Objective. Information on mortality after cholecystectomy in defined populations is limited. In this study we examined the case fatality rates and mortality ratios, based on register data. Material and methods. Hospit...Objective. Information on mortality after cholecystectomy in defined populations is limited. In this study we examined the case fatality rates and mortality ratios, based on register data. Material and methods. Hospital discharge and death certificate data were linked for all patients undergoing cholecystectomy in Sweden in 1987-99. Mortality risk was calculated as the standardized mortality ratio (SMR). Results. From 1 January 1987 to 1 December 1999, 123,099 patients underwent cholecystectomy for acute or chronic gallbladder disease. Between 1987-91 and 1995-99, the incidence of cholecystectomy increased by 13%, median age of patients decreased and the proportion of women increased. From 1995 to 1999, 32%of all cholecystectomies were completed as open cholecystectomy. During this period, 82%of patients aged 70 years or older with acute gallstone disease had an open cholecystectomy. For patients with chronic gallstone disease, the proportion was 43%. Postoperative crude mortality within 30 days for all patients was 0.4%. Patients with acalculous gallbladder disease had double the mortality risk compared with patients with calculous disease, and patients with acute cholecystitis had double the risk compared with patients with chronic disease. High age, previous hospital admission for conditions other than gallbladder disease, and cholecystectomy completed as an open procedure increased the risk, whereas gender and calendar year did not significantly affect the mortality risk. Biliary tract diseases accounted for 61%of all postoperative deaths, whereas 26%were due to cardiovascular diseases. Conclusions. During the 1990s, cholecystectomy incidence increased, whereas postoperative mortality risk remained unchanged. In order to further reduce the mortality risk, particular attention should be paid to elderly and frail patients and to patients with acalculous gallbladder disease.展开更多
Objective . Pancreatic pseudocyst is a common complication of both acute and chronic pancreatitis. The aim of the present study was to evaluate the efficacy and complications of different treatment regimens. Material ...Objective . Pancreatic pseudocyst is a common complication of both acute and chronic pancreatitis. The aim of the present study was to evaluate the efficacy and complications of different treatment regimens. Material and methods . All patients ≥15 years of age admitted to Lund University Hospital from 1994 to 2003 with pancreatic pseudocysts were analysed retrospectively. Pseudocysts were defined according to the Atlanta classification. Results . Forty-four patients (29M(66%), mean age 55±14 years) were included in the study, and all were subjected to treatment on 88 occasions. Mean size of pseudocysts at diagnosis was 9.6±6.8 cm (1.5-40 cm). Recurrence after treatment was 1.0±1.1 times (range 0-4). No difference was found in recurrence rate or pseudocyst size when comparing conservative versus interventional treatment, but patient weight was higher ( p =0.013) and acute pancreatitis was more frequent ( p =0.046) in conservatively treated patients. Surgical treatment tended to be associated with a lower recurrence rate as compared with percutaneous treatments. The rate of hospital admissions was a median 3 (0-16) and median length of stay (LOS) was 12 days (0-141 days). Six patients (14%) had complications and 3 died (7%). Pseudocysts ≥8 cm did not differ significantly from smaller pseudocysts regarding the choice of conservative treatment, LOS, recurrence and gastrointestinal obstruction, but there was a trend towards more complications in the group with larger pseudocysts (5 versus 1). Conclusions. Patients with pancreatic pseudocysts require frequent hospital admissions and repeated treatments. Larger pseudocysts do not imply more recurrences. The lowest recurrence rate overall was seen after open surgery.展开更多
文摘Objective. Information on mortality after cholecystectomy in defined populations is limited. In this study we examined the case fatality rates and mortality ratios, based on register data. Material and methods. Hospital discharge and death certificate data were linked for all patients undergoing cholecystectomy in Sweden in 1987-99. Mortality risk was calculated as the standardized mortality ratio (SMR). Results. From 1 January 1987 to 1 December 1999, 123,099 patients underwent cholecystectomy for acute or chronic gallbladder disease. Between 1987-91 and 1995-99, the incidence of cholecystectomy increased by 13%, median age of patients decreased and the proportion of women increased. From 1995 to 1999, 32%of all cholecystectomies were completed as open cholecystectomy. During this period, 82%of patients aged 70 years or older with acute gallstone disease had an open cholecystectomy. For patients with chronic gallstone disease, the proportion was 43%. Postoperative crude mortality within 30 days for all patients was 0.4%. Patients with acalculous gallbladder disease had double the mortality risk compared with patients with calculous disease, and patients with acute cholecystitis had double the risk compared with patients with chronic disease. High age, previous hospital admission for conditions other than gallbladder disease, and cholecystectomy completed as an open procedure increased the risk, whereas gender and calendar year did not significantly affect the mortality risk. Biliary tract diseases accounted for 61%of all postoperative deaths, whereas 26%were due to cardiovascular diseases. Conclusions. During the 1990s, cholecystectomy incidence increased, whereas postoperative mortality risk remained unchanged. In order to further reduce the mortality risk, particular attention should be paid to elderly and frail patients and to patients with acalculous gallbladder disease.
文摘Objective . Pancreatic pseudocyst is a common complication of both acute and chronic pancreatitis. The aim of the present study was to evaluate the efficacy and complications of different treatment regimens. Material and methods . All patients ≥15 years of age admitted to Lund University Hospital from 1994 to 2003 with pancreatic pseudocysts were analysed retrospectively. Pseudocysts were defined according to the Atlanta classification. Results . Forty-four patients (29M(66%), mean age 55±14 years) were included in the study, and all were subjected to treatment on 88 occasions. Mean size of pseudocysts at diagnosis was 9.6±6.8 cm (1.5-40 cm). Recurrence after treatment was 1.0±1.1 times (range 0-4). No difference was found in recurrence rate or pseudocyst size when comparing conservative versus interventional treatment, but patient weight was higher ( p =0.013) and acute pancreatitis was more frequent ( p =0.046) in conservatively treated patients. Surgical treatment tended to be associated with a lower recurrence rate as compared with percutaneous treatments. The rate of hospital admissions was a median 3 (0-16) and median length of stay (LOS) was 12 days (0-141 days). Six patients (14%) had complications and 3 died (7%). Pseudocysts ≥8 cm did not differ significantly from smaller pseudocysts regarding the choice of conservative treatment, LOS, recurrence and gastrointestinal obstruction, but there was a trend towards more complications in the group with larger pseudocysts (5 versus 1). Conclusions. Patients with pancreatic pseudocysts require frequent hospital admissions and repeated treatments. Larger pseudocysts do not imply more recurrences. The lowest recurrence rate overall was seen after open surgery.
