Medical specialist care utilization prior to the explantation of cosmetic silicone breast implants:A nationwide retrospective data linkage study

Background Explantation is the proposed treatment for breast implant illness (BII). Little is known about which medical specialists are visited and what diagnoses are made before explantation is provided as the treatment. Objectives This study investigated medical specialist care utilization in women with cosmetic breast implants who underwent explantation compared to women who chose breast implant replacement surgery and to women without breast implants. Methods Retrospective cohort study using data linkage with the Dutch Breast Implant Registry and the Dutch health insurance claims database. Visits to medical specialists were examined over the 3 years before explantation. A total of 832 explantation patients were matched and compared to 1463 breast implant replacement patients and 1664 women without breast implants. Results Explantation patients were more likely to have visited > 5 different medical specialties compared to both replacement patients (12.3% vs. 5.7%; p < 0.001) and women without breast implants (12.3% vs. 3.7%; p < 0.001). Among explantation patients, women who underwent explantation because of BII were more likely to have visited > 5 different medical specialties compared to women who underwent explantation because of other reasons (25.0% vs. 11.0%; p < 0.001). Conclusions Women who underwent explantation of breast implants had higher utilization of medical specialist care in the years before explantation compared to women who underwent breast implant replacement surgery and women without breast implants. Medical specialist care use was especially high among women for whom BII was the registered reason for explantation. These findings suggest further research is needed into the link between BII and the use of medical specialist care

Health symptoms and cosmetic silicone breast implants:A retrospective cohort study

BackgroundThere has been a growing concern about a possible causal relationship between silicone breast implants (SBIs) and health symptoms, referred to as breast implant illness. This study assessed the association between SBIs for cosmetic augmentation and health symptoms.MethodsThis retrospective cohort study used the data from the Dutch Breast Implant Registry and Nivel Primary Care Database. A total of 688 women with cosmetic SBIs were age-matched with 1301 women without SBIs. The occurrence of 13 health symptoms presented in general practice was assessed 1 year before implantation until 3 years after implantation. Comparisons were made regarding the number of symptoms and general practice consultations, before and after implantation and between the two groups.ResultsWomen with SBIs were more likely to experience three or more distinct health symptoms and a combination of multiple symptoms with multiple consultations during follow-up than women without SBIs (adjusted OR 1.44, 95% CI 1.06 to 1.96

Predicting sepsis-related mortality and ICU admissions from telephone triage information of patients presenting to out-of-hours GP cooperatives with acute infections:A cohort study of linked routine care databases

BackgroundGeneral practitioners (GPs) often assess patients with acute infections. It is challenging for GPs to recognize patients needing immediate hospital referral for sepsis while avoiding unnecessary referrals. This study aimed to predict adverse sepsis-related outcomes from telephone triage information of patients presenting to out-of-hours GP cooperatives.MethodsA retrospective cohort study using linked routine care databases from out-of-hours GP cooperatives, general practices, hospitals and mortality registration. We included adult patients with complaints possibly related to an acute infection, who were assessed (clinic consultation or home visit) by a GP from a GP cooperative between 2017–2019. We used telephone triage information to derive a risk prediction model for sepsis-related adverse outcome (infection-related ICU admission within seven days or infection-related death within 30 days) using logistic regression, random forest, and neural network machine learning techniques. Data from 2017 and 2018 were used for derivation and from 2019 for validation.ResultsWe included 155,486 patients (median age of 51 years; 59% females) in the analyses. The strongest predictors for sepsis-related adverse outcome were age, type of contact (home visit or clinic consultation), patients considered ABCD unstable during triage, and the entry complaints”general malaise”, “shortness of breath” and “fever”. The multivariable logistic regression model resulted in a C-statistic of 0.89 (95% CI 0.88–0.90) with good calibration. Machine learning models performed similarly to the logistic regression model. A “sepsis alert” based on a predicted probability >1% resulted in a sensitivity of 82% and a positive predictive value of 4.5%. However, most events occurred in patients receiving home visits, and model performance was substantially worse in this subgroup (C-statistic 0.70).ConclusionSeveral patient characteristics identified during telephone triage of patients presenting to out-of-hours GP cooperatives were associated with sepsis-related adverse outcomes. Still, on a patient level, predictions were not sufficiently accurate for clinical purposes

Dutch GP healthcare consumption in COVID-19 heterogeneous regions:An interregional time-series approach in 2020-2021

Background Many countries observed a sharp decline in the use of general practice services after the outbreak of the COVID-19 pandemic. However, research has not yet considered how changes in healthcare consumption varied among regions with the same restrictive measures but different COVID-19 prevalence.Aim To investigate how the COVID-19 pandemic affected healthcare consumption in Dutch general practice during 2020 and 2021, among regions with known heterogeneity in COVID-19 prevalence, from a pre-pandemic baseline in 2019.Design Population-based cohort study using electronic health records.Setting Dutch general practices involved in regional research networks.MethodsInterrupted time-series analysis of changes in healthcare consumption from before to during the pandemic. Descriptive statistics on the number of potential COVID-19 related contacts, reason for contact and type of contact.Results The study covered 3 627 597 contacts (425 639 patients), 3 532 693 contacts (433 340 patients), and 4 134 636 contacts (434 872 patients) in 2019, 2020, and 2021, respectively. Time-series analysis revealed a significant decrease in healthcare consumption after the outbreak of the pandemic. Despite interregional heterogeneity in COVID-19 prevalence, healthcare consumption decreased comparably over time in the three regions, before rebounding to a level significantly higher than baseline in 2021. Physical consultations transitioned to phone or digital over time.Conclusions Healthcare consumption decreased irrespective of the regional prevalence of COVID-19 from the start of the pandemic, with the Delta variant triggering a further decrease. Overall, changes in care consumption appeared to reflect contextual factors and societal restrictions rather than infection rates