Praeoperativt delay hos patienter med perforeret ulcus: en klinisk audit fra Det Nationale Indikatorprojekt

Morten Hylander Møller; Bente Mertz Nørgård; Frank Mehnert; Jørgen Bendix; Ann-Sophie Nielsen; Anne Nakano; Sven Adamsen; Reimar Wernich Thomsen; Morten Hylander Møller; Bente Mertz Nørgård; Frank Mehnert; Jørgen Bendix; Ann-Sophie Nielsen; Anne Nakano Jensen; Sven Adamsen; Reimar Wernich Thomsen

Praeoperativt delay hos patienter med perforeret ulcus: en klinisk audit fra Det Nationale Indikatorprojekt

Translated title of the contribution: Preoperative delay in patients with peptic ulcer perforation: a clinical audit from the Danish National Indicator Project

Morten Hylander Møller, Bente Mertz Nørgård, Frank Mehnert, Jørgen Bendix, Ann-Sophie Nielsen, Anne Nakano, Sven Adamsen, Reimar Wernich Thomsen, Morten Hylander Møller, Bente Mertz Nørgård, Frank Mehnert, Jørgen Bendix, Ann-Sophie Nielsen, Anne Nakano Jensen, Sven Adamsen, Reimar Wernich Thomsen

Abstract

Mortality following perforated peptic ulcer in Denmark is nearly 30%. Delayed surgery is a prognostic factor, but only half of the patients are operated within six hours of perforation - a predefined quality of care criterion in The Danish National Indicator Project. A clinical audit was conducted to investigate possible reasons.

Translated title of the contribution	Preoperative delay in patients with peptic ulcer perforation: a clinical audit from the Danish National Indicator Project
Original language	Danish
Journal	Ugeskrift for læger
Volume	171
Issue number	49
Pages (from-to)	3605-10
Number of pages	6
ISSN	0041-5782
Publication status	Published - 30 Nov 2009

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Møller, M. H., Nørgård, B. M., Mehnert, F., Bendix, J., Nielsen, A.-S., Nakano, A., Adamsen, S., Thomsen, R. W., Møller, M. H., Nørgård, B. M., Mehnert, F., Bendix, J., Nielsen, A.-S., Jensen, A. N., Adamsen, S., & Thomsen, R. W. (2009). Praeoperativt delay hos patienter med perforeret ulcus: en klinisk audit fra Det Nationale Indikatorprojekt. Ugeskrift for læger, 171(49), 3605-10.

Møller, MH, Nørgård, BM, Mehnert, F, Bendix, J, Nielsen, A-S, Nakano, A, Adamsen, S, Thomsen, RW, Møller, MH, Nørgård, BM, Mehnert, F, Bendix, J, Nielsen, A-S, Jensen, AN, Adamsen, S & Thomsen, RW 2009, 'Praeoperativt delay hos patienter med perforeret ulcus: en klinisk audit fra Det Nationale Indikatorprojekt', Ugeskrift for læger, vol. 171, no. 49, pp. 3605-10.

@article{b9429680828e11df928f000ea68e967b,

title = "Praeoperativt delay hos patienter med perforeret ulcus: en klinisk audit fra Det Nationale Indikatorprojekt",

abstract = "INTRODUCTION: Mortality following perforated peptic ulcer in Denmark is nearly 30%. Delayed surgery is a prognostic factor, but only half of the patients are operated within six hours of perforation - a predefined quality of care criterion in The Danish National Indicator Project. A clinical audit was conducted to investigate possible reasons. MATERIAL AND METHODS: All patients (n = 89) surgically treated for peptic ulcer perforation in six university hospitals in Denmark over a period of one year were included. The association between a number of predefined variables related to the internal organisation of health care, the patient's pathological picture and the quality of treatment given, and a preoperative delay of at least 6 hours was examined using modified Poisson regression analyses. RESULTS: The following variables were associated with a preoperative delay = 6 hours: 1) out of hospital versus in hospital perforation (adjusted relative risk (RR) 1.87; 95% confidence interval (CI) 0.86-4.05), 2) no classical clinical symptoms of ulcer perforation (adjusted RR with peritonism 0.32; 95% CI 0.14-0.73), 3) first physician attendance later than median time, i.e. > 25 minutes after debut (adjusted RR 2.78; 95% CI 1.32-5.87), 4) first attendance not by senior physician (adjusted RR 1.97; 95% CI 0.95-4.05) and/or senior physician not called in (adjusted RR 2.53; 95% CI 1.12-5.75), and 5) oxygen saturation not monitored upon admission (adjusted RR 1.45; 95% CI 0.73-2.91). CONCLUSION: Although of limited size, this audit suggests that long preoperative delay in patients with peptic ulcer perforation is associated with factors related to both the internal organisation of the healthcare system, the patient's pathological picture, and the quality of diagnosis and treatment given. Udgivelsesdato: 2009-Nov",

author = "M{\o}ller, {Morten Hylander} and N{\o}rg{\aa}rd, {Bente Mertz} and Frank Mehnert and J{\o}rgen Bendix and Ann-Sophie Nielsen and Anne Nakano and Sven Adamsen and Thomsen, {Reimar Wernich} and M{\o}ller, {Morten Hylander} and N{\o}rg{\aa}rd, {Bente Mertz} and Frank Mehnert and J{\o}rgen Bendix and Ann-Sophie Nielsen and Jensen, {Anne Nakano} and Sven Adamsen and Thomsen, {Reimar Wernich}",

note = "Keywords: Adult; Aged; Aged, 80 and over; Clinical Audit; Clinical Competence; Delayed Diagnosis; Denmark; Duodenal Ulcer; Female; Humans; Male; Middle Aged; Peptic Ulcer Perforation; Preoperative Care; Prognosis; Quality Indicators, Health Care; Stomach Ulcer; Time Factors",

year = "2009",

month = nov,

day = "30",

language = "Dansk",

volume = "171",

pages = "3605--10",

journal = "Ugeskrift for l{\ae}ger",

issn = "0041-5782",

publisher = "Almindelige Danske Laegeforening",

number = "49",

}

TY - JOUR

T1 - Praeoperativt delay hos patienter med perforeret ulcus: en klinisk audit fra Det Nationale Indikatorprojekt

