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  • 1.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Barmparas, Galinos
    Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, USA.
    Riddez, Louis
    Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Ley, Eric J.
    Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, USA.
    Wallin, Göran
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Does beta-blockade reduce the risk of depression in patients with isolated severe extracranial injuries?2017Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 41, nr 7, s. 1801-1806Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Approximately half of trauma patients develop post-traumatic depression. It is suggested that beta-blockade impairs trauma memory recollection, reducing depressive symptoms. This study investigates the effect of early beta-blockade on depression following severe traumatic injuries in patients without significant brain injury.

    METHODS: Patients were identified by retrospectively reviewing the trauma registry at an urban university hospital between 2007 and 2011. Severe extracranial injuries were defined as extracranial injuries with Abbreviated Injury Scale score ≥3, intracranial Abbreviated Injury Scale score <3 and an Injury Severity Score ≥16. In-hospital deaths and patients prescribed antidepressant therapy ≤1 year prior to admission were excluded. Patients were stratified into groups based on pre-admission beta-blocker status. The primary outcome was post-traumatic depression, defined as receiving antidepressants ≤1 year following trauma.

    RESULTS: Five hundred and ninety-six patients met the inclusion criteria with 11.4% prescribed pre-admission beta-blockade. Patients receiving beta-blockers were significantly older (57 ± 18 vs. 42 ± 17 years, p < 0.001) with lower Glasgow Coma Scale score (12 ± 3 vs. 14 ± 2, p < 0.001). The beta-blocked cohort spent significantly longer in hospital (21 ± 20 vs. 15 ± 17 days, p < 0.01) and intensive care (4 ± 7 vs. 3 ± 5 days, p = 0.01). A forward logistic regression model was applied and predicted lack of beta-blockade to be associated with increased risk of depression (OR 2.7, 95% CI 1.1-7.2, p = 0.04). After adjusting for group differences, patients lacking beta-blockers demonstrated an increased risk of depression (AOR 3.3, 95% CI 1.2-8.6, p = 0.02).

    CONCLUSIONS: Pre-admission beta-blockade is associated with a significantly reduced risk of depression following severe traumatic injury. Further investigation is needed to determine the beneficial effects of beta-blockade in these instances.

  • 2.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Matthiessen, Peter
    School of Medical Sciences, Örebro University, Örebro, Sweden; Division of Colorectal Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Sjölin, Gabriel
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    The Relationship Between Severe Complications, Beta-Blocker Therapy and Long-Term Survival Following Emergency Surgery for Colon Cancer2019Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, nr 10, s. 2527-2535Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Emergency surgery for colon cancer carries significant morbidity, and studies show more than doubled mortality when comparing elective to emergency surgery. The relationship between postoperative complications and survival has been outlined. Beta-blocker therapy has been linked to improved postoperative outcomes. This study aims to assess the impact of postoperative complications on long-term survival following emergency surgery for colon cancer and to determine whether beta-blockade can reduce complications.

    STUDY DESIGN: This cohort study utilized the prospective Swedish Colorectal Cancer Registry to identify adults undergoing emergency colon cancer surgery between 2011 and 2016. Prescription data for preoperative beta-blocker therapy were collected from the national drug registry. Cox regression was used to evaluate the effect of beta-blocker exposure and complications on 1-year mortality, and Poisson regression was used to evaluate beta-blocker exposure in patients with major complications.

    RESULTS: A total of 3139 patients were included with a mean age of 73.1 [12.4] of which 671 (21.4%) were prescribed beta-blockers prior to surgery. Major complications occurred in 375 (11.9%) patients. Those suffering major complications showed a threefold increase in 1-year mortality (adjusted HR = 3.29; 95% CI 2.75-3.94; p < 0.001). Beta-blocker use was linked to a 60% risk reduction in 1-year mortality (adjusted HR = 0.40; 95% CI 0.26-0.62; p < 0.001) but did not show a statistically significant association with reductions in major complications (adjusted IRR = 0.77; 95% CI 0.59-1.00; p = 0.055).

    CONCLUSION: The development of major complications after emergency colon cancer surgery is associated with increased mortality during one year after surgery. Beta-blocker therapy may protect against postoperative complications.

  • 3.
    Blomgren, Lena
    Department of Surgery, St. Göran Hospital, Stockholm, Sweden.
    Perforated peptic ulcer: long-term results after simple closure in the elderly1997Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 21, nr 4, s. 412-414; discussion 414Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The relative incidence of peptic ulcer perforation in the elderly is rising, and the optimal surgical treatment has yet to be defined. To evaluate the long-term result after simple closure a follow-up study was initiated at a Swedish community hospital. During 1983-1992 a total of 151 patients were admitted with perforated peptic ulcer; 92 were elderly (i.e., 70 years or older), 63 of whom were operated with simple closure. Mortality at 30 days was 27% (17/63) and the total in-hospital mortality 30% (19/63). After a mean follow-up of 79 months, 14 of the 44 survivors are still alive. So far only three of the survivors have required additional hospitalization for complications of peptic ulcer disease. Because the rate of serious recurrences is low (14%, 6/44), it is concluded that simple closure is an adequate surgical treatment for peptic ulcer perforation in the elderly.

  • 4.
    Elias, Kevin M.
    et al.
    Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    Stone, Alexander B.
    Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    McGinigle, Katharine
    University of North Carolina School of Medicine, Chapel Hill, USA.
    Tankou, Jo'An I.
    Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    Scott, Michael J.
    Virginia Commonwealth University Health System, Richmond, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
    Fawcett, William J.
    Royal Surrey County Hospital, Guilford, UK; University of Surrey, Guilford, UK.
    Demartines, Nicolas
    Lausanne University Hospital CHUV, Lausanne, Switzerland.
    Lobo, Dileep N
    Nottingham Digestive Diseases Centre, Nottingham, UK; National Institute for Health Research (NIHR), Nottingham, UK; Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Queen’s Medical Centre, University of Nottingham, Nottingham, UK.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Urman, Richard D.
    Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    Eras, Society
    The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist: A Joint Statement by the ERAS® and ERAS® USA Societies2019Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, nr 1, s. 1-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Enhanced recovery after surgery (ERAS) programs are multimodal care pathways designed to minimize the physiological and psychological impact of surgery for patients. Increased compliance with ERAS guidelines is associated with improved patient outcomes across surgical types. As ERAS programs have proliferated, an unintentional effect has been significant variation in how ERAS-related studies are reported in the literature.

