Closing a temporary ileostomy within two weeks.

Temporary ileostomy is frequently constructed to relieve a rectal anastomosis and avoid peritonitis if the anastomosis is leaking. Ostomy is a burden for both the patient and society and early closure is therefore desirable to counteract increased morbidity. Several prospective studies and a single randomized controlled trial have shown that closure in less than two weeks was associated with lower or equal morbidity compared with later closure. Thus, current data support early closure of temporary ileostomy performed to cover rectal anastomosis in routine clinical practice.

No reduction in mortality after centralisation in treatment of patients with ruptured abdominal aneurism.

INTRODUCTION: Ruptured abdominal aortic aneurism (rAAA) is a severe condition with all-cause mortality rates reaching 80%. We speculated whether the 2008 centralisation of the treatment of patients with rAAA in Denmark had improved outcome as suggested in other surgical specialties. Accordingly, our aim was to describe temporal changes in mortality for patients undergoing surgery for rAAA in the Capital Region of Denmark between 2009 and 2015. METHODS: This was a retrospective population-based cohort study of patients in the intensive care unit diagnosed and treated for rAAA at Rigshospitalet from 1 January 2009 to 31 December 2015. Patient characteristics and procedure-related variables were obtained from the medical records. The primary outcome measure was death within 90 days of the primary surgical procedure. RESULTS: A total of 339 patients were diagnosed with rAAA, and 275 patients were included in the final study population; 26.9% of the patients died within 90 days of the primary surgical procedure, whereas the 30-day and one-year mortality was 18.5% and 31.6%, respectively. No consistent reduction in mortality was observed throughout the observation period. CONCLUSIONS: In this population-based cohort study of patients surgically treated for rAAA, we found no consistent reduction in mortality over time following centralisation of treatment. FUNDING: none. TRIAL REGISTRATION: not relevant.