The Nordic Arthroplasty Register Association: A unique collaboration between 3 national hip arthroplasty registries with 280,201 THRs

Background and purpose The possibility of comparing results and of pooling the data has been limited for the Nordic arthroplasty registries, because of different registration systems and questionnaires. We have established a common Nordic database, in order to compare demographics and the results of total hip replacement surgery between countries. In addition, we plan to study results in patient groups in which the numbers are too small to be studied in the individual countries.Material and methods Primary total hip replacements (THRs) from 1995–2006 were selected for the study. Denmark, Sweden, and Norway contributed data. A common code set was made and Cox multiple regression, with adjustment for age, sex, and diagnosis was used to calculate prosthesis survival with any revision as endpoint.Results 280,201 operations were included (69,242 from Denmark, 140,821 from Sweden, and 70,138 from Norway). Females accounted for 60% of the patients in Denmark and Sweden, and 70% in Norway. Childhood disease was the cause of 3.1%, 1.8%, and 8.7% of the operations in Denmark, Sweden, and Norway, respectively. Resurfacing of hips accounted for 0.5% or less in all countries. The posterior approach was used in 91% of cases in Denmark, 60% in Sweden, and 24% in Norway. Cemented THRs were used in 46% of patients in Denmark, in 89% of patients in Sweden, and in 79% of patients in Norway.Of the 280,201 primary THRs, 9,596 (3.4%) had been revised. 10-year survival was 92% (95% CI: 91.6–92.4) in Denmark, 94% (95% CI: 93.6–94.1) in Sweden, and 93% (95% CI: 92.3–93.0) in Norway. In Denmark, 34% of the revisions were due to dislocation, as compared to 23% in Sweden and Norway. Replacement of only cup or liner constituted 44% of the revisions in Denmark, 29% in Sweden, and 33% in Norway.Interpretation This unique common Nordic collaboration has shown differences between the countries concerning demographics, prosthesis fixation, and survival. The large number of patients in this database significantly widens our horizons for future research.     

Scandinavian research in anaesthesiology 1981-2000: visibility and impact in EU and world context

BACKGROUND: We wished to assess the development in number and impact of publications in anaesthesiology and intensive care medicine from 1981 to 2000 in the four Scandinavian countries: Sweden, Norway, Finland, and Denmark. For comparison, we also analyzed data from the UK and the Netherlands. METHODS: Publication and citation data from 1981 to 2000 were gathered from National Science Indicators (2001), covering 33 journals indexed in Current Contents. Data were analyzed in running 5-year periods. The following informetric indicators were used: absolute number of publications; absolute number of citations; absolute citation impact (average number of citations per publication per 5-year period); citation impact relative to the European Union and the world; and the percentage of cited papers from each country. RESULTS: The annual number of publications from Denmark was stable over the 20-year period. Sweden increased its production by 35%, while the remaining four countries showed increases from 100% to 146%. Thus, Sweden and Denmark lost visibility within the European Union (EU) and in world context. The EU and world citation shares of Finland and Norway increased slightly, whereas those of Sweden, Denmark, the UK, and the Netherlands all declined significantly. The absolute citation impact (ACI) increased for all the four Scandinavian countries. The ACI of the Netherlands did not change and was surpassed by all the Scandinavian countries by 1994-98, while the UK finished below the other five countries. CONCLUSIONS: (1) The annual number of publications from Sweden, Norway, Finland, the UK, and the Netherlands increased after the late eighties, whereas the net publication output from Denmark was stagnant over the 20-year period investigated; (2) the international publication and citation visibility of Finland and Norway increased slightly, as opposed to the significant decrease seen by the other four countries; (3) judging from the increase in absolute and relative citation impact and in the percentage of cited papers, the recognition of publications from the four Scandinavian countries increased over the past 20 years.     

The Nordic Arthroplasty Register Association

Background and purpose The possibility of comparing results and of pooling the data has been limited for the Nordic arthroplasty registries, because of different registration systems and questionnaires. We have established a common Nordic database, in order to compare demographics and the results of total hip replacement surgery between countries. In addition, we plan to study results in patient groups in which the numbers are too small to be studied in the individual countries.

