Chronic medication usage in Icelandic surgical patients – Can we do better?

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Incidence of hypoglycaemia in fasting children after induction of anaesthesia for elective procedures : a descriptive observational study

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Outcome of mitral valve replacement in Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open Allur texti - Full textIntroduction: Mitral valve replacement (MVR) is the second most common valvular replacement procedure after aortic valve replacement (AVR). Studies on the outcome of MVR in Iceland have been missing. We therefore studied short and long-term results following MVR in Iceland, Material and methods: A retrospective nationwide study on 64 patients (mean age 59 years, 63% males) that underwent 66 MVR procedures in Iceland between 1990-2010. Clinical data was retrieved from patient charts and overall survival estimated. The mean follow-up was 7.4 years. Results: Mitral regurgitation or stenosis was the indication for MVR in 71% and 27% of cases, respectively. Nine patients had endocarditis and 8 a recent myocardial infarction. The mean logEuroSCORE was 14.9% (range 1.5-88.4), 83% of the patients were in NYHA class III/IV preoperatively and 24% had previously undergone cardiac surgery. A biological valve was implanted in six cases and a mechanical valve used in 60 cases. Concomitant CABG was performed in 41% of patients and AVR in 20%. Perioperative myocardial infarction (26%), acute respiratory failure (17%), reoperation for bleeding (15%) and acute renal failure requiring dialysis (9%) were the most common major complications. Three patients required extracorporeal membrane oxygenation (ECMO) and six patients an intra-aortic balloon pump (IABP) postoperatively. Minor complications were noted in 61% of cases. Six patients died within 30 days (9%) and five year survival was 69%. Conclusion: The frequency of complication following MVR was high and represents the severity of the underlying heart disease. The operative mortality in the current study was in the lower range compared to other studies.Inngangur: Míturlokuskipti eru næstalgengasta lokuskiptaaðgerð hér á landi á eftir ósæðarlokuskiptum. Tilgangur rannsóknarinnar var að kanna skammtíma- og langtímaárangur míturlokuskipta á Íslandi en það hefur ekki verið gert áður. Efniviður og aðferðir: Afturskyggn rannsókn á þeim 64 sjúklingum (meðalaldur 59 ár, 63% karlar) sem gengust undir 66 míturlokuskipti á Landspítala frá 1990 til 2010. Klínískar upplýsingar fengust úr sjúkraskrám og var heildarlifun reiknuð út. Meðaleftirfylgd var 7,4 ár. Niðurstöður: Algengasta ábending aðgerðar var lokuleki hjá 47 sjúklingum (71%) en 18 (27%) höfðu lokuþrengsli. Fjórðungur hafði áður gengist undir opna hjartaaðgerð, 9 höfðu virka hjartaþelsbólgu og 8 nýlegt hjartadrep. Meðal logEuroSCORE var 14,9% (bil 1,5-88,4) og 83% sjúklinganna voru í NYHA-flokki III/IV fyrir aðgerð. Sex sjúklingar fengu lífræna loku en hinir gerviloku. Önnur hjartaaðgerð var gerð samtímis hjá tveimur þriðju sjúklinga, oftast kransæðahjáveita (41%) og/eða ósæðarlokuskipti (20%). Hjartadrep í tengslum við aðgerð (26%), öndunarbilun (17%), enduraðgerð vegna blæðingar (15%) og nýrnabilun sem krafðist skilunar (9%) voru algengustu alvarlegu fylgikvillarnir. Að auki þurfti ECMO-dælu í þremur tilfellum vegna hjartabilunar og ósæðardælu hjá 6 sjúklingum. Minniháttar fylgikvillar greindust í 61% tilfella, oftast fleiðruvökvi sem þarfnaðist aftöppunar, nýtilkomið gáttatif og lungnabólga. Sex sjúklingar létust innan 30 daga frá aðgerð (9%) og 5 ára lífshorfur voru 69%. Ályktun: Tíðni fylgikvilla var há eftir míturlokuskipti, enda flestir sjúklinganna með alvarlegan undirliggjandi hjartasjúkdóm. Skurðdauði var lægri hér á landi en í mörgum sambærilegum erlendum rannsóknum

Landspitali–The National University Hospital on the Edg

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Longitudinal changes in inflammatory biomarkers among patients with COVID-19 : A nationwide study in Iceland

Funding Information: This study was supported by Landspitali University Hospital Science Fund. Publisher Copyright: © 2022 Acta Anaesthesiologica Scandinavica Foundation.Objectives: All SARS-CoV-2-positive persons in Iceland were prospectively monitored and those who required outpatient evaluation or were admitted to hospital underwent protocolized evaluation that included a standardized panel of biomarkers. The aim was to describe longitudinal changes in inflammatory biomarkers throughout the infection period of patients with COVID-19 requiring different levels of care. Design: Registry-based study. Setting: Nationwide study in Iceland. Patients: All individuals who tested positive for SARS-CoV-2 by real-time polymerase chain reaction (RT-PCR) from February 28 to December 31, 2020 in Iceland and had undergone blood tests between 5 days before and 21 days following onset of symptoms. Measurements and Main Results: Data were collected from the electronic medical record system of Landspitali–The National University Hospital of Iceland. Data analyses were descriptive and the evolution of biomarkers was visualized using locally weighted scatterplot smoothing curves stratified by the worst clinical outcome experienced by the patient: outpatient evaluation only, hospitalization, and either intensive care unit (ICU) admission or death. Of 571 included patients, 310 (54.3%) only required outpatient evaluation or treatment, 202 (35.4%) were hospitalized, and 59 (10.3%) were either admitted to the ICU or died. An early and persistent separation of the mean lymphocyte count and plasma C-reactive protein (CRP) and ferritin levels was observed between the three outcome groups, which occurred prior to hospitalization for those who later were admitted to ICU or died. Lower lymphocyte count, and higher CRP and ferritin levels correlated with worse clinical outcomes. Patients who were either admitted to the ICU or died had sustained higher white blood cell and neutrophil counts, and elevated plasma levels of procalcitonin and D-dimer compared with the other groups. Conclusions: Lymphocyte count and plasma CRP and ferritin levels might be suitable parameters to assess disease severity early during COVID-19 and may serve as predictors of worse outcome.Peer reviewe

