Rijnland Ziekenhuis

Toepassing van de pre-pack in Curaçao: wat zijn de spelregels? In deze bijdrage staat de pre-packprocedure centraal die is voorafgegaan aan de doorstart van de naamloze vennootschap Curaçaose Dok Maatschappij N.V. Pre-packrichtlijnen scheppen duidelijkheid omtrent het wanneer, waarom en hoe rondom de toepassing van pre-packs. In de richtlijnen zal voor de beoogd curator een stevige rol moeten zijn weggelegd in het voorkomen van diverse aansprakelijkheidsrisico’s. De auteur moedigt het gerecht daarom aan serieus werk te maken van het ontwerpen van pre-packrichtlijnen. Het verdient aanbeveling om daarbij door middel van een consultatieronde de mening van curatoren en andere insolventierechtbeoefenaren te peilen.

Anastomotic leakage is a potential major complication after colorectal surgery. The C-seal was developed to help reduce the clinical leakage rate. It is an intraluminal sheath that is stapled proximal to a colorectal anastomosis, covering it intraluminally and thus preventing intestinal leakage in case of anastomotic dehiscence. The C-seal trial was initiated to evaluate the efficacy of the C-seal in reducing anastomotic leakage in stapled colorectal anastomoses. This RCT was performed in 41 hospitals in the Netherlands, Germany, France, Hungary and Spain. Patients undergoing elective surgery with a stapled colorectal anastomosis less than 15 cm from the anal verge were eligible. Included patients were randomized to the C-seal and control groups, stratified for centre, anastomotic height and intention to create a defunctioning stoma. Primary outcome was anastomotic leakage requiring invasive treatment. Between December 2011 and December 2013, 402 patients were included in the trial, 202 in the C-seal group and 200 in the control group. Anastomotic leakage was diagnosed in 31 patients (7·7 per cent), with a 10·4 per cent leak rate in the C-seal group and 5·0 per cent in the control group (P = 0·060). Male sex showed a trend towards a higher leak rate (P = 0·055). Construction of a defunctioning stoma led to a lower leakage rate, although this was not significant (P = 0·095). C-seal application in stapled colorectal anastomoses does not reduce anastomotic leakage. Registration number: NTR3080 (http://www.trialregister.nl/trialreg/index.asp).

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Background: Although the value of physical therapy (PT) in the rehabilitation of patients undergoing THA and TKA is generally acknowledged, little is known on the actual extent of its delivery and contents. This study aimed to describe the use, characteristics, and determinants of preoperative and postoperative PT in THA and TKA. Methods: One thousand and five patients who underwent THA or TKA in four hospitals in the preceding 7-22 mo were invited to complete a survey on referral, setting, duration, and content regarding preoperative and postoperative PT as well as their current level of physical functioning (Hip Disability and Osteoarthritis Outcome [HOOS] and Knee Injury and Osteoarthritis Outcome Score [KOOS]) and quality of life (Short Form-36 [SF-36]). The association between patients’ characteristics (age and sex), hospital stay, and time since surgery on the one side and the provision of PT on the other and between PT usage and physical function and quality of life were analyzed by multivariable logistic and linear regression analyses. Results: In total, 210 of the 522 responders (54% THA and 46% TKA) patients had preoperative PT (40%; 44%>12 wk; 38% ≥2 times per week) and 514 postoperative PT (99%; 47% ≥12 wk; 67% ≥2 times per week). The most frequently reported interventions (>60% of patients) preoperatively were aerobic exercises and walking stairs and postoperatively, aerobic, muscle strengthening and range of motion exercises, walking stairs, and gait training. Regarding preoperative PT, female sex was the only factor associated with its provision. Moreover, the hospital was related to the proportion of referrals made by the orthopaedic surgeon, and a longer follow-up time since surgery was associated with a lower rate of provision of physical modalities. For postoperative PT, the hospital was associated with duration of PT and the provision of passive exercises, whereas older age was associated with fewer referrals by orthopaedic surgeons and treatment duration less than 12 wk, and female sex was associated with a treatment duration longer than 12 wk. A longer duration of postoperative PT was only associated with a worse physical quality of life, whereas preoperative PT use and the frequency of postoperative PT were not associated with any aspect of the patients’ current health status. Conclusions: Almost all patients undergoing THA or TKA received postoperative PT, whereas fewer than half had preoperative PT. There was considerable variation in the provision of preoperative and postoperative PT in part associated with patient and hospital characteristics and time since surgery, warranting the need for more prospective research into potential practice variation.