Onze Lieve Vrouwe Gasthuis

AimRobotic assisted Trans Abdominal Retromuscular Umbilical Prosthesis (rTARUP) is being increasingly performed to treat Ventral Hernia. Prospective (long-term) studies are scarce. In this study we investigated 125 patients with short and long-term follow-up, regarding surgical and hernia-related quality-of-life outcomes.Material and MethodsPatients undergoing rTARUP were selected from consecutive prospectively collected databases from two teaching hospitals from the Netherlands. The patients were operated by experienced surgeons in a standardized manner. Patient characteristics and short-term outcomes after surgery were retrospectively reviewed and follow up data about hernia recurrence and quality of life was prospectively collected.Results125 rTARUP patients were included for analysis. The most common hernia type was primary (n = 61), followed by recurrent (n = 37) and incisional (n = 27). The median surgical time was 90 min. 44/61 (72%) patients with a primary ventral hernia were treated as daycase. The 30-day complication rate was 7.2%. Median follow up was 24 months after which a large majority of patients (84%) reported to feel better or much better. There were 3 reoperations for recurrences (2.4%).ConclusionrTARUP is a safe and effective procedure that can be performed in a timely manner, with short hospital stay and a low complication rate. Further research is needed into economical costs and benefits to fully justify the use of robotic surgery for these indications.

Background and purposeThe 2 most common surgical approaches in hemiarthroplasty for hip fracture treatment are the posterolateral and the direct lateral approach. We aimed to estimate the relative cost-effectiveness of these approaches.MethodsWe conducted an economic evaluation alongside a randomized controlled superiority trial for 6 months. The trial included 555 patients over 18 years of age with an acute femoral neck fracture. The effectiveness outcome used was quality-adjusted life years (QALYs), assessed using the EQ-5D-5L. Costs were measured through self-reported questionnaires administered at baseline, after 3 months, and after 6 months. We dealt with missing data through multiple imputation and analyzed the imputed datasets by comparing group means in costs and QALYs. A secondary analysis included adjustment for baseline imbalances through linear regression.ResultsThe estimated average treatment effect on the QALYs was 0.02 (95% confidence interval [CI] –0.006 to 0.046). From the healthcare and societal perspective, we found a non-significant average treatment effect on costs of 1,508 (CI –1,744 to 4,760) and 1,583 (CI –1,972 to 5,137), respectively. The probability of cost-effectiveness was 10% at a willingness-to-pay of zero, and then slowly increased to around 50% for higher willingness-to-pay values.ConclusionWe found no conclusive evidence of any differences between the surgical approaches with respect to costs, QALYs, and cost-effectiveness. We therefore suggest that, from an economic viewpoint, the 2 surgical approaches should be treated as interchangeable.

This study aims to assess the peri- and postoperative outcomes of the vNOTES hysterectomy in the Netherlands during implementation. Nationwide cohort study. vNOTES hysterectomies performed in the Netherlands by 15 hospitals since the implementation of the technique, from August 2019 to September 2024. 673 patients undergoing vNOTES hysterectomy. Descriptive data are presented as frequencies with percentage or mean with range. Logistic regression was used to assess the risk of conversions/complications per BMI group. Peri- and postoperative outcomes such as operating time, conversions, and complications. The mean operating time was 67.4 min (range 24-210). There were 37 (5.5%) conversions and 94 (15.5%) complications. Nineteen (2.8%) complications were perioperative, and 75 (12.7%) postoperative. Ten (1.5%) of the perioperative complications were classified as Clavien-Dindo (CD) 1, and nine (1.3%) as CD3. Postoperatively, 18 patients (3.1%) had a reintervention (N = 17 CD3, N = 1 CD4), and two (0.3%) patients were admitted to the intensive care unit (CD4). The mean blood loss was 127 mL (range 50-2000), and 220 (37%) of patients were discharged the same day. This large nationwide cohort study during implementation of the vNOTES hysterectomy demonstrates the safety and feasibility of this upcoming technique, reporting on a short surgery duration and a similar complication percentage compared to other methods of hysterectomy.

