Jan Jakobsson

Rheumatoid arthritis (RA) confers an elevated cardiovascular disease (CVD) risk through systemic inflammation, arterial stiffness, and myocardial dysfunction. The ratio of carotid-femoral pulse wave velocity (PWV) to left ventricular global longitudinal strain (LV-GLS) has been proposed as a novel index of ventricular-arterial coupling. This study investigated whether a one-year physical activity intervention improves the PWV/LV-GLS ratio in RA patients without known CVD. Eighteen participants with RA from the prospective PARA 2010 study underwent baseline and one-year assessments. PWV was measured by oscillometry, and LV-GLS by speckle-tracking echocardiography. Physical activity was promoted through supervised circuit training and additional moderate-to-vigorous activity. At one year, very active participants [≥ 1,000 metabolic equivalent of task (MET)-minutes/week, n = 10] showed a relative reduction in PWV/LV-GLS ratio compared with baseline, while no change was observed in less active participants (< 1,000 MET-minutes/week, n = 8). Between-group comparison at follow-up demonstrated significantly lower PWV/LV-GLS ratio in very active versus less active patients (p < 0.05). No significant between-group differences were observed when PWV and LV-GLS were analyzed separately. In conclusion, a high level of physical activity was associated with improved ventricular-arterial coupling, reflected by a lower PWV/LV-GLS ratio, in RA patients. These findings support a potential dose-dependent effect of physical activity on subclinical cardiovascular function in RA. The clinical trial was registered at http://www.isrctn.com, unique identifier: ISRCTN88886304.

Purpose: Revision knee arthroplasty (rKA) is performed when a primary implant fails and is associated with a higher perioperative risk than primary arthroplasty. Early postoperative mortality after rKA in Sweden is poorly described. We aimed to estimate all‐cause mortality within 90 days after rKA in Sweden and to explore associations with patient characteristics and calendar year. Methods: Register‐based cohort study using data from the Swedish Perioperative Register (SPOR). All adults undergoing rKA (national classification of surgical procedures and the kod for knee revision atrhroplasty) during 2017–2022 were included ( n = 2616). The primary outcome was all‐cause mortality within 90 days. Group comparisons used χ ² tests and analysis of variance; multivariable logistic regression adjusted for calendar year, sex, age group, American Society of Anaesthesiologists (ASA) category and indication for revision. Results: Overall, 90‐day mortality was low (15/2616; 0.57%; 95% confidence interval [CI]: 0.34–0.92) with no significant variation by calendar year ( p = 0.100). Thirty‐day mortality was 0.23% (6/2616; 95% CI: 0.10–0.47). In unadjusted analyses, age >80 years and ASA Class III/IV were associated with higher odds of 90‐day mortality; in adjusted analyses, age >80 years remained the only statistically significant predictor (adjusted odds ratio [OR] 13.63; 95% CI: 3.97–46.77). Sex, ASA class and indication were not statistically significant in the adjusted model. Age, ASA class and indication showed substantial interaction in relation to 90‐day mortality. Conclusions: Ninety‐day mortality after rKA in Sweden was low and remained stable between 2017 and 2022. Advanced age, higher ASA class and revision due to periprosthetic joint infection appeared to be the dominant risk factors. Preoperative preparation, medical optimization and, where feasible, prehabilitation of older and frail patients should be considered. Level of Evidence: Not applicable, quality register‐based study.

Purpose: Knee arthroplasty is one of the most common orthopaedic procedures in Sweden, which is in line with many other countries in the Western world. There is no recent data on all‐cause 30‐day mortality associated with primary knee arthroplasty in Sweden during recent years. The purpose of the present observational quality register study was to investigate the mortality at 0, 7, 30 and 90 days after primary knee arthroplasty, and the impact of age and ASA‐class. Material: Data from SPOR (Swedish PeriOperative Registry) on primary knee arthroplasty (ICD code NGB) registered between 2017 and 2021 in patients ≥18 years was analysed. Perioperative mortality rates and impact of age and ASA were analysed and are presented as numbers, proportions and 95% confidence interval. Results: The study cohort included 35,794 patients. The study found overall low 30‐day mortality rate, 16 out of 35,794 patients (0.045%, 95% confidence Interval 0.027%–0.071%), no patients died on the day of surgery, six died within one week, while 50 died within 90 days, with no significant differences over the years. High age and higher ASA‐class were associated with higher mortality. Conclusions: The study showed a low and stable 30‐day mortality associated with primary knee arthroplasty at 0.045%. Age above 80 years and ASA‐Classes III and IV were associated with increased mortality rate, the benefit versus risk in relation to knee arthroplasty procedure should be assessed individually in patients above 80 years and ASA‐Classes III and IV. Level of Evidence: N/A.

