Henrik Kehlet

IT University of Copenhagen, København, Capital Region, Denmark

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Publications (822)2752.5 Total impact

  • E K Aasvang, M U Werner, H Kehlet
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    ABSTRACT: Persistent postherniotomy pain is located around the scar and external inguinal ring and is often described as deep rather than cutaneous, with frequent complaints of pain in adjacent areas. Whether this pain is due to local pathology or referred/projected pain is unknown, hindering mechanism-based treatment. Deep tissue electrical pain stimulation by needle electrodes in the right groin (rectus muscle, ilioinguinal/iliohypogastric nerve and perispermatic cord) was combined with assessment of referred/projected pain and the cutaneous heat pain threshold (HPT) at three prespecified areas (both groins and the lower right arm) in 19 healthy subjects. The assessment was repeated 10 days later to assess the reproducibility of individual responses. Deep electrical stimulation elicited pain at the stimulation site in all subjects, and in 15 subjects, pain from areas outside the stimulation area was reported, with 90-100% having the same response on both days, depending on the location. Deep pain stimulation significantly increased the cutaneous HPT (P<0.014). Individual HPT responses before and during deep electrical pain stimulation were significantly correlated (ρ>0.474, P≤0.040) at the two test days for the majority of test areas. Our results corroborate a systematic relationship between deep pain and changes in cutaneous nociception. The individual referred/projected pain patterns and cutaneous responses are variable, but reproducible, supporting individual differences in anatomy and sensory processing. Future studies investigating the responses to deep tissue electrical stimulation in persistent postherniotomy pain patients may advance our understanding of underlying pathophysiological mechanisms and strategies for treatment and prevention. ClinicalTrials.gov (NCT01701427). © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    BJA British Journal of Anaesthesia 06/2015; DOI:10.1093/bja/aev170 · 4.35 Impact Factor
  • C C Jørgensen, Ø Jans, H Kehlet
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    ABSTRACT: Preoperative anaemia is a well-established risk factor for use of blood transfusions and postoperative morbidity. Consequently, focus on preoperative evaluation of haemoglobin levels is increasing. In this context, iron deficiency anaemia may be a symptom of undiscovered gastrointestinal (GI) cancer requiring further investigation. However, the association between preoperative anaemia and cancer 1 year after elective total hip (THA) and total knee arthroplasty (TKA) is unknown. We evaluated 1-year cancer diagnoses, particularly GI cancers, in anaemic and non-anaemic THA and TKA patients. A prospective database on preoperative patient characteristics from six Danish orthopaedic centres was cross-referenced with the Danish Cancer Registry for information on diagnoses of new cancers 1 year after surgery. Crude cancer risk estimates were calculated using chi-square and Fisher's exact test in the total study cohort. Adjusted risk estimates were obtained using propensity scores and the Mantel-Haenzel statistic. Of 5400 procedures, 731 (13·5%) were in anaemic patients. These were older and had more comorbidity than non-anaemic patients. There were 17 (2·3%) and 79 (1·6%) new cancers in anaemic and non-anaemic patients, respectively (OR: 1·38; 95% CI: 0·81-2·35, P = 0·228). After propensity matching of 661 anaemic and 1305 non-anaemic patients, we found no association between preoperative anaemia and cancer (OR: 0·94; 95% CI: 0·51-1·73, P = 0·837) or with GI cancers specifically (OR: 0·80; 95% CI: 0·25-2·56, P = 0·707). Preoperative anaemia per se may not be related to being diagnosed with cancer 1 year after THA and TKA. The optimal criteria for preoperative referral of anaemic patients to gastroenterologist in elective THA and TKA need further investigation. © 2015 International Society of Blood Transfusion.
    Vox Sanguinis 05/2015; DOI:10.1111/vox.12255 · 3.30 Impact Factor
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    ABSTRACT: Chronic pain is a highly prevalent and poorly managed human health problem. We used microarray-based expression genomics in 25 inbred mouse strains to identify dorsal root ganglion (DRG)-expressed genetic contributors to mechanical allodynia, a prominent symptom of chronic pain. We identified expression levels of Chrna6, which encodes the α6 subunit of the nicotinic acetylcholine receptor (nAChR), as highly associated with allodynia. We confirmed the importance of α6* (α6-containing) nAChRs by analyzing both gain- and loss-of-function mutants. We find that mechanical allodynia associated with neuropathic and inflammatory injuries is significantly altered in α6* mutants, and that α6* but not α4* nicotinic receptors are absolutely required for peripheral and/or spinal nicotine analgesia. Furthermore, we show that Chrna6's role in analgesia is at least partially due to direct interaction and cross-inhibition of α6* nAChRs with P2X2/3 receptors in DRG nociceptors. Finally, we establish the relevance of our results to humans by the observation of genetic association in patients suffering from chronic postsurgical and temporomandibular pain. Copyright © 2015, American Association for the Advancement of Science.
