Association between troponin I levels and mortality among patients undergoing acute high-risk abdominal surgery-A cohort study.

BACKGROUND: Myocardial injury after noncardiac surgery (MINS) is associated with 30-day mortality in heterogeneous surgical populations but is barely described after acute high-risk abdominal surgery. The impact of dynamic changes has not previously been investigated. The objectives were to determine the incidence of MINS in this population, the association between mortality and MINS, and whether plasma troponin I (TnI) dynamics have any impact on mortality. METHODS: A prospective cohort study of 341 patients undergoing acute high-risk gastrointestinal surgery was conducted. Plasma TnI was measured at the first four postoperative days. MINS was defined as any increased TnI level >59 ng/L. TnI dynamic required either two succeeding measurements of TnI >59 ng/L with a >20% increase/fall or one measurement of TnI >59 ng/L with a succeeding measurement of TnI <59 ng/L with a >50% decrease. Adjusted mortality rates were calculated using inverse probability of treatment weighting and competing risk analyses. RESULTS: The incidence of MINS was 23.8% and dynamic TnI changes occurred in 15.6% of the patients. The unadjusted 30-day and 1-year mortality were 19.8% and 35.9% in patients with MINS, compared with 2.7% and 11.6%, respectively, in patients without MINS (p < 0.001). After adjusting, the differences remained significant. There was no difference in mortality between patients with or without dynamic changes in TnI level. CONCLUSION: MINS occurred frequently and was associated with increased mortality. TnI monitoring might help identify patients with increased risk of mortality and improve care. Research on preventive measures and treatments is warranted. TRIAL REGISTRATION NUMBER AND AGENCY: ClinicalTrials.gov Identifier: NCT05933837, retrospective registered.

The effects of troponin screening among patients undergoing acute high-risk abdominal surgery: A retrospective cohort study.

BACKGROUND: Acute high-risk abdominal (AHA) surgery is associated with a high short-term mortality rate. This might be partly attributed to myocardial injury after non-cardiac surgery (MINS) defined by elevated postoperative troponin levels. The myocardial injury is often asymptomatic; thus, troponin screening seems to be the best diagnostic method. We aimed to assess whether implementing troponin screening with subsequent individualised interventions as standard care is associated with reduced mortality after AHA surgery. We also explored the treatment implications in the screening period. METHODS: A retrospective cohort of 558 patients undergoing surgery from February 2018 to March 2021 was included. The patients undergoing surgery before March 2019 served as the historical control group, while the screening group consisted of patients undergoing surgery from March 1, 2019. Troponin I was to be measured 6-12 h postoperatively and in the morning of the succeeding 4 days. Patients with myocardial injury were assessed, and treatment was individualised after multiple disciplinary consultations. The primary outcome was the unadjusted 30-day mortality rates. Inverse probability treatment weighting was used to adjust for selection bias. RESULTS: We included 558 patients: 382 in the screening group and 176 in the historical control group. In the screening group, 15 patients (3.9%) died before the first blood sampling, and in 31 patients (8.1%), troponin screening was omitted, leaving only 336 patients screened. Myocardial injury was diagnosed in 81 patients (24.1%) of the 336 patients. Of these, 59 (72.8%) had a cardiac consultation. No interventions or alterations in relation to myocardial injury were done in 67 patients (82.7%). The 30-day mortality was 13.8% (95% CI 8.7%-18.9%) in the control group and 11.1% (95% CI 8.0%-14.3%) in the screening group. The absolute risk difference was -2.7% (95% CI -8.7%-3.3%; p = .38), which was unchanged after adjustment. The difference remained unchanged after 90 days and 1 year. CONCLUSION: The implementation of postoperative troponin screening was not associated with reduced mortality after AHA surgery. Research on the prevention and treatment of MINS is warranted before the implementation of standard troponin screening.

Myocardial Injury After Noncardiac Surgery in Major General Surgical Patients a Prospective Observational Cohort Study.