    METHODS: Society launched an effort to create an instrument to assist authors in manuscript preparation. Criteria to include were selected by a combination of literature review and expert opinion. The final checklist was refined by group consensus.

    RESULTS: The Societies present the Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist. The tool contains 20 items including best practices for reporting clinical pathways, compliance auditing, and formatting guidelines.

    CONCLUSIONS: The RECOvER Checklist is intended to provide a standardized framework for the reporting of ERAS-related studies. The checklist can also assist reviewers in evaluating the quality of ERAS-related manuscripts. Authors are encouraged to include the RECOvER Checklist when submitting ERAS-related studies to peer-reviewed journals.

  • 5.
    Francis, Nader K.
    et al.
    Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Higher Kingston, Yeovil, UK; Faculty of Science, University of Bath, Bath, UK.
    Walker, Thomas
    Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Higher Kingston, Yeovil, UK.
    Carter, Fiona
    South West Surgical Training Network, ERAS-UK, Yeovil, UK.
    Hübner, Martin
    Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
    Balfour, Angela
    NHS Lothian Western General Hospital, Edinburgh, UK.
    Jakobsen, Dorthe Hjort
    Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark.
    Burch, Jennie
    Head of Gastrointestinal Nurse Education, Academic Institute, St Mark's Hospital, London, UK.
    Wasylak, Tracy
    Strategic Clinical Networks, Alberta Health Services, Edmonton AB, Canada; Faculty of Nursing, University of Calgary, Calgary AB, Canada.
    Demartines, Nicolas
    Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
    Lobo, Dileep N.
    Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Queen's Medical Centre, University of Nottingham, Nottingham, UK; National Institute for Health Research (NIHR), London, UK.
    Addor, Valerie
    Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Consensus on Training and Implementation of Enhanced Recovery After Surgery: A Delphi Study2018Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, nr 7, s. 1919-1928Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Enhanced Recovery After Surgery (ERAS) is widely accepted in current surgical practice due to its positive impact on patient outcomes. The successful implementation of ERAS is challenging and compliance with protocols varies widely. Continual staff education is essential for successful ERAS programmes. Teaching modalities exist, but there remains no agreement regarding the optimal training curriculum or how its effectiveness is assessed. We aimed to draw consensus from an expert panel regarding the successful training and implementation of ERAS.

    METHODS: A modified Delphi technique was used; three rounds of questionnaires were sent to 58 selected international experts from 11 countries across multiple ERAS specialities and multidisciplinary teams (MDT) between January 2016 and February 2017. We interrogated opinion regarding four topics: (1) the components of a training curriculum and the structure of training courses; (2) the optimal framework for successful implementation and audit of ERAS including a guide for data collection; (3) a framework to assess the effectiveness of training; (4) criteria to define ERAS training centres of excellence.

    RESULTS: An ERAS training course must cover the evidence-based principles of ERAS with team-oriented training. Successful implementation requires strong leadership, an ERAS facilitator and an effective MDT. Effectiveness of training can be measured by improved compliance. A training centre of excellence should show a willingness to teach and demonstrable team working.

    CONCLUSIONS: We propose an international expert consensus providing an ERAS training curriculum, a framework for successful implementation, methods for assessing effectiveness of training and a definition of ERAS training centres of excellence.

  • 6.
    Gustafsson, U. O.
    et al.
    Department of Surgery, Danderyd Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Scott, M. J.
    Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, USA; Department of Anesthesiology, University of Pennsylvania, Philadelphia, USA.
    Hubner, M.
    Department of Visceral Surgery, CHUV, Lausanne, Switzerland.
    Nygren, J.
    Department of Surgery, Ersta Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Demartines, N.
    Department of Visceral Surgery, CHUV, Lausanne, Switzerland.
    Francis, N.
    Colorectal Unit, Yeovil District Hospital, Higher Kingston, Yeovil, UK; University of Bath, Wessex House Bath, UK.
    Rockall, T. A.
    Department of Surgery, Royal Surrey County Hospital NHS Trust, and Minimal Access Therapy Training Unit (MATTU), Guildford, UK.
    Young-Fadok, T. M.
    Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Phoenix, USA.
    Hill, A. G.
    Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland Middlemore Hospital, Auckland, New Zealand.
    Soop, M.
    Irving National Intestinal Failure Unit, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
    de Boer, H. D.
    Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital, Groningen, The Netherlands.
    Urman, R. D.
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    Chang, G. J.
    Department of Surgical Oncology and Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, USA.
    Fichera, A.
    Division of Gastrointestinal Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA.
    Kessler, H.
    Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA.
    Grass, F.
    Department of Visceral Surgery, CHUV, Lausanne, Switzerland.
    Whang, E. E.
    Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    Fawcett, W. J.
    Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust and University of Surrey, Guildford, UK.
    Carli, F.
    Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Canada.
    Lobo, D. N.
    Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, UK.
    Rollins, K. E.
    Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, UK.
    Balfour, A.
    Department of Colorectal Surgery, Surgical Services, Western General Hospital, NHS Lothian, Edinburgh, UK.
    Baldini, G.
    Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Canada.
    Riedel, B.
    Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University and University Hospital, Örebro, Sweden; Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 20182019Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, nr 3, s. 659-695Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: This is the fourth updated Enhanced Recovery After Surgery (ERAS®) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol.

    Methods: A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.

