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Näsvall, Pia
Publikasjoner (10 av 18) Visa alla publikasjoner
Odensten, C., Gunnarsson, U., Johansson, J. & Näsvall, P. (2024). Impact of parastomal hernia on colostomy costs at 1 year: secondary analysis of a randomized clinical trial (STOMAMESH). Scandinavian Journal of Surgery, 113(1), 33-39
Åpne denne publikasjonen i ny fane eller vindu >>Impact of parastomal hernia on colostomy costs at 1 year: secondary analysis of a randomized clinical trial (STOMAMESH)
2024 (engelsk)Inngår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 113, nr 1, s. 33-39Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background and aims: Parastomal hernia (PSH) is a common complication after the creation of a colostomy, with a prevalence of approximately 50%. Despite the high frequency, little is known how PSH affects the cost of colostomy care. The hypothesis in this study was that PSH increases the cost of colostomy care compared with not having a PSH.

Methods: Two groups with (N = 61) and without (n = 147) PSH were compared regarding costs of stoma appliances and visits. The population from a large randomized trial comparing construction of colostomy with or without prophylactic mesh (STOMAMESH) was used and cross-matched with health economic data from the National Pharmaceutical Register, 1 year after initial surgery.

Results: Patients with and without a PSH were similar in basic demographic data. No difference in cost of stoma appliances (with PSH 2668.3 EUR versus no PSH 2724.5 EUR, p = 0.938) or number of visits to a stoma therapist (p = 0.987) was seen, regardless of the presence or not of a PSH.

Conclusions: PSH appears not to affect costs due to colostomy appliances or the need to visit a stoma therapist, in the first year. The lesson to be learnt is that PSHs are not a driver for costs. Other factors may be determinants of the cost of a colostomy, including manufacturers' price and persuasion, means of procurement, and presence of guidelines.

sted, utgiver, år, opplag, sider
Sage Publications, 2024
Emneord
Colostomy, health economy, parastomal hernia
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-213413 (URN)10.1177/14574969231188021 (DOI)001046532600001 ()37563916 (PubMedID)2-s2.0-85167775479 (Scopus ID)
Forskningsfinansiär
Swedish Research Council, 214-7196Norrbotten County CouncilRegion Västerbotten, RV-927121
Tilgjengelig fra: 2023-08-25 Laget: 2023-08-25 Sist oppdatert: 2024-05-02bibliografisk kontrollert
Dahlstrand, U., Gustafsson, P., Näsvall, P., Johansson, J., Gunnarsson, U. & Lindforss, U. (2023). Costs related to diverting ileostomy after rectal cancer surgery: a population-based healthcare cost analysis based on nationwide registers. Inquiry, 60, 1-8
Åpne denne publikasjonen i ny fane eller vindu >>Costs related to diverting ileostomy after rectal cancer surgery: a population-based healthcare cost analysis based on nationwide registers
Vise andre…
2023 (engelsk)Inngår i: Inquiry, ISSN 0046-9580, E-ISSN 1945-7243, Vol. 60, s. 1-8Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Low anterior resection for rectal cancer often includes a diverting loop-ileostomy to avoid the severe consequences of anastomotic leakage. Reversal of the stoma is often delayed, which can incur health-care costs on different levels. The aim is to, on population basis, determine stoma-related costs, and to investigate habitual and socioeconomic factors associated to the level of cost. Multi-register design with data from the Swedish Rectal Cancer Registry, the National Prescribed Drug Register, Statistics Sweden and cost-administrative data from the National Board of Health and Welfare. Data was gathered for 3564 patients with rectal cancer surgery 2007 to 2013, for 3 years following the surgery. Factors influencing the cost of inpatient care and stoma-related consumables were assessed with linear regression analyses. All monthly costs were higher for females (consumables P <.001 and in-patient care P =.031). Post-secondary education (P =.003) and younger age (P =.020) was associated with a higher cost for consumables while suffering a surgical complication was associated with increased cost for inpatient care (P <.001). Patients who had their stoma longer had lower monthly costs (consumables P <.001 and in-patient care P <.001). Female gender, longer duration of stoma, young age, and higher education are associated with higher costs for the care of a diverting stoma after rectal cancer surgery. This study does not allow for analyses of causality but the results together with deepened analyses of underlying reasons form a proper basis for decisions in health care planning and allocation of resources. These findings may have implications on the debate of equal care for all.