Material and methods Primary total hip replacements (THRs) from 1995–2006 were selected for the study. Denmark, Sweden, and Norway contributed data. A common code set was made and Cox multiple regression, with adjustment for age, sex, and diagnosis was used to calculate prosthesis survival with any revision as endpoint.

Results 280,201 operations were included (69,242 from Denmark, 140,821 from Sweden, and 70,138 from Norway). Females accounted for 60% of the patients in Denmark and Sweden, and 70% in Norway. Childhood disease was the cause of 3.1%, 1.8%, and 8.7% of the operations in Denmark, Sweden, and Norway, respectively. Resurfacing of hips accounted for 0.5% or less in all countries. The posterior approach was used in 91% of cases in Denmark, 60% in Sweden, and 24% in Norway. Cemented THRs were used in 46% of patients in Denmark, in 89% of patients in Sweden, and in 79% of patients in Norway.

Of the 280,201 primary THRs, 9,596 (3.4%) had been revised. 10-year survival was 92% (95% CI: 91.6–92.4) in Denmark, 94% (95% CI: 93.6–94.1) in Sweden, and 93% (95% CI: 92.3–93.0) in Norway. In Denmark, 34% of the revisions were due to dislocation, as compared to 23% in Sweden and Norway. Replacement of only cup or liner constituted 44% of the revisions in Denmark, 29% in Sweden, and 33% in Norway.

Interpretation This unique common Nordic collaboration has shown differences between the countries concerning demographics, prosthesis fixation, and survival. The large number of patients in this database significantly widens our horizons for future research.     

The effects of common medical interventions on pain, back function, and work resumption in patients with chronic low back pain: A prospective 2-year cohort study in six countries

STUDY DESIGN: A prospective cohort study with identical questionnaires and inclusion criteria was performed. OBJECTIVES: To compare in six different countries the frequencies and effects of the common medical interventions used for patients with low back pain who are work incapacitated. SUMMARY OF BACKGROUND DATA: Low back pain is a huge problem with increasing costs for health care, industry, and society. METHODS: Cohorts of employed men and women ages 18 to 59 years who had been sick-listed (100%) for a minimum of 90 days because of low back pain were recruited in Denmark, Germany, Israel, Sweden, the Netherlands, and the United States. The subjects received three separate questionnaires with identical questions after 90 days, 1 year, and 2 years. The questionnaires included separate questions about background factors, treatment, and the like, as well as validated scales such as the Hannover Activities of Daily Living, von Korff pain score, Short Form-36, and Karasek-Theorell. Working status was obtained from registers. Main outcome measures were working/not working, back function, and pain. RESULTS: All three questionnaires were completed by 2080 subjects in the six countries. With few exceptions, there were great similarities in the appointments, examinations, and treatments in the different countries. Considerable differences were found between the back surgery rates, which ranged from 6% in Sweden to 32% in the United States during the first 90 days of the study. Very few of the interventions had any noticeable positive effects on work resumption, pain, or back function. Back surgery in Sweden was a striking exception, positively affecting all three outcome measures. The frequencies of work resumption within the first year ranged from 73% in the Netherlands to 32% in Denmark. CONCLUSIONS: Almost none of the commonly occurring and frequently practiced medical interventions for patients who are sick-listed because of low back pain had any positive effects on either the recorded health measures or work resumption.     

Practice Trends in the Use of Extracorporeal Treatments for Poisoning in Four Countries