Prevalence of modifiable risk factors in primary elective arthroplasty and their association with infections

Funding Information: The study was approved by the Science Committee of the Capital area’s Primary Care and University of Iceland and by the Icelandic National Bioethics Committee (case number: VSN-18-098) and is registered at ClinicalTrials. gov (NCT05399186). This study was supported by grants from Landspitali Research Fund (A-2019-056, A-202-042, A-2021-036) and Research fund of Sigridur Larusdottir by University of Iceland. Data sharing is possible after reasonable request. The authors declare no conflict of interest. Completed disclosure forms for this article following the ICMJE template are available on the article page, doi: 10.2340/17453674.2023.8480 Publisher Copyright: © 2023 The Author(s).Background and purpose — The aim of this study was to identify the prevalence of modifiable risk factors of surgical site infections (SSI) in patients undergoing primary elective total joint arthroplasty (TJA) receiving conventional preoperative preparation, and to explore their association with infectious outcomes. Patients and methods — Information regarding modifiable risk factors (anemia, diabetes, obesity, nutritional status, smoking, physical activity) was prospectively gath-ered in patients undergoing primary TJA of hip or knee in 2018–2020 at a single institution with 6 weeks’ follow-up time. Results — 738 patients (median age 68 years [IQR 61–73], women 57%) underwent TJA (knee 64%, hip 36%). Anemia was detected in 8%, diabetes was present in 9%, an additional 2% had undiagnosed diabetes (HbA1c > 47 mmol/mol), and 8% dysglycemia (HbA1c 42–47 mmol/mol). Obesity (BMI ≥ 30) was observed in 52%. Serum albumin, total lymphocyte count, and vitamin D below normal limits was identified in 0.1%, 18%, and 16%, respectively. Current smokers were 7%. Surgical site complications occurred in 116 (16%), superficial SSI in 57 (8%), progressing to periprosthetic joint infection in 7 cases. Univariate analysis identified higher odds of superficial SSI for BMI ≥ 30 (OR 2.1, 95%CI 1.2–3.8) and HbA1c ≥ 42 mmol/mol (OR 2.2, CI 1.1–4.2), but no association was found with other factors. Conclusion — In a general population undergoing primary TJA an association was found between obesity (52%) and dysglycemia/diabetes (19%) and superficial SSI (8%), which progressed to PJI in 12% of cases, generating a 1% total rate of PJI. Modification of these risk factors might mitigate infectious adverse outcomes.Peer reviewe

Long-term survival of Icelandic women following acute myocardial infarction

Publisher Copyright: © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.Objective. To evaluate the impact of sex on treatment and survival after acute myocardial infarction (AMI) in Iceland. Methods. A retrospective, nationwide cohort study of patients with STEMI (2008–2018) and NSTEMI (2013–2018) and obstructive coronary artery disease. Patient and procedural information were obtained from a registry and electronic health records. Survival was estimated with Kaplan–Meier method and Cox regression analysis used to identify risk factors for long-term mortality. Excess mortality from the AMI episode was estimated by comparing the survival with age- and sex-matched population in Iceland at 30-day interval. Results. A total of 1345 STEMI-patients (24% women) and 1249 NSTEMI-patients (24% women) were evaluated. Women with STEMI (mean age: 71 ± 11 vs. 67 ± 12) and NSTEMI (mean age: 69 ± 13 vs. 62 ± 12) were older and less likely to have previous cardiovascular disease. There was neither sex difference in the extent of coronary artery disease nor treatment. Although crude one-year post-STEMI survival was lower for women (88.7% vs. 93.4%, p =.006), female sex was not an independent risk factor after adjusting for age and co-morbidities after STEMI and was protective for NSTEMI (HR 0.67, 95% CI: 0.46–0.97). There was excess 30-day mortality in both STEMI and NSTEMI for women compared with sex-, age- and inclusion year-matched Icelandic population, but thereafter the mortality rate was similar. Conclusion. Women and men with AMI in Iceland receive comparable treatment including revascularization and long-term survival appears similar. Prognosis after NSTEMI is better in women, whereas higher early mortality after STEMI may be caused by delays in presentation and diagnosis.Peer reviewe

Rate of SARS-CoV-2 Reinfection during an Omicron Wave in Iceland

Funding Information: Funding/Support: This work was supported by the Landspitali University Hospital Research Fund (grant A-2021-051). Neither the authors nor their institutions received payment or services from a third party for any aspect of the submitted work.This cohort study estimates the proportion of persons who became reinfected with SARS-CoV-2 during the Omicron wave in Iceland.Peer reviewe

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

© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. Funding Information: This work was supported by the Foundation of St Josef’s Hospital in cooperation with the Icelandic Gerontological Research Centre, the National University Hospital of Iceland (to F.J.), the Landspitali University Hospital Science Fund (to M.I.S.), and the University of Iceland Research Fund (to F.J.). Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.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.Peer reviewe