    Results: All recommendations on ERAS® protocol items are based on best available evidence; good-quality trials; meta-analyses of good-quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly.

    Conclusions: The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS® Society in this comprehensive consensus review.

  • 7. Gustafsson, U. O.
    et al.
    Scott, M. J.
    Schwenk, W.
    Demartines, N.
    Roulin, D.
    Francis, N.
    McNaught, C. E.
    Macfie, J.
    Liberman, A. S.
    Soop, M.
    Hill, A.
    Kennedy, R. H.
    Lobo, D. N.
    Fearon, Ken
    Ljungqvist, Olle
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS(®)) society recommendations2013Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 37, nr 2, s. 259-284Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidenced-based enhanced perioperative protocol.

    METHODS: Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group.

    RESULTS: For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (quality of evidence and recommendations according to the GRADE system).

    CONCLUSIONS: Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, International Association for Surgical Metabolism and Nutrition (IASMEN) and European Society for Clinical Nutrition and Metabolism (ESPEN) present a comprehensive evidence-based consensus review of perioperative care for colonic surgery.

  • 8.
    Gustafsson, Ulf O.
    et al.
    Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Oppelstrup, Henrik
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
    Thorell, Anders
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
    Nygren, Jonas
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden; Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Adherence to the ERAS protocol is Associated with 5-Year Survival After Colorectal Cancer Surgery: A Retrospective Cohort Study2016Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 40, nr 7, s. 1741-1747Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Surgical stress can influence oncological outcome and survival. The enhanced recovery after surgery (ERAS) protocol is designed to reduce perioperative stress and has been shown to reduce postoperative morbidity. We studied if adherence to ERAS is associated with increased long-term survival.

    Methods: Between the years 2002 and 2007, 911 consecutive patients, operated with major colorectal cancer surgery at Ersta Hospital, Stockholm, Sweden were analyzed. The histopathological reports of the resected specimen, date, and cause of death of the patients as well as postoperative CRP levels were obtained. The relation between the rate of adherence to the ERAS protocol at the time of surgery, and the short-term outcomes in relation to 5-year overall and colorectal cancer-specific survival was determined in this retrospective cohort study.

    Results: In patients with ≥70 % adherence to ERAS interventions (N = 273,), the risk of 5-year cancer-specific death was lowered by 42 %, HR 0.58 (0.39-0.88, cox regression) compared to all other patients (<70 % adherence). Significant independent perioperative predictors of increased 5-year survival were avoiding overload of intravenous fluids, HR 0.53 (0.32-0.86); oral intake on the day of operation, HR 0.55 (0.34-0.78); and low CRP levels on postoperative day 1.

    Conclusion: High adherence to the ERAS protocol may be associated with improved 5-year cancer-specific survival after colorectal cancer surgery.

  • 9.
    Gustafsson, Ulf O.
    et al.
    Department of Surgery, Ersta Hospital, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden; Centre for Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden.
    Tiefenthal, Marit
    Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Thorell, Anders
    Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Surgery, Örebro University Hospital, Örebro, Sweden; Institute of Molecular Medicine and surgery, Karolinska Institutet, Stockholm, Sweden.
    Nygrens, Jonas
    Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Laparoscopic-assisted and open high anterior resection within an ERAS protocol2012Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 36, nr 5, s. 1154-1161Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Due to potentially superior short-term outcomes compared with open colorectal surgery, laparoscopic surgery is currently being implemented in clinical practice worldwide. In parallel, enhanced recovery after surgery (ERAS) programs are shown to improve postoperative recovery in open colorectal surgery. This study reports outcomes in laparoscopic versus open surgery in conjunction with compliance to the ERAS protocol.

    Methods: The association between surgical approach (laparoscopic or open surgery), compliance to the ERAS protocol, postoperative symptoms, complications, and length of stay after surgery was studied. Between January 2007 to December 2010, 114 consecutive patients underwent elective high anterior resection with laparoscopic-assisted (n = 55) or open resection (n = 59). All clinical data (114 variables) were prospectively recorded.

    Results: The overall preoperative ERAS-protocol compliance was 77% for both the laparoscopic and open group. Laparoscopic surgery resulted in shorter total length of stay (median 4 vs. 6 days, p = 0.04), earlier pain control (median 2 vs. 3 days, p = 0.008), shorter need for intravenous infusions, improved mobilization on the first postoperative day (POD1), and lower inflammatory response (CRP (POD1) 54 +/- 24 vs. 67 +/- 31 mg/l, p = 0.017) compared with open resection. The trends in fewer postoperative complications (9.1 vs. 16.9%; odds ratio (OR) 0.55; 95% confidence interval (CI) 0.17-1.81) and overall postoperative symptoms delaying recovery (20 vs. 30.5%; OR 0.63; 95% CI 0.22-1.34) in laparoscopic surgery were not statistically significant.

    Conclusions: The use of laparoscopy in colorectal surgery within an ERAS protocol results in faster recovery compared with open resection.

  • 10.
    Inabnet, William B.
    et al.
    Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA.
    Palazzo, Fausto
    Hammersmith Hospital and Imperial College, London, UK.
    Sosa, Julie Ann
    University of California, San Francisco, CA, USA.
    Kriger, Joshua
    Columbia University Mailman School of Public Health, New York, NY, USA.
    Aspinall, Sebastian
    Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
    Barczynski, Marcin
    Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
    Doherty, Gerard
    Brigham and Women's Hospital, Boston, MA, USA.
    Iacobone, Maurizio
    University of Padua, Padua, Italy.
    Nordenström, Erik
    Lund University, Lund, Sweden.
    Scott-Coombes, David
    University Hospital of Wales, Cardiff, UK.
    Wallin, Göran
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Williams, Lauren
    Columbia University Mailman School of Public Health, New York, NY, USA.
    Bray, Rachel
    Columbia University Mailman School of Public Health, New York, NY, USA.
    Bergenfelz, Anders
    Lund University, Lund, Sweden.
    Correlating the Bethesda System for Reporting Thyroid Cytopathology with Histology and Extent of Surgery: A Review of 21,746 Patients from Four Endocrine Surgery Registries Across Two Continents2020Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 44, nr 2, s. 426-435Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The Bethesda system for cytopathology (TBSRTC) is a 6-tier diagnostic framework developed to standardize thyroid cytopathology reporting. The aim of this study was to determine the risk of malignancy (ROM) for each Bethesda category.

