Gå direkt till huvudinnehållet

Operation, riskbedömningar

Senast uppdaterad: Publicerad:
Sakkunnig:


  • Rökstopp och avbrott i hög alkoholkonsumtion i god tid före ett operativt ingrepp ger klart färre komplikationer.
  • För- och nackdelar vid ett tidigt operationsdatum med större komplikationsrisk ska vägas mot operation några få veckor senare med färre komplikationer.
  • Det har inte fastställts hur långt det optimala preoperativa rök- och alkoholuppehållet bör vara.
  1. Tønnesen H. Alcohol abuse and postoperative morbidity. Dan Med Bull 2003; 50: 139-60. PubMed  
  2. Møller AM, Villebro N, Pedersen T et al. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002; 359: 114-7. PubMed  
  3. Spies CD, Dubisz N, Funk W et al. Prophylaxis of alcohol withdrawal syndrome in alcohol-dependent patients admitted to the intensive care unit after tumour resection. Br J Anaesth 1995; 75: 734-9. PubMed  
  4. Kearon C, Hirsh J. Management of anticoagulation before and after elective surgery. N Engl J Med 1997; 336: 1506-11. New England Journal of Medicine  
  5. Horlocker TT, Wedel DJ, Benzon H et al. Regional anesthesia in the anticoagulated patient: defining the risks. Regional Anesth Pain Med 2004; 29(suppl 1): 1-11.
  6. Wentzien TH, O'Reilly RA, Kearns PJ. Prospective evaluation of anticoagulant reversal with oral vitamin K1 while continuing warfarin therapy unchanged. Chest 1998; 114: 1546-50. PubMed  
  7. Nielsen JD, Holm-Nielsen A, Jespersen J. The effect of low-dose acetylsalicylic acid on bleeding after transurethral prostatectomy. Scand J Urol Nephrol 2000; 34: 194-8. PubMed  
  8. Ernst A, Eberhardt R, Wahidi M. Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans. Chest 2006; 129: 734-7. PubMed  
  9. Jepsen P, Toft Sørensen H, Vilstrup H, Ott P. Operativ risiko for patienter med leversygdom. Ugeskr Læger 2006; 168: 4299-4302. PubMed  
  10. Friedman LS. The risk of surgery in patients with liver disease. Hepatology 1999; 29: 1617-23. PubMed  
  11. Møller S, Henriksen JH. Cirrhotic cardiomyopathy: a pathophysiological review of circulatory dysfunction in liver disease. Heart 2002; 87: 9-15. PubMed  
  12. Tønnesen H, Petersen KR, Højgaard L et al. Postoperative morbidity among symptom-free alcohol misusers. Lancet 1992; 340: 334-7. PubMed  
  13. Poulsen LO, Thulstrup AM, Sørensen HT et al. Appendicectomy and perioperative mortality in patients with liver cirrhosis. Br J Surg 2000; 87: 1664-5. PubMed  
  14. Hansen JB, Thulstrup AM, Vilstrup H et al. Danish nationwide cohort study of postoperative death in patients with liver cirrhosis undergoing hernia repair. Br J Surg 2002; 89: 805-6. PubMed  
  15. Keegan MT, Plevak DJ. Preoperative assessment of the patient with liver disease. Am J Gastroenterol 2005; 100: 2116-27. PubMed  
  16. Cheah MH, Kam PCA. Obesity: basic science and medical aspects relevant to anaesthetists. Anaesthesia 2005; 60: 1009-21. PubMed  
  17. Adams JP, Murphy PG. Obesity in anaestesia and intensiv care. Br J Anaesth 2000; 85: 91-108. PubMed  
  18. Schumann R, Jones SB, Ortiz VE et al. Best practice recommendations for anaesthetic perioperative care and pain management in weight loss surgery. Obesity Research 2005; 13: 254-66. PubMed  
  19. Edmonds MJ, Crichton TJ, Runciman WB et al. Evidence-based risk factors for postoperative deep vein thrombosis. ANZ J Surg 2004; 74: 1082-97. PubMed  
  20. Prabhakar G, Haan CK, Peterson ED et al. The risks of moderate and extreme obesity for coronary artery bypass grafting outcomes: a study from the Society of Thoracic Surgeons' database. Ann Thorac Surg 2002; 74: 1125-30. PubMed  
  21. Nasraway SA Jr, Albert M, Donnelly AM et al. Morbid obesity is an independent determinant of death among surgical critically 111 patients. Crit Care Med 2006; 34: 964-70. PubMed  
  22. Flood C, Fleisher LA. Preparation of the cardiac patient for noncardiac surgery. Am Fam Physician 2007; 75: 656-65. American Family Physician  
  23. Devereaux PJ, Goldman L, Cook DJ et al. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the patophysiology of the events and methods to estimate and communicate risk. CMAJ 2005; 173: 627-34. Canadian Medical Association Journal  
  24. Christiansen C, Andersen C, Møller M et al. Rekommandationer for perioperativ behandling af patienter med pacemaker eller ICD. 2005. Dansk Anæstesiologisk Selskab. www.dasaim.dk/ august 2006.
  25. Dansk Cardiologisk Selskab. Hjerteklapsygdom, diagnose og behandling. 2001. www.cardio.dk/august 2006.
  26. Carrel TP, Klingenmann W, Mohacsi PJ et al. Perioperative bleeding and thromboembolic risk during non-cardiac surgery in patients with mechanical prosthetic heart valves: an institutional review. J Heart Valve Dis 1999; 8: 392-8. PubMed  
  27. Howell SJ, Sear JW, Foex P. Hypertension, hypertensive heart disease and perioperative cardiac risk. Br J Anaesth 2004; 92: 570-83. PubMed  
  28. Swiatek F Aa. UL-vejledt anlæggelse af centralt kateter gennem vena jugularis interna. Ugeskr Læger 2002; 164: 2746-7. PubMed  