Extracorporeal treatments (ECTRs) such as hemodialysis (HD), enhance the elimination of a small number of toxins. Changes in overdose trends, prescribing practices, antidotes, and dialysis techniques may alter the indications and rates of ECTR use over time. This study analyzed trends in ECTR for poisonings in four countries. A retrospective study of national poison center databases from the United States, Denmark, United Kingdom, and five regional databases within Canada was performed. All cases of patients receiving an ECTR were included. ECTR cases were totalled annually and reported as annual rates per 100,000 exposures with stratification per types of ECTR and toxins. The data collection varied by countries. United States, 1985–2014; United Kingdom, 2011–2013; Denmark, 2005–2014, and regions of Canada as follows: Alberta, 1991–2015; Saskatchewan, 2001–2015; Nova Scotia‐PEI, 2006–2015; Quebec, 2008–2014; Ontario‐Manitoba, 2009–2015; British Columbia, 2012–2015. During the study period, the total number of ECTRs and rates per 100,000 exposures, respectively, were: United States, 40,258 and 65.7; United Kingdom, 343 and 232.6; Denmark, 616 and 305.5; Canada, 2709 and 177.5; case rates increased over time for the United States, Denmark, and Canada, but decreased in the United Kingdom. Across the United States and Denmark, HD was the preferred modality used. Toxins for which ECTR was most often used were: United States, ethylene glycol; Canada, methanol; United Kingdom, ethylene glycol; Denmark, salicylates. A high number of ECTRs were performed for atypical toxins such as acetaminophen and benzodiazepines. These data demonstrate a growing use of HD for poisoning with significant regional variations in the overall rates and indications.     

Antithrombotic- and anticoagulation regimens in OPCAB surgery. A Nordic survey

OBJECTIVES: The aim of the survey was to determine current practices for antiplatelet- and heparin therapy in OPCAB surgery in the Nordic countries. DESIGN: A postal survey questionnaire was sent to all 26 departments of Cardiothoracic Surgery in Norway, Sweden, Iceland, Finland, and Denmark. RESULTS: The overall response rate was 100%. The respondents performed between 130 and 1000 CABG procedures per year. Between 0.3% and 42.0% of these procedures were performed as OPCAB. Preoperative antiplatelet therapy was administered by 48%, while 96% routinely administer postoperative antiplatelet therapy. In the postoperative antiplatelet therapy there was a trend toward a combination of aspirin and low molecular weight heparin. Perioperative anticoagulation practices with heparin varied among departments as well as reversal with protamine. Eighty percent of the respondents register postoperative complications. CONCLUSION: In the Nordic countries there is no uniform practice regarding antiplatelet therapy pre- and postoperatively as well as heparin therapy perioperatively. Dose regimens are highly variable and standard protocols have not yet been developed.     

Head injury mortality in the Nordic countries

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in Western countries. Effective management planning for these patients requires knowledge of TBI epidemiology. The purpose of this study was to describe and analyze the development of TBI mortality in the Nordic countries during the period 1987-2001. Data on TBI deaths were retrieved from the national official statistical agencies according to specified diagnostic codes. We also collected data on the number of operations for acute TBI in the year 2000 from all Nordic hospitals admitting trauma patients. Finland had about twice as high a TBI mortality rate as the other countries. Similarly, the Finnish incidence of acute TBI operations was nearly twice that of the other countries. The median TBI death rate for Finland was 21.2 per 100,000 per year, and for Denmark, Norway, and Sweden 11.5, 10.4, and 9.5, respectively. There were more male than female deaths in all countries. The mortality rate from extracranial injuries was relatively equal between the countries. We observed a sizeable reduction in TBI mortality rates for all countries, except in Finland. Younger age groups had the most pronounced decrease in TBI mortality rates. The oldest age group had the least favorable development of TBI mortality rates, and the mean age of TBI casualties increased substantially during the study period. This study demonstrates considerable differences in and between the Nordic countries regarding TBI mortality. Preventive measures and implementation of regional guidelines are needed to assure a positive development in the future.     

Countrywise results of total hip replacement: An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database

Background and purpose

An earlier Nordic Arthroplasty Register Association (NARA) report on 280,201 total hip replacements (THRs) based on data from 1995–2006, from Sweden, Norway, and Denmark, was published in 2009. The present study assessed THR survival according to country, based on the NARA database with the Finnish data included.

Material and methods

438,733 THRs performed during the period 1995–2011 in Sweden, Denmark, Norway, and Finland were included. Kaplan-Meier survival analysis was used to calculate survival probabilities with 95% confidence interval (CI). Cox multiple regression, with adjustment for age, sex, and diagnosis, was used to analyze implant survival with revision for any reason as endpoint.

