Perioperative aminoglycoside treatment is associated with a higher incidence of postoperative dialysis in adult cardiac surgery patients.

BACKGROUND: Aminoglycoside treatment has been associated with nephrotoxic effects. However, the effect of perioperative aminoglycoside treatment on the risk of acute kidney injury requiring dialysis among patients undergoing cardiac surgery remains uncertain. METHODS: We performed a register study based on prospectively collected data from population-based health care databases of 3625 consecutive patients undergoing cardiac surgery at the Aarhus University Hospital, Skejby, Denmark. Patients requiring preoperative dialysis were excluded, leaving a total of 3587 patients (99% of original patient cohort), of whom 89 received perioperative aminoglycosides. RESULTS: The cumulative risk of in-hospital dialysis-dependent acute kidney injury was 3.2% (n = 115). Perioperative use of aminoglycosides was associated with an increased risk of postoperative dialysis (adjusted odds ratio [OR], 4.41; 95% confidence interval [CI], 1.83-10.59). Other predictors included reoperation because of bleeding (adjusted OR, 2.80; 95% CI, 1.63-4.80), use of inotropic support during anesthesia (adjusted OR, 2.10; 95% confidence interval, 1.49-2.95), and cardiopulmonary bypass lasting longer than 120 minutes (adjusted OR, 1.95; 95% CI, 1.19-3.20) along with EuroSCORE variables. Postoperative dialysis was associated with higher 30-day mortality (10.9% vs 2.5%, P < .0001, χ(2) test), but use of aminoglycosides was not independently associated with mortality. CONCLUSIONS: Perioperative use of aminoglycosides in adults undergoing cardiac surgery was associated with increased risk of postoperative dialysis.

[Towards evidence-based quality improvement]. / På vej mod evidensbaseret kvalitetsudvikling.

Quality improvement has been an important topic in Danish health care during the past 20 years. Health care services research indicates that implementation of quality improvement strategies can improve the quality of care. Establishment of a research tradition within quality improvement is needed in order to systematically evaluate quality improvement strategies.

Upgraded acute stroke care including thrombolysis is associated with reduced length of hospital stay among non-stroke patients.

BACKGROUND: Implementing thrombolytic therapy in a stroke unit (SU) profoundly affects the resources available to all patients admitted for suspected acute stroke. We examined the benefits of an acute stroke service to non-stroke patients in terms of length of hospitalization, and estimated the economic impact in terms of derived costs. METHODS: We performed a historical follow-up study of 792 non-stroke patients admitted to our SU for suspected stroke before, during and after implementing thrombolysis as part of our service. Data on demographic and clinical characteristics, including imaging data and final diagnoses, and length of stay (LOS) were collected prospectively. Multivariate logistic regression analysis was performed to identify variables associated with LOS. RESULTS: Median LOS for non-stroke patients in the SU decreased from 43.8 h (interquartile range, 19-96) to 23.5 h (16-44) after implementing thrombolytic therapy. Total hospital LOS for non-stroke patients decreased from 52.7 (22-147) to 28.7 (21-124) h during the same period. Initial magnetic resonance imaging was associated with shorter LOS in the SU. The derived cost reductions from shorter LOS reduced the costs of implementing recombinant tissue plasminogen activator treatment. CONCLUSIONS: Stroke care reorganization following the introduction of thrombolytic treatment was associated with a 50% reduction in LOS for non-stroke patients admitted to the SU. Reduced LOS in the SU for non-stroke patients could further add to the cost-effectiveness of thrombolytic treatment.

The validity of self-reported use of hormone replacement therapy among Danish nurses.

BACKGROUND: Recent findings from randomized clinical trials on the effects of hormone replacement therapy (HRT) among postmenopausal women contradict findings from observational studies indicating a protective effect on the development of cardiovascular disease. Most observational studies on HRT are based on self-reported data, although data on the validity of HRT in postmenopausal women are sparse. METHODS: We examined self-reported HRT use from questionnaires administered in 1993 (n = 2694) and again in 1999 (n = 2666) to a cohort of Danish nurses living in two Danish counties compared with prescription-reimbursement data from two administrative databases through the Danish National Health Service. RESULTS: The sensitivity and specificity of the self-reported, current HRT use in 1993 were 78.4%[95% confidence interval (95% CI) 75.4-81.4] and 98.4% (95% CI 97.8-98.9), respectively. In 1999, the estimates were 74.8% (95% CI 72.0-77.7) and 98.0% (95% CI 97.3-98.8), respectively. None of the factors examined--including age, alcohol intake, physical activity, smoking, presence of hypertension, and body mass index--was strongly associated with validity. We found a relatively high validity of self-reported data on HRT use. Furthermore, agreement between self-reported and registry-based data was not strongly associated with a range of demographic and lifestyle factors. CONCLUSION: These findings suggest that use of self-reported data is not an important contributor to the apparent discrepancy between observational studies and randomized trials on the cardiovascular effects of HRT use.