  29. Bartholdy J. Problemer med ASA physical score. DASINFO 2006; 14: 24. PubMed  
  30. Moller AM, Villebro N, Pedersen T et al. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002; 359: 114-7. PubMed  
  31. Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006; 144: 581-95. Annals of Internal Medicine  
  32. Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006; 144: 596-608. Annals of Internal Medicine  
  33. Squadrone V, Coha M, Cerutti E et al. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA 2005; 293: 585-9. Journal of the American Medical Association  
  34. American College for Obstetricians and Gynecologists. Guidelines for diagnostic imaging during pregnancy. Commitee Opinion nr. 158,1995.
  35. Sinai BM, Frangieh A. Maternal adaption to pregnancy. Cur Opin Obstet Gynecol 1995; 7: 420. PubMed  
  36. Babaknia A, Parsa H, Woodruff JD. Appendicitis during pregnancy. Obstet Gynecol 1977; 50: 40-4. PubMed  
  37. Coleman MT, Trianfo VA, Rund DA. Nonobstetric emergencies in pregnancy: trauma and surgical conditions Am J Obstet Gynecol 1997; 177: 497-02.
  38. Pedrosa I, Levine D, Eyvazzadeh AD et al. MR imaging evaluation of acute appendicitis in pregnancy. Radiology 2006; 238: 891-9. Radiology  
  39. Cohen-Kerem R, Railton C, Oren D et al. Pregnancy outcome following non-obstetric surgical intervention Am J Surg 2005; 190: 467-73.
  40. Rojansky N, Shushan A, Fatum M. Laparoscopy versus laparotomy in pregnancy: a comparative study. J Am Assoc Gynecol Laparosc 2002; 9: 108-10. PubMed  
  41. Sandhar BK, Elliott RH, Windram I et al. Peripartum changes in gastric emptying. Anaesthesia 1992; 47: 196-8. PubMed  
  42. Kosten TR, Rounsaville BJ, Kleber HD. Antecedents and consequences of cocaine abuse among opioid addicts: a 2.5 year follow-up. J Nerv Ment Dis 1988; 176: 176-81. PubMed  
  43. Sukanya M, Raymond S. Perioperative management of acute pain in the opioid-dependent patient. Anesthesiology 2004; 101: 212-27. PubMed  
  44. Kondrup J. Den malnutrierede patient. Ugeskr Læger 2006; 168: 4320. PubMed  
  45. Stratton RJ, Green CJ, Elia M. Complications and Clinical Outcome. I: Disease-related Malnutrition: an evidence-based approach to treatment. Wallingford: CABI Publishing, 2003: 143-52.
  46. Keele AM, Bray MJ, Emery PW et al. Two phase randomised controlled clinical trial of postoperative oral dietary supplements in surgical patients. Gut 1997; 40: 393-9. Gut  
  47. Beier-Holgersen R, Boesby S. Influence of postoperative enteral nutrition on postsurgical infections. Gut 1996; 39: 833-5. Gut  
  48. Stratton RJ, Green CJ, Elia M. Surgery (Gastrointestinal and Vascular). I: Disease-related Malnutrition: an evidence-based approach to treatment. Wallingford: CABI Publishing, 2003: 499-509, 661-77.
  49. Stratton RJ, Green CJ, Elia M. Orthopedics. I: Disease-related Malnutrition: an evidence-based approach to treatment. Wallingford: CABI Publishing, 2003: 490-9, 652-5.
  50. Lewis SJ, Egger M, Sylvester PA et al. Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 2001; 323: 773-6. British Medical Journal  
  51. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg 2002; 183: 630-41. PubMed  
  52. Paddon-Jones D, Wolfe RR, Ferrando AA. Amino acid supplementation for reversing bed rest and steroid myopathies. J Nutr 2005; 135: 1809-12. PubMed  
  53. Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriat Soc 2002; 50: 889-96. PubMed  
  54. Convertino VA, Bloomfield SA, Greenleaf JE. An overview of the issues: physiological effects of bed rest and restricted physical activity. Med Sci Sports Exercise 1997; 29: 187-90. PubMed  
  55. Hambrecht R, Walther C, Mobius-Winkler S et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation 2004; 109: 1371-8. Circulation  
  56. Suetta C, Magnusson SP, Rosted A et al. Resistance training in the early postoperative phase reduces hospitalization and leads to muscle hypertrophy in elderly hip surgery patients - a controlled, randomized study. J Am Geriatr Soc 2004; 52: 2016-22. PubMed  
  57. Skelton DA, Kennedy J, Rutherford OM. Explosive power and asymmetry in leg muscle function in frequent fallers and non-fallers aged over 65. Age Ageing 2002; 31: 119-25. PubMed  
  58. Sashika H, Matsuba Y, Watanabe Y. Home program of physical therapy: effect on disabilities patients with total hip arthroplasty. Arch Phys Med Rehab 1996; 77: 273-7. PubMed  
  59. Holm L, Esmarck B, Mizuno M et al. The effect of protein and carbohydrate supplementation on strength training outcome of rehabilitation in ACL patients. J Orthop Res 2006; 24: 2114-23. PubMed  
  • Per Hellman, professor och överläkare, Kirurgkliniken, Akademiska sjukhuset, Uppsala

Tidigare sakkunniga

  • Terje Johannessen, professor i allmänmedicin, Institutt for samfunnsmedisinske fag, Norges teknisk-naturvitenskapelige universitet, Trondheim
  • Sven Erik Gisvold, professor vid NTNU och överläkare vid Anestesiavdelningen, St Olavs Hospital, Trondheim