Long-Term Outcomes After Open Repair for Ruptured Abdominal Aortic Aneurysm

Background Early mortality in ruptured abdominal aneurysm (rAAA) is high, but data on long-term outcome are scarce. The aim of this study was to investigate the long-term outcome in survivors after open surgery for rAAA in well-defined population. Methods This is a population-based, observational long-term follow-up (beyond 30-day mortality) study of patients surgically treated for rAAA from 2000 through 2014. Long-term survival was analysed using Kaplan–Meier estimates and compared to the general population by analyses of relative survival. Results Out of 178 patients operated for rAAA, 95 patients (55%) either died in the perioperative period, were referred from other hospitals or were lost to follow-up (two patients). Altogether 83 patients were eligible for long-term outcomes: 72 men and 11 women. Estimated median crude survival time was 6.5 years [95% confidence interval (CI) 4.8–8.2]. Men had a median survival of 7.3 years (95% CI 5.1–9.4) versus 5.4 years in females (95% CI 3.5–7.3) (P = 0.082). Reinterventions during follow-up occurred in 31 (37%). Relative survival demonstrated a slightly higher risk of death in the rAAA population compared to the general age- and gender-matched population. Age, but not comorbidities, had a significant influence on long-term survival. Conclusion For survivors beyond 30 days after surgery for rAAA, long-term survival compares well to that of an age- and sex-matched population. A high frequency of cardiovascular comorbidities did not seem to affect long-term survival.publishedVersio

Long-Term Outcomes After Open Repair for Ruptured Abdominal Aortic Aneurysm

Background Early mortality in ruptured abdominal aneurysm (rAAA) is high, but data on long-term outcome are scarce. The aim of this study was to investigate the long-term outcome in survivors after open surgery for rAAA in well-defined population. Methods This is a population-based, observational long-term follow-up (beyond 30-day mortality) study of patients surgically treated for rAAA from 2000 through 2014. Long-term survival was analysed using Kaplan–Meier estimates and compared to the general population by analyses of relative survival. Results Out of 178 patients operated for rAAA, 95 patients (55%) either died in the perioperative period, were referred from other hospitals or were lost to follow-up (two patients). Altogether 83 patients were eligible for long-term outcomes: 72 men and 11 women. Estimated median crude survival time was 6.5 years [95% confidence interval (CI) 4.8–8.2]. Men had a median survival of 7.3 years (95% CI 5.1–9.4) versus 5.4 years in females (95% CI 3.5–7.3) (P = 0.082). Reinterventions during follow-up occurred in 31 (37%). Relative survival demonstrated a slightly higher risk of death in the rAAA population compared to the general age- and gender-matched population. Age, but not comorbidities, had a significant influence on long-term survival. Conclusion For survivors beyond 30 days after surgery for rAAA, long-term survival compares well to that of an age- and sex-matched population. A high frequency of cardiovascular comorbidities did not seem to affect long-term survival.publishedVersio

Structured and Systematic Team and Procedure Training in Severe Trauma: Going from ‘Zero to Hero’ for a Time-Critical, Low-Volume Emergency Procedure Over Three Time Periods

Background Resuscitative emergency thoracotomy is a potential life-saving procedure but is rarely performed outside of busy trauma centers. Yet the intervention cannot be deferred nor centralized for critically injured patients presenting in extremis. Low-volume experience may be mitigated by structured training. The aim of this study was to describe concurrent development of training and simulation in a trauma system and associated effect on one time-critical emergency procedure on patient outcome. Methods An observational cohort study split into 3 arbitrary time-phases of trauma system development referred to as ‘early’, ‘developing’ and ‘mature’ time-periods. Core characteristics of the system is described for each phase and concurrent outcomes for all consecutive emergency thoracotomies described with focus on patient characteristics and outcome analyzed for trends in time. Results Over the study period, a total of 36 emergency thoracotomies were performed, of which 5 survived (13.9%). The “early” phase had no survivors (0/10), with 2 of 13 (15%) and 3 of 13 (23%) surviving in the development and mature phase, respectively. A decline in ‘elderly’ (>55 years) patients who had emergency thoracotomy occurred with each time period (from 50%, 31% to 7.7%, respectively). The gender distribution and the injury severity scores on admission remained unchanged, while the rate of patients with signs on life (SOL) increased over time. Conclusion The improvement over time in survival for one time-critical emergency procedure may be attributed to structured implementation of team and procedure training. The findings may be transferred to other low-volume regions for improved trauma care.publishedVersio

Nedgangstid eller samfunnsendring? En undersøkelse av endringene i det arkeologiske materialet i overgangen fra eldre til yngre jernalder i Rogaland