    METHODS: Thyroidectomy-related data from 314 facilities in 22 countries were entered into the following outcome registries: CESQIP (North America), Eurocrine (Europe), SQRTPA (Sweden) and UKRETS (UK). Demographic, cytological, pathologic and extent of surgery data were mapped into one dataset and analyzed.

    RESULTS: Out of 41,294 thyroidectomy patient entries from January 1, 2015, to June 30, 2017, 21,746 patients underwent both thyroid FNA and surgery. A comparison of cytology and surgical pathology data demonstrated a ROM for Bethesda categories 1 to 6 of 19.2%, 12.7%, 31.9%, 31.4%, 77.8% and 96.0%, respectively. Male patients had a higher rate of malignancy for every Bethesda category. Secondary analysis demonstrated a high ROM in male patients with Bethesda 3 category aged 31-35 years (52.1%, 95% confidence interval (CI) 37.9-66.2%), aged 36-40 years (55.9%, 95% CI 39.2-72.6%) and aged 41-45 years (46.9%, 95% CI 33-60.9%). Patients with Bethesda 5 and 6 scores were more likely to undergo total thyroidectomy (65.9% and 84.6%); for patients with Bethesda scores 2 and 3, a higher percentage of females underwent total thyroidectomy compared to males in spite of a higher ROM for males.

    CONCLUSIONS: These data demonstrate that Bethesda categories 1-4 are associated with a higher ROM compared to the first edition of TBSRTC, especially in male patients, and validate findings from the second edition of TBSRTC.

  • 11.
    Khalili, Hosseinali
    et al.
    Department of Neurosurgery, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
    Ahl, Rebecka
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery, Karolinska University Hospital,Stockholm, Sweden; .
    Paydar, Shahram
    Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
    Sjölin, Gabriel
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Fard, Hossein Abdolrahimzadeh
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
    Niakan, Amin
    Department of Neurosurgery, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
    Hanna, Kamil
    Department of Surgery, University of Arizona College of Medicine, Tucson AZ, USA.
    Joseph, Bellal
    Department of Surgery, University of Arizona College of Medicine, Tucson AZ, USA.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery.
    Beta-Blocker Therapy in Severe Traumatic Brain Injury: A Prospective Randomized Controlled Trial2020Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 44, nr 6, s. 1844-1853Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Observational studies have demonstrated improved outcomes in TBI patients receiving in-hospital beta-blockers. The aim of this study is to conduct a randomized controlled trial examining the effect of beta-blockers on outcomes in TBI patients.

    Methods: Adult patients with severe TBI (intracranial AIS >= 3) were included in the study. Hemodynamically stable patients at 24 h after injury were randomized to receive either 20 mg propranolol orally every 12 h up to 10 days or until discharge (BB+) or no propranolol (BB-). Outcomes of interest were in-hospital mortality and Glasgow Outcome Scale-Extended (GOS-E) score on discharge and at 6-month follow-up. Subgroup analysis including only isolated severe TBI (intracranial AIS >= 3 with extracranial AIS <= 2) was carried out. Poisson regression models were used.

    Results: Two hundred nineteen randomized patients of whom 45% received BB were analyzed. There were no significant demographic or clinical differences between BB+ and BB- cohorts. No significant difference in inhospital mortality (adj. IRR 0.6 [95% CI 0.3-1.4], p = 0.2) or long-term functional outcome was measured between the cohorts (p = 0.3). One hundred fifty-four patients suffered isolated severe TBI of whom 44% received BB. The BB? group had significantly lower mortality relative to the BB- group (18.6% vs. 4.4%, p = 0.012). On regression analysis, propranolol had a significant protective effect on in-hospital mortality (adj. IRR 0.32, p = 0.04) and functional outcome at 6-month follow-up (GOS-E >= 5 adj. IRR 1.2, p = 0.02).

    Conclusion: Propranolol decreases in-hospital mortality and improves long-term functional outcome in isolated severe TBI. This randomized trial speaks in favor of routine administration of beta-blocker therapy as part of a standardized neurointensive care protocol.

    Level of evidence: Level II; therapeutic.

    Study type: Therapeutic study.

  • 12. Lassen, Kristoffer
    et al.
    Coolsen, Marielle M. E.
    Slim, Karem
    Carli, Francesco
    de Aguilar-Nascimento, José E.
    Schäfer, Markus
    Parks, Rowan W.
    Fearon, Kenneth C. H.
    Lobo, Dileep N.
    Demartines, Nicolas
    Braga, Marco
    Ljungqvist, Olle
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län.
    Dejong, Cornelis H. C.
    Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS®) society recommendations2013Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 37, nr 2, s. 240-258Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Protocols for enhanced recovery provide comprehensive and evidence-based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length-of-stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy.

    METHODS: An international working group constructed within the Enhanced Recovery After Surgery (ERAS(®)) Society constructed a comprehensive and evidence-based framework for best perioperative care for pancreaticoduodenectomy patients. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group. The quality of evidence was rated "high", "moderate", "low" or "very low". Recommendations were graded as "strong" or "weak".

    RESULTS: Comprehensive guidelines are presented. Available evidence is summarised and recommendations given for 27 care items. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations.

    CONCLUSIONS: The present evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy. A unified protocol allows for comparison between centres and across national borders. It facilitates multi-institutional prospective cohort registries and adequately powered randomised trials.

