At Odense University Hospital (OUH), 5-9% of all unselected cardiac surgical patients undergo reoperation due to excessive bleeding. The reoperated patients have an approximately three times greater mortality than non-reoperated. To reduce the rate of reoperations and mortality due to postoperative bleeding, we aim to identify risk factors that predict reoperation. A total of 1452 consecutive patients undergoing cardiac surgery using extracorporeal circulation (ECC) between November 2005 and December 2008 at OUH were analysed. Statistical tests were used to identify risk factors for reoperation. We performed a case-note review on propensity-matched patients to assess the outcome of reoperation for bleeding regarding morbidity and mortality. In total, 101 patients (7.0%) underwent surgical re-exploration due to excessive postoperative bleeding. Significant risk factors for reoperation for bleeding after cardiac surgery was low ejection fraction, high EuroSCORE, procedures other than isolated CABG, elongated time on ECC, low body mass index, diabetes mellitus and preoperatively elevated s-creatinine. Reoperated patients significantly had a greater increase in postoperative s-creatinine and higher mortality. Surviving reoperated patients significantly had a lower EuroSCORE and a shorter time on ECC compared with non-survivors. The average time to re-exploration was 155 min longer for non-survivors when compared with survivors.

We found an inverse association between the growth rate of abdominal aortic aneurysms and the level of HbA1c, indicating that long-lasting elevated blood sugar impairs aneurysmal progression in individuals with and without known diabetes mellitus.

Metformin use does not increase the risk of RAAA among individuals with diabetes.

This study reviews 594 surgical admissions, of patients aged 80 years and older, to departments of general surgery during 1 year. Half of the patients were admitted as emergencies and 60 per cent underwent surgery. The operative mortality rate was 8 per cent and the overall mortality rate for all admissions 9 per cent. The number of complications and the mortality rate after surgery increased in emergency cases and in patients with coexisting disease. Of all admissions, 72 per cent were uncomplicated and in 70 per cent patients could be discharged directly home; such patients do not generally take up beds and are discharged as soon as medical care is no longer indicated. The number of admissions of patients over 80 years of age will increase by about 30 per cent during this decade and, unless additional resources are provided to meet this challenge, new standards must be considered for the distribution of resources and of indications for surgery in both young and old.

Preoperative APT is associated with increased bleeding and greater transfusion requirements after CABG. Clopidogrel exposure is associated with greater reoperation rates and is an independent risk factor for severe postoperative bleeding.

BackgroundAnimal models support dietary omega‐3 fatty acids protection against abdominal aortic aneurysm (AAA), but clinical data are scarce. The sum of red blood cell proportions of the omega‐3 eicosapentaenoic and docosahexaenoic acids, known as omega‐3 index, is a valid surrogate for long‐term omega‐3 intake. We investigated the association between the omega‐3 index and the prevalence and progression of AAA. We also investigated associations between AAA and arachidonic acid, an omega‐6 fatty acid that is a substrate for proinflammatory lipid mediators.Methods and ResultsWe obtained blood samples from 498 AAA patients (maximal aortic diameter ≥30 mm) within a population‐based ultrasound‐screening trial in men and from 199 age‐matched controls who screened negative. We determined the fatty acids of red blood cells by gas chromatography. During a median follow‐up of 4.85 years, 141 AAA patients reached criteria for vascular surgical repair. Participants were high consumers of omega‐3 (average omega‐3 index: 7.6%). No significant associations were found for omega‐3 index. In contrast, arachidonic acid in AAA patients was higher than in controls (P<0.001), and individuals in the upper tertile of arachidonic acid at baseline had higher probability of having AAA (odds ratio: 1.309; 95% confidence interval, 1.021–1.678; P=0.033). AAA patients at the upper tertile of arachidonic acid at baseline had a 54% higher risk of needing surgical repair during follow‐up (hazard ratio: 1.544; 95% confidence interval, 1.127–2.114; P=0.007).ConclusionsOmega‐3 index is unrelated to men with AAA from a country in which fish consumption is customarily high. Arachidonic acid is associated with AAA presence and progression.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00662480.

High stoma output is a common problem in patients with ileostomy and can lead to dehydration and electrolyte disturbances. The first drug of choice to reduce stoma output is often loperamide. The aim was to assess the acute effect of loperamide on (a) ileostomy output in g/day, (b) gastrointestinal transit time and (c) patient-reported effects. A total of 12 patients completed this double-blinded, randomized, placebo-controlled, crossover study, consisting of a 3-day treatment period with loperamide 12 mg/day or placebo followed by the reverse after a washout period of 5-7 days. Patients collected stoma output and noted food and fluid intake over 48 hr and swallowed a capsule with radiopaque markers for the determination of gastrointestinal transit time over 24 hr. At the end of the study, patients were asked to report their treatment sequence. Ileostomy output was significantly reduced during loperamide treatment (p < 0.02) with a median of 16.5% (range -5% to 46%). Transit time was reduced significantly for the passage of 10% of the markers (p = 0.02), but not for 50% and 100% of the markers. Fifty-eight per cent (N = 7) of the patients reported the correct treatment sequence (p = 0.41). Loperamide 12 mg/day reduced ileostomy output statistically significantly, but with varying effects among patients and without reaching the clinical significance of 20% set-up by this study. Dose-response studies should be performed, and standard treatment doses of loperamide should be reassessed. The study was registered at ClinicalTrials.gov - NCT02266849.

The prevalence and mortality of abdominal aortic aneurysms (AAA) has been reported to decline. The aim of this study is to compare survival, prevalence, and repair rate of AAA in Denmark in the 1990s, the 2000s and the 2010sand to examine any change in factors known to influence the prevalence. Methods: Baseline status and up to 5-year outcomes of 34,079 general population men aged 65-74 were obtained from three RCTs;