sted, utgiver, år, opplag, sider
Sage Publications, 2023
Emneord
cost analysis, defunctioning stoma, healthcare costs, ileostomy, inpatients, low anterior resection, rectal neoplasms, resource allocation, socioeconomic factors, stoma reversal
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-218886 (URN)10.1177/00469580231212126 (DOI)38105185 (PubMedID)2-s2.0-85180186050 (Scopus ID)
Forskningsfinansiär
Region Västerbotten, RV-979794Region Västerbotten, RV-978927Swedish Research Council, 2021-00972Visare Norr, 930645
Tilgjengelig fra: 2024-01-04 Laget: 2024-01-04 Sist oppdatert: 2024-02-08bibliografisk kontrollert
Ringblom, C., Odensten, C., Strigård, K., Gunnarsson, U. & Näsvall, P. (2023). No reduction in parastomal hernia rate 3 years after stoma construction with prophylactic mesh: Three-year follow-up results from stomamesh-a multicenter double-blind randomized controlled trial. Annals of Surgery, 277(1), 38-42
Åpne denne publikasjonen i ny fane eller vindu >>No reduction in parastomal hernia rate 3 years after stoma construction with prophylactic mesh: Three-year follow-up results from stomamesh-a multicenter double-blind randomized controlled trial
Vise andre…
2023 (engelsk)Inngår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 277, nr 1, s. 38-42Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVE: The primary objective was to compare rates of parastomal hernia (PSH) 3 years after stoma construction with prophylactic mesh or no mesh. A secondary objective was to compare complications requiring reintervention within 3 years.

BACKGROUND: Recent studies have shown that a prophylactic mesh does not reduce the rate of PSH contrary to older studies. Long-term data on efficacy and safety is however scarce.

METHODS: A randomized controlled double-blind multicenter trial. Patients planned for permanent end colostomy were randomized to either prophylactic mesh in the retromuscular position around the stoma site or no mesh. They were evaluated for PSH clinically and with computed tomography (CT) 3 years after stoma construction. Medical records of all patients included were also reviewed at 3 years to detect any abdominal or abdominal wall surgery during that period.

RESULTS: A total of 232 patients were randomized. At 3 years, 154 patients were available for clinical evaluation and 137 underwent a CT scan. No significant difference in PSH rates was seen between the treatment allocation arms (clinical: P=0.829 and CT: P=0.761, respectively), nor was there a significant difference in the number of reinterventions, but 2 patients had their mesh removed at emergency surgery.

CONCLUSIONS: Prophylactic mesh does not reduce the rate of PSH and cannot be recommended for routine use.

sted, utgiver, år, opplag, sider
Wolters Kluwer, 2023
Emneord
parastomal hernia, mesh, prevention, prophylaxis
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-202661 (URN)10.1097/SLA.0000000000005537 (DOI)000905219700014 ()35837972 (PubMedID)2-s2.0-85145304565 (Scopus ID)
Forskningsfinansiär
Swedish Research Council, 214-7196Region Västerbotten, VLL-545001Norrbotten County Council
Tilgjengelig fra: 2023-01-12 Laget: 2023-01-12 Sist oppdatert: 2024-02-08bibliografisk kontrollert
Renman, D., Strigård, K., Palmqvist, R., Näsvall, P., Gunnarsson, U. & Edin-Liljegren, A. (2022). Attitudes to and Experiences of Physical Activity After Colon Cancer Diagnosis Amongst Physically Active Individuals: A Qualitative Study. Cancer Control: Journal of the Moffitt Cancer Cente, 29
Åpne denne publikasjonen i ny fane eller vindu >>Attitudes to and Experiences of Physical Activity After Colon Cancer Diagnosis Amongst Physically Active Individuals: A Qualitative Study
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2022 (engelsk)Inngår i: Cancer Control: Journal of the Moffitt Cancer Cente, ISSN 1073-2748, E-ISSN 1526-2359, Vol. 29Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Physical activity improves survival, reduces postoperative complications, and reduces the risk of developing colon cancer. It is important to maintain physical activity after receiving a diagnosis of colon cancer to improve postoperative recovery. Individuals who are physically active and diagnosed with colon cancer presumably have different motivations to maintain physical activity compared to their sedentary counterparts.