  • 13.
    Ljungqvist, Olle
    Region Örebro län.
    Guidelines for perioperative care2013Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 37, nr 2, s. 239-239Artikel i tidskrift (Refereegranskat)
  • 14.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för läkarutbildning.
    Sustainability After Structured Implementation of ERAS Protocols2015Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 39, nr 2, s. 534-535Artikel i tidskrift (Refereegranskat)
  • 15.
    Low, Donald E.
    et al.
    Head of Thoracic Surgery and Thoracic Oncology, C6-GS, Virginia Mason Medical Center, Seattle, USA.
    Allum, William
    The Royal Marsden Hospitals, London, UK.
    De Manzoni, Giovanni
    University of Verona, Verona, Italy.
    Ferri, Lorenzo
    McGill University Health Centre, Montreal, Canada.
    Immanuel, Arul
    Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK.
    Kuppusamy, MadhanKumar
    Head of Thoracic Surgery and Thoracic Oncology, C6-GS, Virginia Mason Medical Center, Seattle, USA.
    Law, Simon
    Queen Mary Hospital, Hong Kong, China.
    Lindblad, Mats
    Karolinska Institutet, Stockholm, Sweden.
    Maynard, Nick
    Oxford Radcliffe Hospitals, Oxford, UK.
    Neal, Joseph
    Head of Thoracic Surgery and Thoracic Oncology, C6-GS, Virginia Mason Medical Center, Seattle, USA.
    Pramesh, C. S.
    Tata Memorial Centre, Mumbai, India.
    Scott, Mike
    Virginia Commonwealth University Health System, Richmond, USA.
    Mark Smithers, B.
    Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia.
    Addor, Valérie
    Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations2019Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, nr 2, s. 299-330Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Enhanced recovery after surgery (ERAS) programs provide a format for multidisciplinary care and has been shown to predictably improve short term outcomes associated with surgical procedures. Esophagectomy has historically been associated with significant levels of morbidity and mortality and as a result routine application and audit of ERAS guidelines specifically designed for esophageal resection has significant potential to improve outcomes associated with this complex procedure.

    METHODS: A team of international experts in the surgical management of esophageal cancer was assembled and the existing literature was identified and reviewed prior to the production of the guidelines. Well established procedure specific components of ERAS were reviewed and updated with changes relevant to esophagectomy. Procedure specific, operative and technical sections were produced utilizing the best current level of evidence. All sections were rated regarding the level of evidence and overall recommendation according to the evaluation (GRADE) system.

    RESULTS: Thirty-nine sections were ultimately produced and assessed for quality of evidence and recommendations. Some sections were completely new to ERAS programs due to the fact that esophagectomy is the first guideline with a thoracic component to the procedure.

    CONCLUSIONS: The current ERAS society guidelines should be reviewed and applied in all centers looking to improve outcomes and quality associated with esophageal resection.

  • 16.
    McQueen, K.
    et al.
    Department of Anesthesiology, Vanderbilt University, Nashville, South Africa.
    Oodit, R.
    University of Cape Town, Cape Town, South Africa.
    Derbew, M.
    Black Lion Hospital, Addis Ababa, Ethiopia.
    Banguti, P.
    Department of Anesthesiology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Enhanced Recovery After Surgery for Low- and Middle-Income Countries2018Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, nr 4, s. 950-952Artikel i tidskrift (Refereegranskat)
  • 17.
    McQueen, Kelly
    et al.
    Department of Anesthesiology, Vanderbilt University, Nashville, South Africa.
    Oodit, Ravi
    University of Cape Town, Cape Town, South Africa.
    Derbew, Miliard
    Black Lion Hospital, Addis Ababa, Ethiopia.
    Banguti, Paulin
    Department of Anesthesiology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Authors' Reply: Enhanced Recovery After Surgery for Low and Middle-Income Countries2018Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, nr 12, s. 4126-4126Artikel i tidskrift (Refereegranskat)
  • 18.
    Meehan, Adrian David
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Geriatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Kardell, Mathias
    Section of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden.
    Landén, Mikael
    Section of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden: Sahlgrenska University Hospital, Gothenburg, Sweden.
    Järhult, Johannes
    Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
    Wallin, Göran
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lithium-Associated Hypercalcemia: Pathophysiology, Prevalence, Management2018Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, nr 2, s. 415-424Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Lithium-associated hypercalcemia (LAH) is an ill-defined endocrinopathy. The aim of the present study was to determine the prevalence of hypercalcemia in a cohort of bipolar patients (BP) with and without concomitant lithium treatment and to study surgical outcomes for lithium-associated hyperparathyroidism.

    METHODS: Retrospective data, including laboratory results, surgical outcomes and medications, were collected from 313 BP treated with lithium from two psychiatric outpatient units in central Sweden. In addition, data were collected from 148 BP without lithium and a randomly selected control population of 102 individuals. Logistic regression was used to compare odds of hypercalcemia in these respective populations.

    RESULTS: The prevalence of lithium-associated hypercalcemia was 26%. Mild hypercalcemia was detected in 87 out of 563 study participants. The odds of hypercalcemia were significantly higher in BP with lithium treatment compared with BP unexposed to lithium (adjusted OR 13.45; 95% CI 3.09, 58.55; p = 0.001). No significant difference was detected between BP without lithium and control population (adjusted OR 2.40; 95% CI 0.38, 15.41; p = 0.355). Seven BP with lithium underwent surgery where an average of two parathyroid glands was removed. Parathyroid hyperplasia was present in four patients (57%) at the initial operation. One patient had persistent disease after the initial operation, and six patients had recurrent disease at follow-up time which was on average 10 years.

    CONCLUSION: The high prevalence of LAH justifies the regular monitoring of calcium homeostasis, particularly in high-risk groups. If surgery is necessary, bilateral neck exploration should be considered in patients on chronic lithium treatment. Prospective studies are needed.

