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T F Andersen

Publications and source records attributed to T F Andersen.

At least 37 records · Page 2Linked to original sources
PubMed1991

Early postoperative mortality following hysterectomy. A Danish population based study, 1977-1981.

The main objective of this cohort study was to analyse the early postoperative mortality after 'simple' hysterectomy for benign indications and to compare it with that of a randomly selected reference group of women matched for age. Registry data covering the entire Danish female population were used. Included in the study were all patients operated in the period 1977-1981. Patients were only included if no cancer was diagnosed and if no major co-surgery was performed (29,192 patients). Cancer patients were also excluded in the reference group (16,182 women). Mortality was studied according to characteristics of patients, their residential area, the surgical approach and operating hospital. Overall 47 patients died within 30 days of admission for hysterectomy (overall mortality 16.1 per 10,000). Only seven deaths were expected on the basis of the population sample, and adjusted for age, the relative risk (RR) for hysterectomy patients was 6.38 (95% CI 4.33-9.39). Early postoperative mortality increased with age, and the risk was elevated among emergency patients (RR = 3.22; 1.72-6.04). Patients with more than one diagnosis at discharge (RR = 4.53; 2.12-9.70) were at high risk, but early postoperative mortality was independent of surgical approach. Causes of death are discussed. Compared to the general population, patients who undergo 'simple' hysterectomy are faced with a sixfold risk of dying within 30 days, but a complete assessment of the risks and benefits of hysterectomy requires prospective studies of survival and morbidity, including quality of life for longer periods of time following operations.

Adult↗
PubMed1991

Prostatectomy in Denmark. Regional variation and the diffusion of medical technology 1977-1985.

In many countries prostatectomy is one of the most common surgical operations in elderly men. We used administrative data for the entire male population of Denmark to study temporal and regional variations in the use of prostatectomy from 1977 to 1985. The total annual number of prostatectomies increased by 43% during the period, when the transurethral procedure (TURP) gradually replaced traditional open surgery. TURP accounted for 56% of all operations in 1977 but increased its share to 92% in 1985. Substantial regional variations occurred with index values for prostatectomy in 72 recruitment areas ranging from 0.56 to 1.62 (SCV x 100 = 5.3). The amount of variation decreased during the process of technology diffusion, but remained at a relatively high level (as in other countries) even after the process had been completed (SCV x 100 = 5.1).

Denmark↗
PubMed1990

Elevated mortality following transurethral resection of the prostate for benign hypertrophy! But why?

This paper reevaluates the recently reported excess mortality following transurethral resection of the prostate (TURP) for benign hypertrophy as compared with traditional open resection (OPEN). We studied survival through linkage of hospital discharge data with mortality data for the entire male population of Denmark (1977-85). For a maximum of 10.5 years 38,067 prostatectomy patients were followed. Adjusting for age and health status before surgery, TURP patients were subject to significantly higher levels of mortality than OPEN patients (RR = 1.19, 95% confidence interval (1.15-1.24). The extent to which this difference is attributable to the surgical intervention itself remains an open question. The two groups of patients are quite different with regard to age and preoperative health status, and available data may not be sufficient to control such differences through statistical analysis. On the other hand, the difference in mortality persisted over calendar time, even during periods when the pattern of utilization for the two procedures changed significantly (constant RR = 1.19, adjusting for age and comorbidity). The most important causes of death among Danish TURP patients differ from the causes suggested on the basis of previously reported Canadian data. The current evidence is thus ambiguous with regard to hypothetical biologic mechanisms behind the excess mortality over TURP patients. Further investigations are needed to evaluate the safety and effectiveness of prostate surgery.

Aged↗
PubMed1989

Mortality and reoperation after open and transurethral resection of the prostate for benign prostatic hyperplasia.

As part of an ongoing effort to evaluate alternative treatments for benign prostatic hyperplasia, we compared the outcomes of transurethral resection of the prostate with those of open prostatectomy. Men undergoing prostatectomy in Denmark (n = 36,703), Oxfordshire, England (n = 5284), and Manitoba, Canada (n = 12,090), were identified retrospectively through administrative data and followed for up to eight years. The cumulative percentage of patients undergoing a second prostatectomy was substantially higher after transurethral than after open prostatectomy (12.0 vs. 4.5 percent in Denmark, 12.0 vs. 1.8 percent in Oxfordshire, and 15.5 vs. 4.2 percent in Manitoba). The long-term age-specific mortality rates associated with transurethral prostatectomy as compared with open prostatectomy were also elevated in each country. The data on 1650 Canadian patients were used to investigate the contribution of coexisting morbid conditions to the elevated risk of death. The relative risk was 1.45 (95 percent confidence interval, 1.15 to 1.83) before risk adjustment and 1.45 (95 percent confidence interval, 1.15 to 1.84) after adjustment; the higher mortality was seen among low-risk as well as high-risk patients. These findings suggest that transurethral prostatectomy is less effective in overcoming urinary obstruction than the open operation. Our data also raise the possibility that transurethral prostatectomy may result in higher long-term mortality, although we cannot rule out potential confounding effects of unmeasured characteristics of patients.

