Wetenschappelijk jaaroverzicht 2012

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1 Wetenschappelijk jaaroverzicht 2012

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3 Wetenschappelijk jaaroverzicht

4 Inhoud Samenstelling Wetenschapscommissie 3 Woord vooraf 4 Wetenschappelijk jaarverslag Wetenschapscommissie Wetenschappelijk jaaroverzicht per vakgroep Anesthesiologie 10 Cardiologie 17 Chirurgie 22 Dermatologie 32 Facilitair bedrijf 34 Gynaecologie 35 Interne geneeskunde 41 Keel, neus en oorheelkunde 50 Kindergeneeskunde 51 Klinische chemie 56 Klinische fysica 57 Klinische geriatrie 58 Leerhuis 59 Longgeneeskunde 62 Maag, darm en lever 64 Medische microbiologie 66 Neurologie 69 Orthopedie 72 Pathologie 73 Psychiatrie 79 Radiologie 80 Reumatologie 83 Spoedeisende geneeskunde 85 Urologie 87 Ziekenhuisapotheek 88 Promoties ASz Wetenschapsdag ASz Mondelinge presentaties 93 Poster presentaties 101 Verantwoording 114 2

5 Samenstelling Wetenschapscommissie Dagelijks bestuur dr. M.C.J.M. Kock, voorzitter, radioloog dr. M-D Levin, vice-voorzitter, internist-hematoloog mw. C.N. van Waardhuizen MSc, beleidsadviseur mw. E.Y. de Kruyf, secretariaat Overige leden 2012 dr. ir. B. van den Berg, klinisch fysicus dr. A. Bischoff, KNO-arts dr. E.F.H. van Bommel, internist-nefroloog drs. R.P.M. Ceulen, dermatoloog Prof. Dr. A.J.M. Cleophas, internist t/m 30 april drs. L.P.L.H. Cuijpers, klinisch psycholoog dr. M.A. Fouraux, klinisch chemicus dr. H.M.E. Frenay, arts-microbioloog mw. R. van Hof, medisch informatiespecialist drs. A.M. van der Velden, arts-assistent spoedeisende geneeskunde drs. A.D. Klaren, manager Leerhuis & Kwaliteit, Veiligheid en Innovatie drs. S. Hendriks, intensivist-anesthesioloog dr. P.W. Plaisier, chirurg drs. J.M.M. van de Ridder, adviseur Medische Vervolgopleidingen Leerhuis dr. T.C.J. Sas, kinderarts dr. A.C. de Mol, kinderarts-neonatoloog drs. E.M. de Vogel, ziekenhuisapotheker dr. P.J. Westenend, patholoog dr. L.J.P.M. van Woerkens, cardioloog dr. D. Zemel, neuroloog drs. J. Alderliesten, MDL arts dr. D. Cheung, longarts drs. S. Rombout-de Weerd, gynaecoloog dr. N.B. Swarte, gynaecoloog Hoofdredactie Wetenschappelijk tijdschrift WASz drs. A.M. van der Velden, arts-assistent spoedeisende geneeskunde dr. N.B. Swarte, gynaecoloog 3 Samenstelling Wetenschapscommissie

6 Woord vooraf Voor u ligt het jaarverslag met een weergave van de wetenschappelijke activiteiten die in 2012 hebben plaatsgevonden in het Albert Schweitzer ziekenhuis (ASz). De activiteiten variëren van promoties en wetenschappelijke activiteiten tot voordrachten en posters met betrekking tot de (directe) patiëntenzorg. Onze professionals hebben ook dit jaar weer meer gepubliceerd dan vorig jaar en de variëteit in wetenschappelijk activiteiten onder verschillende beroepsgroepen in het ASz is eveneens toegenomen. Wij zijn tevreden met de wetenschappelijke output over Het zegt iets over de eigenschappen en deskundigheid van onze professionals. Dit alles om de kwaliteit en doelmatigheid van de patiëntenzorg te verbeteren. Dat neemt niet weg dat we als STZ ziekenhuis ook naar onze processen moeten blijven kijken. Om de wetenschappelijke onderzoekscultuur te bestendigen en om in de toekomst een volwaardig lid van de STZ vereniging te blijven, moeten we continue verder inzetten op het stimuleren en faciliteren van wetenschappelijk onderzoek. Naast het bieden van inhoudelijke ondersteuning bij het opzetten en uitvoeren van wetenschappelijk onderzoek, de organisatie van de jaarlijkse Wetenschapsdag en maandelijkse Wetenschapslunches, en het werken aan het stimuleren van onderzoek onder verpleegkundigen, gaat het om het stroomlijnen van processen, faciliteiten en verdere doorontwikkeling van het ASz Stipendium. Met de organisatie daarvan zijn we nu volop bezig en dit zal in 2013 leiden tot verdere concretisering. Langs deze weg willen we iedereen die, direct dan wel indirect, een bijdrage heeft geleverd aan het wetenschappelijk onderzoek in 2012 in het ASz hartelijk bedanken. Alleen al bij het doorbladeren van dit jaaroverzicht zult u merken dat er gestaag aan de weg getimmerd wordt en dat we trots mogen zijn op de onderzoeksresultaten. Een lijn die we ook naar de toekomst verder uit willen bouwen en vast zullen houden! De Wetenschapscommissie biedt u dit jaarverslag dan ook graag aan ter overzicht en inspiratie. dr. M.C.J.M. Kock Voorzitter Wetenschapscommissie/Radioloog C.N. van Waardhuizen, MSc Beleidsadviseur Wetenschap 4