Results

The 15-year survival, with any revision as an endpoint, for all THRs was 86% (CI: 85.7–86.9) in Denmark, 88% (CI: 87.6–88.3) in Sweden, 87% (CI: 86.4–87.4) in Norway, and 84% (CI: 82.9–84.1) in Finland. Revision risk for all THRs was less in Sweden than in the 3 other countries during the first 5 years. However, revision risk for uncemented THR was less in Denmark than in Sweden during the sixth (HR = 0.53, CI: 0.34–0.82), seventh (HR = 0.60, CI: 0.37–0.97), and ninth (HR = 0.59, CI: 0.36–0.98) year of follow-up.

Interpretation

The differences in THR survival rates were considerable, with inferior results in Finland. Brand-level comparison of THRs in Nordic countries will be required.There is a long tradition of arthroplasty registries in the Nordic countries. The Swedish Hip Arthroplasty Register was established in 1979 (Malchau et al. 2002), the Finnish Arthroplasty Register in 1980 (Paavolainen et al. 1991, Puolakka et al. 2001), the Norwegian Arthroplasty Register in 1987 (Havelin et al. 2000), and the Danish Hip Arthroplasty Register in 1995 (Lucht 2000). The Nordic Arthroplasty Register Association (NARA) was established in 2007 by Sweden, Norway, and Denmark to improve the quality of total hip and knee arthroplasty through registry-based research collaboration. Finland became a full member of NARA in 2010.A multinational implant registry is needed in order to detect inferior implants as early as possible. To date, the NARA database is the most developed multinational database worldwide. However, NARA results are not available on the internet or in yearbooks; the information is shared using scientific papers. Monitoring and comparison of country-specific results is a step forward in the development of NARA activity. An earlier NARA report on 280,201 THRs, based on data from the period 1995–2006 from Sweden, Norway, and Denmark, was published in 2009 (Havelin et al. 2009). In the present paper, we have updated the survival results for THR in the Nordic countries with the Finnish data included and we consider and discuss the differences found.     

The Danish specialist training in vascular surgery.

OBJECTIVE: to present the Danish training in vascular surgery compared with other European countries. METHODS: analysis of prospectively collected data. Data on number of procedures and supervision was obtained from the Danish Vascular Registry for eighteen trainees (fifteen males, three females) in vascular surgery. Demographic data were obtained by direct contact with the units and from EuReg-Vasc. Vascular surgery has been a mono-specialty in Denmark since 1983. RESULTS: in 2000 the median age of the 45 Danish vascular specialists was 48 years (IQR 45-54, range 40-58) and at end of training the age of the 18 vascular trainees was 42 years (IQR 40-43, range 38-51). Vascular surgery was confined to eleven vascular units - eight with trainees. All vascular procedures in Denmark, besides a few emergency cases, were performed at these units - all by vascular specialists or trainees. The 18 trainees were on average exposed to more than 400 surgical procedures over the three years - and over 300 of nine vascular index operations. The number of assisted, supervised and independent operations was unevenly distributed, with low numbers of certain index operations for some of the trainees. CONCLUSION: the structure of vascular surgery in Denmark as a mono-specialty has almost found its final form. Training is satisfactory overall, but with unacceptable variation among trainees with regard to the number of performed index procedures. A minimum number of index procedures must be defined and logbooks introduced. The relatively short weekly working hours in Denmark is not the prime problem.     

