hvidovre, Hvidovre, Denmark
| | - J D Knudsen
- Department of Clinical Microbiology, Copenhagen University Hospital Amager/Hvidovre Hospital, Hvidovre, Denmark
| | - K Fuursted
- Department of Bacteria, Parasites and Fungi, Statens Serum Institute, Copenhagen, Denmark
| | - T G Jensen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - R B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - H C Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - J K Møller
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
| | - I Gögenur
- Department of Surgery, Zealand University Hospital Køge/Roskilde, Køge, Denmark
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18
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Degett TH, Christensen J, Thomsen LA, Iversen LH, Gögenur I, Dalton SO. Nationwide cohort study of the impact of education, income and social isolation on survival after acute colorectal cancer surgery. BJS Open 2019; 4:133-144. [PMID: 32011820 PMCID: PMC6996631 DOI: 10.1002/bjs5.50218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/16/2019] [Indexed: 12/16/2022] Open
Abstract
Background Acute colorectal cancer surgery has been associated with a high postoperative mortality. The primary aim of this study was to examine the association between socioeconomic position and the likelihood of undergoing acute versus elective colorectal cancer surgery. A secondary aim was to determine 1‐year survival among patients treated with acute surgery. Methods All patients who had undergone a surgical procedure according to the Danish Colorectal Cancer Group (DCCG.dk) database, or who were registered with stent or diverting stoma in the National Patient Register from 2007 to 2015, were reviewed. Socioeconomic position was determined by highest attained educational level, income, urbanicity and cohabitation status, obtained from administrative registries. Co‐variables included age, sex, year of surgery, Charlson Co‐morbidity Index score, smoking status, alcohol consumption, BMI, stage and tumour localization. Logistic regression analysis was performed to determine the likelihood of acute colorectal cancer surgery, and Kaplan–Meier and Cox proportional hazards regression methods were used for analysis of 1‐year overall survival. Results In total, 35 661 patients were included; 5310 (14·9 per cent) had acute surgery. Short and medium education in patients younger than 65 years (odds ratio (OR) 1·58, 95 per cent c.i. 1·32 to 1·91, and OR 1·34, 1·15 to 1·55 respectively), low income (OR 1·12, 1·01 to 1·24) and living alone (OR 1·35, 1·26 to 1·46) were associated with acute surgery. Overall, 40·7 per cent of patients died within 1 year of surgery. Short education (hazard ratio (HR) 1·18, 95 per cent c.i. 1·03 to 1·36), low income (HR 1·16, 1·01 to 1·34) and living alone (HR 1·25, 1·13 to 1·38) were associated with reduced 1‐year survival after acute surgery. Conclusion Low socioeconomic position was associated with an increased likelihood of undergoing acute colorectal cancer surgery, and with reduced 1‐year overall survival after acute surgery.
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Affiliation(s)
- T H Degett
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - J Christensen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - L A Thomsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - L H Iversen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Danish Colorectal Cancer Group, Denmark
| | - I Gögenur
- Center for Surgical Science, Zealand University Hospital, Køge, Denmark.,Danish Colorectal Cancer Group, Denmark
| | - S O Dalton
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
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19
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Gómez Ruiz M, Alfieri S, Becker T, Bergmann M, Boggi U, Collins J, Figueiredo N, Gögenur I, Matzel K, Miskovic D, Parvaiz A, Pratschke J, Rivera Castellano J, Qureshi T, Svendsen LB, Tekkis P, Vaz C. Expert consensus on a train-the-trainer curriculum for robotic colorectal surgery. Colorectal Dis 2019; 21:903-908. [PMID: 30963654 DOI: 10.1111/codi.14637] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/12/2019] [Indexed: 12/14/2022]
Abstract
AIM Robotic techniques are being increasingly used in colorectal surgery. There is, however, a lack of training opportunities and structured training programmes. Robotic surgery has specific problems and challenges for trainers and trainees. Ergonomics, specific skills and user-machine interfaces are different from those in traditional laparoscopic surgery. The aim of this study was to establish expert consensus on the requirements for a robotic train-the-trainer curriculum amongst robotic surgeons and trainers. METHOD This is a modified Delphi-type study involving 14 experts in robotic surgery teaching. A reiterating 19-item questionnaire was sent out to the same group and agreement levels analysed. A consensus of 0.8 or higher was considered to be high-level agreement. RESULTS Response rates were 93-100% and most items reached high levels of agreement within three rounds. Specific requirements for a robotic faculty development curriculum included maximizing dual-console teaching, theatre team training, nontechnical skills training, patient safety, user-machine interface training and telementoring. CONCLUSION A clear need for the development of a train-the-trainer curriculum has been identified. Further research is needed to assess feasibility, effectiveness and clinical impact of a robotic train-the-trainer curriculum.
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Affiliation(s)
- M Gómez Ruiz
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain.,IDIVAL, Instituto de Investigación Sanitaria, Santander, Spain
| | - S Alfieri
- Gemelli Robotic Mentoring Center, Catholic University of Sacred Hearth - IRCS Gemelli Foundation, Rome, Italy
| | - T Becker
- General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - M Bergmann
- Department of Visceral Surgery, Surgical Research Laboratories, Vienna, Austria.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - U Boggi
- Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - J Collins
- Department of Urology, Karolinska Institutet, Solna, Sweden
| | - N Figueiredo
- Surgery Unit, Fundação Champalimaud, Lisbon, Portugal
| | - I Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark.,Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - K Matzel
- Leiter Sektion Koloproktologie, Chirurgische Universitätsklinik Erlangen, Erlangen, Germany
| | - D Miskovic
- St Mark's Hospital, Harrow, Middlesex, UK
| | - A Parvaiz
- Poole Hospital NHS Trust, Poole, UK.,School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,Fundação Champalimaud, Lisbon, Portugal
| | - J Pratschke
- Surgery, Charité - Universitätsmedizin Berlin Chirurgische Klinik, Berlin, Germany
| | - J Rivera Castellano
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain.,IDIVAL, Instituto de Investigación Sanitaria, Santander, Spain
| | | | | | - P Tekkis
- Gastrointestinal Surgery, The Royal Marsden, Fulham Road, London, UK
| | - C Vaz
- Colorectal Cancer Unit, Robotic Surgery Unit, Hospital CUF Infante Santo, Lisbon, Portugal
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20
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Bojesen RD, Fitzgerald P, Munk‐Madsen P, Eriksen JR, Kehlet H, Gögenur I. Hypoxaemia during recovery after surgery for colorectal cancer: a prospective observational study. Anaesthesia 2019; 74:1009-1017. [DOI: 10.1111/anae.14691] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2019] [Indexed: 12/27/2022]
Affiliation(s)
- R. D. Bojesen
- Department of Surgery Slagelse Hospital Slagelse Denmark
| | | | - P. Munk‐Madsen
- Department of Surgery Zealand University Hospital Køge Denmark
| | - J. R. Eriksen
- Department of Surgery Zealand University Hospital Køge Denmark
| | - H. Kehlet
- Section of Surgical Pathophysiology Rigshospitalet Copenhagen Denmark
| | - I. Gögenur
- Center for Surgical Science Køge Denmark
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21
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Watt S, Hasselbalch H, Skov V, Kjær L, Thomassen M, Kruse T, Burton M, Gögenur I. Whole blood gene expression profiling in patients undergoing colon cancer surgery identifies differential expression of genes involved in immune surveillance, inflammation and carcinogenesis. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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22
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Bennedsen ALB, Eriksen JR, Gögenur I. Prolonged hospital stay and readmission rate in an enhanced recovery after surgery cohort undergoing colorectal cancer surgery. Colorectal Dis 2018; 20:1097-1108. [PMID: 30307103 DOI: 10.1111/codi.14446] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/02/2018] [Indexed: 02/08/2023]
Abstract
AIM The present database study aimed to identify patients with a longer postoperative length of stay (LOS) or patients readmitted and to characterize both groups based on perioperative factors. METHOD A retrospective review of the Danish Colorectal Cancer Group database and a local database was performed of all patients undergoing elective resection for colorectal cancer in a 25-month period. The primary outcome was the number of patients with a prolonged hospital stay (LOS ≥ 10 days after the primary operation) and readmissions within 30 days after discharge. RESULTS A total of 372 patients with colon resection and 215 patients with rectal resection were included. Patients undergoing colonic resection had a rate of prolonged hospital stay of 10.6% and a readmission rate of 13.7%; prolonged hospital stay was significantly associated with age ≥ 76 years and those who underwent a conversion from a laparoscopic procedure. Patients undergoing rectal cancer resection had a rate of prolonged hospital stay of 17.7% and a readmission rate of 14.0%; Charlson comorbidity score (CCS) ≥ 2, total mesorectal excision (TME) and laparoscopic conversion were significantly associated with prolonged hospital stay, and American Society of Anesthesiologists (ASA) score ≥ 3, TME and a duration of surgery ≥ 300 min were significantly associated with readmission. CONCLUSION In patients with colon cancer, older age and conversion to open surgery were associated with prolonged hospital stay. In patients with rectal cancer, CCS ≥ 2, TME and conversion were associated with prolonged hospital stay, and a preoperative ASA score ≥ 3, TME and a duration of surgery ≥ 300 min were associated with readmission.
