Nicolai Lohse

Information regarding medical evacuations in Greenland is sparse. This study provides an overview of incidence, costs, and diagnoses leading to medical evacuations in Greenland in 2018. This is a retrospective, observational study. Patients with a valid Danish civil personal registration number were included. Data were obtained by scrutinising the itinerary of the Greenland travel coordination office and the medical records. 481 patients were identified. Forty-nine patients were excluded. 432 patients were analysed. Two-thirds of the evacuations were carried out within Greenland. The overall incidence of evacuations was 7.7 evacuations per 1,000 inhabitants per year. This differed, however, between the five different health regions. The cost of a medical evacuation ranged from less than 4,800 US dollars to more than 50,000 US dollars per case. Pregnancy and childbirth accounted for the majority of evacuations in women (31.2%) while diseases within the circulatory system and digestive tract accounted for the majority of evacuations in men (39.8%). The costs of medical evacuations may be reduced when combining evacuations of more than one patient. This indicates that combining evacuations of multiple patients from one health region by applying mandatory use of a central coordinating service may be beneficial.

Background: Emergency abdominal surgery carries a high mortality, as patients are often frail with significant comorbidity. We aimed to evaluate the association between co‐existing ischaemic vascular disease (IVD) and long‐term mortality in patients undergoing emergency abdominal surgery.Methods: We included adult emergency abdominal surgical patients operated on 13 Danish hospitals between 1 January 2009 and 31 December 2010. Appendectomies were excluded. Data were retrieved from the National Patient Registry (NPR) and the Danish Anaesthesia Database. Preoperative IVD status was retrieved from NPR. We used crude and adjusted Cox regression analysis. The primary outcome was mortality within eight years. The secondary outcome was mortality within 30 days.Results: We included 4864 patients, of which 2584 (53.7%) died within 8 years. Some 20.9% (1019/4864) had preoperative IVD. The adjusted association between preoperative IVD and mortality within 8 years was hazard ratio (HR) 1.10 (95% confidence interval [CI], 1.00‐1.20; P = .045). At 30 days, this association was HR 0.97 (95% CI, 0.84‐1.13).Conclusion: In adult major emergency abdominal surgical patients, preoperative IVD was prevalent and associated with a 10% relative increase in long‐term mortality, but not in short‐term mortality.

INTRODUCTION: Patients with diabetic foot ulcers (DFU) suffer from diabetes-related complications and comorbidities. Hyperbaric oxygen therapy (HBOT) is a treatment modality with limited capacity used in the treatment of DFUs. It is important to ensure that HBOT is offered to patients who are suitable for this treatment regarding effect, compliance and life expectancy. The objective of the present study was to describe the population of patients with DFU who were referred to HBOT in Denmark in the 1999-2016 period. METHODS: All patients with DFU who were treated at the HBOT chamber in Copenhagen during the study period were considered. Patients with an invalid social security number or an incorrect diagnosis were excluded. Data on comorbidities, amputation and death were extracted from the Danish National patient Registry and the Danish Civil Registration System. Continuous data were described as median values and binary data were described as proportions. The probability estimate for survival and amputation was investigated by constructing Kaplan-Meier curves. RESULTS: The cohort included 148 patients. Patients were mainly referred from the Capital Region (92%) and multi disciplinary wound care centres were the primary referring departments (67%). Comorbidity rates were high with an initial median Charlson Comorbidity Index score of five. The five year amputation and mortality estimates after referral were 73.5% and 51.8%, respectively. CONCLUSIONS: The study showed that Danish DFU patients who are offered HBOT are in advanced stages of their disease, and the referral hinges on local factors such as geography and the referring source rather than on standardised procedures.

Summary: Provision of paediatric anaesthesia requires careful consideration of the child's cognitive state, unique body composition and physiology. In an observational cohort study, we describe the population characteristics and conduct of anaesthesia in children aged 2–17 years from 1 January 2005 to 31 December 2015. Children were identified from the Danish Anaesthesia Database. We recorded the following variables: age; sex; comorbidities; indications for anaesthesia; practice of anaesthesia; and complications. Results are presented for two age groups: 2–5 and 6–17 years. In total, 32,840 (61% male) children aged 2–5 years received 50,484 anaesthesia episodes and 91,418 (54% male) children aged 6–17 years received 141,082 anaesthesia episodes. The younger children, compared with the older children, were more frequently anaesthetised at a university hospital (50% vs. 36%) and for non‐surgical procedures (24% vs. 8%). For both age groups, general anaesthesia was the primary choice of anaesthesia regardless of the reason for anaesthesia. For surgery, general anaesthesia using inhalational agents in addition to intravenous agents or alone was more frequently used in younger children (49% vs. 15%), whereas older children commonly received total intravenous anaesthesia (50% vs. 83%). Regional anaesthesia was infrequently utilised. Complications occurred in 3.3% of anaesthesia episodes among 2–5 year olds compared with 3.7% of anaesthesia episodes among children aged 6–17 years. In conclusion, we found younger children (aged 2–5), compared with older children (aged 6–17) were more frequently anaesthetised for non‐surgical reasons, at a university hospital and using inhalational agents. Complications were rare.

