[The electronic hospital record--will it be realized?].
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Hospital Records↗
Biomedical subjects
A Trippestad
Publications and source records attributed to A Trippestad.
The influence of age on operative mortality and long-term relative survival following emergency abdominal aortic aneurysm operations.
OBJECTIVE: To study operative mortality and long-term survival following emergency operations for abdominal aortic aneurysm. DESIGN: Retrospective survey in a university hospital. MATERIALS: Two hundred and twenty-seven patients with median age 72 years, (17% women). METHODS: Founded on data from the Norwegian Registrar's Office, operative mortality and long-term survival was estimated using the life-table method. Expected survival for demographically matched subgroups was calculated from death rate tables issued by the Norwegian Central Bureau of Statistics. RESULTS: Operative mortality was 41% for the 175 patients with ruptured aneurysms and 17% for the 52 with imminent rupture. The 6-year survival rate was 61% for all the successfully operated patients, and not different from that of a demographically matched population. For the patients of 72 years or older the 6-year survival rate was 53%. This was equal to that of an age and sex matched population. The younger patients had an observed 6-year survival rate of 64%, which was significantly lower than the expected of 84%. The standard mortality rate for this group was 2.25. No statistically significant difference in long-term survival was detected between the two age groups. CONCLUSIONS: Age at the time of the operation for a symptomatic abdominal aortic aneurysm does not seem to influence long-term survival. Consequently, younger patients experience a higher relative mortality compared to the older.
Adult↗
Operative mortality and long-term relative survival of patients operated on for asymptomatic abdominal aortic aneurysm.
OBJECTIVE: Assessment of mortality and long-term relative survival following repair of asymptomatic abdominal aortic aneurysms. DESIGN: Retrospective review. SETTING: University Hospital. MATERIALS: Three hundred and twenty seven patients with a median age of 68 years and male to female proportion of 10:1. CHIEF OUTCOME MEASURES: Operative mortality and long-term mortality obtained from Norwegian Registrar's Office. Demographically matched expected survival calculated from death rate tables published by the Norwegian Central Bureau of Statistics. MAIN RESULTS: The overall operative mortality was 5.2%. Ten-year survival rate for all the patients was 38% compared to the expected of 52%. The standard mortality rate was 1.30, indicating a 30% higher mortality compared to a demographically matched population. Older patients and patients with known cardiac disease had significantly increased operative mortality. These patients also had the lowest long-term survival. Patients with cardiac disease suffered a postoperative mortality more than two times expected. CONCLUSIONS: Further studies are needed to define subgroups unsuitable for elective surgery.
Age Factors↗
[Ruptured abdominal aortic aneurysm with aortocaval fistula].
Aortocaval fistula is an uncommon complication of ruptured abdominal aortic aneurysm and is only seen in 4% of all ruptured aneurysms. The symptoms may vary from one patient to another but the characteristic physical findings are high output heart failure, widened pulse pressure with low diastolic blood pressure and venous hypertension. When these signs are combined with an abdominal aortic aneurysm and a continuous abdominal bruit, the diagnosis of aortocaval fistula must be seriously considered. It is important to diagnose the fistula before surgical intervention, so as to prevent intraoperative bleeding and complications. In our surgical department we have operated 103 ruptured abdominal aortic aneurysms but only one with an aortocaval fistula. This case is discussed in the light of the literature on the subject.
Aorta, Abdominal↗
Abdominal aortic aneurysms. Is there an association between surgical volume, surgical experience, hospital type and operative mortality? Members of the Norwegian Abdominal Aortic Aneurysm Trial.
