MRI-Based Quantification of Pan-Alimentary Function and Motility in Subjects with Diabetes and Gastrointestinal Symptoms.

Background: Diabetes-induced gastrointestinal (GI) symptoms are common but difficult to correctly diagnose and manage. We used multi-segmental magnetic resonance imaging (MRI) to evaluate structural and functional GI parameters in diabetic patients and to study the association with their symptomatic presentation. Methods: Eighty-six participants (46 with diabetes and GI symptoms, 40 healthy controls) underwent baseline and post-meal MRI scans at multiple timepoints. Questionnaires were collected at inclusion and following the scans. Data were collected from the stomach, small bowel, and colon. Associations between symptoms and collected data were explored. Utilizing machine learning, we determined which features differentiated the two groups the most. Key Results: The patient group reported more symptoms at inclusion and during MRI scans. They showed 34% higher stomach volume at baseline, 40% larger small bowel volume, 30% smaller colon volume, and less small bowel motility postprandially. They also showed positive associations between gastric volume and satiety scores, gastric emptying time and reflux scores, and small bowel motility and constipation scores. No differences in gastric emptying were observed. Small bowel volume and motility were used as inputs to a classification tool that separated patients and controls with 76% accuracy. Conclusions: In this work, we studied structural and functional differences between patients with diabetes and GI symptoms and healthy controls and observed differences in stomach, small bowel, and colon volumes, as well as an adynamic small bowel in patients with diabetes and GI symptoms. Associations between recorded parameters and perceived symptoms were also explored and discussed.

Gastrointestinal complications after fast-track total hip and knee replacement: an observational study in a consecutive 36,932 patient cohort.

INTRODUCTION: Gastrointestinal complications after total hip (THA) and knee arthroplasty (TKA) have been reported to be between 0.3 and 2.6% with bleeding and C. difficile infection in 0-1%, and 0.1-1.7%, respectively. The use of enhanced recovery or "fast-track" protocols have focused on optimizing all aspects of perioperative care resulting in reduced length of hospital stay (LOS) and potentially also gastrointestinal complications. This study is a detailed analysis on the occurrence of postoperative gastrointestinal complications resulting in increased hospital stay or readmissions in a large consecutive cohort of fast-track THA and TKA with complete 90 days follow-up. MATERIALS AND METHODS: This is an observational study on a consecutive cohort of primary unilateral THAs and TKAs performed between January 2010 and August 2017 in nine Danish high-volume fast-track centers. Discharge summaries and relevant patient records were reviewed in patients with readmissions within 90 days or LOS > 4 days caused by gastrointestinal complications. RESULTS: The cohort included 36,932 patients with 58.3% females and 54.1% THAs. Mean age and BMI were 68 years and 28. Median postoperative LOS was 2 days. Only n: 276 (0.75 %) had a LOS > 4 days or a readmission within 90 days due to a gastrointestinal complication (CI 0.67%-0.84%). Of these, only 34 (0.09%) were graded as severe ileus or gastrointestinal bleeding. CONCLUSIONS: The risk of GI-complications within the first 90 postoperative days after fast-track THA and TKA was low (0.75%).

Peripheral nerve-blocks and associations with length of stay and readmissions in fast-track total hip and knee arthroplasty.

