Validation of the date of surgery for esophageal cancer in the Swedish patient registry

Background Bariatric surgery carries a risk of severe postoperative complications, sometimes leading to reinterventions or even death. The incidence and risk factors for reintervention and death within 90 days after bariatric surgery are unclear, and were examined in this study. Methods This population-based cohort study included all patients who underwent bariatric surgery in one of the five Nordic countries between 1980 and 2012. Data on surgical and endoscopic procedures, diagnoses and mortality were retrieved from national high-quality and complete registries. Multivariable Cox regression analysis was used to calculate hazard ratios (HRs), adjusted for country, age, sex, co-morbidity, type of surgery and approach, year and hospital volume of bariatric surgery. Results Of 49 977 patients, 1111 (2·2 per cent) had a reintervention and 95 (0·2 per cent) died within 90 days of bariatric surgery. Risk factors for the composite outcome reintervention/mortality were older age (HR 1·65, 95 per cent c.i. 1·36 to 2·01, for age at least 50 years versus less than 30 years) and co-morbidity (HR 2·66, 1·53 to 4·62, for Charlson co-morbidity index score 2 or more versus 0). The risk of reintervention/mortality was decreased for vertical banded gastroplasty compared with gastric bypass (HR 0·37, 0·28 to 0·48) and more recent surgery (HR 0·51, 0·39 to 0·67, for procedures undertaken in 2010 or later versus before 2000). Sex, surgical approach (laparoscopic versus open) and hospital volume did not influence risk of reintervention/mortality, but laparoscopic surgery was associated with a lower risk of 90-day mortality (HR 0·29, 0·16 to 0·53). Conclusion Reintervention and death were uncommon events within 90 days of bariatric surgery even in this unselected nationwide cohort from five countries. Older patients with co-morbidities have an increased relative risk of these outcomes.

British Journal of Surgery

Section: Discussionmentioning

confidence: 99%

Reintervention or mortality within 90 days of bariatric surgery: population-based cohort study

Kauppila

Santoni

Tao

et al. 2020

“…Data on surgery and co‐morbidity were collected from the patient register, which contains all in‐hospital diagnoses and surgical procedures in Sweden since 1987 and all outpatient specialist care since 2001. The exposure variable date of surgery was available from 1997 onwards, and has at least 95 per cent accuracy for cancer surgery. The codes representing cancer surgery in the patient register have positive predictive values of almost 100 per cent compared with operation charts.…”

Section: Methodsmentioning

confidence: 99%

Weekday of cancer surgery in relation to prognosis

Mattsson

British Journal of Surgery

2017

“…The completeness of recording all new cancers in this registry is 96% 8 and is nearly 100% in patients who undergo surgery. 11,12 The diagnoses defining comorbidities in the Charlson comorbidity index have excellent nationwide coverage and positive predictive values of up to 95%. 9 The Swedish Patient Registry contains data on all inhospital diagnoses and surgical procedures in Sweden since 1987.…”

Section: Validity Of the Data Sourcesmentioning

confidence: 99%

“…10 The variables representing dates and types of cancer surgery have almost 100% positive predictive values compared to operation charts. 11,12 The diagnoses defining comorbidities in the Charlson comorbidity index have excellent nationwide coverage and positive predictive values of up to 95%. 10 The Swedish Causes of Death Registry has 99% completeness for causes of deaths and 100% completeness of dates of deaths for all deceased Swedish residents since 1952.…”

Section: Validity Of the Data Sourcesmentioning

confidence: 99%

Prognosis following cancer surgery during holiday periods

Mattsson

2017

Intl Journal of Cancer

Self Cite

Surgery is the mainstay curative treatment in most cancer. We aimed to test the new hypothesis that cancer surgery performed during holiday periods is associated with worse long-term prognosis than for non-holiday periods. This nationwide Swedish population-based cohort study included 228,927 patients during 1997-2014 who underwent elective resectional surgery for a cancer where the annual number of resections was over 100. The 16 eligible cancer sites were grouped into 10 cancer groups. The exposure, holiday periods, was classified as wide (14-weeks) or narrow (7-weeks). Surgery conducted inside versus outside holiday periods was compared regarding overall disease-specific (main outcome) and overall all-cause (secondary outcome) mortality. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, sex, comorbidity, hospital volume, calendar period and tumor stage. Surgery conducted during wide and narrow holiday periods were associated with increased HRs of disease-specific mortality for cancer of the breast (HR 1.08, 95% CI 1.03-1.13 and HR 1.06, 95% CI 1.01-1.12) and possibly of cancer of the liver-pancreas-bile ducts (HR 1.09, 95% CI 0.99-1.20 and HR 1.12, 95% CI 0.99-1.26). Sub-groups with cancer of the colon-rectum, head-and-neck, prostate, kidney-urine bladder and thyroid also experienced statistically significantly worse prognosis following surgery conducted during holiday periods. No influence of surgery during holiday was detected for cancer of the esophagus-stomach, lung or ovary-uterus. All-cause HRs were similar to the disease-specific HRs. The prognosis following cancer surgery might not be fully maintained during holiday periods for all cancer sites.