7 Wetenschappelijk jaarverslag Wetenschapscommissie

8 Wetenschapscommissie In 2012 heeft de Wetenschapscommissie haar dienstverlening verder geprofessionaliseerd. In het beleidsplan Zorg voor Wetenschap heeft de Wetenschapscommissie haar visie op wetenschap geformuleerd en de lijnen naar de toekomst uitgezet. Begin 2012 werd echter duidelijk dat de doelstellingen uit het beleidsplan bijgesteld moesten worden naar aanleiding van het STZ rapport Bibliometric analysis of STZ-hospitals. Uit dit rapport is gebleken dat zowel kwaliteit als kwantiteit nog verder verbeterd konden worden. Daarnaast beschikt het ASz over een beperkt wetenschappelijk netwerk in vergelijking met andere STZ ziekenhuizen. Om met elkaar een strategie te bedenken om het wetenschappelijk onderzoek in het ASz beter uit de verf te laten komen is er in september 2012 een Heidag Wetenschap Wetenschap in het ASz op weg naar beter georganiseerd. In aanloop naar de Heidag Wetenschap zijn een aantal knelpunten betreffende het wetenschappelijk klimaat in het ASz benoemd. Deze knelpunten zijn aan de genodigden op de heidag wetenschap ASz voorgelegd om gezamenlijk een of meerdere oplossingsrichting(en) te bedenken en bespreken. Naast een interactief deel en plenaire discussies, omvatte het dagprogramma meerdere presentaties vanuit verschillende vakgroepen, RvB en Stafbestuur. Naar aanleiding van de Heidag Wetenschap ASz is een plan van aanpak opgesteld wat zich richt op een aantal strategische punten om het wetenschapsbeleid te verankeren in het ziekenhuisbeleid voor de komende vijf jaar. Dit houdt in dat er de komende tijd belangrijke acties genomen zullen moeten worden door diverse partijen. Het Albert Schweitzer Stipendium Als topklinisch opleidingsziekenhuis wil het ASz (medisch) wetenschappelijk onderzoek van eigen bodem stimuleren en ondersteunen door middel van een wetenschapsfonds Het Albert Schweitzer Stipdium. Het Stipendium biedt onderzoekers de mogelijkheid zich (fulltime) bezig te houden met research activiteiten. Voor de financiële ondersteuning van in ASz geïnitieerd, eigen onderzoek is in 2012 tweemaal een Stipendiumronde gehouden. Het Stipendium is in 2012 toegekend aan de volgende studies/onderzoekers: Toegekende Albert Schweitzer Stipendium/gehonoreerde aanvragen 2012 Den Dekker Kindergeneeskunde De relatie tussen antenatale echografische diagnostiek naar nierafwijkingen en de postnatale bevindingen in het Albert Schweitzer ziekenhuis Pelkmans Interne geneeskunde Retroperitoneale fibrose Sier Chirurgie ISI trial en I-aid studie Oskam SEH Pre-hospitale sepsis behandeling; verminderen van mortaliteit bij ernstige sepsis Aantal verzoeken ingediend in 2012: 9 Aantal toegekend: 4 6

9 WASz In 2012 verscheen onder hoofdredactie van drs. A. van der Velden en dr. N. Swarte tweemaal het Wetenschappelijk tijdschrift Albert Schweitzer ziekenhuis (WASz). Door middel van het tijdschrift worden medewerkers en verwijzers periodiek op de hoogte gehouden van allerlei wetenschappelijke activiteiten van het Albert Schweitzer ziekenhuis. Cursussen De volgende cursussen werden in 2012 gegeven op het gebied van wetenschappelijk onderzoek; Cursus PubMed Poster maken Medical Writing in English Wetenschappelijk onderzoek inclusief SPSS Wetenschapsdag 2012 Op donderdag 21 juni 2012 werd de 8e jaarlijkse Wetenschapsdag Albert Schweitzer ziekenhuis gehouden in het Auditorium op de locatie Dordwijk. De wetenschapsdag van 21 juni was een succesvolle en goed bezochte dag met meer dan 100 bezoekers bestaande uit A(N)IOS, coassistenten, specialisten en verpleegkundigen. Bij ontvangst kregen de deelnemers het Wetenschappelijk Jaaroverzicht 2011 uitgereikt met daarin een uitgebreid overzicht per vakgroep van de wetenschappelijke output. De deelnemers ontvingen ook een abstractboek met daarin een overzicht van alle mondelinge en posterpresentaties op de Wetenschapsdag. In zijn inleiding belichtte dr. Marc Kock, voorzitter van de Wetenschapscommissie, dat er in 2011 wederom meer PubMed publicaties waren dan in voorgaande jaren. Het verdere programma omvatte twee rondes van vier mondelinge presentaties waarin verteld werd over onderzoek dat in ons ziekenhuis verricht is. Na elke presentatie volgde een levendige discussie met de zaal. Daarnaast volgden twee rondes van posterpresentaties. Vele vakgroepen hadden een of enkele geaccepteerde inzendingen. De afwisseling in onderwerp was ook hierbij groot. De externe spreker, mw. dr. M.A.J. de Ridder van de afdeling biostatistiek van het Erasmus MC, heeft een boeiende presentatie gehouden over het gevaar van multiple testing. Tot slot heeft dr. Amerik de Mol een presentatie gehouden over zijn promotieonderzoek met betrekking tot Extracorporeale membraan oxygenatie en het brein. Prijs voor de beste publicatie 2011 ging naar Ewout-Jan van den Bos (Cardiologie) voor onderzoek naar de betekenis van troponine I stijging bij patiënten met atriumfibrilleren. De prijs voor de beste voordracht ging na publieksstemming naar Esther Leung (Klinische Fysica) met haar mooie multimediapresentatie over geluiden van apparaten op de IC. Het publiek verkoos de poster van Ashvin Boeddha (Orthopaedie) over het schrappen van preoperatieve 7

10 bloedgroepbepalingen ten aanzien van mogelijke bloedtransfusie na totale knieprothese in het Albert Schweitzer ziekenhuis tot beste poster. Wetenschappelijk spreekuur In de periode t/m mei 2012 heeft prof. dr. Cleophas het Wetenschappelijk spreekuur in het Asz gehouden. Wegens zijn pensionering is het Leerhuis van het ASz met ingang van 1 mei 2012 een driejarige samenwerking aangaan met de afdeling Biostatistiek van het Erasmus MC om het wetenschappelijk klimaat in het ASz naar een nog hoger niveau te brengen. Op dinsdagen van 9.00 tot uur in de docentenkamer (op de 2e etage voor het vergadercentrum) op locatie Dordwijk zijn of mw. dr. Maria de Ridder of dr. Dimitris Rizopoulos aanwezig in het ASz voor een inloopspreekuur. Een enkele keer heeft dhr. Sten Willemsen het spreekuur in het ASz gehouden. Net als voorheen staat dit inloopspreekuur open voor iedereen die vragen heeft met betrekking tot het schrijven van een onderzoeksopzet, statistische methodes en rapportage van de resultaten. Daarnaast kan op de statistici van het Erasmus MC een beroep worden gedaan om analyses uit te voeren. In 2012 hebben circa 80 personen het inloopspreekuur bezocht. 8