The Scandinavian ACL registries 2004�C2007: baseline epidemiology

Background and purpose No prospective surveillance systems have been available for monitoring the outcome of cruciate ligament surgery in Scandinavia (Denmark, Norway, and Sweden). In the present paper we describe the Scandinavian ACL registries including their main function, similarities, and preliminary baseline results.Methods The Scandinavian registries were established in 2004 (Norway) and 2005 (Denmark and Sweden). The Danish and Swedish registries were originally based on the Norwegian registry, and there is no overriding difference between the three. In Denmark, all hospitals and clinics are legally bound to report to an approved national database. In Norway and Sweden, the registries are based on voluntarily reporting by surgeons.Results The annual incidence of primary ACL reconstructions is higher in Denmark than in Norway, except in females younger than 20 years. Among Scandinavian surgeons, there is a similar approach to the patients. Differences do, however, exist regarding choice of grafts, choice of implants, and choice of treatment of simultaneous meniscal and cartilage injuries; the proportion of ACL reconstructions performed as outpatient surgery; and the use of prophylactic anticoagulation. Clinically, the preoperative KOOS scores are not significantly different between the Scandinavian registries, except that Denmark reports more symptoms both pre- and postoperatively.Interpretation The Scandinavian national ACL registries will generate new data about ACL reconstructions. They will contribute important knowledge regarding ACL epidemiology. They will be the only source of data on the performance of a wide range of different implants and techniques. In addition, they will hopefully have an impact on the selection of methods for ACL reconstructions in Scandinavia and elsewhere.     

Application of human leukocyte antigen matching in the allocation of kidneys from cadaveric organ donors in the Nordic countries

The Nordic organ exchange organization Scandiatransplant was founded in 1969. It covers a population of 24.41 million inhabitants in five countries: Denmark (5.45 million), Finland (5.19 million), Iceland (0.29 million), Norway (4.54 million), and Sweden (8.94 million). Initially, the purpose of Scandiatransplant was to establish and maintain a common waiting list for all Nordic patients with end-stage renal failure waiting for a cadaveric kidney transplant. The basis of maintaining a common Nordic waiting list was the recognition of the wide polymorphism of the human leukocyte antigen system, which demands a substantial pool of waiting patients to provide optimal histocompatibility matching between organ donor and recipient. Thus, one of the major tasks of the organization was and still is to specify rules for the exchange of kidneys between the participating transplant centers. Scandiatransplant includes the cooperation of all 10 Nordic kidney transplant centers in addition to eight immunology laboratories. Denmark has four transplant centers located in Copenhagen, Herlev, Odense, and Aarhus. Finland has one center in Helsinki. Norway has one center located in Oslo. Sweden has four kidney transplantation centers located in each of the university hospitals in G?teborg, Malm?, Stockholm, and Uppsala. The fifth Nordic country, Iceland, is participating fully in organ donation but has no individual transplant center. Organ transplantation in Icelandic patients is performed in other Nordic countries.     

Treatment of Acute Achilles Tendon Rupture in Scandinavia Does Not Adhere to Evidence-based Guidelines: A Cross-sectional Questionnaire-based Study of 138 Departments

The best treatment of acute Achilles tendon rupture has been discussed for decades. During the past half decade, evidence has increased in favor of nonoperative treatment and dynamic and weightbearing rehabilitation. We hypothesized that the treatment strategies would show great variation and that adherence to evidence-based recommendations would not be as good as desired. The purpose of the present study was to investigate how acute Achilles tendon rupture is treated in Scandinavia. A questionnaire was distributed to all orthopedic departments treating acute Achilles tendon ruptures in Denmark, Sweden, Norway, and Finland. The questionnaire was returned by 138 of 148 departments (response rate 93%). Two-way tables with Fisher’s exact test were used for statistical analysis. In Denmark, Norway, Sweden, and Finland, 19 of 23 (83%), 44 of 48 (92%), 26 of 40 (65%), and 8 of 27 (30%) departments recommended surgical treatment (p < .001). Dynamic rehabilitation was used significantly less often in Denmark (5 of 23 [22%]), Norway (17 of 45 [38%]), and Sweden (11 of 40 [28%]) than in Finland (15 of 26 [58%]; p = .015). A significant difference was found among the countries in the educational level of the performing surgeons (p < .001). Surgical treatment was the treatment of choice in Danish, Norwegian, and Swedish hospitals regardless of the increasing evidence favoring nonoperative treatment. Although increasing evidence has favored dynamic rehabilitation, it has gained limited use across Scandinavia. Weightbearing was used in most hospitals. Surgery was performed by junior surgeons in most hospitals across Scandinavia. Treatment algorithms showed considerable variation and often did not adhere to the clinical evidence.     