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Affiliation(s)
- A L B Bennedsen
- Department of Surgery, Zealand University Hospital, Roskilde, Denmark
| | - J R Eriksen
- Department of Surgery, Zealand University Hospital, Roskilde, Denmark
| | - I Gögenur
- Department of Surgery, Zealand University Hospital, Roskilde, Denmark
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23
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Abstract
BACKGROUND AND AIMS Simulation-based training in laparoscopy can improve patient safety and efficiency of care, but it depends on how it is used. Research in medical education has moved from demonstrating transferability of simulation training to the operating room to how to best implement it. This study aims to investigate how simulation-based training in laparoscopy has been implemented Scandinavia. MATERIAL AND METHODS An online survey was sent out to medical doctors at surgical, gynecological, and urological departments at 138 hospitals in Denmark, Norway, and Sweden. The questionnaire included questions on respondents' baseline characteristics, opinions, access, and actual use of simulation-based training in laparoscopy. RESULTS In total, 738 respondents completed the survey. Of these, 636 (86.2%) of respondents agreed or strongly agreed that simulation-based training in laparoscopy should be mandatory. A total of 602 (81.6%) had access to simulation-based training in laparoscopy. Of the total 738 respondents, 141 (19.1%) were offered structured training courses, 129 (17.5%) were required to reach a predefined level of competency, and 66 (8.9%) had mandatory courses in laparoscopy. In all, 72 (9.8%) had never used simulation-based training in laparoscopy. CONCLUSION An implementation gap in laparoscopic simulation-based training still exists in Scandinavia. Simulation equipment is generally available, but there is a lack of structured simulation-based training.
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Affiliation(s)
- K Fjørtoft
- 1 Copenhagen Academy for Medical Education and Simulation-CAMES Rigshospitalet, Copenhagen, Denmark
| | - L Konge
- 1 Copenhagen Academy for Medical Education and Simulation-CAMES Rigshospitalet, Copenhagen, Denmark
| | - I Gögenur
- 2 Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - E Thinggaard
- 1 Copenhagen Academy for Medical Education and Simulation-CAMES Rigshospitalet, Copenhagen, Denmark.,2 Center for Surgical Science, Zealand University Hospital, Køge, Denmark
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24
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Ekeloef S, Alamili M, Devereaux PJ, Gögenur I. Troponin elevations after non-cardiac, non-vascular surgery are predictive of major adverse cardiac events and mortality: a systematic review and meta-analysis. Br J Anaesth 2018; 117:559-568. [PMID: 27799170 DOI: 10.1093/bja/aew321] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients undergoing non-cardiac, non-vascular surgery are at risk of major cardiovascular complications. In non-cardiac surgery, troponin elevation has previously been shown to be an independent predictor of major adverse cardiac events and postoperative mortality; however, a majority of studies have focused on vascular surgery patients. The aim of this meta-analysis was to determine whether troponin elevation is a predictor of major adverse cardiac events and mortality within 30 days and 1 yr after non-cardiac, non-vascular surgery. METHODS A systematic review and meta-analysis was conducted in January 2016 according to the Meta-analysis Of Observational Studies in Epidemiology guidelines. Both interventional and observational studies measuring troponin within the first 4 days after surgery were eligible. A systematic search was performed in PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials. RESULTS Eleven eligible clinical studies (n=2193) were identified. A postoperative troponin elevation was a predictor of 30 day mortality, odds ratio (OR) 3.52 [95% confidence interval (CI) 2.21-5.62; I2=0%], and an independent predictor of 1 yr mortality, adjusted OR 2.53 (95% CI 1.20-5.36; I2=26%). A postoperative troponin elevation was associated with major adverse cardiac events at 30 days, OR 5.92 (95% CI 1.67-20.96; I2=86%), and 1 yr after surgery, adjusted OR 3.00 (95% CI 1.43-6.29; I2=21%). CONCLUSIONS Postoperative myocardial injury is an independent predictor of major adverse cardiac events and mortality within 30 days and 1 yr after non-cardiac, non-vascular surgery. The meta-analysis provides evidence that supports troponin monitoring as a cardiovascular risk stratification tool.