    Science translational medicine 05/2015; 7(287):287ra72. DOI:10.1126/scitranslmed.3009986 · 14.41 Impact Factor
  • H Kehlet, C P Delaney, A G Hill
    BJA British Journal of Anaesthesia 04/2015; DOI:10.1093/bja/aev098 · 4.35 Impact Factor
  • Source
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    ABSTRACT: Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment, outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (i.e., chronic post-surgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues discussed can, in many instances, be extrapolated to other chronic pain conditions. These examples were selected because they are representative models of primary and secondary prevention, reflect persistent pain resulting from multiple insults (i.e., surgery, viral infection, injury, and toxic/noxious element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have the potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials.
    Pain 04/2015; DOI:10.1097/j.pain.0000000000000191 · 5.84 Impact Factor
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    ABSTRACT: Sufficient pain treatment remains a challenge after total knee arthroplasty (TKA), especially in high pain catastrophizing patients. Serotonergic signaling may be involved in pain processing, but the effect of selective serotonin reuptake inhibitors on well-defined postoperative pain has not previously been investigated. The authors hypothesized that perioperative escitalopram would reduce pain after TKA in high pain catastrophizing patients. A total of 120 pain catastrophizing patients (selected using the pain catastrophizing scale as preoperative screening tool) scheduled for TKA were randomized in a double-blind manner to either 10 mg escitalopram or placebo daily from preanesthesia to postoperative day 6 in addition to a standardized analgesic regime. The primary outcome was pain upon ambulation 24 h after surgery. Secondary outcomes were overall pain during well-defined mobilizations and at rest from 2 to 48 h and from days 2 to 6, morphine equivalents, anxiety, depression, and side effects. Pain upon ambulation (mean [95% CI]) 24 h after surgery in the escitalopram versus placebo group was 58 (53 to 64) versus 64 (58 to 69), the mean difference being -5 (-13 to 3), P = 0.20. Overall pain upon ambulation and at rest from days 2 to 6 was lower in the escitalopram versus placebo group, as was depression score at day 6 (all P ≤ 0.01 in analyses uncorrected for multiple tests). Side effects were nonsignificant except for reduced tendency to sweat and prolonged sleep in the escitalopram group. No other between-group differences were observed. Escitalopram did not reduce pain upon ambulation 24 h after TKA in high pain catastrophizing patients. Future studies on optimal timing, dose, and duration of selective serotonin reuptake inhibitor treatment might be warranted.
    Anesthesiology 04/2015; 122(4):884-94. DOI:10.1097/ALN.0000000000000597 · 6.17 Impact Factor
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    ABSTRACT: Patients who are surgically treated for an acute hip fracture in Denmark commence early in-hospital physical rehabilitation (PR) with more than 95% of patients referred to further PR following discharge. However, the specifics of the PR services after discharge are unknown. Thus, the aim of the present paper was to describe the specifics of PR provided to patients following discharge after hip fracture (HF) surgery in Denmark to evaluate the need for future interventions or guidelines. This was a national, cross-sectional questionnaire survey including 56 randomly selected municipalities out of 98. Information was gathered on PR and categorised into outpatient PR (including one-to-one and group), home-based PR, 24-hour in-patient PR units and nursing homes. Sixty PR centres (97%) within 51 municipalities (91%) participated. The PR was initiated within 1-2 weeks after the municipality had received a referral from the hospital in 97% of the participating centres. The duration of PR was 8-12 weeks or 4-7 weeks in 85% of the centres, and most often comprised 1-2 training sessions per week. In all, 72% out of 56 municipalities returned a specific PR programme of which only 14% provided specific information regarding the intensity and the progression of training. PR after hip fracture in Denmark is initiated shortly after referral, for a variable duration of time and with poorly described exercise intensity and progression. This calls for a national description and implementation of an optimised PR programme according to the best available evidence. The study was supported by grants from The IMK Foundation, The Research Foundation of the Capital Region, The Research Foundation of the Danish Physical Therapy Organization, The Research Foundation of Hvidovre Hospital and The UCSF Lundbeck Foundation. The funding agencies had no influence on the study design, methods, subjects, data collection, analyses or on the manuscript. not relevant.