Review of transmission routes of 24 infectious diseases preventable by biosecurity measures and comparison of the implementation of these measures in pig herds in six European countries

This study aimed to review the transmission routes of important infectious pig diseases and to translate these into biosecurity measures preventing or reducing the transmission between and within pig herds. Furthermore, it aimed to identify the level of implementation of these measures in different European countries and discuss the observed variations to identify potentials for improvement. First, a literature review was performed to show which direct and indirect transmission routes of 24 infectious pig diseases can be prevented through different biosecurity measures. Second, a quantitative analysis was performed using the Biocheck.UG ent™, a risk‐based scoring system to evaluate biosecurity in pig herds, to obtain an insight into the implementation of these biosecurity measures. The database contained farm‐specific biosecurity data from 574 pig farms in Belgium, Denmark, France, Germany, the Netherlands and Sweden, entered between January 2014 and January 2016. Third, a qualitative analysis based on a review of literature and other relevant information resources was performed for every subcategory of internal and external biosecurity in the Biocheck.UG ent™ questionnaire. The quantitative analysis indicated that at the level of internal, external and overall biosecurity, Denmark had a significantly distinct profile with higher external biosecurity scores and less variation than the rest of the countries. This is likely due to a widely used specific pathogen‐free (SPF ) system with extensive focus on biosecurity since 1971 in Denmark. However, the observed pattern may also be attributed to differences in data collection methods. The qualitative analysis identified differences in applied policies, legislation, disease status, pig farm density, farming culture and habits between countries that can be used for shaping country‐specific biosecurity advice to attain improved prevention and control of important pig diseases in European pig farms.     

The Scandinavian ACL registries 2004–2007: baseline epidemiology

Background and purpose No prospective surveillance systems have been available for monitoring the outcome of cruciate ligament surgery in Scandinavia (Denmark, Norway, and Sweden). In the present paper we describe the Scandinavian ACL registries including their main function, similarities, and preliminary baseline results.

Methods The Scandinavian registries were established in 2004 (Norway) and 2005 (Denmark and Sweden). The Danish and Swedish registries were originally based on the Norwegian registry, and there is no overriding difference between the three. In Denmark, all hospitals and clinics are legally bound to report to an approved national database. In Norway and Sweden, the registries are based on voluntarily reporting by surgeons.

Results The annual incidence of primary ACL reconstructions is higher in Denmark than in Norway, except in females younger than 20 years. Among Scandinavian surgeons, there is a similar approach to the patients. Differences do, however, exist regarding choice of grafts, choice of implants, and choice of treatment of simultaneous meniscal and cartilage injuries; the proportion of ACL reconstructions performed as outpatient surgery; and the use of prophylactic anticoagulation. Clinically, the preoperative KOOS scores are not significantly different between the Scandinavian registries, except that Denmark reports more symptoms both pre- and postoperatively.

Interpretation The Scandinavian national ACL registries will generate new data about ACL reconstructions. They will contribute important knowledge regarding ACL epidemiology. They will be the only source of data on the performance of a wide range of different implants and techniques. In addition, they will hopefully have an impact on the selection of methods for ACL reconstructions in Scandinavia and elsewhere.     

Selected activities in Scandiatransplant

Scandiatransplant is the Nordic organ exchange organization. It has existed for 35 years and it is owned by all organ transplantation hospital departments in the five Nordic countries--Denmark, Finland, Iceland, Norway, and Sweden. The use of living organ donors for kidney transplantation has become a more common procedure not only in Norway but also in Sweden and Denmark. For the first time, in 2003, one transplant center performed relatively more living donor kidney transplantations than with deceased donors. The overall organ transplant activity reveals a remarkably stable situation in the area covered by Scandiatransplant. Scandiatransplant as an organ exchange organization has changed from a solely kidney exchange organization to an organization in which the more immediate vital organs as liver and heart are exchanged more commonly than kidneys.     