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Affiliation(s)
- S Ekeloef
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege and Roskilde, Denmark
| | - M Alamili
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege and Roskilde, Denmark
| | - P J Devereaux
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - I Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege and Roskilde, Denmark
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25
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Pinar I, Abdul-Wahid W, Fransgaard T, Gögenur I. Association between Abdominal Free Fluid and Postoperative Complications and Mortality in Patients with Small-Bowel Obstruction. Scand J Surg 2018; 108:36-41. [PMID: 29756508 DOI: 10.1177/1457496918772372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS: Small-bowel obstruction is a frequent cause of hospitalization. The condition is potentially life-threatening, causing many admission days and is a heavy burden socioeconomically. Patients with small-bowel obstruction may develop abdominal free fluid and the quality of this fluid may be predictive of worse outcomes. Our aim was to examine whether the presence of free fluid and its density, measured on computed tomography scans, was associated with severe complications and mortality postoperatively. MATERIALS AND METHODS: Patients admitted to the Department of Surgery, Zealand University Hospital with a diagnosis of small-bowel obstruction between January 2010 and December 2015 were included. Medical records were reviewed and preoperative computed tomography scans were examined. A radiologist blinded to the outcomes reviewed all Hounsfield unit values of the free fluid. The primary outcomes evaluated were odds ratios of the severity of complications and hazard ratios of 30- and 90-day mortality postoperatively. RESULTS: A total of 289 patients were included. Analyses revealed an adjusted odds ratio of 1.03 (95%confidence interval = 0.93-1.15) between the presence of free fluid and postoperative complications and an adjusted hazard ratio of 1.28 (95% confidence interval = 0.80-2.05, p = 0.30) of the 30-day mortality in this patient group. Furthermore, the analyses revealed an adjusted odds ratio of 1.22 (95% confidence interval 0.98-1.52) between the density of the free fluid > 20 Hounsfield unit and postoperative complications and an adjusted hazard ratio of 0.85 (95% confidence interval = 0.28-2.63, p = 0.78) of the 30-day mortality. CONCLUSION: No significant correlation was found between the presence of free fluid nor its density in regard to postoperative complications or mortality in patients with small-bowel obstruction.
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Affiliation(s)
- I Pinar
- 1 Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - W Abdul-Wahid
- 2 Department of Radiology, Zealand University Hospital, Køge, Denmark
| | - T Fransgaard
- 1 Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - I Gögenur
- 1 Department of Surgery, Zealand University Hospital, Køge, Denmark
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26
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Andersen RM, Klausen TW, Danielsen AK, Vinther A, Gögenur I, Thomsen T. Incidence and risk factors for parastomal bulging in patients with ileostomy or colostomy: a register-based study using data from the Danish Stoma Database Capital Region. Colorectal Dis 2018; 20:331-340. [PMID: 28980388 DOI: 10.1111/codi.13907] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/04/2017] [Indexed: 02/08/2023]
Abstract
AIM The aim was to investigate the incidence and risk factors for parastomal bulging, a clinically important complication, in patients with an ileostomy or colostomy. METHOD The Danish Stoma Database Capital Region prospectively collects data on patients with a stoma up to a year after surgery. Stoma care nurses clinically assessed the main outcome, parastomal bulging. We linked data from the Stoma Database to data from the Danish Anaesthesia Database. Cumulative incidence of parastomal bulging over the first year was calculated with death and stoma reversal as competing risks. Risk factors were investigated using an exploratory approach. RESULTS In a study population of 5019, the cumulative incidence (with competing risks) of parastomal bulging was 36.2% at 400 days after surgery. Age, colostomy, male gender, alcohol consumption and laparoscopy were associated with an increased risk of parastomal bulging. Compared with cancer, inflammatory bowel disease was associated with a lower risk of parastomal bulging, and diverticulitis was associated with a higher risk. Peristomal mesh and stomas placed through a separate incision were associated with a reduction in risk. There was neither increased nor decreased risk of parastomal bulging for body mass index, American Society of Anesthesiologists score, smoking status, emergency surgery and preoperative stoma site marking. CONCLUSION Parastomal bulging is a common complication affecting one in three patients within 1 year of surgery. Along with previous findings, there is now considerable evidence for age and colostomy as being risk factors for parastomal bulging.
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Affiliation(s)
- R M Andersen
- Abdominal Centre, Rigshospitalet, Copenhagen.,Department of Gastroenterology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - T W Klausen
- Department of Hematology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - A K Danielsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - A Vinther
- Department of Rehabilitation, Herlev and Gentofte Hospital, Herlev, Denmark
| | - I Gögenur
- Department of Surgical Gastroenterology, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - T Thomsen
- Abdominal Centre, Rigshospitalet, Copenhagen.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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27
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Malmstrøm ML, Brisling S, Klausen TW, Săftoiu A, Perner T, Vilmann P, Gögenur I. Staging with computed tomography of patients with colon cancer. Int J Colorectal Dis 2018; 33:9-17. [PMID: 29116438 DOI: 10.1007/s00384-017-2932-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Accurate staging of colonic cancer is important for patient stratification. We aimed to correlate the diagnostic accuracy of preoperative computed tomography (CT) with final histopathology as reference standard. METHODS Data was collected retrospectively on 615 consecutive patients operated for colonic cancer. Evaluation was based upon T-stage. Patients were stratified into high-risk and low-risk groups, based on the extent of tumor invasion beyond the proper muscle layer of more or less than 5 mm. The Kendall tau correlation coefficient was used to calculate concordance between radiological (r)T-stage obtained at CT imaging and pathological (p)T-stage from the final pathology. RESULTS In total, 501 patients were included. We found no significant differences in the Kendall tau values for diagnostic measures between the groups at the 95% confidence interval (CI) level: 49% (95% CI, 43-55) for all individuals, 48% (95% CI, 40-56) for screened individuals, and 47% (95% CI, 37-56) for non-screened individuals. The overall sensitivity and specificity for all individuals in identifying high-risk tumors on CT was 65% (95% CI, 56-73) and 89% (95% CI, 85-92). The risk of ending up in the high-risk group due to overstaging among all individuals was calculated as the number needed to harm 11.7 (95% CI, 9-16). CONCLUSIONS There is basis for improvement of CT-based preoperative staging of patients with colorectal cancer. Supplementary modalities may be needed for correct staging of patients preoperatively, especially in relation to stratification of patients into neoadjuvant treatments or tailored therapy in patients with early cancers.
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Affiliation(s)
- M L Malmstrøm
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Køge, Denmark.
| | - S Brisling
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
| | - T W Klausen
- Department of Hematology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - A Săftoiu
- Research Centre of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - T Perner
- Department of Radiology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
| | - P Vilmann
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - I Gögenur
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Køge, Denmark
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28
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Kleif J, Waage J, Christensen K, Gögenur I. Systematic review of the QoR-15 score, a patient- reported outcome measure measuring quality of recovery after surgery and anaesthesia. Br J Anaesth 2018; 120:28-36. [DOI: 10.1016/j.bja.2017.11.013] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 12/31/2022] Open
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29
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Vendler MMI, Haidari TA, Waage JE, Kleif J, Kristensen B, Gögenur I, Bertelsen CA. Incidence of venous thromboembolic events in enhanced recovery after surgery for colon cancer: a retrospective, population-based cohort study. Colorectal Dis 2017; 19:O393-O401. [PMID: 28980383 DOI: 10.1111/codi.13910] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/14/2017] [Indexed: 01/16/2023]
Abstract
AIM Both the Danish and the National Institute of Clinical Excellence (NICE) guidelines recommend prolonged thromboprophylaxis (PT) with low-molecular-weight heparin (LMWH) for 28 days postoperatively after elective surgery for colon cancer. The evidence relies on data from two randomized clinical trials (RCTs) that included not only colon cancers but also other abdominal cancers or benign colorectal diseases. Neither of those studies investigated the risk of venous thromboembolism (VTE) under enhanced recovery after surgery (ERAS). We aim to describe the risk of VTE and estimate the cost of preventing one case of VTE by PT under ERAS. METHOD This was a retrospective study of 2230 patients undergoing elective surgery for colon cancer Stage I-III in the Capital Region of Denmark, 1 June 2008 to 31 December 2013. Patients who were discharged on postoperative day 28 or later, died during admission or were discharged with a vitamin K antagonist, novel oral anticoagulants or LMWH were excluded. Patients with rectal cancer only were not included. End-points were symptomatic VTE diagnosed within 60 days postoperatively. RESULTS Three-hundred and thirty patients were excluded. For the remaining 1893, the median length of stay (LOS) was 4 [interquartile range (IQR): 3-5] days. Of these 1893 patients, four (0.20%) experienced a nonfatal symptomatic VTE. All four patients had other postoperative complications before the VTE. The cost of each symptomatic VTE prevented is estimated to be between £63 709 and £111 455 when medication and home-care nursing are included. CONCLUSION The risk of symptomatic VTE after uncomplicated, elective surgery for colon cancer with ERAS seems negligible and the cost-effectiveness of PT to prevent one symptomatic VTE seems questionable.
