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Introduction: A supra-physiological dose of glucocorticoid (SDS) is administered routinely in the perioperative management of patients on long-term regular glucocorticoid therapy. The dose of glucocorticoid used in these regimens varies.... more
Introduction: A supra-physiological dose of glucocorticoid (SDS) is administered routinely in the perioperative management of patients on long-term regular glucocorticoid therapy. The dose of glucocorticoid used in these regimens varies. The current treatment is based on two 60-year-old case reports. No data exist to document the required dose of glucocorticoid to prevent perioperative hypotension or the category of patients needing this dose. Having in mind that high doses of glucocorticoids have several potential side effects, this practice ought to be re-evaluated in the light of available evidence. Methods: We searched MEDLINE, Embase and the Cochrane Library for data about perioperative stress dose. The search was conducted by the two authors and repeated by a research librarian to ensure inclusion of all related studies. All original articles and reviews relating to the perioperative use of SDS in chronic glucocorticoid-treated patients were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were applied. Results: A total of 21 studies met the inclusion criteria of which five were prospective studies, five retrospective studies, three randomised controlled trials and eight reviews (three systematic reviews, one Cochrane review, three treatment guidelines, and one meta-analysis). No data supported routine use of SDS. Patients who continued their normal glucocorticoid treatment throughout the perioperative period had no need for SDS. Conclusion: No evidence supports the preoperative use of SDS in patients receiving chronic glucocorticoid therapy.
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AimPatients with Crohn's disease (CD) often suffer from perianal fistulizing disease. Their risk of anorectal cancer remains uncertain. We aimed to examine the long‐term risk of anorectal cancer in a population‐based cohort of CD... more
AimPatients with Crohn's disease (CD) often suffer from perianal fistulizing disease. Their risk of anorectal cancer remains uncertain. We aimed to examine the long‐term risk of anorectal cancer in a population‐based cohort of CD patients with anorectal fistula.MethodOur study population covered all individuals (n = 7 987 520) aged 15+ years living in Denmark from 1978 to 2018. We identified all patients with CD and anorectal fistula in the Danish National Patient Register (NPR) and 50 matched noninflammatory bowel disease (IBD) individuals from the general population. Using Cox regression analyses, we examined the risk of anorectal cancer in CD fistula patients versus non‐IBD individuals. All patients with CD were identified using codes from the International Classification of Diseases and their data extracted from the NPR. The main outcome measure was cases of anorectal cancer.ResultsA total of 2786 CD patients with anorectal fistula and 139 300 non‐IBD individuals were followed for 1 553 917 person‐years. During follow‐up, anorectal cancer was observed in 19 CD patients (0.68%) and 340 non‐IBD individuals (0.24%), corresponding to a 2.9‐fold increased hazard ratio (HR) of anorectal cancer in CD fistula patients (95% CI 1.80–4.53), with a particularly high risk of anal cancer (HR 15.13, 95% CI 6.88–33.31) and a mean time from CD fistula diagnosis to anorectal cancer of 6.7 (SD 6.5) years. The risk was slightly higher in women than men and had no apparent relation to treatment with tumour necrosis factor‐α inhibitors. Sensitivity analyses using CD nonfistula patients for comparison revealed similar results. Individual data on smoking and infection with human papilloma virus were not available.ConclusionPatients with CD and anorectal fistula have a three‐fold increased risk of anorectal cancer compared with the general population. The number needed to surveil to detect one case of anorectal cancer in this patient population was 2160 patients per year in patients with long‐standing fistula (>6 years).
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Introduction: Night duties in surgical wards can be demanding physically and mentally. Staffing the emergency room, performing emergency operations and taking care of the admitted patients are only few of surgeons' tasks during these busy... more
Introduction: Night duties in surgical wards can be demanding physically and mentally. Staffing the emergency room, performing emergency operations and taking care of the admitted patients are only few of surgeons' tasks during these busy duties. Night duties can have different effects on the following day/days tasks, limiting some of the leisure activities and maybe life quality. Literature search, however, shows few studies about the subject. The aim of this study was twofold: to study the effects of night duties on the general health of surgeons and to classify duties according to these effects. Methods: Retrospective study based on modified Short Form Survey (SF)-12. Questionnaire forms were sent to all surgeons in the surgical department at Hvidovre Hospital. Results: The questionnaire forms were sent to 64 surgeons and 38 answered (59.4%). The highest response rate was in the residents group (71.9%: 23/32), senior residents group (70%: 7/10) and the lowest rate in consultants group (36.4%: 8/22). Conclusion: Night duties have no significant effect on surgeons' general health. There is a trend, however, that these duties have an effect on hard physical and/or mental activities in the following day especially for female surgeons. Funding: not relevant. Trial registration: not relevant.