Patients' desire for information about anaesthesia: Danish attitudes

Background : Patients' desire for information about anaesthesia has been examined in a number of Commonwealth countries but not in Scandinavia. A questionnaire was distributed to form a basis for giving Danish patients more appropriate preoperative information.
Methods : 201 preoperative patients in Denmark were asked to complete a questionnaire. The patients were divided into subgroups according to: age, gender, residential origin, ASA group, educational level, type of anaesthesia planned and number of previous anaesthetics.
Results : Patients from a city area required significantly more information than patients from a rural/urban area about pre-medication drugs, drips/catheters, pain/pain relief and complications. Men more than women preferred to know about dangerous complications. Information about pain /pain relief, duration of anaesthesia, and influence of anaesthesia on daily activities such as eating, drinking, mobilisation was given the highest priority, while unpleasant information such as about complications and needles was given the lowest priority. Meeting the anaesthetist and information about alternative methods of anaesthesia and premedication drugs were given only moderate priority. Ranking information in Denmark was significantly correlated with Scotland, Canada and Australia, despite profound differences in priority. More often than Danish patients, Australian patients felt they had right to know, and especially about complications.
Conclusion : Patients from a city area required more information than patients from a rural/urban area. Information about the influence on daily activities was preferred to unpleasant information. Ranking information in Denmark was correlated with a number of Commonwealth countries.     

Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countries

BACKGROUND: For colorectal surgery, evidence suggests that optimal management includes: no pre-operative fasting, a thoracic epidural analgesia continued for 2 days post-operatively, and avoidance of fluid overload. In addition, no long-acting benzodiazepines on the day of surgery and use of short-acting anaesthetic medication may be beneficial. We examined whether these strategies have been adopted in five northern-European countries. METHODS: In 2003, a questionnaire concerning peri-operative anaesthetic routines in elective, open colonic cancer resection was sent to the chief anaesthesiologist in 258 digestive surgical centres in Scotland, the Netherlands, Denmark, Sweden and Norway. RESULTS: The response rate was 74% (n = 191). Although periods of pre-operative fasting up to 48 h were reported, most (> 85%) responders in all countries declared to adhere to guidelines for pre-operative fasting and oral clear liquids were permitted until 2-3 h before anaesthesia. Solid food was permitted up to 6-8 h prior to anaesthesia. In all countries more than 85% of the responders indicated that epidural anaesthesia was routinely used. Except for Denmark, long-acting benzodiazepines were still widely used. Short-acting anaesthetics were used in all countries except Scotland where isoflurane is the anaesthetic of choice. With the exception of Denmark, intravenous fluids were used unrestrictedly. CONCLUSION: In northern Europe, most anaesthesiologists adhere to evidence-based optimal management strategies on pre-operative fasting, thoracic epidurals and short-acting anaesthetics. However, premedication with longer-acting agents is still common. Avoidance of fluid overload has not yet found its way into daily practice. This may leave patients undergoing elective colonic surgery at risk of oversedation and excessive fluid administration with potential adverse effects on surgical outcome.     

International publishing in anaesthesia – how do different countries contribute?

BACKGROUND: The evaluation of the international distribution in biomedicine research is a subject that creates expectations. This study assesses the recent evolution of world-wide distribution of research in the anaesthesiology field and discusses some of the possible factors which could give rise to changes in the interpretation of absolute results. METHODS: A search on Medline was run to obtain the source country of the journal articles (with abstract) from 10 important anaesthesia journals in the 1997-2001 period. The data were analysed and standardized to journal impact factor values of each publication and population size. Annual evolution in the number of publications in the countries with the largest scientific production was analysed. Furthermore, the distribution of articles by country of origin was studied for each journal. RESULTS: The 9724 publications came from 65 countries. In absolute numbers, the USA leads research in anaesthesiology (24.4%). The evaluation of the contribution of the more productive countries revealed a progressive increase in the German contribution (from 5.1% to 9.4%) and a decrease in the American contribution (from 28.6% to 21.8%) over the 5 years analysed. In relative terms, Finland, Sweden and Denmark were the most productive countries per million inhabitants (8.8, 7.2 and 6 publications/year, respectively). CONCLUSION: The geographic distribution of the publications on anaesthesiology must not only be analysed in absolute numbers, where the USA is the most productive. The North-European countries show the largest production/number of inhabitants ratio; whereas the largest percentage increase during the period is found in Germany.