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T Troëng

Publications and source records attributed to T Troëng.

At least 37 records · Page 2Linked to original sources
PubMed1996

Adjusting outcome measurements for case-mix in a vascular surgical register--is it possible and desirable?

OBJECTIVE: We analysed the variation in the outcome of infrainguinal bypass surgery between departments in a register for clinical audit to see if variation in case-mix influenced the results. MATERIALS AND METHODS: The study was a retrospective analysis of 764 infrainguinal bypass operations performed from 1988 to 1990 at six Swedish surgical departments. Results were assessed at 30 days and at 1 year postoperatively. RESULTS: There was a significant variation (p < 0.01) in mortality and amputation rates both at 30 days and at 1 year and in patency rate at 30 days. There were also differences in case-mix. Differences were found in indication, location of distal anastomosis and graft type. Regression analysis found that mortality was influenced by age, diabetes and heart disease and patency rate by location of the distal anastomosis and graft type. When 'hospital' was added as a variable in the regression analysis it was also found to be a significant indicator. CONCLUSION: Location of the distal anastomosis was the main factor in adjusting patency for case-mix.

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PubMed1996

Incidence and clinical presentation of bowel ischaemia after aortoiliac surgery--2930 operations from a population-based registry in Sweden.

OBJECTIVES: To study the incidence and clinical presentation of intestinal ischaemia after aortoiliac/femoral surgery, and to validate a vascular registry concerning a serious complication. DESIGN AND SETTING: In the Swedish Vascular Registry (SWEDVASC) the outcome and complications of all vascular procedures are registered prospectively. MATERIALS AND METHODS: All 2930 patients operated in 1987-93 were analysed for notified complications. A 5% random sample of all patients and a 20% random sample of fatal cases were analysed for un-notified complications. Of 415 requested patient records 413 were analysed. RESULTS: The estimated incidence of bowel ischaemia was 2.8%. Among patients operated on for a ruptured aneurysm in shock it was 7.3%. Of the 63 patients with intestinal ischaemia only 15 presented with early passage of bloody stools. In 60 patients (95%) the lesion affected the left colon within the reach of a sigmoidoscope. Bowel ischemia was unnotified only in fatal cases, the estimated un-notified complication rate was 0.7%. CONCLUSIONS: The incidence in this study on unselected patients did not differ from previous reports from specialised centres. Diagnosis is difficult and justifies a high index of suspicion and early use of sigmoidoscopy. The validity of the SWEDVASC registry was confirmed by a high report-rate for this complication.

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PubMed1996

Operations, total hospital stay and costs of critical leg ischemia. A population-based longitudinal outcome study of 321 patients.

In a longitudinal analysis of all 321 patients in a defined population having surgery for critical leg ischemia during 1 year in Malmöhus county (0.53 million inhabitants), Sweden, we investigated all vascular procedures and amputations on both legs, total hospital stay and hospital costs from the first procedure in each patient until death or at follow-up at least 6 years postoperatively. The first (key) operation during the inclusion year was a reconstructive vascular procedure in 96 patients, a restorative vascular procedure in 111 and a major amputation in 114 patients. One third of those with a reconstructive and half of those with a restorative key procedure had an ipsilateral major amputation. The mean number of surgical procedures and length of hospital stay among all patients were 3 (1-19) procedures and 117 (1-1097) days, respectively. Of the total number of days in hospital, less than half were in surgical departments, 10% in other acute-care departments and almost half in rehabilitation clinics and nursing homes. The total hospital and surgical costs among all patients were USD 15.1 million (mean USD 47,000/patient), with no significant differences in relation to the key operation. We conclude that patients who have undergone surgery for critical leg ischemia accumulate very high total long-term hospital costs due to the need for repetitive surgery and long hospital stays. Our findings also show that a longitudinal study, including hospital stay in departments other than surgical, is necessary for a correct cost-and-outcome analysis.

Amputation, Surgical↗
PubMed1994

Vascular surgical audit during a 5-year period. Steering committee on behalf of the Swedish Vascular Registry (Swedvasc).

UNLABELLED: The objective was to explore possible time trends in the indications for peripheral vascular surgery in Sweden. DESIGN: Analysis of data from the Swedvasc vascular registry 1987-1991. SETTING: Routine vascular surgery in university, county and district hospitals within the Swedish public hospital system. The registry is independent of local administration, run by the surgeons themselves and financed by national authorities. MATERIALS: 4950 procedures registered in the 17 original centres 1987-91 and 1892 procedures registered in 16 new centres 1991. CHIEF OUTCOME MEASURES: Distribution of indications, mortality within 30 days and clinical outcome at one year. MAIN RESULTS: During the first 5 years of the registry (1987 to 1991) the proportion of procedures performed for acute ischaemia significantly decreased from 20% to 14.3%. Simultaneously procedures for critical leg ischaemia significantly increased from 24.8 to 30.3%. Changes in the proportions treated for aortic aneurysms, carotid artery stenosis, claudication, vascular access or other indications were less striking or nonsignificant. The 30-day mortality decreased in patients operated on for acute ischaemia but did not change in other groups. The proportion of elective/emergency operation for aortic aneurysm changed from 1.2 to 2.0 leading to a minimal decrease in overall aneurysm mortality. The proportion of patients treated for claudication who were alive and improved at one year changed from 77.2% to 72.9% which was not statistically significant, while the proportion of patients treated for critical ischaemia who were alive with an intact leg after one year increased from 65.2% to 80.2% which was a significant improvement. CONCLUSIONS: Decision making among vascular surgeons in Sweden appears to have improved as proportionally fewer patients are operated on for acute ischaemia, more for critical ischaemia with possibly an improved outcome.

Humans↗
PubMed1994

[Strategies in treatment of critical leg ischemia. An approach to the solution with decision trees].