  • 19.
    Meehan, Adrian David
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Geriatrics.
    Wallin, Göran
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery.
    Järhult, Johannes
    Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
    Characterization of Calcium Homeostasis in Lithium-Treated Patients Reveals Both Hypercalcaemia and Hypocalcaemia2020Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 44, nr 2, s. 517-525Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Prevalence studies demonstrate that a significant proportion of lithium-treated patients develop hypercalcaemia (3-30%). Lithium-associated hyperparathyroidism (LHPT) is poorly defined, and calcium homeostasis may be affected in a more complicated fashion than purely by elevated PTH secretion. The current study aims to examine in detail calcium homeostasis principally with regard to lithium duration.

    METHODS: Medical records of 297 lithium-treated patients (193 women, 104 men; median age 58 years) were examined, and information on gender, age, lithium treatment duration and calcium homeostasis was obtained. The median treatment duration with lithium was 16 (1.5-45) years.

    RESULTS: A total of 8504 calcium values were retrieved. Before initiation of lithium treatment, serum calcium was on average 2.33 mmol/l (2.02-2.60). During the treatment period, 178 patients (60%) remained normocalcaemic, 102 (34%) developed hypercalcaemia or were strongly suspected of LHPT, 17 (6%) had 3 or more intermittent episodes of hypocalcaemia. Forty-one per cent of patients with suspected or confirmed LHPT had low (<4 mmol) 24-h urine calcium levels. The success rate after 33 parathyroidectomies was 35%, hyperplasia being diagnosed in 75% of extirpated glands.

    CONCLUSIONS: The prevalence of hypercalcaemia during lithium treatment is very high. In addition, hypocalcaemic episodes appear to occur frequently, possibly reflecting a more complicated parathyroid dysfunction than previously known. Long-term surgical results are unsatisfactory. LHPT biochemical profile is different from that of primary hyperparathyroidism and is in some ways similar to familial hypocalciuric hypercalcaemia.

  • 20.
    Mohseni, Shahin
    et al.
    Region Örebro län. Department of Surgery, Division of Acute Care Surgery, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden; Department of Surgery, Division of Acute Care Surgery and Trauma, Karolinska University Hospital Solna, Stockholm, Sweden.
    Talving, Peep
    Department of Surgery, Tartu University Hospital, Tartu, Estonia; Department of Surgery, North Estonia Medical Center, Tallinn, Estonia.
    Thelin, Eric P.
    Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
    Wallin, Göran
    Region Örebro län. Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Surgery, Division of Acute Care Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Department of Surgery, Division of Acute Care Surgery, Örebro University Hospital, Örebro, Sweden.
    Riddez, Louis
    Department of Surgery, Division of Acute Care Surgery and Trauma, Karolinska University Hospital Solna, Stockholm, Sweden.
    The Effect of beta-blockade on Survival After Isolated Severe Traumatic Brain Injury2015Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 39, nr 8, s. 2076-2083Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Several North American studies have observed survival benefit in patients exposed to beta-blockers following traumatic brain injury (TBI). The purpose of this study was to evaluate the effect of beta-blockade on mortality in a Swedish cohort of isolated severe TBI patients.

    The trauma registry of an urban academic trauma center was queried to identify patients with an isolated severe TBI between 1/2007 and 12/2011. Isolated severe TBI was defined as an intracranial injury with an Abbreviated Injury Scale (AIS) a parts per thousand yen3 excluding extra-cranial injuries AIS a parts per thousand yen3. Multivariable logistic regression analysis was used to determine the effect of beta-blocker exposure on mortality. Also, a subgroup analysis was performed to investigate the risk of mortality in patients on pre-admission beta-blocker versus not and the effect of specific type of beta-blocker on the overall outcome.

    Overall, 874 patients met the study criteria. Of these, 33 % (n = 287) were exposed to beta-blockers during their hospital admission. The exposed patients were older (62 +/- A 16 years vs. 49 +/- A 21 years, p < 0.001), and more severely injured based on their admission GCS, ISS, and head AIS scores (GCS a parts per thousand currency sign8: 32 % vs. 28 %, p = 0.007; ISS a parts per thousand yen16: 71 % vs. 59 %, p = 0.001; head AIS a parts per thousand yen4: 60 % vs. 45 %, p < 0.001). The crude mortality was higher in patients who did not receive beta-blockers (17 % vs. 11 %, p = 0.007) during their admission. After adjustment for significant confounders, the patients not exposed to beta-blockers had a 5-fold increased risk of in-hospital mortality (AOR 5.0, CI 95 % 2.7-8.5, p = 0.001). No difference in survival was noted in regards to the type of beta-blocker used. Subgroup analysis revealed a higher risk of mortality in patients naive to beta-blockers compared to those on pre-admission beta-blocker therapy (AOR 3.0 CI 95 % 1.2-7.1, p = 0.015).

    Beta-blocker exposure after isolated severe traumatic brain injury is associated with significantly improved survival. We also noted decreased mortality in patients on pre-admission beta-blocker therapy compared to patients naive to such treatment. Further prospective studies are warranted.

  • 21.
    Nelson, Gregg
    et al.
    Department of Oncology, University of Calgary, Calgary, Canada; Tom Baker Cancer Centre, Calgary AB, Canada.
    Kiyang, Lawrence N.
    Alberta Health Services, , Canada.
    Crumley, Ellen T.
    Alberta Health Services, , Canada.
    Chuck, Anderson
    Institute of Health Economics, Edmonton AB, Canada.
    Nguyen, Thanh
    Institute of Health Economics, Edmonton AB, Canada.
    Faris, Peter
    Alberta Health Services, , Canada.
    Wasylak, Tracy
    Alberta Health Services, , Canada.
    Basualdo-Hammond, Carlota
    Alberta Health Services, , Canada.
    McKay, Susan
    Alberta Health Services, , Canada.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Gramlich, Leah M.
    Department of Medicine, University of Alberta, Edmonton AB, Canada.
    Implementation of Enhanced Recovery After Surgery (ERAS) Across a Provincial Healthcare System: The ERAS Alberta Colorectal Surgery Experience2016Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 40, nr 5, s. 1092-1103Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Enhanced recovery after surgery (ERAS) colorectal guideline implementation has occurred primarily in standalone institutions worldwide. We implemented the guideline in a single provincial healthcare system, and our study examined the effect of the guideline on patient outcomes [length of stay (LOS), complications, and 30-day post-discharge readmissions] across a healthcare system.