Aged↗
PubMed1989

[Regional differences in the use of cholecystectomy in Denmark during the period 1977-1985].

In a register-based study of all cholecystectomized patients in Denmark during the period from 1977-85 (37,048 patients) an account is given of the regional variations observed in connection with the intervention. The cholecystectomy operation is sub-divided into four types of operation dependent on whether the intervention is merely a matter of cholecystectomy or it involves the choledocus, the duodenum, the small intestine or other organs. The variation analysis is based on a division of the country into 75 areas, each primarily served by a single hospital. The method highly reflects the differences in clinical treatment strategies. The summarized rate of cholecystectomy for this period of time was 8.2 per 10,000 persons. In areas with the highest and the lowest rates of operation the figures were 12.3 per 10,000 and 5.1 per 10,000, respectively. In 18 areas, the rates of operation were significantly higher than average and in 18 other areas significantly higher than average and in 18 other areas significantly below average. SCV-score (X100) 2.19. There is no systematic correlation between the degree of specialisation in the operating department and the frequency in employing the operation. Areas with an operation index significantly above average had the same rate of more complicated operations than simple cholecystectomy as the other areas. Possible causes of national as well as international variations in the use of cholecystectomy are discussed, and the need for a radical evaluation of this kind of treatment is emphasized.

Adult↗
PubMed1989

A quasi-experimental design based on regional variations: discussion of a method for evaluating outcomes of medical practice.

A large proportion of common medical practices are subject to substantial regional variation resulting in numerous natural experiments. Opportunities are thereby provided for outcome evaluation through quasi-experimental design. If patients treated in different regions were comparable a natural experiment involving alternative treatments could be regarded as 'pseudo randomised', but empirical investigations are needed to verify this prerequisite. This paper discusses the role of quasi-experimental designs in assessment of medical care with evaluation of outcomes after hysterectomy in Denmark as an example. The design is developed and the comparability of selected groups of patients is elucidated from administrative data, while the outcome results are not presented in this context. One indication for hysterectomy is carcinoma in situ of the cervix uteri which may be treated with either hysterectomy, or conisation. A study group of patients was selected from departments where hysterectomy was the treatment of choice for this indication while the reference group was drawn from departments in which conisation was generally preferred. The comparability of the populations, effects and information for the two groups are elicited from administrative data. We conclude that it is possible to establish a quasi-experimental design based on regional variations and that the comparability of the groups included may be assessed through registry data. The importance of technology diffusion for the prospects of performing quasi randomised studies is emphasised. In this attempt to evaluate hysterectomy, it was not possible to identify groups of patients, which were sufficiently comparable to justify a study of soft outcomes.

Adult↗
PubMed1984

Persistence of social and health problems in the welfare state: a Danish cohort experience from 1948 to 1979.

A cohort of 1112 pre-school children who lived in Copenhagen around 1950 was reidentified three decades later. A historical body of information regarding living conditions during childhood was supplemented with information from public registries concerning adult life experiences of the very same individuals. Childhood conditions were analysed in relation to later occurrences of hospitalization, delinquency and unemployment in adult life. A group of individuals whose childhoods were characterized by unfavourable conditions in the slum clearance sections of Copenhagen in the fifties later experienced a substantial accumulation of health and social problems in adult life. The housing conditions during childhood turned out to be a powerful predictor of later occurrences of somatic as well as psychiatric hospitalization, and furthermore of conviction for criminal offences. The fundamental importance of living conditions for the development of social and health problems permeates the population experience of the highly developed Danish welfare state, in full agreement with its basic properties as a class society.

Adolescent↗
PubMedDate not supplied

Coping with regional variations: the case of surgery in Denmark.

This article examines some of the key research and policy issues that are emerging as a result of recent analyses of regional variations in health care. The article presents a historical background to this important new field of health services' research, and indicates, using some Danish examples of research on hysterectomy, cholecystectomy, and prostatectomy, the relevance of this research to management and policy planning. Regional variations are not yet fully explained in terms of what causes them. What is clear and what is the primary focus of this article is that their very existence, whatever their explanation, creates a major challenge for the management and planning of future health services.

Cholecystectomy↗