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T Troëng

Publications and source records attributed to T Troëng.

At least 19 recordsLinked to original sources
PubMed2004

Risk factors for complications after carotid endarterectomy--a population-based study.

OBJECTIVES: The overall benefit of carotid endarterectomy (CEA) is dependent on the outcome from the procedure. However, many reports are from selected centres and not population-based. The aim of this study was to assess the 30-day complication rate for a whole country and also to determine independent risk factors for serious complications. MATERIALS AND METHODS: One thousand five hundred and eighteen CEA were retrospectively reviewed, covering principally all the CEAs in Sweden, during a three year period. Indications for surgery were; minor stroke 34%, TIA 34%, amaurosis fugax 18%, asymptomatic 11% and others 3%. Data were collected from the Swedish Vascular Registry (Swedvasc). Combined cohort and case-control methodology was used. RESULTS: Registered complications were; 43 permanent strokes, 32 transient strokes (<30 days), 18 TIA/amaurosis fugax and 22 deaths (seven fatal stokes). In the cohort study, the 30-day permanent stroke and death rate were 4.3% (65/1518). Significant risk factors in multivariate analyses were the indication for surgery (minor stroke vs. other indications) (p=0.02, RR=1.38), diabetes (p=0.02, RR=1.41), cardiac disease (p<0.01, RR 1.43) and operation at a university hospital (p=0.02, RR=1.39). In the case-control study comparing the 65 cases of permanent stroke and/or death with 130 matched controls the only significant risk factor was contralateral occlusion (p<0.01, OR=5.27). One patient (1/130) with a permanent stroke was wrongly reported as a local neurological complication (facial paresis). CONCLUSION: This national audit demonstrated population-based data on complication rates after CEA well comparable with previous randomised trials. The validity of the Swedvasc data was confirmed. Combined cohort and case-control methodology was useful in analysing risk factors for serious perioperative complications.

Aged↗
PubMed2002

Discounting and clinical decision making: physicians, patients, the general public, and the management of asymptomatic abdominal aortic aneurysms.

Clinical decisions often entail in intertemporal trade-off. Moreover, they often involve physicians of different specialities. In an experiment dealing with the management of small asymptomatic abdominal aortic aneurysms (a clinically relevant problem) we find that specialists in internal medicine exhibit higher implicit discount rates than vascular surgeons, general practitioners, and actual and prospective patients. Several personal characteristics expected to be directly related to pure time-preference and risk aversion (gender, smoking habits, age, place of employment) have the hypothesised effects. Additionally, financial incentives appear to affect the estimated implicit discount rates of physicians, but are unlikely to have caused the inter-group differences. Differences in discount rates could lead to variations in clinical practice, which may conflict with equality of treatment or equal access to health care.

Aged↗
PubMed2002

Revascularization of the superior mesenteric artery after acute thromboembolic occlusion.

BACKGROUND: The outcome and prognostic factors after revascularization of acute thromboembolic occlusion of the superior mesenteric artery (SMA) are poorly documented. METHODS: Sixty patients with acute thromboembolic occlusion of the SMA had revascularization procedures at 21 hospitals from 1987 to 1998. They were registered prospectively in the Swedish Vascular Registry. Patient files were analysed retrospectively. RESULTS: The median age of the patients was 76 years; 73 per cent suffered from cardiac disease and 23 per cent had previous vascular surgery. Onset of symptoms was classified as sudden (30 per cent), acute (33 per cent) or insidious (37 per cent). The occlusions were thought to be either embolic (67 per cent) or thrombotic (33 per cent). The diagnosis was suspected on first examination in 32 per cent of patients, a group whose median time to operation was shorter (P = 0.01). Fifty-eight patients had an exploratory laparotomy and subsequent revascularization, and two were treated with thrombolysis alone. Second-look laparotomy was performed in 41, and third look in eight patients; 19 required an additional bowel resection. The overall mortality rates were 43, 52, 60 and 67 per cent at 30 days, discharge, 1 and 5 years, respectively. No patient was dependent on intravenous nutrition after 1 year. Previous vascular surgery resulted in a higher institutional mortality rate (79 per cent; P = 0.02). Patients who had a sudden onset of symptoms outside hospital had a better outcome (mortality rate 27 per cent; P = 0.02). CONCLUSION: Many non-diagnostic radiological examinations were performed and a routine second-look is warranted. The results suggest that attempts at revascularization procedures for acute mesenteric ischaemia may improve the outcome.

Adult↗
PubMed2000

[Commission of inquiry scrutinized complications of carotid surgery. Half of the complications could be explicable by errors or dubious indications].

As carotid endarterectomy is a prophylactic procedure, it would seem particularly important to analyze complications with an aim to avoiding them. All carotid endarterectomies in Sweden are registered, and all serious complications (death and permanent neurological deficit) are analyzed in detail, classified and discussed within the profession. During the period 1994-1996 the frequency was 4.3 percent (technical causes in 17 percent, contraindications in 8 percent and dubious indications in 21 percent, but correct indication and surgery in 54 percent). Thus, even when conditions are optimal there is a certain price to pay for the prevention of ischemic stroke.

