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Background: Esophageal perforations cause severe life-threatening diseases with significant mortality and morbidity. The national incidence and long-term prognosis of these patients is incompletely described in the current literature. Methods: Information regarding each treatment episode for esophageal perforations that had occurred in Finland between 1996 and 2017 and survival data of each patient was obtained from national registries. The occurrence of the disease, related interventions, the number and type of later treatment episodes, as well as the prognosis of these patients was analyzed. Results: The total number of patients with esophageal perforations was 1106 (median age 65, 38% female) and the median follow-up time was 113 months. The overall incidence of the disease was 0.95 (95% CI ± 0.12) per 100,000 person years with male predominance and a trend for slightly increasing occurrence. Esophageal cancer was present in 5.8% of cases. Altogether 41% of patients underwent invasive treatment (31% endoscopic stenting, 69% surgery). Particularly stenting was more frequent later in the series. The median number of disease-related hospitalizations was two and later out-patient clinic visits four. The overall 30-day, 90-day, 1-year and 5-year mortality rates were 14%, 22%, 31% and 46%, respectively, and significantly higher in malignancy-associated cases. There were no clear improvements in the mortality rates over the study period, but the prognosis was better in patients that were treated in higher volume hospitals. Conclusion: There is a slightly increasing trend in the occurrence of esophageal perforations. Contemporary treatment is less invasive with similar results. Patients treated in high-volume hospitals have better prognosis. [ABSTRACT FROM AUTHOR]

Objectives: To ascertain whether extended chest tube drainage decreases the occurrence of late tamponade after cardiac surgery.Design: All patients undergoing cardiac surgery at the Tampere University Heart Hospital, Tampere, Finland, between the 23rd of October 2015 and the 17th of August 2016 were included. The first 260 consecutive patients were treated according to a short drainage protocol, in which the mediastinal chest tubes were removed during the first postoperative day unless producing >50ml/h, and the following 224 consecutive patients by an extended drainage protocol, in which the mediastinal chest tubes were kept at least until the second postoperative day, and thereafter if producing >50ml/4h. The incidence of late tamponade and the length and course of postoperative hospitalization, including the development of complications, were compared.Results: The occurrence of late cardiac tamponade was 8.8% following the short drainage protocol and 3.6% after the extended drainage protocol, p = .018. There were no statistically significant differences in the demographics, medical history, or the procedures performed between the study groups. The in-hospital mortality rate was 3.5%, the stroke rate was 2.1%, and the deep sternal wound infection rate was 1.7%, with no statistically significant differences between the groups. There were no differences in the need for reoperations for bleeding, infection rate, need for pleurocentesis, occurrence of atrial fibrillation, or the length of hospitalization between the groups.Conclusions: Longer mediastinal chest tube drainage after cardiac surgery is associated with a significantly lower incidence of late cardiac tamponade. [ABSTRACT FROM AUTHOR]

Objective: Venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism (PE), is an infrequent but consequential and potentially preventable complication after major surgical procedures. The aim of the study was to describe the long-term occurrence of symptomatic VTE in patients undergoing abdominal aortic aneurysm (AAA) repair and to ascertain patient-specific risk factors as well as to compare the rate with that of a reference population., Methods: The study included all patients who had undergone endovascular or open AAA repair, both elective and urgent/acute cases, at the Tampere University Hospital (Finland) between February 2001 and December 2016; 59% of patients had undergone endovascular and 41% open repair, and 23% of all cases had required urgent or emergency treatment. Information about later treatment episodes for symptomatic VTE and survival data were obtained from national registries. The reference population was obtained from national registries with a random sample of inhabitants matched for age, sex, and location of residence with a 4:1 ratio and was analyzed similarly., Results: Altogether, 1021 patients and 4065 controls were included (88% male; median age, 74 years in both groups). The high-risk period for VTE lasted for approximately 3 months, and during that time, its occurrence was highest in patients with coronary disease (2.5%), after open repair (2.4%), and in an urgent or emergency setting (2.6%), whereas the rate was low after endovascular aneurysm repair (1.0%). The cumulative incidence of VTE at 3 months, 1 year, 3 years, and 5 years was 1.1%, 1.6%, 2.7%, and 4.5% in patients and 0.1%, 0.3%, 1.0%, and 1.8% in the reference population, respectively (P < .001 each). Most VTE events were PE in the patient group. The 5-year mortality rates were 37.9% in patients and 23.8% in controls (P < .001)., Conclusions: The incidence of symptomatic VTE, particularly PE, after AAA repair is significant, in both short-term and long-term follow-up. Open surgery, acute setting, and concomitant coronary disease appear to increase the risk., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Objectives: Patients with pleural infections frequently have several comorbidities and inferior long-term survival. We hypothesized that these patients represent a vulnerable cohort with high rates of hospitalization and frequent use of healthcare services. This study aims to ascertain the need for and causes of treatment episodes after pleural infections during long-term follow-up., Methods: Patients treated for pleural infections at Tampere University Hospital between January 2000 and December 2008 (n = 191, 81% males, median age 58 years) were included and compared to a demographically matched population-based random sample of 1910 controls. Seventy percent of the pleural infections were caused by pneumonias and 80% of the patients underwent surgery. Information regarding later in-hospital periods and emergency room and out-patient clinic visits, as well as survival data, was obtained from national registries and compared between patients and controls., Results: Patients treated for pleural infections had significantly higher rates of hospitalizations (8.19 vs 2.19), in-hospital days (88.5 vs 26.6), emergency room admissions (3.18 vs 1.45), out-patient clinic visits (41.1 vs 11.8) and procedures performed (1.26 vs 0.55) per 100 patient-months when compared to controls during 5-year follow-up, in addition to having increased mortality (30% vs 11%), P-value <0.00001 each. Particularly, episodes due to respiratory and digestive diseases, malignancies and mental disorders were more frequent. The patients' comorbidities, such as alcoholism or chronic pulmonary disease, were associated with more frequent use of healthcare services., Conclusions: Patients treated for pleural infections have high rates of hospitalizations, emergency room admissions and out-patient clinic visits during follow-up., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background/aims: Serum lipid concentrations react during acute disease. We sought to measure changes in the serum lipid profile during acute pancreatitis and ascertain whether these changes were associated with the severity of the disease., Methods: A total of 233 patients (71% male, median age 48 years) hospitalized for acute pancreatitis were included in the study. The most common etiology for acute pancreatitis was alcohol (n = 131, 56%), followed by biliary (n = 48, 21%) and idiopathic pancreatitis (n = 36, 16%). Serum lipid levels were measured enzymatically. We analyzed samples obtained during the first days of hospitalization and later follow-up samples to measure changes during the course of the disease., Results: We report profound changes in the serum lipid concentrations during acute pancreatitis. Serum total cholesterol, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol concentrations measured within 2 days of admission (n = 203) were significantly lower in patients who developed severe pancreatitis (3.20 vs. 3.80 mmol/l, p = 0.001; 0.72 vs. 1.05 mmol/l, p < 0.000, and 1.60 vs. 2.14 mmol/l, p < 0.000, respectively). Low serum total cholesterol, HDL cholesterol and LDL cholesterol concentrations were moreover associated with in-hospital mortalities and longer hospitalization (p < 0.05). In the subgroup analysis, the findings remained statistically significant in patients with alcohol-induced acute pancreatitis., Conclusion: Levels of serum total cholesterol, HDL cholesterol and LDL cholesterol are significantly lower in patients with severe acute pancreatitis and are associated with longer hospitalization., (Copyright © 2013 S. Karger AG, Basel.)