Background and purpose: An important quality indicator of perioperative care is the all-cause 30-day mortality. Little is known about early mortality after foot and ankle fracture repair. We aimed to assess the all-cause 30-day mortality associated with surgical repair of foot and ankle fractures in Sweden during 2017–2022 and its seasonal variation.Methods: Foot and ankle fracture patients aged ≥ 18 years registered in the Swedish Perioperative Quality Register (SPOR) between 2017 and June 30, 2022 were included in the analysis (n = 26,404). Patient characteristics, perioperative observations, and early mortality were collected. Seasonal variation was analyzed for summer, autumn, winter, and spring. Perioperative mortality rate and odds ratio (OR) are reported with 95% confidence intervals (CI).Results: The all-cause 30-day mortality rate was 58 of the 26,404 studied patients (0.22%, CI 0.17–0.28). There was no change in mortality rate over the study period including the COVID-19 pandemic year. Increased adjusted odds ratio (OR) for 30-day mortality was seen among the elderly, age > 80 years, OR 22 (CI 9.2–50), and those with low health status, ASA class 3–4, OR 4.2 (CI 2.3–7.9), while surgery during summer was associated with a lower adjusted OR 0.4 (CI 0.1–0.9).Conclusion: The all-cause 30-day mortality rate after foot and ankle fracture surgery in Sweden is reassuringly low with expected higher OR for mortality associated with age and health status, while surgery during summer months was associated with lower mortality.

Introduction: In Sweden approximately 9% of hip-arthroplasty require a revision. All-cause 30-day mortality following hip revisions in Sweden is unknown. Aim: To assess all-cause 30-days mortality among hip-revision in Sweden and whether mortality has changed 2017-2022 based on data from the Swedish perioperative register (SPOR) adjusted for sex, age, ASA-class, indication and fixation technique. Method: This observational cohort study includes all hip revisions registered in SPOR between 2017 – June 2022 analysing 30-day postoperative mortality rates. Inclusion criteria: age >18 having had a hip arthroplasty revision ICD-10-SE codes NFC. Binary-logistic-regressions estimated odds-ratio (OR) for 30-days mortality over the study period, adjusted for sex, age, ASA-class, indication and fixation technique. Result: 6937 patients were included in the analysis, 3333 females and 3063 males mean-age 73 years with an overall 30-day mortality rate of 1.3%. No significant differences in 30-day mortality were found over the study-period. There was no death within 30-days among patients below 65 years and within ASA-class I. Males had a mortality rate of 1.4% vs females 1.1% (ns.). Adjusted OR was significantly higher for patients with age >80 years OR 9.1 ( P < 0.001), AS-classes III OR 3.9 and IV 14.9 ( P < 0.001) infection 3.4 and fracture 9.1 ( P < 0.001) but fixation technique had not. Conclusion: The all-cause 30-day mortality in Sweden was 1.3% with minor differences over the study period and between sexes, while high age especially above 80 and ASA-classes III and IV significantly increased the adjusted OR for 30-day mortality. Efforts to further optimize the perioperative care of this patient group are of importance.