Overgangen fra folkevandringstid til merovingertid er preget av en rekke endringer i det arkeologiske materialet. Blant annet er det langt færre funn og funnlokaliteter fra merovingertid enn i folkevandringstid. Flere arkeologer har sett de arkeologiske endringene i sammenheng med klimaendringer på 500- og 600-tallet, mens andre har hevdet at endringer i samfunnet med blant annet maktkonsentrasjon, endrede arverettigheter og eiendomsforhold. Denne oppgaven tar for seg å diskutere endringene i det arkeologiske materialet fra folkevandringstid til merovingertid i Rogaland i henhold til teorier om krisetid og samfunnsendringer

Decline or social change? Changes in material culture from the Early to the Late Iron Age in Rogaland

Overgangen fra folkevandringstid til merovingertid er preget av en rekke endringer i det arkeologiske materialet. Blant annet er det langt færre funn og funnlokaliteter fra merovingertid enn i folkevandringstid. Flere arkeologer har sett de arkeologiske endringene i sammenheng med klimaendringer på 500- og 600-tallet, mens andre har hevdet at endringer i samfunnet med blant annet maktkonsentrasjon, endrede arverettigheter og eiendomsforhold. Denne oppgaven tar for seg å diskutere endringene i det arkeologiske materialet fra folkevandringstid til merovingertid i Rogaland i henhold til teorier om krisetid og samfunnsendringer.The transition between the Migration period and the Merovingian period in Scandinavia has been a topic of great discussion among archaeologists. In the period surrounding the 6th century, changes in the material culture appear to occur and fewer find, graves and settlements are apparent in the apparent in the archaeological record from the Merovingian period compared to the Migration period. Many have proposed a link may exist between the period of colder climate from 536 to 660 AD and the reduced appearance of evidence in the archaeological record. Others have proposed that the change in material culture correlates closer to societal changes stemming from consolidation of power and wealth, changes in hereditary customs and additional societal factors. In this thesis, I have studied the changes in the distribution of archaeological finds from the Migration period and the Merovingian period in the County of Rogaland in South-Western Norway. The aim of the thesis is to discuss changes in material culture in relation to theories of decline or social change.Arkeologi mastergradsoppgaveMAHF-ARKARK35

Selective Treatment of Symptomatic Gallstones

List of papers I. Vetrhus M, Søreide O, Solhaug JH, Nesvik I, Søndenaa K. Symptomatic, non-complicated gallbladder stone disease. Operation or observation? A randomized clinical study. Scand J Gastroenterol 2002; 37(7); 834-839. II. Vetrhus M, Søreide O, Nesvik I, Søndenaa K. Acute cholecystitis: Delayed surgery or observation. A randomized clinical trial. Scand J Gastroenterol 2003; 38(9):985-990. III. Vetrhus M, Søreide O, Eide GE, Solhaug JH, Nesvik I, Søndenaa K. Pain and quality of life in patients with symptomatic, non-complicated gallbladder stones: Results of a randomized controlled trial. Scand J Gastroenterol 2004; 39(3):270-276. IV. Vetrhus M, Søreide O, Eide GE, Nesvik I, Søndenaa K. Quality of life and pain in patients with acute cholecystitis. Results of a randomized clinical trial. Scand J Surg 2005; 94(1):34- 39. V. Vetrhus M, Berhane T, Søreide O, Søndenaa K. Pain persists in many patients five years after removal of the gallbladder: observations from two randomized controlled trials of symptomatic, noncomplicated gallstone disease and acute cholecystitis. J Gastrointest Surg. 2005; 9(6):826-31

Long-Term Outcomes After Open Repair for Ruptured Abdominal Aortic Aneurysm

Background Early mortality in ruptured abdominal aneurysm (rAAA) is high, but data on long-term outcome are scarce. The aim of this study was to investigate the long-term outcome in survivors after open surgery for rAAA in well-defined population. Methods This is a population-based, observational long-term follow-up (beyond 30-day mortality) study of patients surgically treated for rAAA from 2000 through 2014. Long-term survival was analysed using Kaplan–Meier estimates and compared to the general population by analyses of relative survival. Results Out of 178 patients operated for rAAA, 95 patients (55%) either died in the perioperative period, were referred from other hospitals or were lost to follow-up (two patients). Altogether 83 patients were eligible for long-term outcomes: 72 men and 11 women. Estimated median crude survival time was 6.5 years [95% confidence interval (CI) 4.8–8.2]. Men had a median survival of 7.3 years (95% CI 5.1–9.4) versus 5.4 years in females (95% CI 3.5–7.3) (P = 0.082). Reinterventions during follow-up occurred in 31 (37%). Relative survival demonstrated a slightly higher risk of death in the rAAA population compared to the general age- and gender-matched population. Age, but not comorbidities, had a significant influence on long-term survival. Conclusion For survivors beyond 30 days after surgery for rAAA, long-term survival compares well to that of an age- and sex-matched population. A high frequency of cardiovascular comorbidities did not seem to affect long-term survival