Assessing the Validity and Cover Rate of the National Swedish Hernia Register.

AIM: To assess the validity and cover rate of the Swedish hernia register. MATERIAL AND METHODS: Since the start of the Swedish Hernia register an annual review of randomly selected hospitals has been carried out, and since 2013 in a more standardized form to allow a systematic data collection and evaluation. 10% of all clinics were randomly selected each year in a specific region of Sweden, ensuring a systematic validation of all regions from north to south. Data from 2013 to 2018 were analyzed regarding data quality and from 2014 to 2018 regarding cover rate. All operations registered at the validated clinics were compared with the Swedish Hernia Register to assess cover rate. Fifty operations were randomly selected at each clinic and data in the Swedish Hernia register were compared with the medical records to evaluate data quality. RESULTS: Fifty-five clinics was evaluated and a total of 73,764 variables were compared with the medical records. Cover rate between 2014 and 2018 was 97%. The proportion of correct variables was 98% between 2013 and 2018. Most frequent errors were ASA score, date at which the patient was put on the waiting list and postoperative complications. CONCLUSION: This unique validation of a national hernia register shows a high cover rate and good quality of data. Efforts to maintain and improve national registers are of great importance. Research with data from the Swedish hernia register should be evaluated on the basis of the results presented in this study.

Orally Administered Trimethoprim-Sulfamethoxazole and Metronidazole as Infection Prophylaxis in Elective Colorectal Surgery.

BACKGROUND: This randomized clinical trial evaluated orally administered trimethoprim-sulfamethoxazole and metronidazole (TSM) in elective colorectal surgery as prophylactic for post-operative surgical site infections (SSI). METHODS: Patients undergoing elective colorectal resection were evaluated for inclusion. Randomized subjects received either orally administered TSM or intravenously administered cefuroxime and metronidazole (control group, CXM). The primary endpoint was the rate of SSI. RESULTS: A total of 1073 subjects were randomized to either control (540) or TSM (533). 486 patients in the TSM group and 499 in the control group were followed-up with after 4 weeks. Thirty-seven (3.8%) patients were afflicted by SSI at discharge from hospital and 69 (7.0%) at follow-up four weeks after surgery. After four weeks, the rate of incisional SSI was 7.0% in the TSM group and 3.6% in the control group (p=0.022). For organ/space SSI and the other complications monitored in the study, no differences were observed between the groups. CONCLUSION: Orally administered TSM as prophylaxis before elective colorectal surgery results in a low rate of organ/space SSI but an increased rate of incisional SSI compared with intravenously administered cefuroxime and metronidazole. Thus, when considering orally administered TSM, because of environmental concerns or for economic reasons, the slightly increased infection rate has to be kept in mind.

A preventive effect of unfractionated heparin on post-ERCP pancreatitis is suggested by positive effects on laboratory markers.

BACKGROUND/AIMS: Heparin has anti-inflammatory properties. Serum tests after ERCP might serve as surrogate markers for inflammatory reactions. The aims were to study effects of low-dose unfractionated heparin on post-ERCP laboratory tests and on safety. METHODOLOGY: The design was prospective, randomized, double-blind, placebo-controlled. Eighty-nine patients were randomized to 5000 IE Heparin (0.2 ml of 25000 IE) or 0.2 ml 0.9% NaCL given s.c. 4h before and 4h and 18h after ERCP. Amylase, AST, ALT, CRP and leucocyte count were analyzed at these times and also after 48h. Adverse events were registered. RESULTS: Significant increase was observed after 18h in the placebo group (n=44) for amylase (mean: 0.66 microkat/l, SD:0.8 vs. mean: 4.56 microkat/l, SD:9.9, p = 0.011), AST (mean: 1.37 microkat/l, SD: 1.5 vs. mean: l.96 microkat/l, SD:2.1, p = 0.049) and ALT (mean: 2.42 microkat/l, SD:2.7 vs. mean: 2.91, SD: 2.9% kat/l, p = 0.042). Corresponding elevations were not seen in the heparin group (n=41): p = 0.371, 0.395 and 0.25 respectively. Leucocyte count elevation was higher with longer duration in the placebo group. Mild pancreatitis occurred in 4.7% (placebo: 3, heparin: (1) and 4/89 (placebo: 2, heparin:(2) were excluded due to minor bleeding after the first injection. CONCLUSIONS: Low-dose heparin reduces the characteristic rise in laboratory tests seen after ERCP. Larger studies with acute pancreatitis as the end-point are justified.

Patient symptoms after colonic surgery in the era of enhanced recovery--a long-term follow-up.

AIMS: The main purpose of this study was to analyse, prospectively, patient symptoms during the first four weeks following elective colon surgery. A secondary aim was to find areas to improve inpatient information and postoperative care. BACKGROUND: Fast-track recovery following colon surgery has been proven beneficial to patients in the early postoperative phase. Less is known about the continuous recovery at home. DESIGN: A prospective follow-up survey. METHODS: Consecutive patients (n = 32) planned for elective colon surgery were evaluated. Both open and laparoscopic operations were included. All followed a fast-track protocol in hospital. Patient symptoms were recorded by validated quality of life questionnaires (EORTC QLQ-C 30, EORTC QLQ-CR 38 and Brief Pain Inventory). An interview was conducted five weeks and one year after surgery. RESULTS: The hospital stay was six days, and 10% of patients were readmitted. The fast-track concept worked well. The main problems after discharge were fatigue, nausea and bowel disturbances. Pain was not a significant issue. Most symptoms had disappeared after four weeks. CONCLUSIONS: The first period at home is troublesome, and better information about common symptoms is needed. A direct telephone line has been set up to answer questions and to lower patient anxiety. RELEVANCE TO CLINICAL PRACTICE: Clinical guidelines for patient's discharge planning can be performed based on the results from this study. Further improvement regarding the epidural anaesthesia is needed to reduce minor side effects.

Postoperative impact of daily life after primary treatment of proximal/distal tibiafracture with Ilizarov external fixation.

AIMS AND OBJECTIVES: To describe patients' experience of the impact of their health-related life situation on their daily life two and four weeks after primary fracture treatment with Ilizarov external fixation. BACKGROUND: A few studies have been conducted postoperatively focussing on fracture treatment with Ilizarov fixation. DESIGN: A prospective descriptive research design. METHOD: Patients who had been treated for a proximal/distal tibial fracture were invited to participate in the study. Data were collected with a semi-structured questionnaire where 20 patients described in their own words their situation at home two and four weeks postoperatively. The process used when analysing the data was similar to content analysis. RESULTS: Four key themes were identified: 'limitations in the home environment', 'limitations outside the home', 'limitations to social relations' and 'experience of having an Ilizarov fixation'. The patient's life situation was strongly affected during the first postoperative month. This took the form of clear limitations on activities outside the home and a degree of limitation on coping with household chores and personal hygiene. These limitations became less severe after between 2-4 weeks and were very much a consequence of using crutches. CONCLUSION: This study points to limitations in the patient's daily life situation in the home. The results from the study make it obvious that the information given to patients prior to discharge, concerning the value of putting weight on the leg, had not been clear or that the patients had not understood it. This had a negative impact on the patient's daily life after discharge. Further data are needed to uncover the extent of the issue to be able to optimise patient outcomes. RELEVANCE TO CLINICAL PRACTICE: There is a need for clearer and more active information from the nurse before discharge but also a need to follow up how the information given is understood.