Hip arthroplasty is a common orthopaedic procedure worldwide. There is an ongoing debate related to the fixation and anaesthesia impact on the 30-day mortality, particularly in the aging population with higher American Society of Anaesthesiology (ASA) Physical-Status. To study the 30-day all-cause mortality in patients undergoing primary hip arthroplasty, with regards to the impact of age, ASA-class, anaesthesia techniques, indication for surgery and fixation techniques. Perioperative data for primary hip arthroplasty procedures for osteoarthritis and hip fractures registered in the Swedish Perioperative Registry (SPOR) between 2013 and June 2022 were collected. Binary logistic regressions were performed to assess the impact of age, ASA-class, anaesthetic technique, indication for surgery and fixation on odds ratio for 30-day mortality in Sweden. In total, 79,114 patients, 49,565 with osteoarthritis and 29,549 with hip fractures were included in the main study cohort. Mortality was significantly higher among hip fracture patients compared with osteoarthritis, cumulative 8.2% versus 0.1% at 30-days respectively (p < 0.001). Age above 80 years (OR3.7), ASA 3–5 (OR3.3) and surgery for hip fracture (OR 21.5) were associated with significantly higher odds ratio, while hybrid fixation was associated with a significantly lower odds ratio (OR0.4) of 30-day mortality. In the same model, for the subgroups of osteoarthritis and hip fracture, only age (OR 3.7) and ASA-class (OR 3.3) had significant impact, increasing the odds ratio for 30-day mortality. Hemi arthroplasty was commonly used among the hip fracture patients 20.453 (69.2%), and associated with a significantly higher odds ratio for all-cause 30-day mortality as compared to total hip arthroplasty when adjusting for age and ASA-class and fixation 2.3 (95%CI 1.9–2.3, p < 0.001). All-cause 30-day mortality associated with arthroplasty differed significantly between the two cohorts, hip fracture, and osteoarthritis (8.2% and 0.1% respectively) and mortality expectedly increased with age and higher ASA-class. Anaesthetic method and cement-fixation did not impact the odds ratio for all-cause 30-day mortality after adjustment for age and ASA-class.

Background: Wrist fracture is one of most common fractures frequently requiring surgical anaesthesia. There is limited information related to the anaesthetic practice and quality including 30‐day mortality associated with wrist fracture in Sweden in recent years.Aim: The aim of the present register‐based study was to investigate the anaesthesia techniques used and quality indices including 30‐day mortality associated with wrist fracture surgery in Sweden during the period 2018–2021.Materials and Methods: All fracture repositions, and surgical interventions related to wrist fracture requiring anaesthesia in patients aged >18 years registered in the Swedish Perioperative Register (SPOR) between 2018 and 2021 were included in the analysis. Information on age, ASA class, anaesthesia technique, severe operative events, most reported side‐effects during recovery room stay and all‐cause 30‐day mortality was collected.Results: The data set included 25,147 procedures split into 14,796 females and 10,252 males (missing information n = 99) with a mean age of 52.9 ± 18.7 years and a significant age difference between females and males, 60.3 ± 15.4 and 42.2 ± 17.7 years, respectively. Mean age and ASA class increased during the study period (2018–2021), from 52.8 ± 18.6 to 54.0 ± 18.4 and ASA class 3–5 from 8.1% to 9.4% (p < .001 and p < .041, respectively). General anaesthesia (GA), GA combined with regional anaesthesia (RA), RA with or without sedation and sedation only was used in 41%, 13%, 40% and 6% of procedures, respectively, with minor changes over the study period. Pain at arrival in the recovery room (RR), (3.4%), severe pain during RR stay (2.1%), hypothermia (1.4%), postoperative nausea and vomiting (PONV) (1.2%) and urinary retention (0.5%) were the most reported side‐effects during the RR stay. (RA) was associated with significantly lower occurrence of pain and PONV, and shorter RR stay, compared with GA (p < .001). The all‐cause 30‐day mortality was low (19 of 25,147 (0.08%)) with no differences over the period studied or anaesthetic technique.Conclusion: General anaesthesia or general anaesthesia combined with regional anaesthesia are the most used anaesthetic techniques for wrist fracture procedures in Sweden. Recovery room pain, PONV, hypothermia and urinary retention is reported in overall low frequencies, with no change over the period studied, but in lower frequencies for regional anaesthesia. All‐cause 30‐day mortality was low; 0.08% with no change over time or between anaesthetic techniques. Thus, the present quality review based on SPOR data supports high quality of perioperative anaesthesia care.