In critical leg ischemia the main treatment options are reconstructive vascular surgery and primary amputation but in some cases conservative treatment can be considered. The choice between the alternatives is difficult as a large number of factors must be considered. Among these are significant complication rates, reoperation rates and perioperative mortality as well as medical risk-factors. This paper demonstrates how formal decision analysis using special computer software can contribute by structuring of the decision situation and by quantification of risks and gains. Important is also the possibility of sensitivity analysis, i.e. to examine the effect of varying values of pertinent variables. The explicit structure and the quantification makes a formal decision analysis open for critique, discussion and improvement. This is a distinct advantage over the usual spontaneous clinical decision making.

Adult↗
PubMed1994

Incidence and causes of adverse outcomes of operation for chronic ischaemia of the leg.

OBJECTIVE: To assess the incidence of adverse outcomes after operation for chronic leg ischemia, to identify risk factors for an adverse outcome at one year, and to evaluate survival after operation. DESIGN: Retrospective study. SETTING: University department. SUBJECTS: 1635 consecutive patients recorded on the Swedvasc registry, 1987-1989. INTERVENTIONS: Data were analysed by logic regression and Cox's proportional hazards model. MAIN OUTCOME MEASURES: Morbidity and mortality at 30 days, one year, and 1000 days. RESULTS: At 30 days 54 of the 609 patients with claudication (8.8%) had either not improved or got worse, and this had increased to 126 (20.7%) at one year. Among the 1026 patients with critical ischaemia 124 had either had their limbs amputated or were dead at 30 days (12.2%), and the corresponding figure for one year was 359 (35.0%). Main factors associated with adverse outcome were age, heart disease, previous vascular surgery, reoperation within 30 days, and the presence of complications. Experience of the surgeon and the type of hospital were less important. At 1000 days 528 of the 609 patients with claudication (86.6%) were alive, compared with 628 of the 1026 with critical ischaemia (61.2%).* CONCLUSIONS: Better selection of patients may improve the survival figures at one year. More aggressive treatment of coexistent diseases may improve the results in the group with claudication.

Adult↗
PubMed1994

Increased thrombogenicity after polymer coating: experiences with the first version of a new woven Dacron graft for aortic reconstruction.

OBJECTIVE: To assess the initial results of insertion of a new woven Dacron graft coated with a polymer for occlusive and aneurysmal aortoiliac disease. DESIGN: Open study. SETTING: Four Swedish vascular surgical units. SUBJECTS: 28 patients who required aortoiliac or aortofemoral reconstruction between September 1988 and June 1989. MAIN OUTCOME MEASURES: Incidence of, and time to, occlusion; type of intervention; whether the graft needed to be replaced; and mortality. RESULTS: Two patients died in the postoperative period, and five during follow-up, giving an overall mortality of 25%. None of the tube grafts occluded but 17 of 24 bifurcation grafts did (71%), the median time to occlusion being 126 days (range 10-820). Our results have led to this graft being removed from the market while modifications are made in the process of impregnation of polymer. CONCLUSIONS: Strict protocols for the assessment of new graft materials should be introduced and enforced.

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PubMed1993

The choice of strategy in the treatment of intermittent claudication--a decision tree approach.

OBJECTIVES: to compare possible outcomes of the non-operative treatment for intermittent claudication with that of surgery. DESIGN: decision tree approach using published and vascular registry data. The valuation of clinical outcomes was estimated by index weights using the Rosser index and the Quality of Well-Being scale. SETTING: routine health care in Sweden. MATERIALS: published data on 224 non-operatively treated claudicants and data from 805 claudicants treated with surgery or angioplasty from the Swedvasc registry. No diabetics were included. Chief outcome measure: expected utility value at one year after decision on treatment given the clinical data and the estimated health status valuations. MAIN RESULTS: it was possible to identify a success rate for surgery above which it was the better alternative. However, depending on which of two health indices that was used, and if reconstruction was supra- or infrainguinal, this threshold value varied from 0-81%. CONCLUSIONS: reliable measures of the value of outcomes have to be developed and, in addition, long-term data on outcome and costs in routine care have to be collected before a comprehensive economic assessment based on the decision tree approach can be made to support decisions on treatment for intermittent claudication.

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PubMed1992

Adverse outcome in surgery for chronic leg ischaemia--risk factors and risk prediction when using different statistical methods.

OBJECTIVE: to compare two different statistical methods in predicting the outcome of surgery for chronic leg ischaemia. MATERIAL: the present study from the Swedvasc registry is based on an inception cohort of 1635 patients with chronic leg ischaemia (intermittent claudication in 609 and critical ischaemia in 1026 patients), who have been followed until 1 year after surgery. Outcome was classified as improved vs. not improved, amputated or dead in claudication and as the intact leg vs. amputation or death in critical ischaemia. METHODS: logistic regression analysis was compared to the inductive expert system program, Assistant Professional, in the prediction of outcome. Seventy per cent of cases in the data base were used to create a risk factor model including 17 variables registered in Swedvasc. These variables included an assessment of patients overall health status, severity of disease, the surgeon's experience and surgical procedures. This model was then evaluated using the remaining 30% of the patients in the data base. RESULTS: a risk score indicating a probability of an adverse outcome exceeding 0.5 was, in patients with intermittent claudication, associated with a sensitivity of 38% using logistic regression and 26% using Assistant Professional. The percentages of correctly predicted adverse outcomes were 29 and 50%, respectively. In patients with critical ischaemia, the sensitivities with the two methods were 68 and 38% and the predictive values 42 and 57%, respectively. CONCLUSIONS: the risk scores created with the two methods gave low sensitivities. It is concluded that risk functions could not be used to predict an adverse outcome in patients operated on for chronic leg ischaemia with the data set used.

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