11 Wetenschappelijk jaaroverzicht 2012 per vakgroep 9

12 Anesthesiologie PubMed publicaties Designing a strategy to implement cost-effective blood transfusion management in elective hip and knee arthroplasties: A study protocol. Voorn VM, de Mheen PJ, So-Osman C, Vlieland TP, Koopman-van Gemert AWMM, Nelissen RG, van Bodegom-Vos L; for the LISBOA study group. Implement Sci Jun 30;7(1):58. BACKGROUND: Total hip and knee arthroplasties are two of the most commonly performed procedures in orthopedic surgery. Different blood-saving measures (BSMs) are used to reduce the often-needed allogenic blood transfusions in these procedures. A recent large randomized controlled trial showed it is not cost effective to use the BSMs of erythropoietin and perioperative autologous blood salvage in elective primary hip and knee arthroplasties. Despite dissemination of these study results, medical professionals keep using these BSMs. To actually change practice, an implementation strategy is needed that is based on a good understanding of target groups and settings and the psychological constructs that predict behavior of medical professionals. However, detailed insight into these issuses is lacking. Therefore, this study aims to explore which groups of professionals should be targeted at which settings, as well as relevant barriers and facilitators that should be taken into acount in the strategy to implement evidence-based, cost-effective blood transfusion management and to de-implement BSMs. METHODS: The study consists of three phases. First, a questionnaire survey among all Dutch orthopedic hospital departments and independent treatment centers (n = 99) will be conducted to analyze current blood management practice. Second, semistructured interviews will be held among 10 orthopedic surgeons and 10 anesthesiologists to identify barriers and facilitators that are relevant for the uptake of cost-effective blood transfusion management. Interview questions will be based on the Theoretical Domains Interview framework. The interviews will be followed by a questionnaire survey among 800 medical professionals in orthopedics and anesthesiology (400 professionals per discipline) in which the identified barriers and facilitators will be ranked by frequency and importance. Finally, an implementation strategy will be developed based on the results from the previous phases, using principles of intervention mapping and an expert panel. DISCUSSION: The developed strategy for cost-effective blood transfusion management by de-implementing BSMs is likely to reduce costs for elective hip and knee arthroplasties. In addition, this study will lead to generalized knowledge regarding relevant factors for the de-implementation of non-cost-effective interventions and insight in the differences between implementation and de-implementation strategies. PMCID: PMC PMID: [PubMed - as supplied by publisher] 10

13 The Long-term Efficacy and Safety of Percutaneous Cervical Nucleoplasty in Patients with a Contained Herniated Disk. Halim W, Wullems JA, Lim T, Aukes HA, van der Weegen W, Vissers KC, Gültuna I, Chua NH. Pain Pract Oct 31. [Epub ahead of print] BACKGROUND: Percutaneous cervical nucleoplasty (PCN) is a safe and effective treatment in symptomatic patients with contained cervical herniated disks. It provides simple and efficient disk decompression, using a controlled and highly localized ablation, but evidence regarding long-term efficacy is limited. We conducted a retrospective study to investigate the longterm efficacy and safety of PCN, and the influence of ideal selection settings. METHODS: A total of 27 patients treated with PCN fulfilling ideal selection criteria (Group A) were studied and compared to 42 patients not meeting these criteria (Group B). Outcomes were assessed using the Visual Analogue Scale (VAS) and a four-level Likert item for perceived pain and satisfaction, the Neck Disability Index (NDI), and the Short Form 36 (SF-36). Additional relevant outcomes were retrieved from medical records. RESULTS: The postoperative mean VAS pain for Group A was 29.9 (SD ± 32.6) at a mean follow-up of 24 months (range: 2-45). Only 10% of these patients reported mild transient adverse events. There was a trend, but no difference between both groups in pain scores; however, treatment satisfaction was higher for Group A (74.1 ± ± 31.4, P = 0.02). Group A also reported better physical functioning based on the Physical Component Summary (43.6 ± ± 12.0, P = 0.03) and showed a larger proportion of patients no longer using any medication postoperatively (63-26%, P = 0.01). CONCLUSION: These results show long-term effectiveness and safety of PCN in patients with a one-level contained cervical herniated disk, and the reliance of selecting patients meeting ideal criteria for successful PCN. PMID: [PubMed - as supplied by publisher] Pubmed collaborative authorship publicaties Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, Bratty JR, Takala J; Dexmedetomidine for Long-Term Sedation Investigators. Collaborator: Koopman-van Gemert AWMM JAMA Mar 21;307(11): CONTEXT: Long-term sedation with midazolam or propofol in intensive care units (ICUs) has serious adverse effects. Dexmedetomidine, an α(2)-agonist available for ICU sedation, may reduce the duration of mechanical ventilation and enhance patient comfort. OBJECTIVE: To determine the efficacy of dexmedetomidine vs midazolam or propofol(preferred usual care) in maintaining sedation; reducing duration of mechanical ventilation; and improving patients interaction with nursing care. DESIGN, SETTING, AND PATIENTS: Two phase 3 multicenter, randomized, double-blind trials carried out from 2007 to The MIDEX trial compared midazolam with dexmedetomidine in ICUs of 44 centers in 9 European countries; the PRODEX trial compared propofol with dexmedetomidine in 31 centers in 6 European countries and 2 centers in Russia. Included 11 Anesthesiologie