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Introduction: Tumour necrosis factor α (TNF-α) plays a role in the immune defence, angiogenesis and collagen synthesis. Inhibition of these pathways may increase the risk of infections and impair wound healing in patients after surgery.... more
Introduction: Tumour necrosis factor α (TNF-α) plays a role in the immune defence, angiogenesis and collagen synthesis. Inhibition of these pathways may increase the risk of infections and impair wound healing in patients after surgery. Biologic treatments including anti-TNF-α agents are increasingly used in the treatment of inflammatory bowel disease. Taking into consideration the biologics' mechanism of action, fears have been expressed that they might increase the rate of post-operative complications. Results from 18 retrospective studies were conflicting, and meta-analyses based on these studies did not agree. The objective of this study was to review data from present reviews and meta-analyses in an attempt to come to conclusions for the use of anti-TNF-α in Crohn's disease patients in clinical practice. Methods: Literature search using both electronic and manual searches was conducted according to a pre-defined protocol. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied. Results: Two systematic reviews and six meta-analyses were found. Meta-analyses that included a large number of patients and applied quality assessment showed an increased risk of overall post-operative complications and an increased rate of infectious or anastomosis-related complications in patients receiving anti-TNF-α. Conclusion: The use of anti-TNF-α agents in Crohn's disease patients is associated with an increased risk of post-operative complications after abdominal surgery.
Research Interests: Dentistry, Surgery, Risk, Medicine, Inflammatory Bowel Disease, and 15 moreHumans, Ulcerative colitis, Pubmed, Disease, Risk factors, Meta Analysis, Systematic review, Clinical Sciences, Retrospective Studies, Tumor necrosis factor-alpha, Risk Factors, Abdominal Surgery, Crohn Disease, Abdomen, and Postoperative Complications
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Research Interests: Medicine, Comorbidity, Inflammatory Bowel Disease, Humans, Smoking Cessation, and 15 moreAntibiotic Prophylaxis, Nutritional Status, Risk factors, Length of Stay, Clinical Sciences, Colorectal Disease, Odds ratio, Risk Factors, Abdominal Surgery, Inflammatory Bowel Diseases, Postoperative Complications, Perioperative, Nutrition assessment, purines, and Biological products
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There are concerns that biologic treatments or immunomodulation may negatively influence anastomotic healing. This study investigates the relationship between these treatments and anastomotic complications after surgery for... more
There are concerns that biologic treatments or immunomodulation may negatively influence anastomotic healing. This study investigates the relationship between these treatments and anastomotic complications after surgery for Crohn's disease. Retrospective study on 417 operations for Crohn's disease performed at four Danish hospitals in 2000-2007. Thirty-two patients were preoperatively treated with biologics and 166 were on immunomodulation. In total, 154 were treated with corticosteroids of which 66 had prednisolone 20 mg or more. Anastomotic complications occurred at 13% of the operations. There were no difference in patients on biologic treatment (9% vs. 12% (p = 0.581)) or in patients on immunomodulation (10% vs. 14% (p = 0.263)). Patients on 20 mg prednisolone or more had more anastomotic complications (20% vs. 11% (p = 0.04)). Anastomotic complications were more frequent after a colo-colic anastomosis than after an entero-enteric or entero-colic (33% vs. 12% (p = 0.013)). Patients with anastomotic complications were older (40 years vs. 35 years (p = 0.014)), had longer disease duration (7.5 years vs. 4 years (p = 0.04)), longer operation time (155 min vs. 115 min (p = 0.018)) and more operative bleeding (200 ml vs. 130 ml (p = 0.029)). Multivariate analysis revealed preoperative treatment with prednisolone 20 mg or more, operation time and a colo-colic anastomosis as negative predictors of anastomotic complications. Preoperative biologic treatment or immunomodulation had no influence on anastomotic complications. The study confirms previous findings of corticosteroids and a colo-colic anastomosis as negative predictors and also that surgical complexity, as expressed by bleeding and operation time, may contribute to anastomotic complications.
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Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study... more
Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...
