Epidemiology and association with outcomes of polypharmacy in patients undergoing surgery: retrospective, population-based cohort study

BACKGROUND: The aim of this study was to determine the prevalence of preoperative polypharmacy and the incidence of postoperative polypharmacy/hyper-polypharmacy in surgical patients and their association with adverse outcomes. METHODS: This was a retrospective, population-based cohort study among patients older than or equal to 18 years undergoing surgery at a university hospital between 2005 and 2018. Patients were categorized based on the number of medications: non-polypharmacy (fewer than 5); polypharmacy (5-9); and hyper-polypharmacy (greater than or equal to 10). The 30-day mortality, prolonged hospitalization (greater than or equal to 10 days), and incidence of readmission were compared between medication-use categories. RESULTS: Among 55 997 patients, the prevalence of preoperative polypharmacy was 32.3 per cent (95 per cent c.i. 33.5 to 34.3) and the prevalence of hyper-polypharmacy was 25.5 per cent (95 per cent c.i. 25.2 to 25.9). Thirty-day mortality was higher for patients exposed to preoperative hyper-polypharmacy (2.3 per cent) and preoperative polypharmacy (0.8 per cent) compared with those exposed to non-polypharmacy (0.6 per cent) (P < 0.001). The hazards ratio (HR) of long-term mortality was higher for patients exposed to hyper-polypharmacy (HR 1.32 (95 per cent c.i. 1.25 to 1.40)) and polypharmacy (HR 1.07 (95 per cent c.i. 1.01 to 1.14)) after adjustment for patient and procedural variables. The incidence of longer hospitalization (greater than or equal to 10 days) was higher for hyper-polypharmacy (11.3 per cent) and polypharmacy (6.3 per cent) compared with non-polypharmacy (4.1 per cent) (P < 0.001). The 30-day incidence of readmission was higher for patients exposed to hyper-polypharmacy (10.2 per cent) compared with polypharmacy (6.1 per cent) and non-polypharmacy (4.8 per cent) (P < 0.001). Among patients not exposed to polypharmacy, the incidence of new postoperative polypharmacy/hyper-polypharmacy was 33.4 per cent (95 per cent c.i. 32.8 to 34.1), and, for patients exposed to preoperative polypharmacy, the incidence of postoperative hyper-polypharmacy was 16.3 per cent (95 per cent c.i. 16.0 to 16.7). CONCLUSION: Preoperative polypharmacy and new postoperative polypharmacy/hyper-polypharmacy are common and associated with adverse outcomes. This highlights the need for increased emphasis on optimizing medication usage throughout the perioperative interval

Er þörf á sérstakri heilbrigðismóttöku fyrir háskólanemendur?

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnTilgangur: Víða erlendis hafa háskólanemendur aðgang að heilbrigðisþjónustu sem er sérstaklega ætluð þeim. Tilgangur þessarar könnunar meðal nemenda við Háskóla Íslands var að skoða þörf þeirra fyrir sérstaka heilbrigðismóttöku. Aðferð: Rafræn könnun var lögð fyrir 9744 nemendur við háskólann vorið 2011 sem voru á póstlista. Spurningalistinn var saminn af vinnuhópi sem í voru fulltrúar frá öllum deildum Heilbrigðisvísindasviðs Háskóla Íslands. Stuðst var við lýsandi tölfræði við gagnagreiningu. Niðurstöður: Alls bárust svör frá 1487 þátttakendum, 1427 íslenskumælandi og 60 enskumælandi, og gefa svörin því mynd af viðhorfum 15,2% nemenda við skólann. Úrtakið endurspeglar einkum viðhorf kvenstúdenta og nema í grunnnámi. Tæplega 40% íslensku nemanna og um 70% þeirra erlendu höfðu ekki heimilislækni á höfuðborgarsvæðinu. Niðurstöður sýndu að meirihluti þeirra þurfti á heilbrigðisþjónustu að halda á árinu fyrir könnunina en rúmlega helmingur beið með að leita eftir heilbrigðisþjónustu og var meginástæða þess kostnaður. Um þriðjungur íslensku nemanna og fimmtungur þeirra erlendu sögðust eiga í fjárhagsvanda. Um 92% þeirra íslensku og allir erlendu nemarnir sögðust mundu leita á móttöku þar sem þjónustan væri veitt af nemendum skólans undir leiðsögn kennara. Báðir hóparnir vildu hafa aðgang að fjölbreyttri heilbrigðisþjónustu. Ályktanir: Niðurstöðurnar gefa til kynna að þeir háskólanemendur, sem þátt tóku í könnuninni, hafi mikla þörf fyrir sérstaka heilbrigðismóttöku. Kostnaður hefur hvað mest hindrað þá í að leita eftir heilbrigðisþjónustu. Jafnframt er stór hópur án heimilislæknis, einkum sá erlendi, og hefur því ekki greiðan aðgang að heilbrigðisþjónustu á heilsugæslustöðvum.Purpose: In many neighbouring countries university students have access to health services which are specially geared to their needs. The purpose of this survey among university students at the University of Iceland was to explore their need for a special health service. Method: The online survey was administered to 9744 students at the university in the spring of 2011 who were registered e-mail recipients, both Icelandic and English-speaking. The questionnaire was developed by a working group which consisted of representatives from all the faculties at the School of Health Sciences. Data were analysed by descriptive statistical methods. Results: There were 1487 participants who responded, 1427 Icelandic and 60 English-speaking representing 15,2% of the university student population. The sample represents especially the attitudes of undergraduate and female students. Almost 40% of the Icelandic students and nearly 70% of the English-speaking students did not have a family practitioner in the capital area. The results showed that the great majority of respondents had needed health services in the year before the study took place. More than half of them reported that they had postponed seeking health services citing cost as the main reason. About 92% of the Icelandic students and all of the foreign students reported that they would attend a health clinic which was provided by university students under supervision. Both groups would like to have access to various health care services. Conclusions: The results indicate that university students who answered the questionnaire had a great need for special health clinic. Costs of service had mainly prevented them from seeking health care services. Additionally, the proportion of students without a family practitioner is high, especially among the foreign students, which is a further hindrance regarding access to primary health care services.Heilbrigðisvísindasvið Landspítal

„Það er fróðlegt og krefjandi að vinna í teymi“- Þverfræðilegt nám á heilbrigðisvísindasviði Háskóla Íslands: þriggja ára þróunarverkefni

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Sequence variants at the TERT-CLPTM1L locus associate with many cancer types

The common sequence variants that have recently been associated with cancer risk are particular to a single cancer type or at most two. Following up on our genome-wide scan of basal cell carcinoma, we found that rs401681[C] on chromosome 5p15.33 satisfied our threshold for genome-wide significance (OR = 1.25, P = 3.7 x 10(-12)). We tested rs401681 for association with 16 additional cancer types in over 30,000 cancer cases and 45,000 controls and found association with lung cancer (OR = 1.15, P = 7.2 x 10(-8)) and urinary bladder, prostate and cervix cancer (ORs = 1.07-1.31, all P < 4 x 10(-4)). However, rs401681[C] seems to confer protection against cutaneous melanoma (OR = 0.88, P = 8.0 x 10(-4)). Notably, most of these cancer types have a strong environmental component to their risk. Investigation of the region led us to rs2736098[A], which showed stronger association with some cancer types. However, neither variant could fully account for the association of the other. rs2736098 corresponds to A305A in the telomerase reverse transcriptase (TERT) protein and rs401681 is in an intron of the CLPTM1L gene

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p&lt;0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology