Poor agreement between data from the National Patient Registry and the Danish Patient Insurance Association.

INTRODUCTION: Septic arthritis after knee arthroscopy requires in-patient treatment and should thus be reported to the National Patient Registry (NPR). It also meets the requirements for financial compensation if claimed to the Danish Patient Insurance Association (DPIA). The aim of this study was to assess data from the two independent data sources, the NPR and DPIA, with a view to comparing the registration of septic arthritis after knee arthroscopy. MATERIAL AND METHODS: This was a retrospective study assessing two three-year periods. From the NPR, we initially received all contacts coded as arthroscopic knee surgery. A second NPR query was made for patients found in the first query who had had a hospital contact within 30 days postoperatively with codes indicating septic arthritis (450 patients). Correspondingly, the DPIA files of patients claiming an infection following knee arthroscopy were searched to identify those (157 patients) with post-arthroscopic septic arthritis. RESULTS: We found poor agreement between the 450 patients in the second NPR data extraction and the 157 verified patients from the DPIA. Only 105 patients from DPIA were found in the NPR, while 52 patients in the DPIA were not returned as part of the second NPR data extraction. CONCLUSION: Coding of infections after arthroscopy in the NPR is inconsistent and incomplete. An underreporting of septic arthritis to the DPIA might exist.

Post-operative urinary retention in a general surgical population.

BACKGROUND AND OBJECTIVE: Post-operative urine retention is a frequent and serious complication. The aims of this study were to evaluate the prevalence of post-operative urinary retention in a general surgical population and to identify the perioperative risk factors for developing this condition. METHODS: Data were obtained from 334 consecutive adult surgical patients, operated without a urethral catheter placed from 1 June to 13 July 2006. A bladder scan was performed within 30 min of arrival to the recovery ward, in case of bladder symptoms, and before referral to the surgical ward. Post-operative urinary retention was defined as a bladder volume above 600 ml and insufficient voiding within 30 min. RESULTS: Mean age (SD) was 58.6 years (± 16.6). One hundred and eighteen men (35.3%) and 216 women (64.7%) were included. The prevalence of post-operative urinary retention was 4.8%. Significant independent risk factors were diabetes mellitus (odds ratio, 5.9; 95% confidence interval, 1.760-19.882) and administration of atropine intraoperatively (odds ratio, 5.9; 95% confidence interval, 1.005-34.680). CONCLUSION: The risk of developing post-operative urinary retention is approximately 5% in the present general surgical population studied, and co-existing diabetes mellitus and administration of atropine intraoperatively are pre-disposing factors.

Effect of Gabapentin on morphine demand and pain after laparoscopic sterilization using Filshie clips. A double blind randomized clinical trial.

BACKGROUND: A considerable number of patients require opioids during recovery after laparoscopic sterilization. This implies nausea, dizziness and sedation and increases the number of unplanned admissions. Gabapentin has shown excellent postoperative analgesic effect in a number of recent studies with few side effects. This study was designed to test whether gabapentin given preoperatively can reduce the number of patients needing morphine in the recovery period. METHODS: 80 females scheduled for laparoscopic sterilization using Filshie clips were randomized to two treatment groups (Gaba group and control group). All patients received lornoxicam 8 mg p.o. 30 min. before the procedure. Patients in the Gaba group received gabapentin 1200 mg p.o. and patients in the control group received placebo capsules prior to the procedure. All patients were anesthetized according to a protocol, using remifentanil and propofol. Postoperative analgesia was obtained with patient controlled infusion of morphine. Pain, nausea, dizziness and sedation were scored at 2 and 4 hours after end of anesthesia. The expenditure of morphine was the primary measure for the effect of analgesia and the number of patients demanding morphine was the primary endpoint. RESULTS: Three patients were excluded because of procedural errors and one because of conversion to open surgery. 38 patients completed the study in each group.32 (84%) patients in the gabapentin group and 37 (97%) patients in the control group did require morphine in the recovery period. (p = 0,049). There was no significant difference between mean morphine consumption, pain scores and frequency of adverse effects (nausea, dizziness, sedation and vomiting) CONCLUSION: The postoperative analgesic effect of gabapentin given preoperatively was confirmed in this study. For this procedure, with pain predominantly in the immediate recovery period, and of less intensity than after major surgical procedures, the effect demonstrated is much less pronounced than in similar studies of major surgery. General use of gabapentin as analgesic for laparoscopic sterilization is not supported by this study. TRIAL REGISTRATION: Current Controlled Trials ISCRTN39209275.