The effects of number of operations, experience of the surgeon, and type of hospital on operative mortality have been studied in 444 patients treated for abdominal aortic aneurysms. In the elective group (n = 279) there was a significant difference in mortality between hospitals in which more than 10 such operations were done compared with those in which less than 10 were done during the study period (p = 0.05; odds ratio (OR) 2.7). In the ruptured group there was no statistically significant difference (p = 0.14; OR 1.9). In the elective group, units with vascular surgical experience had an operative mortality of 4.8% compared with 11.3% for other units (p = 0.05; OR 2.6). In the ruptured group the figures were 52.5% and 73.3% respectively (p = 0.03; OR 2.5). There was no difference in operative mortality between university, county and local hospitals. Outcome of treatment after operations for abdominal aortic aneurysm was related to number of operations carried out and experience, whereas the type of hospital seemed less important.
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Abdominal aortic aneurysms--a study of factors influencing postoperative mortality. Norwegian Aortic Aneurysm Trial.
Factors which influenced outcome after surgery have been studied in 444 patients with abdominal aortic aneurysm included in a Norwegian multicentre study. Two-hundred and seventy-nine patients were treated electively, 51 had impending rupture and 114 had a ruptured aneurysm. In the elective group age, a large aneurysm, impaired renal function, the presence of angina pectoris and intraoperative blood loss of more than 4 units were found to significantly increase hospital mortality. In the impending rupture group excess blood loss during the operation had a negative influence on hospital death but the limited number of patients in this group restricts the value of analysis. A low systolic blood pressure and an older patient were the only 2 risk factors which had a detrimental effect on postoperative survival in the ruptured group. The formulation of a risk index for these patients was not possible although Odds ratios for the individual factors found to be of importance may give some risk estimates.
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Characteristics of patients operated on because of suspected arterial embolism: a multivariate analysis.
In order to improve the understanding and classification of patients with suspected arterial embolism, we performed a loglinear analysis to study the interactions among eight characteristics in 202 patients operated on as a result of this diagnosis. Female patients were generally older, were in a poorer cardiac state (NYHA class), and had shorter duration of symptoms before operation than male patients. Atrial dysrhythmias were more common in women than in men less than 75 years of age. After the age of 75, however, the incidence was similar in both sexes. Thus, apparently, poor cardiac function is more commonly associated with acute arterial occlusion in women than in men. In men arterial thrombosis secondary to arteriosclerotic occlusive disease may be more frequent. Ischemic heart disease, age of more than 75 years, and the fact that the patient was a woman were independent predictors of poor cardiac function. Atrial dysrhythmias increased the odds for proximal arterial occlusion compared with distal occlusion, but only in NYHA class 1-2, which suggests that low cardiac output might be of importance in distal thrombotic occlusion in patients with both atrial dysrhythmia and poor cardiac function. Patients with arteriosclerosis had symptoms of longer duration than patients without arteriosclerosis and men had symptoms of longer duration than women, which indicate that the diagnosis was more uncertain, or the disease less severe, in these patients. In patients without evidence of ischemic heart disease, poor cardiac function was a predictor of short duration of symptoms, which suggests that patients with nonatherosclerotic heart disease were correctly treated for arterial emboli without undue delay.
Age Factors↗
Abdominal aortic aneurysms--a national multicentre study.
A prospective, observational, multicentre study has been carried out on 444 consecutive patients with abdominal aortic aneurysms to study the effect of the diffusion of vascular service on treatment results. Two-hundred and seventy-nine patients were admitted for elective surgery (E), 114 patients had a ruptured aneurysm (R), and 51 had impending rupture (IR). Patients with acute symptoms (R + IR) were generally older and had larger aneurysms than the E group. The postoperative mortality was 7.5%, 16.7%, and 63.1% in the E, IR and R group respectively. The study demonstrates that overall treatment results in these high risk patients are inferior to results published from specialised institutions. Consequently, the diffusion of vascular surgical service seems not to have worked to the benefit of our patients although further analysis may modify this conclusion.
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Patient survival and limb prognosis after arterial embolectomy.