    We compared pre- and post-guideline implementation in consecutive elective colorectal patients, a parts per thousand yen18 years, from six Alberta hospitals between February 2013 and December 2014. Participants were followed up to 30 days post discharge. We used summary statistics, to assess the LOS and complications, and multivariate regression methods to assess readmissions and to estimate cost impacts.

    A total of 1333 patients (350 pre- and 983 post-ERAS) were analysed. Of this number, 55 % were males. Median overall guideline compliance was 39 % in pre- and 60 % in post-ERAS patients. Median LOS was 6 days for pre-ERAS compared to 4.5 days in post-ERAS patients with the longest implementation (p value < 0.0001). Adjusted risk ratio (RR) was 1.71, 95 % CI 1.09-2.68 for 30-day readmission, comparing pre- to post-ERAS patients. The proportion of patients who developed at least one complication was significantly reduced, from pre- to post-ERAS, difference in proportions = 11.7 %, 95 % CI 2.5-21.0, p value: 0.0139. The net cost savings attributable to guideline implementation ranged between $2806 and $5898 USD per patient.

    The findings in our study have shown that ERAS colorectal guideline implementation within a healthcare system resulted in patient outcome improvements, similar to those obtained in smaller standalone implementations. There was a significant beneficial impact of ERAS on scarce health system resources.

  • 22.
    Nilsson, Ulrica
    et al.
    Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Perioperative Medicine and Intensive Care, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Dahlberg, Karuna
    Örebro universitet, Institutionen för hälsovetenskaper.
    Jaensson, Maria
    Örebro universitet, Institutionen för hälsovetenskaper.
    Low Preoperative Mental and Physical Health is Associated with Poorer Postoperative Recovery in Patients Undergoing Day Surgery: A Secondary Analysis from a Randomized Controlled Study2019Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, nr 8, s. 1949-1956Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Day surgical procedures are increasing both in Sweden and internationally. Day surgery patients prepare for and handle their recovery on their own at home. The aim of this study was to investigate patients' preoperative mental and physical health and its association with the quality of their recovery after day surgery.

    METHOD: This was a secondary analysis of a randomized controlled trial. Data were collected at four-day surgery units in Sweden. Health-related quality of life was measured using the Short Form 36 (SF-36) Health Survey, and postoperative recovery was assessed using the Swedish web version of the Quality of Recovery (SwQoR) scale.

    RESULT: This study included 756-day surgery patients. A low, compared with a high, preoperative mental component score was associated with poorer recovery as shown by responses to 21/24 and 22/24 SwQoR items, respectively, on postoperative days (PODs) 7 and 14. A low compared with a high preoperative physical component score was associated with poorer recovery in 18/24 SwQoR items on POD 7 and 13/24 on POD 14.

    CONCLUSION: A clear message from this study is for surgeons, anaesthetists and nurses to consider the fact that postoperative recovery largely depends on patients' preoperative mental and psychical status. A serious attempt must be made, as a part of the routine preoperative assessment, to assess and document not only the physical but also the mental status of patients undergoing anaesthesia and surgery.

    TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT0249219.

  • 23. Nygren, J
    et al.
    Thacker, J
    Carli, F
    Fearon, KC
    Norderval, S
    Lobo, DN
    Ljungqvist, Olle
    Örebro universitet, Institutionen för läkarutbildning.
    Soop, M
    Ramirez, J
    Guidelines for perioperative care in elective rectal/pelvic surgery: enhanced recovery after surgery (ERAS(®)) society recommendations2013Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 37, nr 2, s. 285-305Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: This review aims to present a consensus for optimal perioperative care in rectal/pelvic surgery, and to provide graded recommendations for items for an evidenced-based enhanced recovery protocol.

    METHODS: Studies were selected with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group.

    RESULTS: For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (evidence grade: high or moderate).

    CONCLUSIONS: Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, European Society for Clinical Nutrition and Metabolism (ESPEN) and International Association for Surgical Metabolism and Nutrition (IASMEN) present a comprehensive evidence-based consensus review of perioperative care for rectal surgery.

  • 24.
    Pisarska, Magdalena
    et al.
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
    Torbicz, Grzegorz
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
    Gajewska, Natalia
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
    Rubinkiewicz, Mateusz
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
    Wierdak, Mateusz
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
    Major, Piotr
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
    Budzyński, Andrzej
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery.
    Pędziwiatr, Michał
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
    Compliance with the ERAS Protocol and 3-Year Survival After Laparoscopic Surgery for Non-metastatic Colorectal Cancer2019Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, nr 10, s. 2552-2560Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Enhanced recovery after surgery (ERAS) pathways have been proven to enhance postoperative recovery, reduce morbidity, and reduce length of hospital stay after colorectal cancer surgery. However, despite the benefits of the ERAS program on short-term results, little is known about its impact on long-term results.

    OBJECTIVE: The aim of the study was to determine the association between adherence to the ERAS protocol and long-term survival after laparoscopic colorectal resection for non-metastatic cancer.

    MATERIAL AND METHODOLOGY: Between 2013 and 2016, 350 patients underwent laparoscopic colorectal cancer resection in the 2nd Department of General Surgery, Jagiellonian University Medical College, and were enrolled for further analysis. The relationship between the rate of compliance with the ERAS protocol and 3-year survival was analyzed according to the Kaplan-Meier method with log-rank tests. Patients were divided into two groups according to their degree of adherence to the ERAS interventions: Group 1 (109 patients), < 80% adherence, and Group 2 (241 patients), ≥ 80% adherence. The primary outcome was overall 3-year survival. The secondary outcomes were postoperative complications, length of hospital stay, and recovery parameters.