The effect of hospitalisation in emergency department-based short-stay units (SSUs) has not been studied in older patients. We compared SSU hospitalisation with standard care at an Internal Medicine Department (IMD) in acutely admitted older internal medicine patients. pragmatic randomised clinical trial. We randomly assigned patients aged 75 years or older, acutely admitted for an internal medicine disease and assessed to be suitable for SSU hospitalisation to SSU hospitalisation or IMD hospitalisation. SSU hospitalisation was provided by a pragmatic ‘fast-track’ principle. The primary outcome was 90-day mortality. Secondary outcomes included adverse events, change in Lawton Instrumental Activities of Daily Living (IADL) score within 90 days from admission, in-hospital length of stay and unplanned readmissions within 30 days after discharge. between January 2015 and October 2016, 430 participants were randomised (median age 84 years in both groups). Ninety-day mortality was 22(11%) in the SSU group and 32(15%) in the IMD group (odds ratio (OR) 0.66; 95% confidence interval (CI) 0.37–1.18; P = 0.16). When comparing the SSU group to the IMD group, 16(8%) vs. 45(21%) experienced at least one adverse event (OR 0.31; 95% CI 0.17–0.56; P < 0.001); 6(3%) vs. 35(20%) experienced a reduction in IADL score within 90 days from admission (P < 0.001); median in-hospital length of stay was 73 h [interquartile range, IQR 36–147] vs. 100 h [IQR 47–169], (P < 0.001), and 26(13%) vs. 58(29%) were readmitted (OR 0.37; 95% CI 0.22–0.61; P < 0.001). mortality at 90 days after admission was not significantly lower in the SSU group, but SSU hospitalisation was associated with a lower risk of adverse events, less functional decline, fewer readmissions and shorter hospital stay. NCT02395718

INTRODUCTION: The prevalence of hip dislocations after total hip arthroplasty (THA) is 2-4% in Denmark. Patients with a dislocated THA are often elderly citizens with comorbidities and severe pain in the pre-reposition phase. Evidence as to which method of anaesthesia and airway management is best for hip relocation is lacking. The aim of this study was to determine how anaesthesiologists in Denmark provide anaesthesia for relocation of THAs, and if a local guideline is available. METHODS: A questionnaire was distributed by e-mail to all members of the Danish Association of Anaesthesiology and Intensive Care and the Danish Society of Young Anaesthesiologists. RESULTS: A total of 480 doctors completed the questionnaire. Of these, 61% (291/480) worked at a department providing anaesthesia for relocation of THAs of whom 85% (248/291) had provided anaesthesia during at least one hip dislocation during the past two years. A total of 27% (67/248) had access to a local guideline of whom 72% (48/67) followed the guideline. In all, 55% (134/248) preferred the patient to be fasting before anaesthesia. The preferred methods of anaesthesia were general anaesthesia with laryngeal mask 43% (106/248) and endotracheal intubation 45% (112/248). Five percent (12/248) had experienced complications to anaesthesia. Cardiovascular complications and aspiration were the most frequently reported complications. CONCLUSIONS: Provision of anaesthesia for relocation of a dislocated THA varies across Denmark. Few anaesthesiologists have access to a local guideline.

Summary: There are few data available that describe the current anaesthetic management of children. We have analysed anaesthetic practice and peri‐operative complications for children in Denmark aged less than two years. We conducted a population‐based observational cohort study using the Danish Anaesthesia Database to identify children who received anaesthesia in hospital from 1 January 2005 until 31 December 2015. Data were combined with that from the Danish National Patient Registry and the Danish Civil Registration System. Age, sex, height, weight, ASA physical status, days in hospital before anaesthesia, number of anaesthetics per child, indications for anaesthesia, methods of anaesthesia, airway management and complications were all recorded. A total of 17,436 children (64% of whom were male) received 27,653 anaesthetics during the study period. In 58% of cases, the child had an ASA physical status score of 1. Thirty‐seven percent had a previous anaesthetic episode. Seventy‐nine percent were anaesthetised at a university hospital. The indications for anaesthesia were surgery (70%), diagnostic radiology (16%), non‐surgical care (11%) and other indications (3%). General anaesthesia combining intravenous and inhalational agents was the most common approach for surgery (68%) and diagnostic radiology (47%). For non‐surgical care, general anaesthesia using inhalational agents was the most common method (42%). Neuraxial blocks were used infrequently. The most common regional anaesthetic nerve block was an infraclavicular brachial plexus block (11%). Peri‐operative complications occurred in 1.71% of cases. A large proportion of anaesthetics were conducted in children with comorbidities. Non‐surgical indications for anaesthesia were frequent and peri‐operative complications were rare.

Background: Implementation of the first Danish helicopter emergency medical service (HEMS) was associated with reduced time from first medical contact to treatment at a specialized centre for patients with suspected ST elevation myocardial infarction (STEMI). We aimed to investigate effects of HEMS on mortality and labour market affiliation in patients admitted for primary percutaneous coronary intervention (PCI).Methods: In this prospective observational study, we included patients with suspected STEMI within the region covered by the HEMS from January 1, 2010, to April 30, 2013, transported by either HEMS or ground emergency medical services (GEMS) to the regional PCI centre. The primary outcome was 30‐day mortality.Results: Among the 384 HEMS and 1220 GEMS patients, time from diagnostic ECG to PCI centre arrival was lower with HEMS (median 71 min vs. 78 min with GEMS; P = 0.004). Thirty‐day mortality was 5.0% and 6.2%, respectively (adjusted OR = 0.82, 95% CI 0.44–1.51, P = 0.52. Involuntary early retirement rates were 0.62 (HEMS) and 0.94 (GEMS) per 100 PYR (adjusted IRR = 0.68, 0.15–3.23, P = 0.63). The proportion of patients on social transfer payments longer than half of the follow‐up time was 22.1% (HEMS) vs. 21.2% (adjusted OR = 1.10, 0.64–1.90, P = 0.73).Conclusion: In an observational study of patients with suspected STEMI in eastern Denmark, no significant beneficial effect of helicopter transport could be detected on mortality, premature labour market exit or work ability. Only a study with random allocation to one system vs. another, along with a large sample size, will allow determination of superiority of helicopter transport.