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Andersson, Manne
Publications (6 of 6) Show all publications
Baubeta Fridh, E., Andersson, M., Thuresson, M., Sigvant, B., Kragsterman, B., Johansson, S. R., . . . Nordanstig, J. (2017). Amputation Rates, Mortality, and Pre-operative Comorbidities in Patients Revascularised for Intermittent Claudication or Critical Limb Ischaemia: A Population Based Study. European Journal of Vascular and Endovascular Surgery, 54(4), 480-486
Open this publication in new window or tab >>Amputation Rates, Mortality, and Pre-operative Comorbidities in Patients Revascularised for Intermittent Claudication or Critical Limb Ischaemia: A Population Based Study
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2017 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 54, no 4, p. 480-486Article in journal (Refereed) Published
Abstract [en]

Objectives

The aims of this population based study were to describe mid- to long-term amputation risk, cumulative incidence of death or amputation, and differences in pre-operative comorbidities in patients revascularised for lower limb peripheral artery disease (PAD).

Methods

This was an observational cohort study. Data from the Swedish National Quality Registry for Vascular Surgery (Swedvasc) were combined with mandatory national health care registries and patient medical records. All patients who underwent revascularisation in Sweden between May 2008 and May 2013 for intermittent claudication (IC) or critical limb ischaemia(CLI), aged 50 years and older, were identified through the Swedvasc database. The mandatory national health care registries and medical records provided data on comorbidities, mortality, and major amputations.

Results

A total of 16,889 patients with PAD (IC, n = 6272; CLI, n = 10,617) were studied. The incidence of amputations in IC patients was 0.4% (range 0.3%–0.5%) per year. Among CLI patients, the amputation rate during the first 6 months following revascularisation was 12.0% (95% CI 11.3–12.6). Thereafter, the incidence declined to approximately 2% per year. The cumulative combined incidence of death or amputation 3 years after revascularisation was 12.9% (95% CI 12.0–13.9) in IC patients and 48.8% (95% CI 47.7–49.8) in CLI patients. Among CLI patients, compared with IC patients, the prevalence of diabetes, ischaemic stroke, heart failure, and atrial fibrillation was approximately doubled and renal failure was nearly tripled, even after age standardisation.

Conclusion

The risk of amputation is particularly high during the first 6 months following revascularisation for CLI. IC patients have a benign course in terms of limb loss. Mortality in both IC and CLI patients is substantial. Revascularised CLI patients have different comorbidities from IC patients.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Arterial occlusive diseases; Peripheral arterial disease; Intermittent claudication; Mortality; Amputation; Comorbidity
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-142428 (URN)10.1016/j.ejvs.2017.07.005 (DOI)000412967500016 ()28797662 (PubMedID)2-s2.0-85026830716 (Scopus ID)
Note

Funding Agencies|AstraZeneca; Futurum Academy for Health and Care, Region Jonkoping County, Sweden

Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2018-04-18Bibliographically approved
Di Saverio, S., Birindelli, A., Kelly, M. D., Catena, F., Weber, D. G., Sartelli, M., . . . Andersson, R. (2016). WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World Journal of Emergency Surgery, 11(34)
Open this publication in new window or tab >>WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis
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2016 (English)In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 11, no 34Article, review/survey (Refereed) Published
Abstract [en]

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2016
Keywords
Acute Appendicitis; Guidelines; Consensus Conference; Alvarado Score; Appendicitis diagnosis score; Non-operative management; Antibiotics; Complicated appendicitis; Appendectomy; Laparoscopic appendectomy; Phlegmon; Appendiceal abscess
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-130377 (URN)10.1186/s13017-016-0090-5 (DOI)000379972500001 ()27437029 (PubMedID)
Available from: 2016-08-15 Created: 2016-08-05 Last updated: 2017-11-28
Andersson, M. & Andersson, R. (2015). Routine versus selective diagnostic imaging in patients with intermediate probability of acute appendicitis: A randomised controlled multicentre study.
Open this publication in new window or tab >>Routine versus selective diagnostic imaging in patients with intermediate probability of acute appendicitis: A randomised controlled multicentre study
2015 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background

Diagnostic imaging is increasingly used in patients with suspected appendicitis, with increased costs and concerns about exposure to ionising radiation. Indications suggest that routine imaging is associated with a higher detection rate and treatment of potentially resolving appendicitis. The efficiency of routine imaging compared with in-hospital observation and selective imaging is not well studied.

Methods

The proportions of negative appendectomy and treatments for appendicitis are studied in 1068 patients with intermediate suspicion of appendicitis, indicated by an Appendicitis Inflammatory Response (AIR) score sum of five to eight points, randomly allocated by opaque sealed envelopes to early routine diagnostic imaging (Imaging group, n=543) or re-assessment after 4–8 hours inhospital observation followed by selective diagnostic imaging (Observation group, n=525). Some 21 hospitals in Sweden participated in this multicentre study.