OBJECTIVE: Enlighten how the diagnosis of colon cancer might affect physically active individuals in their attitude and experiences towards physical activity.

METHODS: A qualitative study using content analysis was conducted in northern Sweden based on semi-structured telephone interviews of twenty patients diagnosed with colon cancer. All participants met the recommendations for physical activity issued by the World Health Organization.

RESULTS: Participants were between 50 and 88 years and 50% were male. Three main categories were identified: I'll fight the cancer and come out stronger; The diagnosis makes no difference; and The diagnosis is an obstacle for physical activity. These main categories represent the ways the individuals reacted to the diagnosis of colon cancer regarding their physical activity.

CONCLUSION: Attitudes to and experience of physical activity after colon cancer diagnosis varied from a will to increase physical activity and fight the cancer, to the diagnosis putting a stop to physical activity. It is important that healthcare professionals recommend physical activity even in already physically active individuals, to encourage continued physical activity after diagnosis of colon cancer.

sted, utgiver, år, opplag, sider
Sage Publications, 2022
Emneord
colon cancer, content analysis, interview study, physical activity, qualitative research
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-199246 (URN)10.1177/10732748221119352 (DOI)000854140200001 ()36066380 (PubMedID)2-s2.0-85137745234 (Scopus ID)
Forskningsfinansiär
Cancerforskningsfonden i Norrland, AMP-20-99-8Cancerforskningsfonden i Norrland, AMP-18-936Visare Norr, 967732Visare Norr, 929704The Kempe Foundations, 5573
Tilgjengelig fra: 2022-09-08 Laget: 2022-09-08 Sist oppdatert: 2023-03-23bibliografisk kontrollert
Odensten, C., Strigård, K., Dahlberg, M., Gunnarsson, U. & Näsvall, P. (2020). Parastomal hernia repair; seldom performed and seldom reported: Results from a nationwide survey. Scandinavian Journal of Surgery, 109(2), 96-101
Åpne denne publikasjonen i ny fane eller vindu >>Parastomal hernia repair; seldom performed and seldom reported: Results from a nationwide survey
Vise andre…
2020 (engelsk)Inngår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 109, nr 2, s. 96-101Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Parastomal hernia is common, but there are few population-based studies showing the frequency and outcome of parastomal hernia repair in routine surgical practice. The aim of this study was to identify patients undergoing surgery for parastomal hernia in Sweden and to define risk factors for complication and recurrence.

METHODS: A broad search of the Swedish National Patient Register 1998-2007 for all possible parastomal hernia repairs using surgical procedure codes. Records of all patients identified were reviewed and those with a definite parastomal hernia procedure were included and analyzed.

RESULTS: A total of 71 patients were identified after review of the records. The most common reason for surgery was cosmetic and the most frequent method was relocation of the stoma. Parastomal hernia recurrence rate was 18% during follow-up of a minimum 2 years. Overall, a surgical complication occurred in 32%. Possible risk factors were analyzed including emergency surgery versus planned, gender, age, indication for surgery, and method of surgery; none of which was significant.

CONCLUSION: The frequency of parastomal hernia procedures was much lower than suggested by previous studies. The number of procedures per surgeon was even lower than expected. No specific risk factor could be identified. Parastomal hernia auditing in the form of a nationwide quality register should be mandatory. Centralization should be considered.

sted, utgiver, år, opplag, sider
Sage Publications, 2020
Emneord
Hernia, abdominal wall, colorectal surgery, ostomy, risk factors, treatment outcome
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-154781 (URN)10.1177/1457496918818984 (DOI)000536875200004 ()30563418 (PubMedID)2-s2.0-85059001799 (Scopus ID)
Forskningsfinansiär
Norrbotten County Council
Tilgjengelig fra: 2019-01-03 Laget: 2019-01-03 Sist oppdatert: 2023-11-01bibliografisk kontrollert
Tivenius, M., Näsvall, P. & Sandblom, G. (2019). Parastomal hernias causing symptoms or requiring surgical repair after colorectal cancer surgery - a national population-based cohort study. International Journal of Colorectal Disease, 34(7), 1267-1272
Åpne denne publikasjonen i ny fane eller vindu >>Parastomal hernias causing symptoms or requiring surgical repair after colorectal cancer surgery - a national population-based cohort study
2019 (engelsk)Inngår i: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 34, nr 7, s. 1267-1272Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