The diurnal rhythm of the hypothalamic-pituitary-adrenal (HPA) axis is essential for physical and mental health. There are sex differences in this diurnal rhythm, including steeper diurnal cortisol slopes in females compared to males, and sex hormones likely contribute to this difference. While previous studies found changes in HPA axis responsivity and serum cortisol in transgender people starting gender-affirming hormone therapy (GAHT), no study examined the effect of GAHT on diurnal salivary cortisol. This study examined sex differences in diurnal cortisol and changes in diurnal cortisol after three months of GAHT.We analyzed salivary cortisol levels in eleven transmasculine (TM) and seven transfeminine (TF) participants before GAHT and after three months of GAHT. Participants collected saliva samples at 30 min, 5.5 h and 10.5 h after awakening, and at bedtime. Absolute cortisol levels and diurnal cortisol slopes were compared between the groups at baseline, and in each group between baseline and three months of GAHT.Before starting GAHT, the TM group showed a steeper diurnal cortisol slope compared to the TF group. Neither the TM group nor the TF group showed any significant changes in cortisol levels or slopes after GAHT.We replicate previously reported sex differences in diurnal cortisol levels at baseline, but we find no significant changes in diurnal salivary cortisol after participants start GAHT. This could be associated with homeostatic adaptation of the HPA axis and cortisol-binding globulin concentrations. Future studies should focus on the role of bound and unbound cortisol and stress-related cortisol changes.

Hepatic encephalopathy is a frequent complication of cirrhosis. Rifaximin-α has been included in guidelines for secondary prevention of hepatic encephalopathy, but there are few real-world data on its efficacy and impact on healthcare utilization. In this study, we aimed to assess the effect of rifaximin-α on healthcare utilization. We conducted a cohort analysis in patients from seven hospitals in the Netherlands, who received rifaximin-α as secondary prophylaxis for hepatic encephalopathy. Data were compared 6months before and 6months after the prescription of rifaximin-α. The primary endpoint was the effect of rifaximin-α on healthcare utilization. Secondary endpoint was the effect of rifaximin-α on healthcare costs. We included 126 patients (65% male; median age 68) with a median Model for End-stage Liver Disease score of 15. The mean number of hepatic encephalopathy episodes after starting rifaximin-α was lower than before starting rifaximin-α (0.9 vs. 2.2; p<0.001). Mean healthcare utilization decreased from 6.1 contacts in the 6months before rifaximin-α to 3.3 contacts in the 6months after starting rifaximin-α (p<0.001). The mean number of hospital admissions decreased from 1.7 admissions per patient to 1.0 admissions after starting rifaximin-α (p<0.001). The mean number of outpatient visits also decreased after starting rifaximin-α (2.4 visits per patient to 1.7; p=0.001). Annual costs per patient before starting rifaximin-α were €13,320. This was similar to the costs after rifaximin-α was prescribed (€13,120). Rifaximin-α significantly reduced the number of episodes of hepatic encephalopathy, the number of hospital admissions as well as the number of outpatient and emergency department visits, contributing to a reduction in healthcare utilization. There was no reduction in overall costs.

BackgroundA wide range of effective antiretroviral therapy (ART) regimens with favourable side effects are available. More than 70% of HIV care costs in the Netherlands are attributed to ART. We developed an ART algorithm to proactively switch virologically suppressed individuals to a more cost-effective HIV treatment.MethodsThis prospective study implemented our ART algorithm in two large Dutch HIV clinics, where a pharmacist screened ART regimens for 1 year. Individuals were considered suitable for a switch if their current ART exceeded €600 per month, considering renal function and/or tubular toxicity, hepatitis B status, and resistance history. If eligible, advice with a switch proposal was recorded in the patient file. The objective was to investigate the acceptance of the proposal and the effect of proactive switching on the total costs of ARTs.FindingsOf 1596 people living with HIV, 840 (52.6%) were eligible. Prescribers accepted 81.1% of the switch proposals, and 84.9% of eligible individuals agreed to the proposed switch. Ultimately, 558 individuals accepted the new ART regimen proposal, with doravirine/tenofovir disoproxil fumarate/lamuvidine (DOR/TDF/3TC) being the most prescribed (61.6%). The switch led to significant cost savings, reducing annual ART expenditure from €10 923 to €8580 per eligible individual, totalling almost €2 million (−21.4%) in savings annually.InterpretationOur ART algorithm demonstrated high acceptance by prescribers and people with HIV, leading to substantial cost savings. The algorithm can be easily implemented in other HIV clinics to offer even more significant cost savings to Dutch healthcare payers.