Research Interests: Orthopedic Surgery, Cardiothoracic Surgery, Global Health, Environmental Sustainability, Global Health Policy, and 15 moreMedicine, Cardiac and Thoracic Surgery, Laparoscopic Surgery, Cardiac Surgery, Oral and Maxillofacial Surgery, Green Energy, Cataract surgery, Oral Surgery, Pediatric Surgery, Global Surgery, Delphi method, Orthopaedic Surgery, Green and Sustainability Practices, Head and Neck Surgery, and Medical and Health Sciences
Background A regular task by developers and users of synthetic data generation (SDG) methods is to evaluate and compare the utility of these methods. Multiple utility metrics have been proposed and used to evaluate synthetic data.... more
Background A regular task by developers and users of synthetic data generation (SDG) methods is to evaluate and compare the utility of these methods. Multiple utility metrics have been proposed and used to evaluate synthetic data. However, they have not been validated in general or for comparing SDG methods. Objective This study evaluates the ability of common utility metrics to rank SDG methods according to performance on a specific analytic workload. The workload of interest is the use of synthetic data for logistic regression prediction models, which is a very frequent workload in health research. Methods We evaluated 6 utility metrics on 30 different health data sets and 3 different SDG methods (a Bayesian network, a Generative Adversarial Network, and sequential tree synthesis). These metrics were computed by averaging across 20 synthetic data sets from the same generative model. The metrics were then tested on their ability to rank the SDG methods based on prediction performan...
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Background The molecular profile of early-onset colonic cancer is undefined. This study evaluated clinicopathological features and oncological outcomes of young patients with colonic cancer according to microsatellite status. Methods... more
Background The molecular profile of early-onset colonic cancer is undefined. This study evaluated clinicopathological features and oncological outcomes of young patients with colonic cancer according to microsatellite status. Methods Anonymized data from an international collaboration were analysed. Criteria for inclusion were patients younger than 50 years diagnosed with stage I–III colonic cancer that was surgically resected. Clinicopathological features, microsatellite status, and disease-specific outcomes were evaluated. Results A total of 650 patients fulfilled the criteria for inclusion. Microsatellite instability (MSI) was identified in 170 (26.2 per cent), whereas 480 had microsatellite-stable (MSS) tumours (relative risk of MSI 2.5 compared with older patients). MSI was associated with a family history of colorectal cancer and lesions in the proximal colon. The proportions with pathological node-positive disease (45.9 versus 45.6 per cent; P = 1.000) and tumour budding (20....
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BACKGROUND: It is controversial whether extensive resection of right-sided colon cancer confers oncological benefits. OBJECTIVE: The aim of this study was to evaluate short- and long-term outcomes of extended surgical removal of the... more
BACKGROUND: It is controversial whether extensive resection of right-sided colon cancer confers oncological benefits. OBJECTIVE: The aim of this study was to evaluate short- and long-term outcomes of extended surgical removal of the mesocolon compared to the conventional approach. DESIGN: This was a retrospective population-based study. SETTING: Study is based on a prospectively maintained Danish Colorectal Cancer Group database. MAIN OUTCOME MEASURES: Primary outcome measures included local-regional recurrence in patients who underwent curative resection for right-sided colon cancer and 30-day postoperative complications. Distant metastasis, unplanned intraoperative adverse events, and 30- and 90-day postoperative mortality were also investigated. Patients who had palliative or compromised resection, emergency surgery, or neoadjuvant chemotherapy were excluded. RESULTS: Of the 12,855 patients with resection of right-sided colon cancer retrieved, 1151 underwent extended right hemico...
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Background In patients with active Crohn’s disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate... more
Background In patients with active Crohn’s disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD. Methods A multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categ...
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SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international,... more
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
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SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to... more
SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
Research Interests: Surgery, Neurosurgery, Vascular Surgery, Medicine, General Surgery, and 15 moreAnaesthesia, Pulmonary Embolism, Thromboembolism, Clinical Sciences, Cirugia, DVT Prevention, Odds ratio, Venous thromboembolism, Chirurgia, Neurosciences, Cirugía, Deep Venous Thrombosis, Chirurgie, Prospective Cohort Study, and CoVid
AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international... more
AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units.MethodAn online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted.ResultsOf hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability ...
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Background Management of spontaneous intra-abdominal abscess (IAA) in patients with Crohn’s disease (CD) with radiologically guided percutaneous drainage (PD) was debated. Methods This is a secondary analysis from a multicenter,... more
Background Management of spontaneous intra-abdominal abscess (IAA) in patients with Crohn’s disease (CD) with radiologically guided percutaneous drainage (PD) was debated. Methods This is a secondary analysis from a multicenter, retrospective cohort study of all the patients with CD who underwent PD followed by surgery at 19 international tertiary centers. Results Seventeen patients (4.8%) who did not undergo surgery after PD were compared to those who had PD followed by surgical intervention 335/352 (95.2%). Patients who had PD without surgery were those with longer disease duration, more frequently had previous surgery for CD (laparotomies/laparoscopies), enteric fistula, on steroid treatment before and continue to have it after PD. Patients who had PD without subsequent surgical resection had a higher risk of stoma construction at later stages 8/17 (47.1%) versus 90/326 (27.6%) (P < .01). Patients with PD with no subsequent surgery had numerically higher rates of abscess recur...