Adult↗
PubMed2000

[Multidisciplinary cooperation behind a quality registry for carotid surgery. Good coverage during the first two years].

Carotid surgery prevents recurrent stroke in patients with symptomatic tight stenosis of the carotid artery. The Swedish Carotid Surgery Monitoring Registry seeks to promote selection of patients with significant spontaneous risk for recurrent stroke, with an eye toward expediting evaluation and minimizing surgical complications. To this end, professionals at participating hospitals are informed about their own patient selection and surgery risk in comparison with those in the country as a whole and with set targets. We report the results from the first two years, during which it is estimated that more than half of all patients eligible for carotid surgery in Sweden were included in the registry. Although almost all patients had recent onset of relevant neurological symptoms, less than 60% had a documented tight (80-99% occlusion) stenosis. While the final decision to operate a patient was made within 4 weeks of onset of symptoms for only 18% of the patients the first year, this proportion increased to 33% in the following year. The total incidence of surgery related stroke, myocardial infarct and death was 7.7%, while the incidence of severe stroke, myocardial infarct and death was 3.0%.

Amaurosis Fugax↗
PubMed1999

[Intestinal ischemia after abdominal aorta surgery. A dreaded complication surveyed by a combination of different methods].

The article consists of a review of findings in previously published reports on intestinal ischaemia after abdominal aortic surgery. In a combined cohort and case-control study of 2,824 patients from the Swedish vascular registry, the incidence of intestinal ischaemia was 2.8%. The independent risk factors identified were preoperative shock, emergency surgery, renal insufficiency, advanced age, operation at a regional hospital, aortabifemoral grafting, ligation of one or both internal iliac arteries, bleeding > 10 litres, and operating and cross-clamping time. Cardinal symptoms were unreliable predictors. Sigmoidoscopy was potentially diagnostic in 95 per cent of cases. In a clinical study of 34 patients, sigmoid colon pHi was highly predictive of ischaemic colitis and other life-threatening complications. In a por-cine model of ischaemic colitis, blood flow in the superior mesenteric artery, colonic pHi and histological mucosal damage were unaffected by dobutamine.

Aged↗
PubMed1999

Diabetes mellitus as a risk factor for early outcome after carotid endarterectomy--a population-based study.

BACKGROUND AND PURPOSE: to determine if diabetes mellitus is a risk factor for outcome after carotid endarterectomy (CEA). METHODS: the outcome and complications of all vascular procedures performed in Sweden are registered prospectively in the Swedish Vascular Registry (Swedvasc) and form the basis of this report. During the 10-year period 1987-96 2622 CEAs were analysed for notified complications. RESULTS: of the 2622 CEAs, 341 (13%) were performed on diabetics and 2281 (87%) on non-diabetics. Patients with diabetes presented at a younger age (67.1+/-8.3 years vs. 68.2+/-8.3 years p =0.028), were more likely to have a history of hypertension (61.9% vs. 50% p =0.001) and were less often smokers (34.9% vs. 43.2% p =0.001). Diabetics presented more often with minor stroke (41.3% vs. 30.8% p =0.002) and non-diabetics more often with amaurosis fugax (18.9% vs. 14.4% p =0.04). Diabetics had a higher 30-day mortality (3.2% vs. 1. 4% p =0.02). The 30-day neurologic and cardiac morbidity did not differ. The 1-year mortality was 7.9% in diabetics and 4.4% in non-diabetics (p =0.008). Non-diabetics operated on in 1992-96 compared to those operated on in 1987-91 had a significantly lower combined permanent stroke and death rate (3.7% vs. 5.7% p =0.05), a difference not found in diabetics (6.3% for 1987-92 and 6.8% for 1992-96; N.S). CONCLUSIONS: diabetics had both a higher 30-day and 1-year mortality after CEA compared to non-diabetics, mainly because of cardiac complications. However, postoperative neurologic morbidity did not differ.

Aged↗
PubMed1999

Complications after carotid endarterectomy are related to surgical errors in less than one-fifth of cases. Swedvasc--The Swedish Vascular Registry and The Quality Committee for Carotid Artery Surgery.

OBJECTIVES: to study possible relations between indications, contraindications and surgical technique and stroke and/or death within 30 days of carotid endarterectomy (CEA). DESIGN: analysis of hospital records for patients identified in a national vascular registry. METHOD: during 1995-1996, 1518 patients were reported to the Swedish Vascular Registry - Swedvasc. Among these the sixty-five with a stroke and/or death within 30 days were selected for study. Complete surgical records were reviewed by three approved reviewers using predetermined criteria for indications and possible errors. RESULTS: an error of surgical technique or postoperative management was found in eleven patients (17%). In six cases (9%) the indication was inappropriate or there was an obvious contraindication. The indication was questionable in fourteen (21.5%). Half of the patients (52.5%) had surgery for an appropriate indication, and no contraindication or error in surgical technique or management was identified. CONCLUSION: more than half the complications of CEA represent the "method cost", i.e. the indication, risk and surgical technique were correct. However, the stroke and/or death rate might be reduced if all operations conformed to agreed criteria.