Antibiotic overtreatment in infants is a significant problem, due to lack of accurate diagnostic tools for late-onset neonatal sepsis (LONS). We aimed to investigate the diagnostic accuracy of presepsin for LONS at initial suspicion. In this multicenter prospective observational cohort study, we consecutively included all term and preterm infants who started on antibiotics empirically for a nosocomial LONS suspicion. Presepsin concentrations were determined at initial LONS suspicion before antibiotic initiation (t = 0), and 12 and 24 h afterwards. Diagnostic accuracy measures for LONS were calculated. A total of 63 episodes of suspected LONS (32 classified as LONS, including 23 culture-positive and 9 culture-negative episodes) in 50 infants were included. Presepsin concentrations were significantly higher in LONS cases compared with non-LONS at all time-points. The AUC for all LONS cases at t = 0 was 0.77 (95% CI 0.66-0.89) and 0.80 (95% CI 0.67-0.92) for culture-positive LONS cases only. Presepsin seems to have insufficient accuracy as single biomarker to serve as a biomarker for ruling out LONS in infants suspected of LONS. Future larger studies are warranted to validate our findings and to investigate the clinical impact of presepsin, in combination with other biomarkers, as diagnostic tool to facilitate decision-making regarding the initiation of antibiotics, thereby supporting antibiotic stewardship. Presepsin seems to have insufficient accuracy as single biomarker for the decision to treat or not at initial suspicion of late-onset neonatal sepsis. This is the first prospective observational cohort study on the diagnostic accuracy of presepsin for late-onset neonatal sepsis consecutively recruiting all infants suspected of late-onset neonatal sepsis, minimizing bias. Future larger studies are warranted to investigate the clinical impact of presepsin in facilitating decision-making regarding the initiation of antibiotics in infants, thereby supporting antibiotic stewardship.

ABSTRACTBackgroundThird‐generation resorbable magnesium scaffold (RMS) was developed with stronger mechanical properties and thinner struts compared to its predecessor. This study aimed to assess the influence of the OCT‐derived underlying plaque characteristics on in‐scaffold late lumen loss (LLL) in patients treated with RMS up to 12‐months.MethodsPatients enrolled in the BIOMAG‐I trial and who underwent OCT imaging before and after the index procedure were included in the current analysis. The acquired intravascular imaging data were evaluated to assess the presence of fibrous, calcific, or lipidic lesions. We calculated the proportions of each plaque feature per pullback and assessed their correlation with LLL obtained at 6‐ and 12‐months follow‐up. In addition, we investigated the potential impact of scaffold edge dissection and strut malapposition on in‐scaffold LLL.ResultsEighty‐four patients and 84 lesions were evaluated in the current analysis. There was no significant correlation between the underlying plaque characteristic and in‐scaffold LLL at 6‐months (p = 0.79 for fibrous, p = 0.88 for calcific, p = 0.67 for lipid lesions). This trend was similar at 12 months follow‐up (p = 0.56 for fibrous, p = 0.75 for calcific, p = 0.69 for lipid lesions). The presence or absence of edge dissection did not influence the degree of in‐scaffold ‐ (p = 0.51 at 6‐months, p = 0.68 at 12‐months follow‐up) or in‐segment LLL (p = 0.88 at 6‐months, p = 0.70 at 12‐months follow‐up).ConclusionThe underlying plaque characteristics, edge dissection or strut malapposition had no significant impact on in‐scaffold LLL following DREAMS 3 G implantation up to 12 months. This suggests better device performance irrespective of the underlying plaque characteristics.Trial RegistrationClinicalTrials.gov ID: NCT04157153.

Background/Objectives: An acute aortic dissection (AAD) is a cardiovascular emergency with high mortality rates if left untreated. Survival has increased due to improvements in diagnosis and therapy. However, during their recovery, survivors frequently encounter major social, psychological, and physical challenges. This study aimed to evaluate the recovery experience of AAD survivors in The Netherlands. Insights on sleep quality, physical activity, and quality of life were collected from a unique nationwide cohort of AAD survivors recruited through the national patient support network ‘Stichting Aorta Dissectie Nederland’. Methods: This study was conducted among AAD survivors who were recruited through a national association for aortic dissection known as ‘Stichting Aorta Dissectie Nederland (SADN)’. The participants (n = 61) completed questionnaires assessing demographic data, physical activity, sleep quality, and health-related QoL. Results: The cohort had a mean age of 60.1 years, and 47.5% of the participants were female. The prevalence of sleep disruptions was high, as 55.7% of the people were categorized as bad sleepers (PSQI > 5). Poor sleep was associated with low physical activity and a higher BMI. The physical activity levels varied, with 47.5% reporting moderate activity levels and 44.3% reporting high activity levels. The QoL scores varied greatly among the participants, with significant impairment across all fields and reduced enthusiasm for daily activities. Poor sleepers reported significantly lower QoL (p < 0.001). Conclusions: Our study highlights significant gaps in post-AAD care, particularly addressing QoL, sleep, and physical activity. By acknowledging the multifaceted nature of recovery, healthcare providers can develop tailored interventions that empower survivors to achieve better quality of life.