14 were adult ICU patients receiving mechanical ventilation who needed light to moderate sedation for more than 24 hours (midazolam, n = 251, vs dexmedetomidine, n = 249; propofol, n = 247, vs dexmedetomidine, n = 251). INTERVENTIONS: Sedation with dexmedetomidine, midazolam, or propofol; daily sedation stops; and spontaneous breathing trials. MAIN OUTCOME MEASURES: For each trial, we tested whether dexmedetomidine was noninferior to control with respect to proportion of time at target sedation level (measured by Richmond Agitation-Sedation Scale) and superior to control with respect to duration of mechanical ventilation. Secondary end points were patients ability to communicate pain (measured using a visual analogue scale [VAS]) and length of ICU stay. Time at target sedation was analyzed in per-protocol population (midazolam, n = 233, vs dexmedetomidine, n = 227; propofol, n = 214, vs dexmedetomidine, n = 223). RESULTS: Dexmedetomidine/midazolam ratio in time at target sedation was 1.07 (95% CI, ) and dexmedetomidine/propofol, 1.00 (95% CI, ). Median duration of mechanical ventilation appeared shorter with dexmedetomidine (123 hours [IQR, ]) vs midazolam (164 hours [IQR, ]; P =.03) but not with dexmedetomidine (97 hours [IQR, ]) vs propofol (118 hours [IQR, ]; P =.24). Patients interaction (measured using VAS) was improved with dexmedetomidine (estimated score difference vs midazolam, 19.7 [95% CI, ]; P <.001; and vs propofol, 11.2 [95% CI, ]; P <.001). Length of ICU and hospital stay and mortality were similar. Dexmedetomidine vs midazolam patients had more hypotension (51/247 [20.6%] vs 29/250 [11.6%]; P =.007) and bradycardia (35/247 [14.2%] vs 13/250 [5.2%]; P <.001). CONCLUSIONS: Among ICU patients receiving prolonged mechanical ventilation, dexmedetomidine was not inferior to midazolam and propofol in maintaining light to moderate sedation. Dexmedetomidine reduced duration of mechanical ventilation compared with midazolam and improved patients ability to communicate pain compared with midazolam and propofol. More adverse effects were associated with dexmedetomidine. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT , NCT PMID: [PubMed - indexed for MEDLINE] Mortality after surgery in Europe: a 7 day cohort study. Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, Vallet B, Vincent JL, Hoeft A, Rhodes A; European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology. Koopman-van Gemert AWMM Lancet Sep 22;380(9847): BACKGROUND: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe. METHODS: We did this 7 day cohort study between April 4 and April 11, We collected data describing consecutive patients aged 16 years and older undergoing inpatient noncardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ(2) and Fisher s exact tests to compare categorical variables and the t test or the Mann-Whitney U 12

15 test to compare continuous variables. Significance was set at p<0 05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries. FINDINGS: We included 46,539 patients, of whom 1855 (4%) died before hospital discharge (8%) patients were admitted to critical care after surgery with a median length of stay of 1 2 days (IQR ) (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1 2% [95% CI ] for Iceland to 21 5% [ ] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0 44 [95% CI ; p=0 06]for Finland to 6 92 [ ; p=0 0004] for Poland). INTERPRETATION: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients. FUNDING: European Society of Intensive Care Medicine, European Society of Anaesthesiology. PMCID: PMC PMID: [PubMed - indexed for MEDLINE] Boek of hoofdstuk in boek Autotransfusion: Therapeutic, Principles, Efficacy and Risks. Koopman-van Gemert AWMM. Chapter 12 in Blood transfusions in Clinical Practice, Puneet Kaur Kochhar editor, ISBN , also as e-book A randomised controlled trial on erythropoietin and blood salvage as transfusion alternatives in orthopaedic surgery using a restrictive transfusion policy Cynthia So-Osman, MD, M Sc, Rob G H H Nelissen, MD, PhD, Koopman-van Gemert AWMM, MD, PhD, Ewoud Kluyver, MD, Ruud G Pöll, MD, PhD, Ron Onstenk, MD; Joost A Van Hilten, MD, PhD, Thekla M Jansen- Werkhoven, PhD, Wilbert B van den Hout, PhD, Ronald Brand, PhD and Anneke Brand, MD, PhD. In: Patient Blood Management in Elective Orthopaedic Surgery. Hoofdstuk 7 in Proefschrift Cynthia So-Osman. Oktober Overige publicaties Autotransfusie. Therapeutische principes, efficiëntie en risico s. Koopman-van Gemert AWMM A&I, 2012 ; 3 : Reactie Commissie Juridische zaken van de Nederlandse Vereniging voor Anesthesiologie. Rubriek Ingezonden. Reacties op uitspraak van 6 januari Kop B. Tijdschrift voor gezondheidsrecht (TvGR) nr p Anesthesiologie

16 Subcutaneous stimulation as an Additional Therapy to Spinal Cord Stimulation for the treatment of lower limb pain and/ or Back pain: A feasibility study. Hamm- Faber TE, Aukes HA, de Loos F and Gültuna I. Neuromodulation: Technology at the Neural Interface 2012; volume 15, p: Posters Improving Patient Safety by Team Learning: a systems approach. Koopman-van Gemert AWMM et al., International Forum on Safety and Quality in Healthcare:17-20 april 2012, Paris. Schrappen van preoperatieve bloedgroepbepalingen ten aanzien van mogelijke bloedtransfusie na totale knieprothese in het Albert Schweitzer Ziekenhuis. Boeddha AV, Koeveringen van AJ, Gelder van W, Breimer LTM Wetenschapsdag ASz. 12 juni Bloedtransfusiebeleid : TOMaat- vs niet -TOMaat-patiënten. Koopman-van Gemert AWMM, Kuijpers AG, Mandl EW Wetenschapsdag ASz. 12 juni 2012 Implementation of a Rapid Response System decreases the number of in-hospital cardiac arrests in a large teaching hospital. So KL et al. International Forum on Safety and Quality in Healthcare, april 2012, Paris France. Implementation of a Rapid Response System decreases the number of in-hospital cardiac arrests in a large teaching hospital. So KL et al. NVIC dagen, 9-10 februari 2012, Ede. Implementation of a Rapid Response System decreases the number of in-hospital cardiac arrests in a large teaching hospital. Koopman-van Gemert AWMM. International Forum on Quality and Safety in Healthcare, BMJ-IHI april, Paris France. First result of the PREPARE study. Prepare team, Koopman-van Gemert AWMM namens ASz. ESA, 9-12 juni 2012, Parijs Frankrijk. A randomised controlled trial on erythropoietin and blood salvage as transfusion alternatives in orthopaedic surgery using a restrictive transfusion policy. So-Osman C, Nelissen RGHH, Koopman-van Gemert AWMM, Kluyver E, Pöll R, Onstenk R, Van Hilten JA, Jansen-Werkhoven TM, Brand R, Brand A. EFFORT congress, May 2012, Berlin Germany. 14