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Affiliation(s)
- M M I Vendler
- Department of Surgery, North Zealand Hospital Hillerød, University of Copenhagen, Copenhagen, Denmark.,Department of Urology, Herlev University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T A Haidari
- Department of Surgery, North Zealand Hospital Hillerød, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J E Waage
- Department of Surgery, North Zealand Hospital Hillerød, University of Copenhagen, Copenhagen, Denmark
| | - J Kleif
- Department of Surgery, North Zealand Hospital Hillerød, University of Copenhagen, Copenhagen, Denmark
| | - B Kristensen
- Clinical Physiology, Herlev University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - I Gögenur
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C A Bertelsen
- Department of Surgery, North Zealand Hospital Hillerød, University of Copenhagen, Copenhagen, Denmark
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30
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Kleif J, Kirkegaard A, Vilandt J, Gögenur I. Randomized clinical trial of preoperative dexamethasone on postoperative nausea and vomiting after laparoscopy for suspected appendicitis. Br J Surg 2017; 104:384-392. [PMID: 28072446 DOI: 10.1002/bjs.10418] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/08/2016] [Accepted: 09/30/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Few studies have investigated the effects of preoperative dexamethasone in acute surgical patients. This study examined the effects of 8 mg dexamethasone administered intravenously 30 min before surgery for suspected acute appendicitis. METHODS A multicentre, parallel-group, double-blind, placebo-controlled study was conducted at two university hospitals in Denmark. Adults undergoing laparoscopic surgery for suspected appendicitis were eligible for inclusion. Participants, healthcare staff and investigators were blinded until all data analysis had been done. The primary outcome was the incidence of postoperative nausea and vomiting (PONV) during the first postoperative day. Secondary outcomes were pain, fatigue, sleep, opioid consumption, use of antiemetics, quality of recovery and duration of convalescence. Analysis was done according to the intention-to-treat principle. RESULTS A total of 120 patients were enrolled; 57 patients in the dexamethasone group and 59 in the placebo group were eligible for primary analysis. In the dexamethasone group, 47 (95 per cent c.i. 35 to 60) per cent of patients experienced PONV compared with 63 (50 to 74) per cent) in the placebo group. The absolute risk reduction in PONV was 15 (-3 to 33) per cent in favour of the dexamethasone group (P = 0·098). Patients in the dexamethasone group had less pain at rest (difference in score on visual analogue scale (VAS) 9 (95 per cent c.i. 1 to 17) mm; P = 0·024), were less fatigued (difference in VAS score 7 (0 to 14) mm; P = 0·038), used fewer opioids (absolute risk reduction 17 (2 to 33) per cent; P = 0·033) and had better quality of recovery (difference in QoR-15 score 13 (4 to 22); P = 0·006) during the first postoperative day. There was no difference in postoperative complications (P = 0·595). CONCLUSION Preoperative dexamethasone did not reduce PONV by the target level of 50 per cent. Registration number: NCT02415335 ( http://www.clinicaltrials.gov).
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Affiliation(s)
- J Kleif
- Departments of Surgery, Nordsjaellands Hospital, Copenhagen University Hospital, Hillerød, Denmark
| | - A Kirkegaard
- Køge Sygehus, Zealand University Hospital, Køge, Denmark
| | - J Vilandt
- Departments of Surgery, Nordsjaellands Hospital, Copenhagen University Hospital, Hillerød, Denmark
| | - I Gögenur
- Køge Sygehus, Zealand University Hospital, Køge, Denmark
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31
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Pedersen T, Watt SK, Tolstrup MB, Gögenur I. 30-Day, 90-day and 1-year mortality after emergency colonic surgery. Eur J Trauma Emerg Surg 2016; 43:299-305. [DOI: 10.1007/s00068-016-0742-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 11/15/2016] [Indexed: 11/30/2022]
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32
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Tengberg LT, Cihoric M, Foss NB, Bay-Nielsen M, Gögenur I, Henriksen R, Jensen TK, Tolstrup MB, Nielsen LBJ. Complications after emergency laparotomy beyond the immediate postoperative period - a retrospective, observational cohort study of 1139 patients. Anaesthesia 2016; 72:309-316. [PMID: 27809332 DOI: 10.1111/anae.13721] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 12/25/2022]
Abstract
Mortality and morbidity occur commonly following emergency laparotomy, and incur a considerable clinical and financial healthcare burden. Limited data have been published describing the postoperative course and temporal pattern of complications after emergency laparotomy. We undertook a retrospective, observational, multicentre study of complications in 1139 patients after emergency laparotomy. A major complication occurred in 537/1139 (47%) of all patients within 30 days of surgery. Unadjusted 30-day mortality was 20.2% and 1-year mortality was 34%. One hundred and thirty-seven of 230 (60%) deaths occurred between 72 h and 30 days after surgery; all of these patients had complications, indicating that there is a prolonged period with a high frequency of complications and mortality after emergency laparotomy. We conclude that peri-operative, enhanced recovery care bundles for preventing complications should extend their focus on continuous complication detection and rescue beyond the first few postoperative days.