OBJECTIVE: The objective of this study was to determine the prognostic relevance, clinical characteristics, and 30-day outcomes associated with myocardial injury after noncardiac surgery (MINS) in major general surgery patients. BACKGROUND: MINS has been independently associated with 30-day mortality after noncardiac surgery. The characteristics and prognostic importance of MINS in major general surgical patients have not been described. METHODS: This was an international prospective cohort study of a representative sample of 22,552 noncardiac surgery patients 45 years or older, of whom 4490 underwent major general surgery in 24 centers in 13 countries. All patients had fifth-generation plasma high-sensitivity troponin T (hsTnT) concentrations measured during the first 3 postoperative days. MINS was defined as a hsTnT of 20-65 ng/L and absolute change >5 ng/L or hsTnT ≥65 ng/L secondary to ischemia. The objectives of the present study were to determine (1) whether MINS is prognostically important in major general surgical patients, (2) the clinical characteristics of major general surgical patients with and without MINS, (3) the 30-day outcomes for major general surgical patients with and without MINS, and (4) the proportion of MINS that would have gone undetected without routine postoperative monitoring. RESULTS: The incidence of MINS in the major general surgical patients was 16.3% (95% CI, 15.3-17.4%). Thirty-day all-cause mortality in the major general surgical cohort was 6.8% (95% CI, 5.1%-8.9%) in patients with MINS compared with 1.2% (95% CI, 0.9%-1.6%) in patients without MINS ( P <0.01). MINS was independently associated with 30-day mortality in major general surgical patients (adjusted odds ratio 4.7, 95% CI, 3.0-7.4). The 30-day mortality was higher both among MINS patients with no ischemic features (ie, no ischemic symptoms or electrocardiogram findings) (5.4%, 95% CI, 3.7%-7.7%) and among patients with 1 or more clinical ischemic features (10.6%, 95% CI, 6.7%-15.8%). The proportion of major general surgical patients who had MINS without ischemic symptoms was 89.9% (95% CI, 87.5-92.0). CONCLUSIONS: Approximately 1 in 6 patients experienced MINS after major general surgery. MINS was independently associated with a nearly 5-fold increase in 30-day mortality. The vast majority of patients with MINS were asymptomatic and would have gone undetected without routine postoperative troponin measurement.

Long-term outcome after Bascom's cleft-lift procedure under tumescent local analgesia for pilonidal sinus disease: a cohort study.

AIM: Bascom's cleft-lift procedure for pilonidal sinus disease under tumescent local analgesia is feasible and well tolerated with favourable short-term outcomes. We aimed to assess the 10-year treatment success rate after cleft-lift under tumescent local analgesia. METHOD: This was a single-centre cohort study based on prospectively registered perioperative data and survey data with additional data from electronic medical records. The cleft-lift procedure was performed under tumescent local analgesia in a day-surgical setting at a tertiary referral hospital between 1 July 2008 and 31 March 2014. The primary outcome was the 10-year risk treatment success defined as complete wound healing within 180 days of surgery or no recurrence assessed with competing risk analyses. Secondary outcomes were time to complete wound healing, persistent pain and cosmetic satisfaction. RESULTS: Two hundred patients with complex pilonidal sinus disease were included. Indication was incomplete wound healing after pilonidal sinus surgery in 43 (21.5%) patients, recurrence after previous intervention in 78 (39.0%) or moderate to complex sinuses assessed by a consultant surgeon in 79 (39.5%). One hundred and ninety-five patients had complete wound healing within 180 days with a median time of 29 days (interquartile range 16-47). The cumulative risk of 10-year recurrence was 11.3% (95% CI 6.2%-16.4%) with a median follow-up time of 8.5 (1.0-10.7) years. Treatment success was 86.1% (95% CI 80.6%-91.5%). No significant predictors were associated with recurrence, and 90% of patients experienced no persistent pain. CONCLUSION: Cleft-lift performed under tumescent local analgesia has an acceptable 10-year treatment failure rate, making the method feasible in a day-surgery setting.

Long-term outcome after Bascom's pit-pick procedure for pilonidal sinus disease: A cohort study.

