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henrik kehlet

Pelle B Petersen, Henrik Kehlet, Christoffer C Jørgensen
Background and purpose - Acute myocardial infarction (MI) is a leading cause of mortality following total hip and knee arthroplasty (THA/TKA). The reported 30-day incidence of MI varies from 0.3% to 0.9%. However, most data derive from administration and insurance databases or large RCTs with potential confounding factors. We studied the incidence of and potential modifiable risk factors for postoperative MI in a large, multicenter optimized "fast-track" THA/TKA setting. Patients and methods - A prospective cohort study was conducted on consecutive unselected elective primary unilateral THA and TKA, using prospective information on comorbidities and complete 90-day follow-up from the Danish National Patient Registry...
October 17, 2018: Acta Orthopaedica
Brian Lee, Stephan A Schug, Girish P Joshi, Henrik Kehlet
Post-operative pain management protocols may be optimised by examining procedure-specific evidence and outcomes. This recognition led to the formation of the PROcedure-SPECific Pain ManagemenT (PROSPECT) collaboration of anaesthesiologists and surgeons. The aim of PROSPECT is to provide practical and evidence-based recommendations to prevent and treat post-operative pain after specific surgical procedures, thereby overcoming the limitations of generic, non-specific guidelines. Updates in the methodology of PROSPECT in 2017 have placed an increased emphasis on the clinical relevance of studies, including a focus on interventions in the context of multimodal analgesia strategies and consideration of risks and benefits of interventions in specific surgical settings...
June 2018: Best Practice & Research. Clinical Anaesthesiology
Henrik Kehlet, Girish P Joshi
No abstract text is available yet for this article.
October 12, 2018: Anesthesia and Analgesia
Thomas Bandholm, Thomas W Wainwright, Henrik Kehlet
Exercise-based interventions applied before and after total hip and knee arthroplasty (THA and TKA, respectively) have been investigated for a number of years, based on the assumption that they will enhance post-operative recovery. Although recent studies suggest that high-volume, pre-operative exercise may enhance post-operative recovery after TKA, studies of post-operative exercise-based interventions, have not found superiority of one exercise regime over another. It seems, however, that post-operative, exercise-based, rehabilitation is superior to no or minimal rehabilitation after THA and TKA...
October 11, 2018: Journal of Experimental Orthopaedics
Martin Blomberg Jensen, Henrik Husted, Poul Jannik Bjerrum, Anders Juul, Henrik Kehlet
Surgical stress reduces concentrations of most proteins in serum and necessitates a rapid adjustment of hormones dependent on protein binding. Activation of vitamin D by renal 1α-hydroxylation is dependent on protein binding because 1,25-dihydroxyvitamin D (1,25(OH)2 D3 ) is formed after megalin-mediated reabsorption of 25-hydroxyvitamin D (25OHD) bound to vitamin D binding protein (DBP). Postoperative alterations in serum concentrations of DBP and albumin may therefore impair 1,25(OH)2 D3 production. Our objective was to determine sex-specific changes in serum concentrations of vitamin D metabolites and sex steroids 2, 6, 24, and 48 hours and 3 weeks postoperatively...
September 2018: JBMR Plus
Kristian Kiim Jensen, Jannie Dressler, Niklas Nygaard Baastrup, Henrik Kehlet, Lars Nannestad Jørgensen
BACKGROUND: Enhanced recovery after surgery has been shown to lead to improved postoperative outcomes after several surgical procedures. However, only a few studies have examined the application of enhanced recovery after surgery after abdominal wall reconstruction. The aim of the current observational cohort study was to evaluate the outcomes of enhanced recovery after surgery after abdominal wall reconstruction in a large cohort. METHOD: This was a retrospective cohort study comparing patients undergoing abdominal wall reconstruction in a standard care pathway (control group) with patients undergoing abdominal wall reconstruction in an enhanced recovery after surgery pathway...
September 5, 2018: Surgery
Kasper Wennervaldt, Anne Mette Kejs, Henriette Lipczak, Paul Bartels, Michael Borre, Claus Wilki Fristrup, Henrik Kehlet
INTRODUCTION: Surgical treatment for pancreatic cancer carries a high risk of both morbidity and mortality. Even so, it remains the best curative treatment option. In Denmark, pancreatic surgery has been extensively centralised since the millennium, but the effect of this centralisation on patient outcome has not been evaluated. This study describes regional variation within pancreatic surgery on a malignant indication, focusing on production volume, length of stay, readmission rates and mortality...