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Affiliation(s)
- L T Tengberg
- Copenhagen University Hospital, Hvidovre, Denmark
| | - M Cihoric
- Copenhagen University Hospital, Hvidovre, Denmark
| | - N B Foss
- Copenhagen University Hospital, Hvidovre, Denmark
| | | | - I Gögenur
- Copenhagen University Hospital, Køge, Denmark
| | - R Henriksen
- Copenhagen University Hospital, Hillerød, Denmark
| | - T K Jensen
- Copenhagen University Hospital, Herlev, Denmark
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33
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Kokotovic D, Sjølander H, Gögenur I, Helgstrand F. Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safe. Hernia 2016; 20:281-7. [DOI: 10.1007/s10029-016-1464-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 01/16/2016] [Indexed: 12/20/2022]
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34
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Bertelsen CA, Neuenschwander AU, Jansen JE, Kirkegaard-Klitbo A, Tenma JR, Wilhelmsen M, Rasmussen LA, Jepsen LV, Kristensen B, Gögenur I. Short-term outcomes after complete mesocolic excision compared with 'conventional' colonic cancer surgery. Br J Surg 2016; 103:581-9. [PMID: 26780563 DOI: 10.1002/bjs.10083] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/03/2015] [Accepted: 11/18/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Complete mesocolic excision (CME) seems to be associated with improved oncological outcomes compared with 'conventional' surgery, but there is a potential for higher morbidity. METHODS Data for patients after elective resection at the four centres in the Capital Region of Denmark (June 2008 to December 2013) were retrieved from the Danish Colorectal Cancer Group database and medical charts. Approval from a Danish ethics committee was not required (retrospective study). RESULTS Some 529 patients who underwent CME surgery at one centre were compared with 1701 patients undergoing 'conventional' resection at the other three hospitals. Laparoscopic CME was performed in 258 (48·8 per cent) and laparoscopic 'conventional' resection in 1172 (68·9 per cent). More extended right colectomy procedures were done in the CME group (17·4 versus 3·6 per cent). The 90-day mortality rate in the CME group was 6·2 per cent versus 4·9 per cent in the 'conventional' group (P = 0·219), with a propensity score-adjusted logistic regression odds ratio (OR) of 1·22 (95 per cent c.i. 0·79 to 1·87). Laparoscopic surgery was associated with a lower risk of mortality at 90 days (OR 0·63, 0·42 to 0·95). Intraoperative injury to other organs was more common in CME operations (9·1 per cent versus 3·6 per cent for 'conventional' resection; P < 0·001), including more splenic (3·2 versus 1·2 per cent; P = 0·004) and superior mesenteric vein (1·7 versus 0·2 per cent; P < 0·001) injuries. Rates of sepsis with vasopressor requirement (6·6 versus 3·2 per cent; P = 0·001) and postoperative respiratory failure (8·1 versus 3·4 per cent; P < 0·001) were higher in the CME group. CONCLUSION CME is associated with more intraoperative organ injuries and severe non-surgical complications than 'conventional' resection for colonic cancer.
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Affiliation(s)
- C A Bertelsen
- Department of Surgery, Hillerød University Hospital, University of Copenhagen, Hillerød, Denmark
| | - A U Neuenschwander
- Department of Surgery, Hillerød University Hospital, University of Copenhagen, Hillerød, Denmark
| | - J E Jansen
- Department of Surgery, Hillerød University Hospital, University of Copenhagen, Hillerød, Denmark
| | - A Kirkegaard-Klitbo
- Department of Surgery, Herlev University Hospital, University of Copenhagen, Herlev, Denmark.,Department of Surgery, Køge Roskilde University Hospital, University of Copenhagen, Køge, Denmark
| | - J R Tenma
- Department of Surgery, Bispebjerg University Hospital, University of Copenhagen, København, Denmark
| | - M Wilhelmsen
- Department of Surgery, Hvidovre University Hospital, University of Copenhagen, Hvidovre, Denmark
| | - L A Rasmussen
- Department of Surgery, Hillerød University Hospital, University of Copenhagen, Hillerød, Denmark
| | - L V Jepsen
- Department of Surgery, Hillerød University Hospital, University of Copenhagen, Hillerød, Denmark
| | - B Kristensen
- Department of Clinical Physiology, Herlev University Hospital, University of Copenhagen, Herlev, Denmark
| | - I Gögenur
- Department of Surgery, Køge Roskilde University Hospital, University of Copenhagen, Køge, Denmark
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35
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Fransgaard T, Thygesen LC, Gögenur I. Increased 30-day mortality in patients with diabetes undergoing surgery for colorectal cancer. Colorectal Dis 2016; 18:O22-9. [PMID: 26467438 DOI: 10.1111/codi.13158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/25/2015] [Indexed: 12/31/2022]
Abstract
AIM The primary aim of the study was to determine whether preexisting diabetes is associated with increased 30-day mortality after curative resection of colorectal cancer (CRC). The association between antidiabetic treatment and 30-day mortality was also examined. METHOD Patients diagnosed with CRC between 1 January 2003 and 31 December 2012 were identified through the Danish Colorectal Cancer Group National Clinical Database (DCCG). The Danish National Patient Register (NPR) collated all hospital contacts in Denmark and the diagnosis of diabetes was identified by combining NPR data with the use of antidiabetic drugs identified through the Danish National Prescription Registry and DCCG. The 30-day mortality was examined by the Kaplan-Meier method with the log-rank test and the Cox regression model used to test statistical significance. RESULTS The study included 29 353 patients, of whom 3250 had preexisting diabetes. The 30-day mortality was significantly increased in patients with CRC and preexisting diabetes (adjusted hazard ratio 1.17, 95% CI 1.01-1.35, P = 0.03). The type of antidiabetic medication used was not associated with 30-day mortality. CONCLUSION Preexisting diabetes was associated with a higher short-term mortality in patients with CRC. No association between the type of antidiabetic medication and short-term mortality could be shown.
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Affiliation(s)
- T Fransgaard
- Department of Surgery, Køge Hospital, Køge, Denmark
| | - L C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - I Gögenur
- Department of Surgery, Køge Hospital, Køge, Denmark.,Danish Colorectal Cancer Group, Copenhagen, Denmark
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DeAsis F, Gitelis M, Chao S, Lapin B, Linn J, Denham W, Haggerty S, Carbray J, Ujiki M, Olory-Togbe JL, Gbessi DG, Dossou FM, Lawani I, Souaibou YI, Gnangnon I, Denakpo M, Soton RR, Djrouo G, Gogan P, Trukhalev W, Kukosh M, Panyushkin A, Safronova E, Jairam A, Kaufmann R, Jeekel J, Lange JF, Volmer U, Kersten CC, Arlt G, Skach J, Harcubova R, Petrakova V, Mandoboy JD, Ngom G, Faye AL, Ndour O, Sankale AA, Ndoye M, Daneiii P, Leone N, Ballerini A, Bondurri A, Cavallaro G, Silecchia G, Raparelli L, Greco F, Iorio O, Iossa A, De Angelis F, Rizzello M, Olmi S, Cesana G, Baldazzi G, Manoocheri F, Campanile FC, Munipalle P, Khan S, Gwiti P, Kanakala V, Viswanath Y, Kokotovic D, Sjølander H, Gögenur I, Helgstrand F, Devadhar S, Hounnou G, Elegbede OTA, Hadonou AA, Mensah ED, Agossou-Voyeme AK, Konate I, Toure AO, Cisse M, Zaki M, Diao ML, Tendeng JN, Toure FB, Toure CT, Subramanian V, Froghi F, de Carvalho FC, Salimin L, Drabble E. Humbilical & Epigastric Hernia. Hernia 2015; 19 Suppl 1:S35-42. [PMID: 26518843 DOI: 10.1007/bf03355324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F DeAsis
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - M Gitelis
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - S Chao
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - B Lapin
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - J Linn
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - W Denham
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - S Haggerty
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - J Carbray
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - M Ujiki
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | | | - D G Gbessi
- Faculté des sciences de la Santé, Foto, Benin
| | - F M Dossou
- Faculté des sciences de la Santé, Foto, Benin
| | - I Lawani
- Faculté des sciences de la Santé, Foto, Benin
| | | | - I Gnangnon
- Faculté des sciences de la Santé, Foto, Benin
| | - M Denakpo
- Faculté des sciences de la Santé, Foto, Benin
| | - R R Soton
- Faculté des sciences de la Santé, Foto, Benin
| | - G Djrouo
- Faculté des sciences de la Santé, Foto, Benin
| | - P Gogan
- Faculté des sciences de la Santé, Foto, Benin
| | - W Trukhalev
- State Medical Academy, Nizhnij Novgorod, Russia
| | - M Kukosh
- State Medical Academy, Nizhnij Novgorod, Russia
| | | | | | - A Jairam
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - R Kaufmann
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus Medical Centre, Rotterdam, Netherlands
| | - J F Lange
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - U Volmer
- Department of Surgery, Park-Klinik Weissensee, Berlin, Germany
| | | | | | - J Skach
- Hernia Center, Regional Hospital Liberec, Liberec, Czech Republic
| | - R Harcubova
- Hernia Center, Regional Hospital Liberec, Liberec, Czech Republic
| | - V Petrakova
- Hernia Center, Regional Hospital Liberec, Liberec, Czech Republic
| | - J Danga Mandoboy
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - G Ngom
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - A L Faye
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - O Ndour
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - A A Sankale
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - M Ndoye