Findings

The Imaging and Observation groups had the same proportion of negative appendectomies (6·5% in both, difference 0·03%, CI –3·0%–3·1%, p=0·98) but routine imaging was associated with an increased proportion of patients treated for appendicitis (53·4% vs 46·3%, difference  7·1%, CI 1·0–13·2%, p=0·020). As secondary outcomes, the Imaging group had shorter time to surgery (median 13·7 hours vs 15·5 hours, p<0·01), but no difference in admissions, number of perforations or length of hospital stay.

Interpretation

Patients with suspected appendicitis and equivocal clinical findings do not benefit from early routine diagnostic imaging compared with re-assessment after observation and selective imaging. The latter is associated with fewer operations for non-perforated appendicitis which supports the hypothesis of resolving appendicitis.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113765 (URN)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, SwedenMedical Research Council of Southeast Sweden (FORSS)
Available from: 2015-01-30 Created: 2015-01-30 Last updated: 2015-01-30Bibliographically approved
Andersson, M. (2015). Structured management of patients with suspected acute appendicitis. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Structured management of patients with suspected acute appendicitis
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background. Acute appendicitis (“appendicitis”) is one of the most common abdominal surgical emergencies worldwide. In spite of this, the diagnostic pathways are highly variable across countries, between centres and physicians. This has implications for the use of resources, exposure of patients to ionising radiation and patient outcome. The aim of this thesis is to construct and validate a diagnostic appendicitis score, to evaluate new inflammatory markers for inclusion in the score, and explore the effect of implementing a structured management algorithm for patients with suspected appendicitis. Also, we compare the outcome of management with routine diagnostic imaging versus observation and selective imaging in equivocal cases.

Methods. In study I, the Appendicitis Inflammatory Response (AIR) score was constructed from eight variables with independent diagnostic value (right lower quadrant pain, rebound tenderness or muscular defence, WBC count, proportion of polymorphonuclear granulocytes, CRP, body temperature and vomiting). Its diagnostic properties were evaluated and compared with the Alvarado score. In study II, we performed an external validation and evaluation of novel inflammatory markers for inclusion in the score on patients with suspected appendicitis at two Swedish hospitals. In study III we externally validated and evaluated the impact of an AIR-scorebased algorithm assigning patients to a low or high risk of having appendicitis in an interventional multicentre study involving 25 Swedish hospitals and 3791 patients. In study IV, we compared the efficiency of routine diagnostic imaging with repeated clinical assessment followed by selective imaging in a randomised trial of 1028 patients with equivocal signs of appendicitis, as indicated by an intermediate AIR score, from study III.

Main results. In study I we found that the AIR score could assign 63% of the patients to either a high- or low-risk group of appendicitis with an accuracy of 97%, which compared favourably with the Alvarado score. In study II, the diagnostic properties of the AIR score proved to be  reproducible, but the inclusion of novel inflammatory markers did not improve the diagnostic accuracy. In study III, the AIR-score-based algorithm led to a reduction in negative explorations, operations for nonperforated appendicitis and hospital admissions in the low-risk group and reduced use of imaging in both low- and high-risk groups. In study IV, routine imaging led to more operations for nonperforated appendicitis but had no effect on negative explorations or perforated appendicitis.

Conclusions. The AIR score was found to have promising diagnostic properties that were not improved further with the inclusion of novel inflammatory variables. Structured management of patients with suspected appendicitis according to an AIR-score-based algorithm may improve outcome while reducing hospital admissions and use of imaging. Patients with equivocal signs of appendicitis do not benefit from routine imaging which may lead to an increased detection of, and treatment for, uncomplicated cases of appendicitis that are otherwise allowed to resolve spontaneously.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. p. 110
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1442
National Category
Clinical Medicine Surgery
Identifiers
urn:nbn:se:liu:diva-113766 (URN)10.3384/diss.diva-113766 (DOI)978-91-7519-137-9 (ISBN)
Public defence
2015-03-06, Originalet, Qulturum, Länssjukhuset Ryhov, Jönköping, 13:00
Opponent
Supervisors
Funder
Futurum - Academy for Health and Care, Jönköping County Council, SwedenMedical Research Council of Southeast Sweden (FORSS)
Available from: 2015-01-30 Created: 2015-01-30 Last updated: 2015-11-16Bibliographically approved
Andersson, M., Kolodziej, B. & Andersson, R. (2015). Structured Management of Patients with Suspected Acute Appendicitis Using a Clinical Score and Selective Imaging (STRAPPSCORE).
Open this publication in new window or tab >>Structured Management of Patients with Suspected Acute Appendicitis Using a Clinical Score and Selective Imaging (STRAPPSCORE)
2015 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background

The management of patients with suspected appendicitis is highly variable with implications for the rate of diagnostic errors, unnecessary admissions and resource consumption. We hypothesise that a structured management algorithm based on the Appendicitis Inflammatory Response (AIR) score can improve diagnostic accuracy, limit the use of diagnostic imaging, and reduce the number of hospital admissions for patients with suspected appendicitis.

