Background and purposePrevious work has shown that despite preventive measures, intraoperative contamination of joint replacements is still common, although most of these patients seem to do well in follow-up of up to 5 years. We analyzed the prevalence and bacteriology of intraoperative contamination of primary joint replacement and assessed whether its presence is related to periprosthetic joint infection (PJI) on long-term follow-up.Patients and methods49 primary total hip replacements (THRs) and 41 total knee replacements (TKRs) performed between 1990 and 1991 were included in the study. 4 bacterial swabs were collected intraoperatively during each procedure. Patients were followed up for joint-related complications until March 2011.Results19 of 49 THRs and 22 of 41 TKRs had at least 1 positive culture. Coagulase-negative staphylococci and Staphylococcus aureus were the most common organisms, contaminating 28 and 9 operations respectively. Where information was available, bacteria from 27 of 29 contaminated operations were susceptible to the prophylactic antibiotic administered. 13% of samples gathered before 130 min of surgery were contaminated, as compared to 35% collected after that time. 2 infections were diagnosed, both in TKRs. 1 of them may have been related to intraoperative contamination.InterpretationIntraoperative contamination was common but few infections occurred, possibly due to the effect of prophylactic antibiotics. The rate of contamination was higher with longer duration of surgery. It appears that positive results from intraoperative swabs do not predict the occurrence of PJI.

The long-term outcome following myocardial revascularization, using the left internal mammary artery and the great saphenous vein as conduits, is favourable and improving. This is reflected by the 5-year survival of 89.9%, deviating minimally from the survival rate of the general Icelandic population, together with a freedom from major adverse cardiac and cerebrovascular events of 80.3%.

OBJECTIVES Our aim was to investigate the outcome of patients with diabetes undergoing coronary artery bypass grafting (CABG) surgery in a whole population with main focus on long-term mortality and complications. METHODS This was a nationwide retrospective analysis of all patients who underwent isolated primary CABG in Iceland between 2001 and 2016. Overall survival together with the composite end point of major adverse cardiac and cerebrovascular events was compared between patients with diabetes and patients without diabetes during a median follow-up of 8.5 years. Multivariable regression analyses were used to evaluate the impact of diabetes on both short- and long-term outcomes. RESULTS Of a total of 2060 patients, 356 (17%) patients had diabetes. Patients with diabetes had a higher body mass index (29.9 vs 27.9 kg/m2) and more often had hypertension (83% vs 62%) and chronic kidney disease (estimated glomerular filtration rate ≤60 ml/min/1.73 m2, 21% vs 14%). Patients with diabetes had an increased risk of operative mortality [odds ratio 2.52, 95% confidence interval (CI) 1.27–4.80] when adjusted for confounders. 5-Year overall survival (85% vs 91%, P < 0.001) and 5-year freedom from major adverse cardiac and cerebrovascular events were also inferior for patients with diabetes (77% vs 82%, P < 0.001). Cox regression analysis adjusting for potential confounders showed that the diagnosis of diabetes significantly predicted all-cause mortality [hazard ratio (HR) 1.87, 95% CI 1.53–2.29] and increased risk of major adverse cardiac and cerebrovascular events (HR 1.47, 95% CI 1.23–1.75). CONCLUSIONS Patients with diabetes have significantly lower survival after CABG, both within 30 days and during long-term follow-up.

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ur innan 30 daga frá opinni hjartaaðgerð en þar er kvenkyn sér-stakur áhaettuþáttur. 15 Þaer fáu rannsóknir sem hafa borið saman langtímalifun milli kynja eftir kransaeðahjáveitu hafa í flestum tilvikum sýnt lakari horfur kvenna. 8,16,17 Rannsóknum virðist þó ekki bera saman um hvort kvenkyn sé sjálfstaeður áhaettuþáttur síðri lifunar eftir kransaeðahjáveitu, enda þótt nýleg safngreining á 20 rannsóknum hafi bent til þess. 16 Árangur kransaeðahjáveituaðgerða á Íslandi hefur töluvert verið rannsakaður á síðustu árum og hafa vísindagreinar verið birtar úr þessum efnivið. Meðal annars hafa undirhópar sjúklinga, eins og aldraðir, sykursjúkir og sjúklingar sem þjást af offitu, verið teknir fyrir en einnig birtist nýlega rannsókn um langtímaárangur eftir kransaeðahjáveitu. [18][19][20][21] Árangur kransaeðahjáveituaðgerðahjá konum á Íslandi Á G R I P InngangurMarkmið þessarar rannsóknar var að bera saman árangur kransaeða-hjáveituaðgerða hjá konum og körlum á Íslandi með áherslu á snemmog síðkomna fylgikvilla, 30 daga dánartíðni og langtímalifun. Efniviður og aðferðirAfturskyggn rannsókn á öllum sjúklingum sem gengust undir kransaeðahjáveituaðgerð á Íslandi á árunum 2001-2013. Upplýsingar fengust úr sjúkraskrám og Dánarmeinaskrá Embaettis landlaeknis. Fylgikvillum var skipt í snemm-og síðkomna fylgikvilla og heildarlifun reiknuð með aðferð Kaplan-Meier. Fjölþátta aðhvarfsgreining var notuð til að meta forspárþaetti dauða innan 30 daga og Cox aðhvarfs-greining til að meta forspárþaetti verri langtímalifunar. Meðaleftirfylgd var 6,8 ár. NiðurstöðurAf 1755 sjúklingum voru 318 konur (18%). Meðalaldur þeirra var fjórum árum haerri en karla (69 ár á móti 65 árum, p<0,001), þaer höfðu oftar sögu um háþrýsting (72% á móti 64%, p=0,009) og EuroSCOREst þeirra var haerra (6,1 á móti 4,3, p<0,001). Hlutfall annarra áhaettu-þátta eins og sykursýki var hins vegar sambaerilegt, líkt og útbreiðsla kransaeðasjúkdóms. Alls létust 12 konur (4%) og 30 karlar (2%) innan 30 daga frá aðgerð en munurinn var ekki marktaekur (p=0,08). Tíðni snemmkominna fylgikvilla, baeði minniháttar (53% á móti 48% p=0,07) og alvarlegra (13% á móti 11%, p=0,2), var sambaerileg. Fimm árum frá aðgerð var lifun kvenna 87% borin saman við 90% hjá körlum (p=0,09). Þá var tíðni síðkominna fylgikvilla sambaerileg hjá konum og körlum 5 árum frá aðgerð (21% á móti 19%, p=0,3). Kvenkyn reyndist hvorki sjálfstaeður forspárþáttur 30 daga dánartíðni (OR 0,99; 95%-ÖB: 0,97-1,01) né verri lifunar (HR 1,08; 95%-ÖB: 0,82-1,42). ÁlyktunMun faerri konur en karlar gangast undir kransaeðahjáveituaðgerð á Íslandi og eru þaer fjórum árum eldri þegar kemur að aðgerð. Árangur kransaeðahjáveitu er góður hjá konum líkt og körlum, en 5 árum eftir aðgerð eru 87% kvenna á lífi. InngangurKransaeðasjúkdómur er ein helsta dánarorsök Íslendinga, baeði kvenna og karla. 1 Fyrir tíðahvörf er tíðni kransaeðasjúkdóms laegri meðal kvenna og þaer eru að jafnaði allt að áratug eldri en karlar þegar þaer greinast með sjúkdóminn.2 Ástaeðan fyrir þessum mun er ekki að öllu leyti þekkt en er helst rakin...