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | | | | | | | | | - G Cavallaro
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - G Silecchia
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - L Raparelli
- General Surgery Unit, GB Grassi Hospital, Rome, Italy
| | - F Greco
- General Surgery Unit, Andosilla Hospital, Civita Castellana, VT, Italy
| | - O Iorio
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - A Iossa
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - F De Angelis
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - M Rizzello
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - S Olmi
- General and Oncologic Surgery Unit, San Marco Hospital, Zingonia, BG, Italy
| | - G Cesana
- General and Oncologic Surgery Unit, San Marco Hospital, Zingonia, BG, Italy
| | - G Baldazzi
- General and Mini-invasive Surgery Unit, Abano Terme Hospital, Abano Terme, PD, Italy
| | - F Manoocheri
- General and Mini-invasive Surgery Unit, Abano Terme Hospital, Abano Terme, PD, Italy
| | - F C Campanile
- General Surgery Unit, Andosilla Hospital, Civita Castellana, VT, Italy
| | - P Munipalle
- James Cook University Hospital, Middlesbrough, UK
| | | | | | | | | | - D Kokotovic
- Dept. of Surgery, Køge Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - S Devadhar
- Department of Surgery, Pune India, Devadhar Nursing Home, Pune, India
| | - G Hounnou
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - O T A Elegbede
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - A A Hadonou
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - E D Mensah
- CHD/B, Service de Chirurgie Générale, Parakou, Benin
| | - A K Agossou-Voyeme
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - I Konate
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - A O Toure
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | - M Cisse
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | - M Zaki
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | - M L Diao
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - J N Tendeng
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - F B Toure
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - C T Toure
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | | | - F Froghi
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | | | - L Salimin
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | - E Drabble
- Plymouth Hospitals NHS Trust, Plymouth, UK
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Kleif J, Edwards HM, Sort R, Vilandt J, Gögenur I. Translation and validation of the Danish version of the postoperative quality of recovery score QoR-15. Acta Anaesthesiol Scand 2015; 59:912-20. [PMID: 25867135 DOI: 10.1111/aas.12525] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/17/2015] [Accepted: 03/09/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patient perceived quality of recovery is an important outcome after surgery and should be measured in clinical trials. Quality of recovery after surgery and general anaesthesia can be measured by the QoR-15. A high score indicates a good recovery and the score ranges from 0 to 150. The aim of this study was to translate the QoR-15 questionnaire into Danish and do a full psychometric evaluation of the Danish version. METHODS A translation and cultural adaption of the original version of the QoR-15 into a Danish version, the QoR-15D, was performed. After obtaining consent, patients undergoing elective abdominal, orthopaedic or gynaecological surgery under general anaesthesia were included. Patients completed the QoR-15D before surgery and on the first postoperative day. The validity, reliability, responsiveness and clinical feasibility of the QoR-15D were evaluated. RESULTS One hundred and forty patients returned their pre- and postoperative questionnaire successfully giving a completion rate of 56%. The postoperative QoR-15 score was negatively correlated with duration of surgery (ρ = -0.21, 95% CI: -0.04 to -0.36, P < 0.02) and postoperative stay (ρ = -0.28, 95% CI: -0.12 to -0.43, P < 0.01). Postoperative QoR-15D scores were inversely related to the extent of surgery: minor, intermediate or major (127 ± 22, 106 ± 29 and 96 ± 24, respectively, P < 0.01). Cronbach's alpha and split-half reliability was 0.90 and 0.88. Test-retest reliability was 0.99 (95% CI: 0.94-1.00). Cohen's effect size was 1.13 and the standardized response mean was 0.82. CONCLUSION The QoR-15D has preserved the validity, excellent reliability, high degree of responsiveness and the clinical feasibility of the original English version.
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Affiliation(s)
- J. Kleif
- Department of Surgery; Nordsjaellands Hospital; Copenhagen University Hospital; Hillerød Denmark
| | - H. M. Edwards
- Department of Gynaecology and Obstetrics; Herlev Hospital; Copenhagen University Hospital; Herlev Denmark
| | - R. Sort
- Department of Anaesthesiology; Herlev Hospital; Copenhagen University Hospital; Herlev Denmark
| | - J. Vilandt
- Department of Surgery; Nordsjaellands Hospital; Copenhagen University Hospital; Hillerød Denmark
| | - I. Gögenur
- Department of Surgery; Køge Sygehus; Copenhagen University Hospital; Køge Denmark
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Thinggaard E, Bjerrum F, Strandbygaard J, Gögenur I, Konge L. Validity of a cross-specialty test in basic laparoscopic techniques (TABLT). Br J Surg 2015; 102:1106-13. [PMID: 26095788 PMCID: PMC4744674 DOI: 10.1002/bjs.9857] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 01/27/2015] [Accepted: 04/16/2015] [Indexed: 01/22/2023]
Abstract
Background Box trainer systems have been developed that include advanced skills such as suturing. There is still a need for a portable, cheap training and testing system for basic laparoscopic techniques that can be used across different specialties before performing supervised surgery on patients. The aim of this study was to establish validity evidence for the Training and Assessment of Basic Laparoscopic Techniques (TABLT) test, a tablet‐based training system. Methods Laparoscopic surgeons and trainees were recruited from departments of general surgery, gynaecology and urology. Participants included novice, intermediate and experienced surgeons. All participants performed the TABLT test. Performance scores were calculated based on time taken and errors made. Evidence of validity was explored using a contemporary framework of validity. Results Some 60 individuals participated. The TABLT was shown to be reliable, with an intraclass correlation coefficient of 0·99 (P < 0·001). ANOVA showed a difference between the groups with different level of experience (P < 0·001). The Bonferroni correction was used to confirm this finding. A Pearson's r value of 0·73 (P < 0·001) signified a good positive correlation between the level of laparoscopic experience and performance score. A reasonable pass–fail standard was established using contrasting groups methods. Conclusion TABLT can be used for the assessment of basic laparoscopic skills and can help novice surgical trainees in different specialties gain basic laparoscopic competencies. Simple, cheap and valid
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Affiliation(s)
- E Thinggaard
- Centre for Clinical Education, Capital Region of Denmark, Copenhagen, Denmark.,Department of General Surgery, Roskilde and Koege Hospital, Koege, Denmark
| | - F Bjerrum
- Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | | | - I Gögenur
- Department of General Surgery, Roskilde and Koege Hospital, Koege, Denmark
| | - L Konge
- Centre for Clinical Education, Capital Region of Denmark, Copenhagen, Denmark
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39
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Olsen J, Kirkeby L, Eiholm S, Espersen M, Olsen J, Jess P, Gögenur I, Troelsen J. P-193 Downregulation of CDX2 is associated with MMR-deficiency but not recurrence in colon cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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40
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Fonnes S, Donatsky AM, Gögenur I. Expression of core clock genes in colorectal tumour cells compared with normal mucosa: a systematic review of clinical trials. Colorectal Dis 2015; 17:290-7. [PMID: 25418520 DOI: 10.1111/codi.12847] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/15/2014] [Indexed: 12/15/2022]
Abstract
AIM Experimental studies have shown that some circadian core clock genes may act as tumour suppressors and have an important role in the response to oncological treatment. This study investigated the evidence regarding modified expression of core clock genes in colorectal cancer and its correlation to clinicopathological features and survival. METHOD A systematic review was conducted without meta-analysis according to the PRISMA guidelines on 24 March 2014 using PubMed and EMBASE. Eligibility criteria were: study design, original research article, English language, human subjects and gene expression of colorectal cancer cells compared with healthy mucosa cells from specimens analysed by real-time or quantitative real-time polymer chain reaction. The expression of the core clock genes Period, Cryptochrome, Bmal1 and Clock in colorectal tumours were compared with healthy mucosa and correlated with clinicopathological features and survival. RESULTS Seventy-four articles were identified and 11 studies were included. Overall, gene expression of Period was significantly decreased in colorectal cancer cells compared with healthy mucosa cells. This tendency was also seen in the gene expression of Clock. Other core clock genes did not appear to be differentially expressed. Decreased Period gene expression was correlated to some clinicopathological features. CONCLUSION The Period genes seemed to be modified in colorectal tumour cells compared with normal mucosa. Core clock genes might be possible future biomarkers in colorectal cancer.