AU - Møller, Morten Hylander

AU - Nørgård, Bente Mertz

AU - Mehnert, Frank

AU - Bendix, Jørgen

AU - Nielsen, Ann-Sophie

AU - Nakano, Anne

AU - Adamsen, Sven

AU - Thomsen, Reimar Wernich

AU - Møller, Morten Hylander

AU - Nørgård, Bente Mertz

AU - Mehnert, Frank

AU - Bendix, Jørgen

AU - Nielsen, Ann-Sophie

AU - Jensen, Anne Nakano

AU - Adamsen, Sven

AU - Thomsen, Reimar Wernich

N1 - Keywords: Adult; Aged; Aged, 80 and over; Clinical Audit; Clinical Competence; Delayed Diagnosis; Denmark; Duodenal Ulcer; Female; Humans; Male; Middle Aged; Peptic Ulcer Perforation; Preoperative Care; Prognosis; Quality Indicators, Health Care; Stomach Ulcer; Time Factors

PY - 2009/11/30

Y1 - 2009/11/30

N2 - INTRODUCTION: Mortality following perforated peptic ulcer in Denmark is nearly 30%. Delayed surgery is a prognostic factor, but only half of the patients are operated within six hours of perforation - a predefined quality of care criterion in The Danish National Indicator Project. A clinical audit was conducted to investigate possible reasons. MATERIAL AND METHODS: All patients (n = 89) surgically treated for peptic ulcer perforation in six university hospitals in Denmark over a period of one year were included. The association between a number of predefined variables related to the internal organisation of health care, the patient's pathological picture and the quality of treatment given, and a preoperative delay of at least 6 hours was examined using modified Poisson regression analyses. RESULTS: The following variables were associated with a preoperative delay = 6 hours: 1) out of hospital versus in hospital perforation (adjusted relative risk (RR) 1.87; 95% confidence interval (CI) 0.86-4.05), 2) no classical clinical symptoms of ulcer perforation (adjusted RR with peritonism 0.32; 95% CI 0.14-0.73), 3) first physician attendance later than median time, i.e. > 25 minutes after debut (adjusted RR 2.78; 95% CI 1.32-5.87), 4) first attendance not by senior physician (adjusted RR 1.97; 95% CI 0.95-4.05) and/or senior physician not called in (adjusted RR 2.53; 95% CI 1.12-5.75), and 5) oxygen saturation not monitored upon admission (adjusted RR 1.45; 95% CI 0.73-2.91). CONCLUSION: Although of limited size, this audit suggests that long preoperative delay in patients with peptic ulcer perforation is associated with factors related to both the internal organisation of the healthcare system, the patient's pathological picture, and the quality of diagnosis and treatment given. Udgivelsesdato: 2009-Nov

AB - INTRODUCTION: Mortality following perforated peptic ulcer in Denmark is nearly 30%. Delayed surgery is a prognostic factor, but only half of the patients are operated within six hours of perforation - a predefined quality of care criterion in The Danish National Indicator Project. A clinical audit was conducted to investigate possible reasons. MATERIAL AND METHODS: All patients (n = 89) surgically treated for peptic ulcer perforation in six university hospitals in Denmark over a period of one year were included. The association between a number of predefined variables related to the internal organisation of health care, the patient's pathological picture and the quality of treatment given, and a preoperative delay of at least 6 hours was examined using modified Poisson regression analyses. RESULTS: The following variables were associated with a preoperative delay = 6 hours: 1) out of hospital versus in hospital perforation (adjusted relative risk (RR) 1.87; 95% confidence interval (CI) 0.86-4.05), 2) no classical clinical symptoms of ulcer perforation (adjusted RR with peritonism 0.32; 95% CI 0.14-0.73), 3) first physician attendance later than median time, i.e. > 25 minutes after debut (adjusted RR 2.78; 95% CI 1.32-5.87), 4) first attendance not by senior physician (adjusted RR 1.97; 95% CI 0.95-4.05) and/or senior physician not called in (adjusted RR 2.53; 95% CI 1.12-5.75), and 5) oxygen saturation not monitored upon admission (adjusted RR 1.45; 95% CI 0.73-2.91). CONCLUSION: Although of limited size, this audit suggests that long preoperative delay in patients with peptic ulcer perforation is associated with factors related to both the internal organisation of the healthcare system, the patient's pathological picture, and the quality of diagnosis and treatment given. Udgivelsesdato: 2009-Nov

M3 - Tidsskriftartikel

SN - 0041-5782

VL - 171

SP - 3605

EP - 3610

JO - Ugeskrift for læger

JF - Ugeskrift for læger

IS - 49

ER -

Praeoperativt delay hos patienter med perforeret ulcus: en klinisk audit fra Det Nationale Indikatorprojekt

Abstract

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