September 2018: Danish Medical Journal
René Vonlanthen, Peter Lodge, Jeffrey S Barkun, Olivier Farges, Xavier Rogiers, Kjetil Soreide, Henrik Kehlet, John V Reynolds, Samuel A Käser, Peter Naredi, Inne Borel-Rinkes, Sebastiano Biondo, Hugo Pinto-Marques, Michael Gnant, Philippe Nafteux, Miroslav Ryska, Wolf O Bechstein, Guillaume Martel, Justin B Dimick, Marek Krawczyk, Attila Oláh, Antonio D Pinna, Irinel Popescu, Pauli A Puolakkainen, Georgius C Sotiropoulos, Erkki J Tukiainen, Henrik Petrowsky, Pierre-Alain Clavien
OBJECTIVES: To critically assess centralization policies for highly specialized surgeries in Europe and North America and propose recommendations. BACKGROUND/METHODS: Most countries are increasingly forced to maintain quality medicine at a reasonable cost. An all-inclusive perspective, including health care providers, payers, society as a whole and patients, has ubiquitously failed, arguably for different reasons in environments. This special article follows 3 aims: first, analyze health care policies for centralization in different countries, second, analyze how centralization strategies affect patient outcome and other aspects such as medical education and cost, and third, propose recommendations for centralization, which could apply across continents...
November 2018: Annals of Surgery
Henrik Kehlet
No abstract text is available yet for this article.
September 2018: Pain
Jens R Eriksen, Pia Munk-Madsen, Henrik Kehlet, Ismail Gögenur
BACKGROUND: Orthostatic hypotension (OH) and intolerance (OI) are common findings in the early postoperative period after major surgery and may delay early mobilization. The mechanism of impaired orthostatic competence and OI symptoms is not fully understood, and specific data after colorectal surgery with well-defined perioperative care regimens and mobilization protocols are lacking. The aim of this study was to investigate the prevalence, possible risk factors and the impact of OI in patients undergoing elective minimal invasive colorectal cancer resection...
August 10, 2018: Acta Anaesthesiologica Scandinavica
Iben Engelund Luna, Henrik Kehlet, Heidi Raahauge Wede, Susanne Jung Hoevsgaard, Eske Kvanner Aasvang
Although reduced early physical function after total hip- and knee arthroplasty (THA/TKA) is well-described, the underlying reasons have not been clarified with detailed studies on pathophysiological mechanisms related to recovery, thereby prohibiting advances in rehabilitation. Thus, we aimed to describe early post-THA/TKA physical activity measured by actigraphy and potential underlying pathophysiological mechanisms related to recovery in a well-defined cohort of THA and TKA patients. Daytime-activity was measured from 2 days before until 13 (THA) or 20 (TKA) days after surgery...
July 23, 2018: Journal of Clinical Monitoring and Computing
Hocine Slimani, Leon Plaghki, Paola Valenti, Mads U Werner, Henrik Kehlet, Ron Kupers
It remains unclear which nerve fibers are responsible for mediating hyperalgesia after skin injury. Here, we examined the role of Aδ and C fibers in inflammatory hyperalgesia after a first-degree burn injury. A CO2 laser delivered ultrafast short constant-temperature heat pulses to the upper part of the lower leg to stimulate selectively the relatively fast-conducting thinly myelinated Aδ and the slowly conducting unmyelinated C fibers. Participants were asked to respond as fast as possible whenever they detected a thermal stimulus...
July 9, 2018: Pain
Li Yun, Jiang Zhiwei, Henrik Kehlet, Wang Gang, Liu Jiang, Li Jieshou
No abstract text is available yet for this article.
July 2, 2018: Annals of Surgery
Viktoria Lindberg-Larsen, Henrik Kehlet, Jens Bagger, Sten Madsbad
BACKGROUND: To evaluate the effect of a single preoperative dose of 125 mg methylprednisolone (MP) on glycemic homeostasis early after fast-track total hip and knee arthroplasty. METHODS: One-hundred thirty-four patients undergoing elective unilateral total hip arthroplasty and total knee arthroplasty were randomized (1:1) to preoperative intravenous MP 125 mg (group MP) or isotonic saline intravenous (group C). All procedures were performed under spinal anesthesia, using a standardized multimodal analgesic regime...