    Danish Medical Journal 04/2015; 62(4):A5023. · 0.61 Impact Factor
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    ABSTRACT: Pain after Caesarean section is often treated with opioids with a risk of side effects. Wound infiltration with local anaesthetics is effective and has few side effects, but volume vs. dose concentration has not been examined. Ninety patients scheduled for elective Caesarean section included in a randomised, double-blinded, placebo-controlled trial receiving infiltration with 50 ml ropivacaine 0.5% or 125 ml ropivacaine 0.2% or 50 ml 0.9% saline (placebo) during surgery. Surgery was performed under lumbar spinal anaesthesia. Primary endpoint was post-operative pain. Secondary endpoints were rescue analgesic, post-operative nausea and vomiting, time spent in the postanesthesia care unit (PACU) and time to first mobilisation. No difference in pain response between groups, but time until maximum pain score was prolonged in the ropivacaine 0.5% group compared with the placebo group (P = 0.0493). The administration of ketobemidone at 24 h post-operatively in the ropivacaine 0.5% group was reduced compared with the placebo group (P = 0.020), and between the ropivacaine 0.2% group and the ropivacaine 0.5% group (P = 0.044). No significant differences between groups were found concerning time spent in the PACU, to first mobilisation or in number of women with nausea/vomiting (P ≥ 0.05). No complications related to ropivacaine were observed. Systematic infiltration with a high concentration, low volume compared with low concentration, high volume showed no significant effect on post-operative pain intensity. However, a statistically significant, but clinically limited opioid sparing effect was demonstrated compared with placebo in the high concentration, low volume group. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
    Acta Anaesthesiologica Scandinavica 03/2015; 59(5). DOI:10.1111/aas.12509 · 2.31 Impact Factor
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    ABSTRACT: Postoperative delirium (PD) is a common but serious problem after major surgery with a multifactorial pathogenesis including age, pain, opioid use, sleep disturbances and the surgical stress response. These factors have been minimised by the "fast-track methodology" previously demonstrated to enhance recovery and reduce morbidity. Clinical symptoms of PD were routinely collected three times daily from preoperatively until discharge in a well-defined enhanced recovery program after colonic surgery in 247 consecutive patients. Total median length of hospital stay was 3 days. Seven patients (2.8 %) developed clinical signs of PD most within the first 72 postoperative hours and only 1 patient with PD extending to 120 h postoperatively. Only 1 PD patient required treatment with serenase. PD patients were older (83 vs. 73 years) and had longer median stay (6 vs. 3 days). No difference in development of PD between open and laparoscopic operation could be demonstrated. Among the 7 patients with PD, 3 of these patients had later surgical complications. One patient had a subsequent strangulated small intestine, another an anastomotic leakage complicated by a bleeding gastric ulcer and death on day 12 and 1 with fever, abdominal pain and suspected but disproven anastomotic leakage (stay 21, 12 and 22 days, respectively). The remaining 4 PD patients stayed 4, 4, 5 and 6 days with an uncomplicated course. These data support that an enhanced postoperative recovery program may decrease the risk and duration of PD after colonic surgery.
    Langenbeck s Archives of Surgery 03/2015; 400(4). DOI:10.1007/s00423-015-1297-8 · 2.16 Impact Factor
  • Acta Anaesthesiologica Scandinavica 03/2015; 59(4). DOI:10.1111/aas.12495 · 2.31 Impact Factor
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    ABSTRACT: Variability in heart rate response (HRR) can be used as a measure for autonomic nervous system function, which may influence sleep disturbances and the recovery phase after major surgery. The aim of this study was to evaluate autonomic function by assessment of HRR during sleep arousals in the postoperative period after fast-track hip and knee arthroplasty. Determination of autonomic function was gained from polysomnographic evaluation of 10 patients >60 years undergoing either hip or knee arthroplasty (mean age 69.9 years) evaluating HRR during the different sleep phases. Sleep monitoring took place in the patients' home preoperatively, during hospitalization on the first postoperative night, and on the fourth postoperative night at home. HRR was reduced (P < 0.01) during arousal from non-REM stage 2 sleep on the first postoperative night, and was still reduced on the fourth postoperative night compared to preoperative level (P = 0.01). HRR during arousal from REM sleep was not different between the preoperative and fourth postoperative night (P = 0.92), while this could not be determined on the first postoperative night where REM sleep disappeared. The reduced HRR during sleep arousal after major arthroplasty surgery in elderly patients may reflect a functional change in sympathetic nervous system potentially relevant for postoperative sleep changes, fatigue and cognitive function.
