BackgroundStudies on penetrating injuries in Europe are scarce and often represent data from single institutions. The aim of this study was to describe the incidence and demographic features of patients hospitalized for stab injury in a whole nation.Materials and methodsThis was a retrospective nationwide population-based study on all consecutive adult patients who were hospitalized in Iceland following knife and machete-related injuries, 2000–2015. Age-standardized incidence was calculated and Injury Severity Score (ISS) was used to assess severity of injury.ResultsAltogether, 73 patients (mean age 32.6 years, 90.4% males) were admitted during the 16-year study period, giving an age-standardized incidence of 1.54/100,000 inhabitants. The incidence did not vary significantly during the study period (P = 0.826). Most cases were assaults (95.9%) occurring at home or in public streets, and involved the chest (n = 32), abdomen (n = 26), upper limbs (n = 26), head/neck/face (n = 21), lower limbs (n = 10), and the back (n = 6). Median ISS was 9, with 14 patients (19.2%) having severe injuries (defined as ISS > 15). The median length of hospital stay was 2 days (range 0–53). Forty-seven patients (64.4%) underwent surgery and 26 of them (35.6%) required admission to an intensive care unit (ICU), all with ISS scores above 15. Three patients did not survive for 30 days (4.1%); all of them had severe injuries (ISS 17, 25, and 75).ConclusionStab injuries that require hospital admission are rare in Iceland, and their incidence has remained relatively stable. One in every five patients sustained severe injuries, two-thirds of whom were treated with surgical interventions, and roughly one-third required ICU care. Although some patients were severely injured with high injury scores, their 30-day mortality was still low in comparison to other studies.
OBJECTIVES Excessive bleeding leading to re-exploration is a severe complication of cardiac surgical procedures, associated with early postoperative morbidity and mortality. Less is known about the long-term outcome of these patients. We evaluated the impact of re-exploration after cardiac surgery on peri- and postoperative morbidity and mortality, as well long-term mortality, in a well-defined nationwide population. METHODS In this retrospective study, 48 060 consecutive patients undergoing coronary artery bypass grafting (CABG) and/or valve surgery from 2006 to 2015 were analysed. Multivariable logistic regression was used to identify factors associated with re-exploration, morbidity and mortality. Cox regression analysis was implemented to explore the association between re-exploration and long-term mortality. The mean follow-up time was 4.6 years (range 0–10 years) with follow-up time set at 31 December 2015. RESULTS Overall, 2371 patients (4.9%) underwent re-exploration. Factors associated with re-exploration included advanced age, procedures other than isolated CABG and acute surgery. Re-explored patients had an increased risk of unadjusted mortality at 30, 90 and beyond 90 days (all P < 0.001). Significance was maintained after adjustment at 30 days [odds ratio: 3.94, 95% confidence interval (CI): 3.19–4.85, P < 0.001] and 90 days (odds ratio: 3.79, 95% CI: 3.14–4.55, P < 0.001), but not with long-term mortality (hazard ratio: 1.02, 95% CI: 0.91–1.15, P = 0.712). Furthermore, re-exploration was independently associated with other postoperative complications, e.g. prolonged hospital stay, stroke and renal injury. CONCLUSIONS Patients who are re-explored for bleeding within 24 h have almost four-fold higher odds of mortality within 3 months post-procedure. However, the increased risk of death following re-exploration is not maintained in the long term.