AIM: Previous studies have shown favourable short-term results after Bascom's pit-pick procedure for simple pilonidal sinus disease. A minimum 5-year follow-up is considered the gold standard but only a few long-term studies have previously been reported. Here, we aimed to estimate the long-term risk of treatment failure, incomplete wound healing or recurrence, postoperative complications and patient reported outcome measures such as chronic pain and satisfaction with cosmetic appearance. METHODS: Medical records of patients registered in a local database after undergoing Bascom's pit-pick procedure were reviewed and follow-up data updated. The patients received an online survey including questions about demographics, lifestyle, complications, reintervention, pain, satisfaction with cosmetic appearance and supplemented with telephone interviews if no response was received. RESULTS: A total of 158 patients underwent Bascom's pit-pick procedure during the period August 2007 to March 2014. Median follow-up was 7.98 (0.66, 10.96) years. Twelve patients (8%) had reintervention due to incomplete wound healing. A total of 32 patients experienced a recurrence. In competing risk analyses, the 10-year cumulative recurrence rate was 27% (95% CI: 19%-35%) of patients with complete wound healing. Treatment success was 68%. Recurrence was associated with active smoking, HR of 5.30 (95% CI: 1.42-19.86; p = 0.01), and number of primary pits ≥3, HR of 5.11 (95% CI: 1.49-17.47; p = 0.01). More than 90% had no postoperative complications or chronic pain, and more than 70% reported a high satisfaction with the cosmetic appearance. CONCLUSION: Bascom's pit-pick seems to be adequate treatment for most patients with a simple pilonidal sinus.

25-Hydroxyvitamin D at time of breast cancer diagnosis and breast cancer survival.

PURPOSE: Previous studies have shown that low levels of 25-hydroxyvitamin D (25(OH)D) are associated with a poorer breast cancer survival. The relationship between vitamin D status and breast cancer outcomes is however still debated. The aim of the present study was to investigate the association between 25(OH)D blood levels measured at time of diagnosis and event-free survival (EFS) and overall survival (OS) in a large cohort of patients with early-stage primary invasive breast cancer. METHODS: From April 2008 to April 2013, 25(OH)D status was measured at time of diagnosis in all women operated for early stage primary invasive breast cancer at Rigshospitalet, Copenhagen, Denmark. Associations between 25(OH)D and EFS and OS were investigated using a Cox Proportional hazards model, adjusting for age, disease characteristics, time period, and BMI. Differences in survival were evaluated by hazard ratios (HR). RESULTS: In the present study, 2510 women with primary invasive breast cancer were included. Women with the lowest 25(OH)D levels (≤ 52 nmol/L) had an inferior EFS with a HR of 1.63 (95% CI 1.21-2.19) compared to women in the third quartile (76-99 nmol/L). Women with the highest 25(OH)D levels (≥ 99 nmol/L) also had an inferior EFS with a HR of 1.37 (95% CI 1.02-1.83). Plotting 25(OH)D status against EFS, the association was inversely J-shaped. For OS, a similar association with 25(OH)D status was observed. CONCLUSION: We confirmed previous findings suggesting that a low 25(OH)D status is associated with an inferior breast cancer survival, but unlike previous findings, we found an indication of poorer breast cancer survival also among women with high 25(OH)D levels.

[Perianal abscess after anal intercourse should raise suspicion of rectal gonorrhoeae infection].

Neisseria gonorrhoeae infection is a sexually transmitted disease. Rectal gonorrhoea is often asymptomatic, the most common symptoms are anal pain, bleeding and purulent discharge. This case report describes a younger man, who experienced increasing anal pain and later fever after anal intercourse. N. gonorrhoeae infection was verified, before a clinical examination revealed a perianal abscess. During incision of the abscess an anal fistula was suspected, and six weeks after primary surgery and treatment with relevant antibiotics, transanal ultrasonography showed perianal scarring and no signs of anocutaneous fistula.

Women's reasons for choosing abortion method: A systematic literature review.

AIMS: We aim to describe and classify reasons behind women's choice between medical and surgical abortion. METHODS: A systematic literature review was conducted in PubMed and PsycINFO in October 2015. The subjects were women in early pregnancy opting for abortion at clinics or hospitals in high-income countries. We extracted women's reasons for choice of abortion method and analysed these qualitatively, looking at main reasons for choosing either medical or surgical abortion. RESULTS: Reasons for choice of method were classified to five main groups: technical nature of the intervention, fear of complications, fear of surgery or anaesthesia, timing and sedation. Reasons for selecting medical abortion were often based on the perception of the method being 'more natural' and the wish to have abortion in one's home in addition to fear of complications. Women who opted for surgical abortion appreciated the quicker process, viewed it as the safer option, and wished to avoid pain and excess bleeding. Reasons were often based on emotional reactions, previous experiences and a lack of knowledge about the procedures. Some topics such as pain or excess bleeding received little attention. Overall the quality of the studies was low, most studies were published more than 10 years ago, and the generalisability of the findings was poor. CONCLUSION: Women did not base their choice of abortion method only on rational information from professionals but also on emotions and especially fears. Support techniques for a more informed choice are needed. Recent high-quality studies in this area are lacking.