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Affiliation(s)
- S Fonnes
- Centre for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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41
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Hansen MV, Danielsen AK, Hageman I, Rosenberg J, Gögenur I. The therapeutic or prophylactic effect of exogenous melatonin against depression and depressive symptoms: a systematic review and meta-analysis. Eur Neuropsychopharmacol 2014; 24:1719-28. [PMID: 25224106 DOI: 10.1016/j.euroneuro.2014.08.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/27/2014] [Accepted: 08/10/2014] [Indexed: 11/16/2022]
Abstract
Circadian- and sleep disturbances may be central for understanding the pathophysiology and treatment of depression. The effect of melatonin on depression/depressive symptoms has been investigated previously. This systematic review assesses the current evidence of a therapeutic- and prophylactic effect of melatonin in adult patients against depression or depressive symptoms. A search was performed in The Cochrane Library, PubMed, EMBASE and PsycINFO for published trials on November 14th 2013. Inclusion criteria were English language, RCTs or crossover trials. Our outcome was measurement of depression/depressive symptoms with a validated clinician-administered or self-rating questionnaire. PRISMA recommendations were followed and the Cochrane risk-of-bias tool used. Ten studies in 486 patients were included in the final qualitative synthesis and four studies, 148 patients, were included in two meta-analyses. Melatonin doses varied from 0.5-6 mg daily and the length of follow-up varied from 2 weeks to 3.5 years. Three studies were done on patients without depression at inclusion, two studies in patients with depression and five studies included a mixture. Six studies showed an improvement in depression scores in both the melatonin and placebo groups but there was no significant difference. One study showed a significant prophylactic effect and another found a significant treatment effect on depression with melatonin compared to placebo. The two meta-analyses did not show any significant effect of melatonin. No serious adverse events were reported. Although some studies were positive, there was no clear evidence of a therapeutic- or prophylactic effect of melatonin against depression or depressive symptoms.
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Affiliation(s)
- M V Hansen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Denmark.
| | - A K Danielsen
- Faculty of Health and Technology, Metropolitan University College, Denmark
| | - I Hageman
- Psychiatric Center Copenhagen, Rigshospitalet, University of Copenhagen, Denmark
| | - J Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Denmark
| | - I Gögenur
- Department of Surgery, Herlev Hospital, University of Copenhagen, Denmark
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42
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Affiliation(s)
- L. P. H. Andersen
- Department of Surgery D; Herlev Hospital; University of Copenhagen; Copenhagen Denmark
| | - M. U. Werner
- Multidisciplinary Pain Center 7612; Neuroscience Center; Copenhagen Denmark
| | - J. Rosenberg
- Department of Surgery D; Herlev Hospital; University of Copenhagen; Copenhagen Denmark
| | - I. Gögenur
- Department of Surgery D; Herlev Hospital; University of Copenhagen; Copenhagen Denmark
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43
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Halladin NL, Zahle FV, Rosenberg J, Gögenur I. Interventions to reduce tourniquet-related ischaemic damage in orthopaedic surgery: a qualitative systematic review of randomised trials. Anaesthesia 2014; 69:1033-50. [DOI: 10.1111/anae.12664] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2014] [Indexed: 01/01/2023]
Affiliation(s)
| | - F. V. Zahle
- Department of Orthopaedic Surgery; Nordsjaellands Hospital; Hillerød Denmark
| | - J. Rosenberg
- Department of Surgery; Herlev Hospital; Herlev Denmark
| | - I. Gögenur
- Department of Surgery; Herlev Hospital; Herlev Denmark
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44
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Eriksen TF, Lassen CB, Gögenur I. Treatment with corticosteroids and the risk of anastomotic leakage following lower gastrointestinal surgery: a literature survey. Colorectal Dis 2014; 16:O154-60. [PMID: 24215329 DOI: 10.1111/codi.12490] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/29/2013] [Indexed: 12/13/2022]
Abstract
AIM Background Anastomotic leakage is a serious complication in colorectal surgery. Treatment with corticosteroids is known to impair wound healing but their effect on the healing of a colorectal anastomosis remains unclear, and studies have reported conflicting results. Objective The aim of this study was to evaluate the current evidence regarding the effect of corticosteroids on the risk of anastomotic leakage following colorectal surgery. METHOD Search strategy A systematic review was conducted following a search of PubMed and Embase. Selection criteria Inclusion criteria were studies published in English and involving humans. A minimum cohort of 50 patients was required and anastomoses involving the ileum, colon and rectum were included. Studies that investigated corticosteroids as a risk factor for anastomotic leakage were included regardless of the duration and the dose of corticosteroids. Data Collection and analysis A comparison was conducted between anastomotic leakage in noncorticosteroid- and corticosteroid-treated patients. The main outcome measure was the risk of anastomotic leakage. RESULTS Twelve studies with a total of 9564 patients were included in the review. In total, 1034 patients received corticosteroids in the preoperative period, and 344 patients were diagnosed with anastomotic leakage, 70 of whom had received corticosteroids. Six of the 12 studies showed an increased risk for anastomotic leakage in the corticosteroid group. Overall, the anastomotic leakage rate was 6.77% (95% CI: 5.48-9.06) in the corticosteroid group and 3.26% (95% CI: 2.94-3.58) in the noncorticosteroid group. CONCLUSION Caution should be shown in patients scheduled for lower gastrointestinal surgery with anastomosis.