17 Voordrachten From Anatomy through Diagnostics to Best Practice in Advanced Neuromodulation Therapies, A hands on cadaver workshop for the experinced user. Gültuna I. European Continuing Medical Training(ECMT), january 2012, Brussel Belgium. Ervaringen met TRM op de Intensive Care. So KL. NVIC-dagen, 10 februari 2012, Ede. VAR als motor voor kwaliteitsverbetering. NVZ Netwerk Patientveiligheid& verpleegkundige rol. So KL. NVZ dagen, 5 april 2012, Woerden. Groot bloedverlies: alternatieven? Koopman-van Gemert AWMM. 3e refresher course Obstetrische Anesthesie, 18 april 2012, de Driehoek Utrecht. Alternatieve strategieën voor pijnbestrijding: lachgas weer in de mode? Schyns-van den Berg AMJV. 3e refresher course Obstetrische Anesthesie, 18 april 2012, de Driehoek Utrecht. Improving Patient Safety by Team Learning: a systems approach. Buljac Samardzic M, Dekker van Doorn CM, Huijsman R, Klein J, Koopman-van Gemert AWMM, Wauben LSGL, van Wijngaarden JDH. International Forum on Quality and Safety in Healthcare, april 2012, Paris France. Mortality as a motor for quality improvement So KL. Congres. Dag van de Herverzekeraars ASz Dordrecht. 12 oktober 2012 Dordrecht Pre-operatief Bloedmanagement Koopman-van Gemert AWMM. Symposoium Transfusiegeneeskunde, 18 oktober 2012 Boerhave Leiden Effectief teamfunctioneren en veiligheid in de zorg. So KL Jaarlijkse arts-assistentendag Risk Management 25 oktober 2012, ASz Dordrecht. Advanced Neuromodulation training 15 Anesthesiologie

18 Richtlijnen in de praktijk. Koopman-van Gemert AWMM. NVA dagen, 9-10 mei 2012, Maastricht. Mortality as a motor for quality improvement. So KL. Reed congres Patiëntveiligheid: niet later maar nu, 22 mei 2012, Ede. Patient Blood Management. Stand van zaken POP-I studie. Koopman-van Gemert AWMM. Depot Noord, 24 mei 2012, Rotterdam. LISBOA-study. Marang-van de Mheen PJ, So-Osman C, Vliet Vlieland TPM, Koopman-van Gemert AWMM, Nelissen RGHH, Bodgom-Vos L. ISBT, 7-12 juli 2012 Cancun, Mexico. Advanced Neuromodulation training. Gültuna I. Subcutaneous peripheral field stimulation technical aspects, october 2012, Graz Austria. Levenslang doorontwikkelen van medisch specialisten.door appraisal & assessment. So KL. NVMO november 2012, Maastricht. Hoe kan de medisch staf in algemene ziekenhuizen bij opleiden betrokken worden? van de Ridder JMM, Bommel EFH, Koopman-van Gemert AWMM, Oostenbroek RJ, Verheijen FM, Zanting A. NVMO congres, november 2012, Maastricht. Kinderanesthesie in een niet academische setting. Koopman-van Gemert AWMM. WKC, 17 november 2012, Utrecht. Ervaringen met Rotem in het ASz. Koopman-van Gemert AWMM. Symposium Rotem, 23 november 2012, Hotel Mijdrecht Marickenland Mijdrecht. Clinical and Basic Science for the management of the chronic pain patient. Gültuna I. Neuromodulation course cadaver workshop, 30 november- 1 december 2012, Barcelona. Workshop Expeditie Koopman-van Gemert AWMM. Congres Modernisering Medische Vervolgopleidingen, 12 december 2012, NBC Nieuwegein. 16

19 Cardiologie PubMed publicaties Bicuspid aortic valve with vertical opening and double raphe. Brugts JJ, Kurvers M, Kofflard MJ. Eur Heart J Cardiovasc Imaging Jan;13(1):123. PMID: [PubMed - in process] Acute coronary syndrome in a patient with a single coronary artery arising from the right sinus of Valsalva. Liesting C, Brugts JJ, Kofflard MJ, Dirkali A. World J Cardiol Aug 26;4(8): Coronary artery anomalies are usually encountered as coincidental findings during coronary angiography or at autopsy. Life threatening symptoms, such as arrhythmias, syncope, myocardial infarction, or sudden death, can occur in up to 20% of patients. However, the majority of anomalies (80%) are benign and asymptomatic. A single coronary artery (SCA) is one of the most rarely seen coronary anomalies with an incidence of 0.05%. We report the case of a 55-year old male patient who presented with symptoms of chest pain associated with an acute myocardial infarction. Coronary angiography revealed an anomalous left main coronary artery (LMCA) originating from the right coronary ostium, and an occluded distal right coronary artery. The occluded distal right coronary artery was successfully treated by thrombosuction and stenting. In order to confirm the origin and course of the SCA, multi-slice computed tomography (MSCT) of the heart was performed after coronary angiography. MSCT showed that the anomalous LMCA originated from the right coronary artery ostium and then passed the interventricular septum, instead of being intra arterial, and under the right ventricular infundibulum. The anomalous LMCA was classified as R-II S subtype according to Lipton s classification. PMCID: PMC PMID: [PubMed] A rare case of massive papillary fibroelastoma of the right ventricular free wall. Baks T, Galema TW, Bakker J, Kofflard MJ. Neth Heart J Aug;20(7-8): PMCID: PMC PMID: [PubMed] Right-to-left atrial shunting with normal intracardiac pressures following cardiac surgery: pathophysiology and management. Brugts JJ, Liesting C, Kofflard MJ, van den Bos EJ. J Card Surg May;27(3): Cardiologie