Background Surgical revascularization is an established indication for patients with advanced coronary artery disease and reduced left ventricular ejection fraction (LVEF). Long-term outcomes for these patients are not well defined. We studied the long-term outcomes of patients with ischaemic cardiomyopathy who underwent surgical revascularization in a well-defined nationwide cohort. Materials and methods A retrospective study on 2,005 patients that underwent isolated coronary artery bypass grafting (CABG) in Iceland between 2000–2016. Patients were catagorized into two groups based on their preoperative LVEF; LVEF ≤35% (n = 146, median LVEF 30%) and LVEF >35% (n = 1859, median LVEF 60%). Demographics and major adverse cardiac and cerebrovascular events (MACCE), were compared between groups along with cardiac-specific and overall survival. Mean follow-up was 7.6 years. Results Demographics were similar in both groups regarding age, gender, and most cardiovascular risk factors. However, patients with LVEF ≤35% more often had diabetes, renal insufficiency, chronic obstructive pulmonary disease and a previous history of myocardial infarction. Thirty-day mortality was four times higher (8% vs 2%, p < 0.001) in the LVEF ≤35%-group compared to controls. MACCE-free survival was 83% and 62% at 1 and 5 years for LVEF ≤35%-group compared to 94% and 82% for the control group. Overall survival was also significantly lower in the same groups, or 87% and 69% (p < 0.001) compared to 98% and 91% (p < 0.001), at 1 and 5 years respectively. Conclusions A good long-term outcome after CABG can be expected for patients with reduced LVEF, however, their survival is still significantly inferior to patients with normal ventricular function.
Objectives. To evaluate the distribution and impact of ABO blood groups on postoperative outcomes in patients undergoing surgery for acute type A aortic dissection (ATAAD). Design. A total of 1144 surgical ATAAD patients from eight Nordic centres constituting the Nordic consortium for acute type A aortic dissection (NORCAAD) were analysed. Blood group O patients were compared to non-O subjects. The relative frequency of blood groups was assessed with t-distribution, modified for weighted proportions. Multivariable logistic regression was performed to identify independent predictors of 30-day mortality. Cox regression analyses were performed for assessing independent predictors of late mortality. Results. There was no significant difference in the proportions of blood group O between the study populations in the NORCAAD registry and the background population (40.6 (95% CI 37.7-43.4)% vs 39.0 (95% CI 39.0-39.0)%). ABO blood group was not associated with any significant change in risk of 30-day or late mortality, with the exception of blood group A being an independent predictor of late mortality. Prevalence of postoperative complications was similar between the ABO blood groups. Conclusions. In this large cohort of Nordic ATAAD patients, there were no associations between ABO blood group and surgical incidence or outcomes, including postoperative complications and survival.
Á Íslandi eru gerðar 100-150 kransaeðahjáveituaðgerðir á ári. Fyrstu nóttina eftir aðgerð hafa allir sjúklingar hingað til dvalist á gjörgaesludeild til eftirlits. Sumir sjúklingar þurfa þó lengri dvöl vegna umfangsmeiri gjörgaeslumeðferðar eftir aðgerðina eða fylgikvilla. Á Landspítala eru tvaer gjörgaesludeildir sem rúma alls 22 sjúklinga, en undanfarin tvö ár hefur ekki verið unnt að nýta nema 12-13 pláss vegna skorts á hjúkrunarfraeðingum. Á sama tíma hefur baeði sjúklingum og legudögum á gjörgaesludeildinni fjölgað, einkum vegna bráðainnlagna, sem getur valdið því að valkvaeðum gjörgaesluinnlögnum er frestað. 1 Árið 2018 var rúmlega þriðjungi allra hjartaaðgerða frestað vegna plássleysis á gjörgaeslu.Tímalengd gjörgaesludvalar eftir kransaeðahjáveitu er mismunandi og fer meðal annars eftir innlagnarástaeðu, gangi skurðaðgerðar og hvort fylgikvillar koma upp eftir aðgerð. Í erlendum greinum hafa eftirtaldir áhaettuþaettir lengdrar gjörgaesludvalar verið nefndir til sögunnar: hár aldur, skert útstreymisbrot (ejection fraction) vinstri slegils og langvinnir lungnasjúkdómar. 