Mortality and morbidity after arterial thromboembolectomy were studied in 202 patients. Factors affecting reoperation and survival were identified according to Cox's proportional hazards model. 30-day mortality was 26% and amputation rate 18.5%. NYHA classification was the most important predictor for survival; class 3-4 had a 3.35 times higher death rate than class 1-2. An age greater than 75 years increased the death rate by 2.35 times and the presence of ischaemic heart or peripheral arteriosclerotic disease increased it by 1.69 and 1.65 times, respectively. Symptoms less than or equal to 1 day in duration were associated with a death rate 1.53 times higher than for a longer duration. Reoperation rate was 2.15 times greater in the absence of atrial dysrhythmias. The amputation rate was 3.79 times higher in NYHA class 3-4 than in class 1-2, and 2.47 times higher in the presence of peripheral arteriosclerotic disease. Apparently, thrombosis rather than recurrent embolism is the most important cause of reoperation and amputation. The severity of pre-existing cardiopulmonary disease largely determines prognosis regardless of the severity of the superimposed acute occlusion.
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Four years' results of a prospective, randomized clinical trial comparing polytetrafluoroethylene and modified human umbilical vein for below-knee femoropopliteal bypass.
Polytetrafluoroethylene (PTFE) (Gore-Tex) and human umbilical vein (Biograft) arterial grafts were compared for below-knee femoropopliteal bypass grafting in a prospective randomized clinical trial. One hundred five patients (105 limbs) entered the trial. Seventy-six percent suffered from rest pain, ulceration, or gangrene. The median postoperative ankle-arm blood pressure index was 0.36. Twenty-three limbs had three patent tibial arteries, 46 limbs had two tibial arteries, 31 limbs had one patent artery, and five limbs had isolated popliteal segments. Thirty-four percent were repeat operations. Fifty-five patients were allocated to receive PTFE grafts and 50 to receive human umbilical vein grafts. The two groups were comparable as to preoperative risk factors and operative and postoperative treatment. During the first 4 years (maximum 1609 days) 40 PTFE grafts and 24 umbilical veins occluded. At 1 year the PTFE patency rate was 53% and at 4 years was 22%. For umbilical vein the corresponding figures were 74% and 42% (p = 0.005, Gehan test). During follow-up the incidence of PTFE failure was on the average 2.1 times higher than that of umbilical vein failure (95% confidence limits 1.2 to 3.4).
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Management of graft dilation and non-infected anastomotic aneurysms.
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Aneurysm↗
Late rupture of knitted Dacron double velour arterial prostheses. Report on four cases.
Late fibre breakage with longitudinal tears occurred in 4 patients of a series of some 300 implanted knitted Dacron double velour arterial prostheses. The four patients all received their grafts for occlusive aortoiliac disease in the year 1978, and the rupture was found 4 to 6 years later. Three of the failures occurred in axillo-bifemoral bypass grafts, whereas the fourth patient had a bifurcated aortic prosthesis. Dilatation was significant in the latter graft only. Structural weakness might appear during production, during later handling, or possibly as a result of interference from infected material or host factors. The cause of graft failures in the present series could not be ascertained. Whatever type of knitted Dacron used, a 2-3% incidence of graft deterioration might be expected. Therefore regular, life-long follow-up of patients with Dacron arterial prostheses seems warranted.
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Dilatation and rupture of Dacron arterial grafts.
Dilatation and rupture of Dacron vascular grafts have been infrequently reported in the literature. Graft rupture occurred in five patients of a series of some 300 Cooley double velour knitted Dacron arterial prostheses implanted at Haukeland Hospital. An incidence of 3% graft ruptures has been reported in the literature. It is important that this complication is recognized and properly treated by the vascular surgeon. Regular life-long follow-up examinations of all patients with vascular prostheses are recommended.
Arteries↗
A randomized clinical trial of PTFE versus human umbilical vein for femoropopliteal bypass surgery. Preliminary results.