Aged↗
PubMed1998

[Significant regional differences in the frequency of vascular surgery].

The six health care regions of Sweden were compared with regard to the frequency of vascular surgery for three diagnoses: chronic lower extremity ischaemia, abdominal aorta aneurysm, and carotid stenosis. In 1995, the frequency of intervention for chronic lower extremity ischaemia varied from 26/100,000 of the population in northern Sweden to 68/100,000 in the southern region, the variation being greater for critical limb ischaemia than for intermittent claudication. In the country as a whole, the frequency of abdominal aorta aneurysm surgery increased five-fold from 1987-89 to 1993-95. During 1995, regional figures varied from 4.7 to 8.4 per 100,000 for elective procedures, and from 3.8 to 5.5 per 100,000 for emergency procedures. Overall surgical mortality varied regionally, and emergency surgery mortality differed between regional and county hospitals. Carotid surgery manifested the greatest regional difference in frequency, which was 7-fold greater in the southern than in the northern region, while its overall mean frequency was 6/100,000.

Aortic Aneurysm, Abdominal↗
PubMed1998

[Vascular surgery is steadily increasing in Sweden].

Analysis of the development of arterial surgery between 1980 and 1995, on the basis of questionnaire response and data from the Swedish vascular registry (Swedvasc), showed the annual incidence of elective procedures to have increased from 2,284 to 7,425, and that of emergency procedures from 1,619 to 1,951, the overall annual incidence of operations being 1,068 per million of the population in 1995. There are manifest regional differences in the country as a whole, and the period studied was characterized by relative redistribution of operations from regional to county hospitals. Detailed scrutiny of carotid artery surgery again showed manifest regional differences to exist, but at few hospitals were more than 50 operations performed annually. There was good agreement between Swedvasc data and official operation statistics.

Elective Surgical Procedures↗
PubMed1997

Risk factors for intestinal ischaemia after aortoiliac surgery: a combined cohort and case-control study of 2824 operations.

OBJECTIVE: To identify risk factors for intestinal ischaemia after aortoiliac surgery. MATERIALS AND METHODS: Among 2824 patients operated on during 1987-93 and registered prospectively in the Swedish Vascular Registry, 62 cases of postoperative intestinal ischaemia were identified. They were compared with the remaining 2762 patients through the registry and with a random sample of 127 controls through patient records. Multivariate analysis was performed. RESULTS: Patients in shock operated on for ruptured aneurysms were at greatest risk of developing postoperative intestinal ischaemia. Excluding patients in shock, operation for aneurysmal disease and for occlusive disease carried the same risk. Renal disease, emergency surgery, age, type of hospital, aortobifemoral graft, operating time, cross-clamping time and ligation of one or both internal iliac arteries were independent risk factors. CONCLUSIONS: Patient-related haemodynamic risk factors together with surgical skill and decision making defines the risk for this serious complication.

Aged↗
PubMed1997

Staged reconstruction of hypospadias with chordee: outcome and costs.

One-hundred-and-forty patients with hypospadias and chordee were reviewed from the points of view of surgical results and hospital costs. Ninety cases constituted a historical series, and 50 patients a current personal series. All were operated on by Byars' two-staged protocol with release of the chordee followed by urethral reconstruction. Complementary surgery was necessary in a total of 37 instances, particularly in cryptohypospadias with tight chordee and in penoscrotal hypospadias. Increasing personal experience with the operative technique has gradually reduced the need for such procedures. The final results were satisfactory in all but one patient, who has had recurring strictures. The hospital cost for a patient according to basic assumptions was 100,280 SEK (about US$ 14,000). If the time in operating theatre could be shortened by 10 minutes, the stay in hospital reduced by one day, and the complication rate halved, the overall cost would be reduced by 14.3%. Consequently we believe that staged reconstruction remains an attractive alternative in cases of hypospadias with marked curvation of the penis.

Adolescent↗
PubMed1997

Decisions about treatment of aortoiliac claudication: the current practice among Swedish vascular surgeons.

OBJECTIVE: To find out what information vascular surgeons consider before they decide on treatments for intermittent claudication. SUBJECTS: 25 randomly selected vascular surgeons who participate in the Swedish Vascular Registry. METHOD: Interviews about what information and investigations the surgeons would need before they make recommendations for treatment of 6 test cases. MAIN OUTCOME MEASURES: The pattern of numbers and types of questions and of recommendations for treatment. RESULTS: Surgeons asked a median of five questions (range 0-13) before they came to a decision. Only 9% of those questions concerned the patients' preferences. Open surgery was recommended in 59 of the 150 consultations (39.3%), for some by none and for others by up to 80% of surgeons. CONCLUSIONS: Vascular surgeons primarily consider the patient's history and physical findings when treating claudication. They pay little attention to the preferences of the patients. Vascular surgeons in Sweden differ considerably in their patterns of questioning and do not agree about the treatment of intermittent claudication in individual patients.

Aged↗