20 We present a case of acute respiratory insufficiency with right-to-left atrial shunting under normal intracardiac pressures discovered several days after aortic surgery for aortic dissection. We discuss the possible mechanisms and management of right-to-left atrial shunting through an atrial septum defect with normal intracardiac pressures following cardiac surgery. PMID: [PubMed - indexed for MEDLINE] Obstructive giant cardiac tumour in a patient with chest pain and acute respiratory insufficiency. Brugts JJ, van den Bos EJ, Raap JB, van de Woestijne PC, Kofflard MJ, Dirkali A. J Cardiovasc Med (Hagerstown) Apr;13(4): A 77-year-old woman presented with dyspnoea and respiratory-related thoracic pain, which was accompanied by dizziness and fatigue but no syncopal attacks. Auscultation of the heart disclosed an opening snap with mid-diastolic murmur. Laboratory assessment revealed no abnormalities but an elevated D-dimer level (1.49 mg/l). Electrocardiography was normal. The chest radiograph showed an enlarged heart without other abnormalities. Computed tomography (CT) scan for a suspected diagnosis of pulmonary embolism was performed. The CT scan did not reveal pulmonary embolism, but a large cardiac tumour in the left atrium. PMID: [PubMed - indexed for MEDLINE] Lack of long-term clinical benefit of thrombus aspiration during primary percutaneous coronary intervention with paclitaxel-eluting stents or bare-metal stents: post-hoc analysis of the PASSION-trial. Vink MA, Dirksen MT, Tijssen JG, Suttorp MJ, Patterson MS, van Geloven N, IJsselmuiden AJ, Slagboom T, Kiemeneij F, Laarman GJ. Catheter Cardiovasc Interv May 1;79(6): BACKGROUND: Although current clinical guidelines recommend the use of thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI), previous studies evaluating TA demonstrated contradictory results. The aim of this study was to evaluate long-term clinical outcome after TA in adjunct to PPCI for acute ST-segment myocardial infarction (STEMI), as compared with conventional treatment, with the use of paclitaxel-eluting stents or baremetal stents. METHODS: We analyzed data of the PASSION trial, in which 619 patients with STEMI were randomly assigned to a paclitaxel-eluting stent or a bare-metal stent. TA was performed in 311 patients (50.2%). Clinical endpoints at 2 years were compared between patients who received TA during PPCI with patients who underwent conventional PPCI. The primary outcome of interest was a composite of cardiac death, recurrent myocardial infarction (MI), or target-lesion revascularization (TLR). A propensity score model was made to account for baseline differences that could have affected the probability of performing TA. RESULTS: Complete follow-up was available for 598 patients (96.6%). The cumulative incidence of the combined outcome measure of cardiac death, recurrent MI, or TLR was 40 (13.0%) in the TA group and 41 (13.5%) in the conventional PPCI group (HR 0.96; 95% CI ; P = 0.84). Also after adjusting for propensity score, no significant difference in event rate was observed between both treatment groups. 18

21 CONCLUSIONS: In this post-hoc analysis of the PASSION trial, TA in adjunct to PPCI did not affect rates of major adverse cardiac events at 2 years follow-up, as compared with conventional PPCI. PMID: [PubMed - indexed for MEDLINE] Pubmed collaborative authorship publicaties n-3 fatty acids and cardiovascular outcomes in patients with dysglycemia. ORIGIN Trial Investigators, Bosch J, Gerstein HC, Dagenais GR, Díaz R, Dyal L, Jung H, Maggiono AP, Probstfield J, Ramachandran A, Riddle MC, Rydén LE, Yusuf S. Collaborators: Kurvers M, Stoel I N Engl J Med Jul 26;367(4): BACKGROUND: The use of n-3 fatty acids may prevent cardiovascular events in patients with recent myocardial infarction or heart failure. Their effects in patients with (or at risk for) type 2 diabetes mellitus are unknown. METHODS: In this double-blind study with a 2-by-2 factorial design, we randomly assigned 12,536 patients who were at high risk for cardiovascular events and had impaired fasting glucose, impaired glucose tolerance, or diabetes to receive a 1-g capsule containing at least 900 mg (90% or more) of ethyl esters of n-3 fatty acids or placebo daily and to receive either insulin glargine or standard care. The primary outcome was death from cardiovascular causes. The results of the comparison between n-3 fatty acids and placebo are reported here. RESULTS: During a median follow up of 6.2 years, the incidence of the primary outcome was not significantly decreased among patients receiving n-3 fatty acids, as compared with those receiving placebo (574 patients [9.1%] vs. 581 patients [9.3%]; hazard ratio, 0.98; 95% confidence interval [CI], 0.87 to 1.10; P=0.72). The use of n-3 fatty acids also had no significant effect on the rates of major vascular events (1034 patients [16.5%] vs patients [16.3%]; hazard ratio, 1.01; 95% CI, 0.93 to 1.10; P=0.81), death from any cause (951 [15.1%] vs. 964 [15.4%]; hazard ratio, 0.98; 95% CI, 0.89 to 1.07; P=0.63), or death from arrhythmia (288 [4.6%] vs. 259 [4.1%]; hazard ratio, 1.10; 95% CI, 0.93 to 1.30; P=0.26). Triglyceride levels were reduced by 14.5 mg per deciliter (0.16 mmol per liter) more among patients receiving n-3 fatty acids than among those receiving placebo (P<0.001), without a significant effect on other lipids. Adverse effects were similar in the two groups. CONCLUSIONS: Daily supplementation with 1 g of n-3 fatty acids did not reduce the rate of cardiovascular events in patients at high risk for cardiovascular events.(funded by Sanofi; ORIGIN ClinicalTrials.gov number, NCT ). PMID: [PubMed - indexed for MEDLINE] Basal insulin and cardiovascular and other outcomes in dysglycemia. ORIGIN Trial Investigators, Gerstein HC, Bosch J, Dagenais GR, Díaz R, Jung H, Maggioni AP, Pogue J, Probstfield J, Ramachandran A, Riddle MC, Rydén LE, Yusuf S. Collaborators: Kurvers M, Stoel I N Engl J Med Jul 26;367(4): Cardiologie