    RESULTS: The groups were similar in terms of demographics and surgical parameters. The median compliance to ERAS interventions was 85.2%. The Cox proportional model showed that AJCC III (HR 3.28, 95% CI 1.61-6.59, p = 0.0021), postoperative complications (HR 2.63, 95% CI 1.19-5.52, p = 0.0161), and compliance with ERAS protocol < 80% (HR 3.38, 95% CI 2.23-5.21, p = 0.0102) were independent predictors for poor prognosis. Additionally, analysis revealed that adherence to the ERAS protocol in Group 2 with ≥ 80% adherence was associated with a significantly shorter length of hospital stay (6 vs. 4 days, p < 0.0001), a lower rate of postoperative complications (44.7% vs. 23.3%, p < 0.0001), and improved functional recovery parameters: tolerance of oral diet (53.4% vs. 81.5%, p < 0.0001) and mobilization (77.7% vs. 96.1%, p < 0.0001) on the first postoperative day.

    CONCLUSIONS AND RELEVANCE: This study reports an association between adherence to the ERAS protocol and long-term survival after laparoscopic colorectal resection for non-metastatic cancer. Lower adherence to the protocol, independent from stage of cancer and postoperative complications, was an independent risk factors for poorer survival rates.

  • 25.
    Pędziwiatr, Michał
    et al.
    2nd Department of General Surgery, Jagiellonian University, Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
    Pisarska, Magdalena
    2nd Department of General Surgery, Jagiellonian University, Medical College, Kraków, Poland.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Authors' Reply: Compliance with the ERAS Protocol and 3-Year Survival After Laparoscopic Surgery for Nonmetastatic Colorectal Cancer2020Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 44, nr 1, s. 314-315Artikel i tidskrift (Refereegranskat)
  • 26.
    Sosa, Julie Ann
    et al.
    Department of Surgery, University of California at San Francisco-UCSF, San Francisco, CA, USA.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery.
    World Journal of Surgery Becomes the Official Publication of the ERAS Society2018Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, nr 9, s. 2689-2690Artikel i tidskrift (Refereegranskat)
  • 27.
    Wanjura, Viktor
    et al.
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Lundström, Patrik
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Österberg, Johanna
    Department of Surgery, Mora Hospital, Mora, Sweden.
    Rasmussen, Ib
    Department of Surgery, Falun County Hospital, Falun, Sweden.
    Karlson, Britt-Marie
    Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Sandblom, Gabriel
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Gastrointestinal quality-of-life after cholecystectomy: indication predicts gastrointestinal symptoms and abdominal pain2014Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 38, nr 12, s. 3075-3081Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Despite the fact that cholecystectomy is a common surgical procedure, the impact on long-term gastrointestinal quality of life is not fully known.

    Methods: All surgical procedures for gallstone disease performed at Mora County Hospital, Sweden, between 2 January 2002 and 2 January 2005, were registered on a standard database form. In 2007, all patients under the age of 80 years at follow-up were requested to fill in a form containing the Gastrointestinal Quality-of-Life Index (GIQLI) questionnaire and a number of additional questions. The outcome was analysed with respect to age, gender, smoking, surgical technique, and original indication for cholecystectomy.

    Results: A total of 627 patients (447 women, 180 men) underwent cholecystectomy, including laparoscopic cholecystectomy (N = 524), laparoscopic cholecystectomy converted to open cholecystectomy (N = 43), and open cholecystectomy (N = 60). The mean time between cholecystectomy and follow-up with the questionnaire was 49 months. The participation rate was 79 %. Using multivariate analysis in the form of generalised linear modelling, the original indication for cholecystectomy in combination with gender (p = 0.0042) was found to predict the GIQLI score. Female gender in combination with biliary colic as indication for cholecystectomy correlated with low GIQLI scores. Female gender also correlated with a higher risk for pain in the right upper abdominal quadrant after cholecystectomy (p = 0.028).

    Conclusions: We found the original indication for cholecystectomy, together with gender, to predict gastrointestinal symptoms and abdominal pain after cholecystectomy. Careful evaluation of symptoms is important before planning elective cholecystectomy.

  • 28.
    Wanjura, Viktor
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery.
    Sandblom, Gabriel
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    How Do Quality-of-Life and Gastrointestinal Symptoms Differ Between Post-cholecystectomy Patients and the Background Population?2016Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 40, nr 1, s. 81-88Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Previous studies have indicated a correlation between indication for cholecystectomy and long-term gastrointestinal quality-of-life (QoL). The aim of the present study was to compare QoL in a post-cholecystectomy cohort with the background population and with historical controls.

    Methods: A post-cholecystectomy study group (on average 4 years after cholecystectomy) was compared with a control group from the background population using the Gastrointestinal Quality-of-Life Index (GIQLI). EQ-5D scores were compared with expected scores derived from recent historical data.

    Results: The post-cholecystectomy study group (N = 451) had better QoL measured by the EQ-5D compared with historical controls (p < 0.001), similar total GIQLI scores as the control group (N = 390), but scored worse on the GIQLI gastrointestinal symptoms subscale score (p < 0.001). The results include an item-by-item breakdown of the GIQLI questionnaire where the scores for diarrhea, bowel urgency, bloating, regurgitation, abdominal pain, flatus, fullness, nausea, uncontrolled stools, belching, heartburn, restricted eating, and bowel frequency were found to be significantly lower (i.e. worse) in the post-cholecystectomy cohort than in the control group. The opposite was true for relationships, endurance, sexual life, physical strength, feeling fit, not being frustrated by illness, and being able to carry out leisure activities, i.e. items related to general performance and well-being.

    Conclusions: In this study, QoL after cholecystectomy was good, but there was an increased prevalence of gastrointestinal symptoms compared to the background population.

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