BACKGROUND: Peripheral nerve blocks (PNB) have recently been recommended in total hip (THA) and knee (TKA) arthroplasty as they may reduce pain, morphine consumption, length of stay (LOS) and complications. However, whether PNBs are associated with early discharge within an enhanced recovery protocol including multimodal analgesia is uncertain. METHODS: An observational multicenter study from January to August 2017 in six Danish Arthroplasty Centers with established fast-track protocols. Prospective recording of preoperative characteristics and information on PNB, LOS and readmissions through the Danish National Patient Registry and medical records. Multiple logistic regression was used to investigate associations between PNB and a LOS >1 day, LOS >4 days, and 30-days readmissions. We also reported on mobilization, pain, opioid and fall-related complications leading to LOS >4 days or readmissions. RESULTS: A total of 2027 (58.6%) THA and 1432 (41.4%) TKAs with a median LOS of 1 day (IQR 1-2) and 5.3% (CI:4.6-6.1) 30-days readmission rate were identified. PNB was used in 40.7% (CI:38.2-43.3) of TKA and 2.7% (CI:2.0-3.5) of THA, but with considerable interdepartmental variation (0.0-89.0% for TKA). There was no association between PNB and LOS >1 day (OR:1.19 CI:0.82-1.72; p = .354), LOS >4 days (OR:1.4 CI:0.68-2.89; p = .359) or 30-days readmissions (OR:1.02 CI:0.63-1.65; p = .935) in TKA. Logistic regression in THA was not possible due to limited use of PNB. In TKA there were 12 (2.1% CI:1.2-3.6) with and 1 (0.1% CI:0.02-0.7) without a PNB, who had mobilization, pain or opioid-related complications, and 5 (0.9% CI:0.4-2.0) versus 4 (0.5% CI:0.2-1.2) who fell. Correspondingly, 2 (3.7% CI:1.0-12.6) and 11 (0.6% CI:0.3-1.0) of THA patients had these complications, while 0 (0.0% CI:0.0-6.6) and 17 (0.8% CI:0.5-1.3) fell. CONCLUSION: Routine use of peripheral nerve blocks was not associated with early discharge or 30-days readmissions in fast-track THA and TKA. Future studies should focus on benefits of PNB in high-risk patients.

Projection of primary and revision hip arthroplasty surgery in Denmark from 2020 to 2050.

BACKGROUND AND PURPOSE: The incidence of primary and revision total hip arthroplasty (THA) has increased over the last decades. Previous forecasts from different healthcare systems have predicted a continuous increase. We present a forecast of both primary and revision surgery from 2020 to 2050 based on 25 years data from the healthcare system in Denmark. PATIENTS AND METHODS: We retrieved data from the Danish Hip Arthroplasty Register on 198,835 primary and 29,456 revision surgeries. Historical censuses and population forecasts were retrieved from Statistics Denmark. Logistic and Gompertz regression analysis was used to forecast incidence rates (IR) and total numbers in the next 30 years. RESULTS: Our forecast predicts an increase in IR of 3-9% and an increase in total numbers of primary THA of between 12% and 19% in 2050. For revision THA the IRs have reached a plateau but total numbers are predicted to increase by 19% in 2050. CONCLUSION: Our forecast shows that both primary and revision THA will increase in total numbers in the next decades, but the IR for primary THA is near its plateau and for revision THA the plateau has already been reached. The forecast may aid in healthcare resource planning for the decades to come.

A projection of primary knee replacement in Denmark from 2020 to 2050.

Background and purpose - The incidence of knee replacements (KRs) has increased in the past decades. Previous studies have forecast a continuous and almost exponential rise in the use of KRs, but this rise must cease at some point. We estimated when and at what incidence the use of KRs will plateau in Denmark.Patients and methods - We retrieved 138,223 primary KRs conducted from 1997 to 2019 from the Danish Knee Arthroplasty Registry. Censuses from 1997 to 2019 as well as population projections from 2020 through 2050 were collected from Statistics Denmark. We applied logistic and Gompertz regression analysis to the data to estimate the future incidence until 2050 with root mean squared error (RMSE) as a quantitative measurement of the models' fit.Results - The Danish incidence of KRs from 1997 to 2009 increased by more than 300%, but has stalled since 2009. Logistic and Gompertz regression had an RMSE of 14 and 15 indicating that these models fitted the data well. Logistic and Gompertz regressions estimated that the maximum incidence will be reached in 2030 at 250 (95% prediction interval [PI]) 159-316) KRs per 105 or in 2035 at 260 (PI 182-336) KRs per 105, respectively.Interpretation - The Danish incidence of KRs seems set to plateau within the coming decades. Countries experiencing a current exponential rise at a lower incidence may benefit from this study's projection when forecasting their future demand for KRs.