PurposeParastomal hernia is a complication with high morbidity that affects the patient's quality of life. The aim of this study was to assess the cumulative incidence of parastomal hernia in patients who have undergone colorectal cancer surgery and to identify potential risk factors that could predispose to the development of this type of hernia in a large population-based cohort over a long follow-up period.MethodsThe Swedish Colorectal Cancer Registry and the National Patient Register were used to collect study cohort data between January 2007 and September 2013. All patients undergoing colorectal cancer surgery including a permanent stoma were included in the study group.ResultsA total of 39,984 patients were registered during the study period. Of these, 7649 received a permanent stoma. Multivariate proportional hazard analysis, based on 6329 patients for whom all covariates could be retrieved, showed that the only independent risk factor for developing a parastomal hernia was BMI30 (HR 1.49; 95% CI 1.02-2.17; p<0.037). A slightly elevated hazard ratio was found for preoperative radiotherapy (HR 1.36; 95% CI 0.96-1.91; p<0.070). The cumulative incidence of patients diagnosed or surgically treated for parastomal hernia over a follow-up period of 5years was 7.7% (95% CI 6.1-9.2%).ConclusionsThe cumulative incidence of parastomal hernia causing symptoms or requiring surgery after 5years was at least 7.7%. Obesity increases the risk of developing parastomal hernia.

sted, utgiver, år, opplag, sider
Springer, 2019
Emneord
Parastomal hernia, Colorectal cancer, Colorectal surgery, Obesity, Population-based, Enteostomy
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-161506 (URN)10.1007/s00384-019-03292-4 (DOI)000471613000013 ()31147771 (PubMedID)2-s2.0-85066811398 (Scopus ID)
Tilgjengelig fra: 2019-07-12 Laget: 2019-07-12 Sist oppdatert: 2023-03-24bibliografisk kontrollert
Odensten, C., Strigård, K., Rutegård, J., Dahlberg, M., Ståhle, U., Gunnarsson, U. & Näsvall, P. (2019). Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial—STOMAMESH. Annals of Surgery, 269(3), 427-431
Åpne denne publikasjonen i ny fane eller vindu >>Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial—STOMAMESH
Vise andre…
2019 (engelsk)Inngår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, nr 3, s. 427-431Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh.

Background: Prevention of PSH is important as it often causes discomfort and leakage from stoma dressing. Different methods of prevention have been tried, including several mesh techniques. The incidence of PSH is high; up to 78%.

Methods: Randomized controlled double-blinded multicenter trial. Patients undergoing open colorectal surgery, including creation of a permanent end colostomy, were randomized into 2 groups, with and without mesh. A lightweight polypropylene mesh was placed around the colostomy in the sublay position. Follow up after 1 month and 1 year. Computerized tomography and clinical examination were used to detect PSH at the 1-year follow up. Data were analyzed on an intention-to-treat basis.

Results: After 1 year, 211 of 232 patients underwent clinical examination and 198 radiologic assessments. Operation time was 36 minutes longer in the mesh arm. No difference in rate of PSH was revealed in the analyses of clinical (P = 0.866) and radiologic (P = 0.748) data. There was no significant difference in perioperative complications.

Conclusions: The use of reinforcing mesh does not alter the rate of PSH. No difference in complication rate was seen between the 2 arms. Based on these results, the prophylactic use of mesh to prevent PSH cannot be recommended.