Methods

Prospective interventional multicentre study. Patients at 25 Swedish hospitals over the age of five, presenting with suspected appendicitis at the emergency department were considered for inclusion. After an initial period of routine management and registration of the AIR score parameters (baseline period), an AIR-score-based management algorithm was implemented (intervention period). The study analyses the discriminating capacity and predictive value of the AIR score and the impact of implementing the AIR-score-based algorithm.

Results

In total, 3791 patients were included. Advanced appendicitis is unlikely at an AIR score <5 points (sensitivity 0.96), and appendicitis is likely at an AIR score >8 (specificity 0.98). The implementation of the AIR-score-based algorithm resulted in fewer negative explorations and operations for phlegmonous appendicitis (1.6% vs 3.4%, p=0.019 and 5.5% vs 9.4%, p=0.003, respectively), a reduction in admissions to hospital and use of imaging (29.5% vs 42.8%, p<0.001 and 19.2% vs 34.5%, respectively), and no difference with regard to advanced appendicitis in the low-risk group, and a decrease in the use of diagnostic imaging in the high-risk group (38.5% vs 53.1%, p=0.021).

Conclusions

The AIR score has high discriminating capacity. Implementing an AIR-score-based algorithm increased diagnostic accuracy and lowered the use of diagnostic imaging and in-hospital observation.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113764 (URN)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, SwedenMedical Research Council of Southeast Sweden (FORSS)
Available from: 2015-01-30 Created: 2015-01-30 Last updated: 2015-01-30Bibliographically approved
Andersson, M., Rubér, M., Ekerfelt, C., Björnsson, H., Olaison, G. & Andersson, R. (2014). Can New Inflammatory Markers Improve the Diagnosis of Acute Appendicitis?. World Journal of Surgery, 38(11), 2777-2783
Open this publication in new window or tab >>Can New Inflammatory Markers Improve the Diagnosis of Acute Appendicitis?
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2014 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 38, no 11, p. 2777-2783Article in journal (Refereed) Published
Abstract [en]

The diagnosis of appendicitis is difficult and resource consuming. New inflammatory markers have been proposed for the diagnosis of appendicitis, but their utility in combination with traditional diagnostic variables has not been tested. Our objective is to explore the potential of new inflammatory markers for improving the diagnosis of appendicitis. The diagnostic properties of the six most promising out of 21 new inflammatory markers (interleukin [IL]-6, chemokine ligand [CXCL]-8, chemokine C-C motif ligand [CCL]-2, serum amyloid A [SAA], matrix metalloproteinase [MMP]-9, and myeloperoxidase [MPO]) were compared with traditional diagnostic variables included in the Appendicitis Inflammatory Response (AIR) score (right iliac fossa pain, vomiting, rebound tenderness, guarding, white blood cell [WBC] count, proportion neutrophils, C-reactive protein and body temperature) in 432 patients with suspected appendicitis by uni- and multivariable regression models. Of the new inflammatory variables, SAA, MPO, and MMP9 were the strongest discriminators for all appendicitis (receiver operating characteristics [ROC] 0.71) and SAA was the strongest discriminator for advanced appendicitis (ROC 0.80) compared with defence or rebound tenderness, which were the strongest traditional discriminators for all appendicitis (ROC 0.84) and the WBC count for advanced appendicitis (ROC 0.89). CCL2 was the strongest independent discriminator beside the AIR score variables in a multivariable model. The AIR score had an ROC area of 0.91 and could correctly classify 58.3 % of the patients, with an accuracy of 92.9 %. This was not improved by inclusion of the new inflammatory markers. The conventional diagnostic variables for appendicitis, as combined in the AIR score, is an efficient screening instrument for classifying patients as low-, indeterminate-, or high-risk for appendicitis. The addition of the new inflammatory variables did not improve diagnostic performance further.

Place, publisher, year, edition, pages
Springer, 2014
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-112174 (URN)10.1007/s00268-014-2708-7 (DOI)000343048900006 ()25099684 (PubMedID)
Note

Funding Agencies|Jonkoping County Research Council; Research Council of South-Eastern Sweden (FORSS); Futurum- Academy of Health Care, Jonkoping County Council, Jonkoping, Sweden

Available from: 2014-11-18 Created: 2014-11-18 Last updated: 2017-12-05Bibliographically approved
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