2,3 Einnig Algengi og áhaettuþaettir lengdrar dvalar á gjörgaesludeild eftir kransaeðahjáveituaðgerð Á G R I P INNGANGUR Til að hámarka nýtingu gjörgaeslurýma er mikilvaegt að þekkja algengi og áhaettuþaetti lengdrar dvalar á gjörgaesludeild eftir kransaeðahjáveituaðgerð en slík rannsókn hefur ekki verið gerð áður hér á landi. EFNIVIÐUR OG AÐFERÐIR Rannsóknin var afturskyggn og náði til allra sjúklinga sem gengust undir kransaeðahjáveituaðgerð á Landspítala á árunum 2001-2018. Skráðar voru upplýsingar um heilsufar sjúklinganna, aðgerðartengda þaetti og fylgikvilla eftir aðgerðina. Sjúklingar sem lágu á gjörgaeslu í eina nótt voru bornir saman við þá sem lágu þar tvaer naetur eða lengur. Lifun var áaetluð með aðferð Kaplan-Meiers. Forspárþaettir dvalarlengdar á gjörgaeslu voru fundnir með lógistískri aðhvarfsgreiningu og niðurstöðurnar notaðar til að útbúa reiknivél sem áaetlar líkur á lengri gjörgaesludvöl. NIÐURSTÖÐURAf 2177 sjúklingum þurftu 20% gjörgaesludvöl í tvaer naetur eða lengur. Sjúklingar sem lágu tvaer eða fleiri naetur á gjörgaeslu voru oftar konur (23% á móti 16%, p=0,001). Þessir sjúklingar höfðu einnig oftar áhaettuþaetti kransaeðasjúkdóms og fyrri sögu um aðra hjartasjúkdóma eins og hjartabilun, lokusjúkdóma og skert útstreymisbrot vinstri slegils. Auk þess var EuroSCORE II gildi þeirra haerra (4,7 á móti 1,9, p<0,001) og höfðu þeir oftar skerta nýrnastarfsemi fyrir aðgerð (30% á móti 16%, p<0,001) og þurftu frekar á bráðaaðgerð að halda (18% á móti 2%, p<0,001). Sjúklingar sem dvöldu tvaer naetur eða lengur höfðu haerri tíðni skammog langtímafylgikvilla og verri langtímalifun en sjúklingar í viðmiðunarhópi (78% á móti 93% lifun 5 árum frá aðgerð, p<0,0001). Sjálfstaeðir áhaettuþaettir lengri gjörgaesludvalar voru aldur, kyn, EuroSCORE II gildi, fyrri saga um aðra hjartasjúkdóma, skert nýrnastarfsemi og bráðaaðgerð. ÁLYKTANIRFimmti hver sjúklingur þarf gjörgaesludvöl í tvaer eða fleiri naetur eftir kransaeðahjáveitu á Landsp...
INTRODUCTION: Impaired renal function as seen in chronic kidney disease (CKD) is a known risk factor for coronary artery diseases and has been linked to inferior outcome after myocardial revascularization. Studies on the outcome of coronary bypass grafting (CABG) in CKD-patients are scarce. We aimed to study this subgroup of patients following CABG in a well defined whole-nation cohort, focusing on short term complications and 30 day mortality. MATERIALS AND METHODS: A retrospective study on 2300 consecutive patients that underwent CABG at Landspítali University Hospital 2001-2020. Patients were divided into four groups according to preoperative estimated glomerular filtration rate (GFR), and the groups compared. GFR 45–59 mL/mín/1.73m2, GFR 30-44 mL/mín/1.73m2, GFR <30 mL/mín/1.73m2 and controls with normal GFR (≥60 mL/mín/1.73m2). Clinical information was gathered from medical records and logistic regression used to estimate risk factors of 30-day mortality. RESULTS: Altogether 429 (18.7%) patients had impaired kidney function; these patients being more than six years older, having more cardiac symptoms and a higher mean EuroSCORE II (5.0 vs. 1.9, p<0.001) compared to controls. Furthermore, their left ventricular ejection fraction was also lower, their median hospital stay extended by two days and major short-term complications more common, as was 30 day mortality (24.4% vs. 1.4%, p<0.001). In multivariate analysis advanced age, ejection fraction <30% and GFR <30 mL/min/1.73m2 were independent predictors of higher 30-day mortality (OR=10.4; 95% CI: 3.98-25.46). CONCLUSIONS: Patients with impaired renal function are older and more often have severe coronary artery disease. Early complications and 30-day mortality were much higher in these patients compared to controls and advanced renal failure and the strongest predictor of 30-day mortality.
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