22 BACKGROUND: The provision of sufficient basal insulin to normalize fasting plasma glucose levels may reduce cardiovascular events, but such a possibility has not been formally tested. METHODS: We randomly assigned 12,537 people (mean age, 63.5 years) with cardiovascular risk factors plus impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes to receive insulin glargine (with a target fasting blood glucose level of 95 mg per deciliter [5.3 mmol per liter]) or standard care and to receive n-3 fatty acids or placebo with the use of a 2-by-2 factorial design. The results of the comparison between insulin glargine and standard care are reported here. The coprimary outcomes were nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes and these events plus revascularization or hospitalization for heart failure. Microvascular outcomes, incident diabetes, hypoglycemia, weight, and cancers were also compared between groups. RESULTS: The median follow-up was 6.2 years (interquartile range, 5.8 to 6.7). Rates of incident cardiovascular outcomes were similar in the insulin-glargine and standard-care groups: 2.94 and 2.85 per 100 person-years, respectively, for the first coprimary outcome (hazard ratio, 1.02; 95% confidence interval [CI], 0.94 to 1.11; P=0.63) and 5.52 and 5.28 per 100 person-years, respectively, for the second coprimary outcome (hazard ratio, 1.04; 95% CI, 0.97 to 1.11; P=0.27). New diabetes was diagnosed approximately 3 months after therapy was stopped among 30% versus 35% of 1456 participants without baseline diabetes (odds ratio, 0.80; 95% CI, 0.64 to 1.00; P=0.05). Rates of severe hypoglycemia were 1.00 versus 0.31 per 100 person-years. Median weight increased by 1.6 kg in the insulin-glargine group and fell by 0.5 kg in the standard-care group. There was no significant difference in cancers (hazard ratio, 1.00; 95% CI, 0.88 to 1.13; P=0.97). CONCLUSIONS: When used to target normal fasting plasma glucose levels for more than 6 years, insulin glargine had a neutral effect on cardiovascular outcomes and cancers. Although it reduced new-onset diabetes, insulin glargine also increased hypoglycemia and modestly increased weight. (Funded by Sanofi; ORIGIN ClinicalTrials.gov number, NCT ). PMID: [PubMed - indexed for MEDLINE] Overige publicaties Incidence of cardiotoxicity of trastuzumab in Her2Neu positive breast cancer: a single centre experience. Liesting C, Brugts JJ, Levin M-D, Kofflard MJM. Neth Heart J 2012;20 (Suppl):3. Assessment of prognostic LV parameters with CMR in hypertrophic cardiomyopathy: impact of the papillary muscles. Gommans DHF, Bakker J, Cramer GE, Kurvers MJ, Brouwer MA, Verheugt FWA, Kofflard MJM. Journal of Cardiovascular Magnetic Resonance 2012;14 (Suppl 1): P 160. Voordrachten Potential Damage to Early Endothelial Progenitor Cell Mobilization after Percutaneous Coronary Intervention Because of Amplified Mitochondrial Production of Reactive Oxygen Species in White Blood Cells. van Waardenburg J, IJsselmuiden AJJ, Riedl JA, Kofflard MJM. Wetenschapsdag ASZ 21 juni 2012 Dordrecht. 20

23 Self-expanding stents in complex anatomy. IJsselmuiden AJJ. STENTYS CLINICAL FORUM III, 26/27 april 2012, Athene Griekenland. Self-expanding Stenting Yields Improved Stent Strut Apposition Compared to Balloon Expandable stenting 3 Days after Primary Percutaneous Coronary Intervention, Hypothesised to Decrease Oxidative Stress and Increase Endothelial Progenitor Cell function. van Waardenburg J, IJsselmuiden AJJ, Dirkali A, Kulekci K, de Vries AG, on behalf of the Apposition investigators Geaccrediteerde Presentatie NVVC Voorjaarscongres, 12 april 2012, Noordwijkerhout. Self-expanding stent in STEMI. IJsselmuiden AJJ. EuroPCR2012 congres, 17 mei 2012, Parijs Frankrijk. APPOSITION III - Evaluation of the STENTYS self-apposing bare and drugeluting stent in 1000 STEMI patients in a real-life setting: in-hospital and 30-day outcomes. Amoroso G, Koch K, IJsselmuiden AJJ. EuroPCR2012 congres, 18 mei 2012, Parijs Frankrijk. Incidence of cardiotoxicity of Trastuzumab in Her2Neu positive breast cancer: a single centre experience. Kofflard MJM. Najaarscongres NVVC, 4 oktober 2012, Papendal. Beeldvorming bij Hypertrofische Cardiomyopathie. Kofflard MJM. Cardiovasculaire beeldvormingsavond georganiseerd door het CVOI, 11 oktober 2012, Vergadercentrum Hoog Brabant, Utrecht. Posters Assessment of prognostic LV parameters with CMR in hypertrophic cardiomyopathy: impact of the papillary muscles. Gommans DHF, Bakker J, Cramer GE, Kurvers MJ, Brouwer MA, Verheugt FWA, Kofflard MJM. 15th Annual SCMR Scientific Sessions, Orlando Florida USA, 2-5 February Short and Long Term Clinical Outcomes of Chronic Total Occlusion Treatment with a Latest Generation Drug Eluting Stent. Chauvet AA, Blank R, Dirkali A, Doshi S, Erglis A, Hsien-Li Kao P, Lotan C, Neskovic A, Polad J, Vlasenko S. TCT geaccrediteerd congres, 23 oktober 2012, Miami Verenigde Staten. 21 Cardiologie

24 Chirurgie PubMed publicaties Histological type is not an independent prognostic factor for the risk pattern of breast cancer recurrences. Kwast AB, Groothuis-Oudshoorn KC, Grandjean I, Ho VK, Voogd AC, Menke-Pluymers MB, van der Sangen MJ, Tjan-Heijnen VC, Kiemeney LA, Siesling S. Breast Cancer Res Treat Jul 19. [Epub ahead of print] Invasive lobular breast cancer (ILC) is less common than invasive ductal breast cancer (IDC) and appears to have a distinct biology. Inconsistent findings regarding disease-free survival (DFS) are probably due to the fact that histologic type is related to hormone receptor status. This study aims to determine whether the type of the primary breast cancer histology is an independent prognostic factor for DFS, the risk pattern of loco-regional recurrences and distant metastases (DM), and whether it is a prognostic factor for the site of DM. All Dutch women diagnosed between 2003 and 2005 with ILC (n = 2,949) or IDC (n = 22,378) were selected from the Netherlands Cancer Registry. DFS was assessed using proportional hazard regression analysis. Compared to patients with IDC, those with ILC were significantly older and more likely to have more than three positive lymph nodes and have larger, better differentiated, more multifocal, and hormone receptor positive tumors (all P < 0.001). ILC was more likely to metastasize to the gastrointestinal organs and bones and less likely to the lung, central nervous system, and lymph nodes. Within the ER+PR+ and ER+PR- subgroups ILC was still more likely to metastasize to gastrointestinal organs and less likely to the lung. The timing of recurrence was correlated to hormone receptor status, independent of histological type. Highest risks were observed among ER-PR- patients within 2 years of surgery. Multivariable analysis showed that histological type is not an independent significant prognostic factor of DFS for the first 3 years post-surgery and thereafter (<3 years HR 0.91, 95 % CI , >3 years HR 1.07, 95 % CI ). Histological type should not be considered an important prognostic factor for the risk and risk pattern of recurrences. PMID: [PubMed - as supplied by publisher] Comparison of 30-day, 90-day and in-hospital postoperative mortality for eight different cancer types. Damhuis RA, Wijnhoven BP, Plaisier PW, Kirkels WJ, Kranse R, van Lanschot JJ. Br J Surg Aug;99(8): BACKGROUND: Various definitions are used to calculate postoperative mortality. As variation hampers comparability between reports, a study was performed to evaluate the impact of using different definitions for several types of cancer surgery. METHODS: Population-based data for the period were retrieved from the Rotterdam Cancer Registry for resectional surgery of oesophageal, gastric, colonic, rectal, breast, lung, renal and bladder cancer. Postoperative deaths were tabulated as 30-day, in-hospital or 90-day mortality. Postdischarge deaths were defined as those occurring after discharge from hospital but within 30 days. 22