PTFE (Goretex) and modified human umbilical vein (Biograft) vascular grafts were compared in femorodistal popliteal artery bypass surgery in a randomized clinical multicentre trial. During 18 months 104 patients (104 limbs) entered the trial. Twenty-five patients suffered from claudication, 54 suffered rest pain and 25 patients had ulceration or gangrene. The median preoperative ankle-arm blood pressure index was 0 . 34. Twenty-three limbs had 3 patent tibial arteries, 45 limbs had 2 tibial arteries, 31 limbs had 1 tibial artery while 5 limbs had an isolated popliteal segment. Thirty-six of the operations were redo-operations. Fifty-four patients were allocated to PTFE and 50 to umbilical vein. During follow-up (maximum 650 days) 24 PTFE grafts occluded against 12 umbilical veins. The 1-year patency rate was 40 per cent in the PTFE group against 75 per cent in the umbilical vein group (P = 0 . 014, Gehans test). During the first year the PTFE failure rate was on average 3 . 1 times higher than that of the umbilical vein.
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Time and cause of death for 301 patients operated on for abdominal aortic aneurysms.
Time and cause of death were studied in 301 patients operated on for an abdominal aortic aneurysm (AA). The hospital mortality rate was 4% for electively operated patients, 19% for patients with impending rupture, and 58% for those with a ruptured aneurysm. The one- and five-year survival rates were 94% and 68% for the elective group, 70% and 44% for those with impending rupture, and 41% and 31% for patients with a ruptured aneurysm. Of all inpatient deaths, 20% were caused by multi-organ failure. Cardiovascular deaths accounted for 71% of all deaths in patients with AA. 'Sudden death' (cause not known) occurred in 6.6% of all deaths, and in 18% of the late deaths. Although survival probabilities for patients operated on for AA are good if the patients survive the operation and the immediate postoperative period, we found that the majority of deaths were caused by cardiovascular diseases.
Aorta, Abdominal↗
Salvage of the severely ischaemic limb by intra-arterial prostacyclin (PGI2) infusion. A case report.
A 75-year-old male patient with impending gangrene of the left lower limb due to advanced arteriosclerosis was treated with intra-arterial infusion of prostacyclin (PGI2). Pain at rest disappeared completely soon after treatment was started. Blood flow to the extremity measured by a Doppler velocity meter increased significantly during PGI2 infusion. Although some reduction in flow was found after termination of the infusion, the flow values up to 6 weeks after treatment were still markedly higher than pretreatment levels.
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Abdominal aortic aneurysms: survival analysis of four hundred thirty-four patients.
Cases of 434 patients who underwent surgery for abdominal aortic aneurysms in five surgical departments in Norway have been studied with respect to survival patterns and survival probabilities. Of these, 200 patients (median age 63 years) had elective surgery, 173 patients (median age 69 years) had ruptured aneurysms, and 61 patients (median age 67 years) had impending rupture (i.e., emergency operations were performed, but no rupture was found). The hospital mortality rates in the groups were 3.5%, 59%, and 24.6%, respectively. The general probabilities of survival of these groups have been compared with those of a demographically similar population (standard population). Patients who had elective surgery had a slightly, but significantly, lower survival probabilities than did the standard population, whereas the patients who underwent emergency surgery and who survived the first postoperative month showed no increased risk of dying as compared with the standard population. For the elective surgery group, age had a significant effect on survival, whereas the period of operation did not. In the group with ruptured aneurysms both the age of the patient and the period of operation had significant effects on survival, whereas no such effects were found for patients with impending rupture. The survival probabilities for patients surviving the operation were generally good, with a high 5-year survival rate. The mortality rate for patients with ruptured aneurysms decreased significantly from period I (surgery performed before 1976) to period II (surgery performed in 1976 or later). The survival probabilities for patients of advanced age were relatively good, even for patients who had emergency surgery.
Adult↗
Umbilical vein grafts and PTFE grafts for femoro-popliteal bypass. Preliminary results.
This retrospective, multiple-center study includes 172 PTFE (Gore-Tex) and 35 umbilical vein grafts (Bio-graft) used for femoro-popliteal bypass grafting. The one-year patency rate was approximately 63% in both groups. Until further experience is accumulated, autogenous saphenous vein should probably be the first choice for femoro-popliteal bypass grafting. Prosthetic grafts should preferably be used when the saphenous vein is absent or insufficient.
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