sted, utgiver, år, opplag, sider
Wolters Kluwer, 2019
Emneord
mesh, parastomal hernia, prophylaxis
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-142585 (URN)10.1097/SLA.0000000000002542 (DOI)000467458600023 ()29064900 (PubMedID)2-s2.0-85050207106 (Scopus ID)
Tilgjengelig fra: 2017-12-07 Laget: 2017-12-07 Sist oppdatert: 2023-10-31bibliografisk kontrollert
Odensten, C., Strigård, K., Rutegård, J., Dahlberg, M., Ståhle, U., Gunnarsson, U. & Näsvall, P. (2018). Response to: "Follow-up of the STOMAMESH Cohort" [Letter to the editor]. Annals of Surgery, 268(2), e31-e31
Åpne denne publikasjonen i ny fane eller vindu >>Response to: "Follow-up of the STOMAMESH Cohort"
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2018 (engelsk)Inngår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 268, nr 2, s. e31-e31Artikkel i tidsskrift, Letter (Fagfellevurdert) Published
sted, utgiver, år, opplag, sider
Wolters Kluwer, 2018
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-148347 (URN)10.1097/SLA.0000000000002787 (DOI)000452663200006 ()29985812 (PubMedID)2-s2.0-85050122389 (Scopus ID)
Tilgjengelig fra: 2018-06-04 Laget: 2018-06-04 Sist oppdatert: 2019-01-22bibliografisk kontrollert
Odensten, C., Strigård, K., Rutegård, J., Dahlberg, M., Ståhle, U., Gunnarsson, U. & Näsvall, P. (2018). Response to: "Prophylactic Mesh for the Prevention of Parastomal Hernias: Need for a Deep Dive" [Letter to the editor]. Annals of Surgery, 268(2), E30-E30
Åpne denne publikasjonen i ny fane eller vindu >>Response to: "Prophylactic Mesh for the Prevention of Parastomal Hernias: Need for a Deep Dive"
Vise andre…
2018 (engelsk)Inngår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 268, nr 2, s. E30-E30Artikkel i tidsskrift, Letter (Fagfellevurdert) Published
sted, utgiver, år, opplag, sider
Lippincott Williams & Wilkins, 2018
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-154653 (URN)10.1097/SLA.0000000000002807 (DOI)000452663200004 ()29742528 (PubMedID)2-s2.0-85050157202 (Scopus ID)
Tilgjengelig fra: 2018-12-21 Laget: 2018-12-21 Sist oppdatert: 2023-03-24bibliografisk kontrollert
Näsvall, P., Rutegård, J., Dahlberg, M., Gunnarsson, U. & Strigård, K. (2017). Parastomal hernia repair with intraperitoneal mesh. Surgery Research and Practice, 2017, Article ID 8597463.
Åpne denne publikasjonen i ny fane eller vindu >>Parastomal hernia repair with intraperitoneal mesh
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2017 (engelsk)Inngår i: Surgery Research and Practice, ISSN 2356-7759, Vol. 2017, s. 51+4artikkel-id 8597463Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Purpose. Parastomal hernia is a common complication following a stoma and may cause leakage or incarceration. No optimal treatment has been established, and existing methods using mesh repair are associated with high recurrence rates and a considerable risk for short- and long-term complications including death. A double-layer intraperitoneal on-lay mesh (IPOM), the Parastomal Hernia Patch (BARD™), consisting of ePTFE and polypropylene, has been developed and tailored to avoid recurrence. To evaluate the safety of and recurrence rate using this mesh, a nonrandomised prospective multicentre study was performed. Method. Fifty patients requiring surgery for parastomal hernia were enrolled. Clinical examination and CT scan prior to surgery were performed. All patients were operated on using the Parastomal Hernia Patch (BARD). Postoperative follow-up at one month and one year was scheduled to detect complications and hernia recurrence. Results. The postoperative complication rate at one month was 15/50 (30%). The parastomal hernia recurrence rate at one year was 11/50 (22%). The reoperation rate at one month was 7/50 (14%), and further 5/50 (10%) patients were reoperated on during the following eleven months.

sted, utgiver, år, opplag, sider
Hindawi Publishing Corporation, 2017. s. 51+4
HSV kategori
Forskningsprogram
kirurgi
Identifikatorer
urn:nbn:se:umu:diva-103309 (URN)10.1155/2017/8597463 (DOI)29204515 (PubMedID)978-91-7601-241-3 (ISBN)
Merknad

Originally included in thesis in manuscript form.

Tilgjengelig fra: 2015-05-20 Laget: 2015-05-20 Sist oppdatert: 2018-06-07bibliografisk kontrollert
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