25 RESULTS: This study included patients. Thirty-day mortality rates were highest after gastric (8 8 per cent) and colonic (6 0 per cent) surgery, and lowest after breast (0 2 per cent) and renal (2 0 per cent) procedures. For most tumour types, the difference between 30-day and in-hospital rates was less than 1 per cent. For bladder and oesophageal cancer, however, the in-hospital mortality rate was considerably higher at 5 1 per cent (+1 3 per cent) and 7 3 per cent (+2 8 per cent) respectively. For gastric, colonic and lung cancer, 1 0 per cent of patients died after discharge. For gastric, lung and bladder cancer, more than 3 per cent of patients died between discharge and 90 days. CONCLUSION: The 30-day definition is recommended as an international standard because it includes the great majority of surgery-related deaths and is not subject to discharge procedures. The 90-day definition, however, captures mortality from multiple causes; although this may be of less interest to surgeons, the data may be valuable when providing information to patients before surgery. PMID: [PubMed - in process] A Hospital-Based Work Support Intervention to Enhance the Return to Work of Cancer Patients: A Process Evaluation. Tamminga SJ, de Boer AG, Bos MM, Fons G, Kitzen JJ, Plaisier PW, Verbeek JH, Frings-Dresen MH. J Occup Rehabil Jun 15. [Epub ahead of print] PURPOSE: To perform a process evaluation of a hospital-based work support intervention for cancer patients aimed at enhancing return to work and quality of life. The intervention involves the delivery of patient education and support at the hospital and involves the improvement of the communication between the treating physician and the occupational physician. In addition, the research team asked patient s occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan. METHODS: Eligible were cancer patients treated with curative intent and who have paid work. Data were collected from patients assigned to the intervention group (N = 65) and from nurses who delivered the patient education and support at the hospital (N = 4) by means of questionnaires, nurses reports, and checklists. Data were quantitatively and qualitatively analysed. RESULTS: A total of 47 % of all eligible patients participated. Nurses delivered the patient education and support in 85 % of the cases according to the protocol. In 100 % of the cases at least one letter was sent to the occupational physician. In 10 % of the cases the meeting with the patient, the occupational physician and the supervisor took place. Patients found the intervention in general very useful and nurses found the intervention feasible to deliver. CONCLUSIONS: We found that a hospital- based work support intervention was easily accepted in usual psycho-oncological care but that it proved difficult to involve the occupational physician. Patients were highly satisfied and nurses found the intervention feasible. PMID: [PubMed - as supplied by publisher] Outcome of surgery for colovesical and colovaginal fistulas of diverticular origin in 40 patients. Smeenk RM, Plaisier PW, van der Hoeven JA, Hesp WL. J Gastrointest Surg Aug;16(8): Epub 2012 Jun Chirurgie

26 INTRODUCTION: According to literature, colonic resection with a primary anastomosis and no defunctioning ileostomy is a safe treatment for colovesical or colovaginal fistula of diverticular origin. This study investigates the outcome of surgery for this patient group in a regional hospital. METHODS: Patients were obtained from a prospective database in the period Several variables were investigated for their relation with surgical outcome. RESULTS: A colovesical (n = 35) or colovaginal (n = 5) fistula was diagnosed in 18 men and 22 women. The mean age was 69 years (range, 45-90). A rectosigmoid resection with primary anastomosis was performed in 32 patients. Fourteen patients received a defunctioning ileostomy. Eight patients were treated with a Hartmann procedure. Overall 30-day treatmentrelated morbidity and mortality was 48 and 8 %, respectively. Major morbidity, because of anastomotic leakage, was mainly observed in the primary anastomosis group without a defunctioning ileostomy. Morbidity and mortality were associated with high body mass index, diabetes, use of corticosteroids, and American Society of Anesthesiologists classification, though not significantly. CONCLUSIONS: One should be liberal in the use of a defunctioning ileostomy in case of a primary anastomosis after colonic resection for a diverticular fistula, in order to prevent high morbidity rates due to anastomotic leakage. PMID: [PubMed - in process] Predictors of functional outcome following femoral neck fractures treated with an arthroplasty: limitations of the Harris hip score. Reuling EM, Sierevelt IN, van den Bekerom MP, Hilverdink EF, Schnater JM, van Dijk CN, Goslings JC, Raaymakers EL. Arch Orthop Trauma Surg Feb;132(2): Epub 2011 Nov 24. INTRODUCTION: To study the association between potential prognostic factors and functional outcome at 1 and 5 year follow-up in patients with femoral neck fractures treated with an arthroplasty. To analyze the reliability of the Harris hip score (HHS). MATERIALS AND METHODS: A multicenter analysis which included 252 patients who sustained a femoral neck fracture treated with an arthroplasty. Functional outcome after surgery was assessed using a modified HHS and was evaluated after 1 (HHS1) and 5 (HHS5) years. Several prognostic factors were analyzed and reliability of the HHS was assessed. RESULTS: After 1 year the presence of co-morbidities was a significant (p = 0.002) predictor for a poor functional outcome (mean HHS with co-morbidities, and 80.6 without co-morbidities). After 5 years none of the potential prognostic factors had significant influence on functional outcome. Internal consistency testing of the HHS showed that when pain and function of the HHS were analyzed together, the internal consistency was poor (HHS and HHS5 0.20). The internal consistency of the HHS solely in function (without pain)improved to 0.68 (HHS1) and 0.46 (HHS5). Analyzing the functional aspect exclusively, age and the existence of co-morbidities could be defined as predictors for functional outcome of femoral neck fractures after 1 and 5 years. CONCLUSION: After using the HHS in a modification, age and the existence of pre-operative co-morbidities appeared to be predictors of the functional outcome after 1 and 5 years. The HHS, omitting pain, is a more reliable score to estimate the functional outcome, than HHS analyzing pain and function in one scoring system. PMCID: PMC PMID: [PubMed - indexed for MEDLINE] 24