October 2018: Anesthesia and Analgesia
Kenneth Geving Andersen, Maj-Britt Jensen, Henrik Kehlet, Rune Gärtner, Lise Eckhoff, Niels Kroman
Background Persistent pain after breast cancer treatment (PPBCT) is a considerable clinical problem affecting between 25 and 60% of breast cancer survivors [1]. Several risk factors have been proposed, among them nerve damage caused by adjuvant treatment [2]. Taxanes used in adjuvant therapy for breast cancer are neurotoxic, and thereby being a potential risk factor for PPBCT and sensory disturbances. However, the long term influence of taxanes on PPBCT is not well documented. Thus, the aim of this study was therefore to compare a nationwide cohort treated with cyclophosphamide and epirubicin + docetaxel (CE + T) versus a nationwide cohort treated with cyclophosphamide, epirubicin and fluoruracil (CEF), in order to assess differences in reporting of PPBCT, sensory disturbances in surgical area, symmetric peripheral sensory disturbances, and functional impairment...
December 29, 2017: Scandinavian Journal of Pain
Kim Wildgaard, Thomas K Ringsted, Henrik Kehlet, Mads U Werner
Background/aims Quantitative sensory testing (QST) is a reference method in characterization of neuropathic pain components. Variability data on thermal thresholds have been presented for a number of diseases, but not for patients with persistent post-surgical pain. Thus, the objectives of the present study were to assess the day-to-day variation, but also topographic variability in thermal threshold assessments in post-thoracotomy pain syndrome (PTPS) patients. The variability in thermal thresholds between pre-specified sites, on the surgical and the non-surgical side were compared to each other and to the area of maximum pain...
December 29, 2017: Scandinavian Journal of Pain
Mads U Werner, Thomas K Ringsted, Henrik Kehlet, Kim Wildgaard
Background/aims Mirror-image sensory dysfunction (MISD) has been described in various medical conditions, but has not been systematically characterized following major surgery. Methods The presence of MISD was evaluated with standardized thermal and mechanical stimuli, in a group of preoperative patients scheduled for thoracotomy (n = 14) and in patients with post-thoracotomy pain syndrome (PTPS = 14). The primary outcome was areas with sensory dysfunction evaluated by dynamic sensory mapping with metal-rollers and a brush...
December 29, 2017: Scandinavian Journal of Pain
Lotte Linnemann Rønfeldt, Dorthe Hjort Jakobsen, Henrik Kehlet, Henriette Lipczak, Kasper Wennervaldt
INTRODUCTION: Clinical practice guidelines (CPGs) support enhanced post-operative recovery and decrease morbidity. In addition, patient information leaflets (PILs) are associated with enhanced overall outcomes and improved patient satisfaction. The aim of this study was to provide an overview of the quality of CPGs and PILs in cancer surgery departments undertaking pulmonary lobectomy, nephrectomy, cystectomy, whipples, colorectal and ovarian surgery. METHODS: We conducted a cross-sectional descriptive study within 44 surgical departments in six cancer subspecialties: lung (n = 4), kidney (n = 9), bladder (n = 5), pancreas (n = 4), colorectal (n = 18) and ovarian (n = 4)...
June 2018: Danish Medical Journal
Kristian Kjær Petersen, Troels Haxholdt Lunn, Henrik Husted, Lars Tambour Hansen, Ole Simonsen, Mogens Berg Laursen, Henrik Kehlet, Lars Arendt-Nielsen
BACKGROUND AND AIMS: Approximately 20% of patients having total knee arthroplasty (TKA) will experience chronic postoperative pain. Recently, preoperative pain facilitation has been associated with chronic pain after TKA, and gabapentin has been shown to decrease pain facilitation. The current study is a secondary follow-up of a primary RCT investigating the effect of gabapentin on acute postoperative pain after TKA and exploring the effect of pre- and perioperative administration of gabapentin on chronic postoperative pain and psychological state 3-4 years after TKA...
April 25, 2018: Scandinavian Journal of Pain
Henrik Kehlet, Viktoria Linberg-Larsen
No abstract text is available yet for this article.
May 21, 2018: Acta Orthopaedica
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