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Affiliation(s)
- T F Eriksen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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Halladin NL, Ekeløf S, Alamili M, Bendtzen K, Lykkesfeldt J, Rosenberg J, Gögenur I. Lower limb ischaemia and reperfusion injury in healthy volunteers measured by oxidative and inflammatory biomarkers. Perfusion 2014; 30:64-70. [DOI: 10.1177/0267659114530769] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Ischaemia-reperfusion (IR) injury is partly caused by the release of reactive oxygen species and cytokines and may result in remote organ injury. Surgical patients are exposed to surgical stress and anaesthesia, both of which can influence the IR response. An IR model without these interfering factors of surgery is, therefore, useful to test the potential of antioxidant and cytokine-modulatory treatments. The aim of this study was to characterize a human ischaemia-reperfusion model with respect to oxidative and inflammatory biomarkers. Materials and methods: Ten male volunteers were exposed to 20 minutes of lower limb ischaemia. Muscle biopsies and blood samples were taken at baseline and 5, 15, 30, 60 and 90 minutes after tourniquet release and analysed for malondialdehyde (MDA), ascorbic acid, dehydroascorbic acid, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-1 receptor antagonist (IL-1Ra), IL-6, IL-10, TNF-receptor (TNF-R)I, TNF-RII and YKL-40. Results: We found no significant increase in MDA in the muscle biopsies after reperfusion. Plasma levels of oxidative and pro- and anti-inflammatory parameters showed no significant differences between baseline and after reperfusion at any sampling time. Conclusion: Twenty minutes of lower limb ischaemia does not result in an ischaemia-reperfusion injury in healthy volunteers, measurable by oxidative and pro- and anti-inflammatory biomarkers in muscle biopsies and in the systemic circulation.
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Affiliation(s)
- NL Halladin
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - S Ekeløf
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - M Alamili
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - K Bendtzen
- Institute for Inflammation Research, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - J Lykkesfeldt
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - J Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - I Gögenur
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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46
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Affiliation(s)
- L P H Andersen
- Department of Surgery, Herlev Hospital, University of Copenhagen, DK-2730 Herlev, Denmark
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47
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Klein M, Holst Andersen LP, Gögenur I, Rosenberg J. COX-2 selective NSAIDs should not be used after colorectal surgery. Colorectal Dis 2013; 15:1186. [PMID: 23701434 DOI: 10.1111/codi.12298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 03/02/2013] [Indexed: 02/08/2023]
Affiliation(s)
- M Klein
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, Herlev, DK-2730, Denmark.
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Abstract
BACKGROUND AND AIMS Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum bilirubin may be a useful marker for appendiceal perforation. The purpose of this systematic review was to evaluate studies investigating elevated serum bilirubin as a predictor for appendiceal perforation. MATERIAL AND METHODS Medline, Embase, and Cochrane databases were searched for studies evaluating elevated bilirubin in the diagnosis of perforated appendicitis. Study selection criteria included English language papers evaluating serum bilirubin as a marker of appendiceal perforation in humans. A total of 189 abstracts were screened for eligibility, of which five clinical studies were included in this study. RESULTS Bilirubin was significantly higher in patients with appendiceal perforation compared with patients with appendicitis without perforation. Elevated serum bilirubin had a sensitivity ranging from 0.38 to 0.77 and a specificity ranging from 0.70 to 0.87 in predicting appendiceal perforation. CONCLUSIONS Elevated serum bilirubin for determining the risk of perforation in appendicitis has low sensitivity but higher specificity. This measure can therefore be used as a supplement in the diagnostic process.
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Affiliation(s)
- J Burcharth
- Department of Surgery D, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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49
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Abstract
BACKGROUND The unspecific non-steroidal anti-inflammatory drug (NSAID) ketorolac is used during surgery as a single dose regimen to reduce immediate postoperative pain. Many studies have shown an increased risk of bleeding in patients treated with NSAIDs. We wanted to investigate whether intraoperative ketorolac administered at the end of surgery resulted in increased bleeding assessed by reduction in haemoglobin and need for blood transfusion. METHODS This was a retrospective review including all patients undergoing laparoscopic Roux-en-Y gastric bypass in the period between January 1st and March 1st, 2010. Haemoglobin levels, time of surgery, fluid treatment and the need for blood transfusion or reoperation were registered. RESULTS A total of 162 patients were operated in the given period. Of these, the first 47 received intraoperative ketorolac. For the remaining 115 patients, ketorolac was withdrawn. The reduction in haemoglobin in patients receiving intraoperative ketorolac was higher compared with the patients who did not receive ketorolac (-11.3(7.6) % vs. -8.4(6.4) %; p = 0.018). No significant difference was found between the two groups with respect of transfusion requirements (2 out of 47 patients in the ketorolac group versus 0 patients out of 115 in the control group (p = 0.08)). CONCLUSIONS Ketorolac given during surgery may increase the risk of postoperative haemorrhage after laparoscopic Roux-en-Y gastric by-pass.
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Affiliation(s)
- M. Klein
- Herlev Hospital, University of Copenhagen, Department of Surgery D, Herlev, Denmark
| | | | - J. Rosenberg
- Herlev Hospital, University of Copenhagen, Department of Surgery D, Herlev, Denmark
| | - I. Gögenur
- Herlev Hospital, University of Copenhagen, Department of Surgery D, Herlev, Denmark
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50
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Klein M, Krarup PM, Kongsbak MB, Agren MS, Gögenur I, Jorgensen LN, Rosenberg J. Effect of postoperative diclofenac on anastomotic healing, skin wounds and subcutaneous collagen accumulation: a randomized, blinded, placebo-controlled, experimental study. ACTA ACUST UNITED AC 2012; 48:73-8. [PMID: 22343935 DOI: 10.1159/000336208] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 01/04/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Retrospective studies have drawn attention to possible detrimental effects of non-steroidal anti-inflammatory drugs (NSAIDs) on the anastomotic leakage rate after colorectal resection. In this study, we examined the effects of the NSAID diclofenac on the breaking strength of an experimental colonic anastomosis and a skin incision as well as subcutaneous collagen accumulation. METHODS This was a randomized, blinded, placebo-controlled experimental study in 60 male Wistar rats treated with diclofenac 4 mg/kg/day or placebo. In each rat, a colonic anastomosis was performed and an expanded polytetrafluoroethylene (ePTFE) tube was placed subcutaneously. Incisional and anastomotic wound breaking strength and hydroxyproline content in the ePTFE tubes were measured 7 days after the operation. RESULTS We found no significant differences in any of the breaking strength measurements, but showed a median 38% reduction in hydroxyproline deposition as a result of diclofenac treatment (p = 0.03). In the placebo group, subcutaneous collagen deposition tended to correlate positively with skin incisional but negatively with anastomotic bio-mechanical strength. CONCLUSION Postoperative diclofenac treatment significantly inhibited collagen deposition in subcutaneous granulation tissue. Anastomotic strength and skin wound strength were not significantly affected. The ePTFE model is suitable for assessing the effect of various drugs on collagen formation and thus on wound healing.
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Affiliation(s)
- M Klein
- Department of Surgical Gastroenterology D, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
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