    Sleep and Biological Rhythms 03/2015; DOI:10.1111/sbr.12108 · 0.76 Impact Factor
  • Anesthesiology 03/2015; DOI:10.1097/ALN.0000000000000632 · 6.17 Impact Factor
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    ABSTRACT: Persistent postoperative pain is a well-established clinical problem with potential severe personal and socioeconomic implications. The prevalence of persistent pain varies across surgery types. Severe persistent pain and related impairment occur in 5% to 10% of patients after groin hernia repair. The substantial interindividual variability in pain-related phenotypes within each surgery type cannot be explained by environmental factors alone, suggesting that genetic variation may play a role. We investigated the contribution of COMT and GCH1 to persistent postherniotomy pain (PPP)-related functional impairment. Prospective data from 429 Caucasian male patients with hernia were collected. Three COMT and 2 GCH1 tagging single-nucleotide polymorphisms (SNPs) were genotyped and analyzed for association with PPP-related activity impairment at 6 months after herniotomy. Fifty-five (12.8%) patients had moderate-to-severe pain-related activity impairment 6 months postoperatively as measured by Activity Assessment Scale (≥8.3). Patients with the G allele of COMT SNP rs6269 and C allele of COMT SNP rs4633 had less impairment (P = 0.03 and 0.01, respectively); in addition, the COMT haplotype GCG was associated with less impairment. For GCH1, the A allele of SNP rs3783641, T allele of rs8007267, and AT haplotype showed a protective effect trend (although nonsignificant; P = 0.08, 0.06, and 0.08, respectively). A prediction model of substantial PPP-related activity impairment, combining COMT and GCH1 SNPs with clinical, psychophysical, and psychological risk factors, had a "good" (0.8 < area under curve < 0.9) discriminatory power. These data suggest that functional variations in COMT and GCH1 combined with clinical factors are predictive of PPP-related impairment after groin herniotomy.
    Pain 02/2015; 156(2):273-9. DOI:10.1097/01.j.pain.0000460307.48701.b0 · 5.84 Impact Factor
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    ABSTRACT: Background The mesh fixation technique in laparoscopic incisional hernia repair may influence the rates of hernia recurrence and chronic pain. This study investigated the long-term risk of recurrence and chronic pain in patients undergoing laparoscopic incisional hernia repair with either absorbable or non-absorbable tacks for mesh fixation.Methods This was a nationwide consecutive cohort study based on data collected prospectively concerning perioperative information and clinical follow-up. Patients undergoing primary, elective, laparoscopic incisional hernia repair with absorbable or non-absorbable tack fixation during a 4-year interval were included. Follow-up was by a structured questionnaire regarding recurrence and chronic pain, supplemented by clinical examination, and CT when indicated. Recurrence was defined as either reoperation for recurrence or clinical/radiological recurrence.ResultsOf 1037 eligible patients, 84·9 per cent responded to the questionnaire, and 816 were included for analysis. The median observation time for the cohort was 40 (range 0–72) months. The cumulative recurrence-free survival rate was 71·5 and 82·0 per cent after absorbable and non-absorbable tack fixation respectively (P = 0·007). In multivariable analysis, the use of absorbable tacks was an independent risk factor for recurrence (hazard ratio 1·53, 95 per cent c.i. 1·11 to 2·09; P = 0·008). The rate of moderate or severe chronic pain was 15·3 and 16·1 per cent after absorbable and non-absorbable tack fixation respectively (P = 0·765).Conclusion Absorbable tack fixation of the mesh was associated with a higher risk of recurrence than non-absorbable tacks for laparoscopic mesh repair of incisional hernia, but did not influence chronic pain.
    British Journal of Surgery 02/2015; 102(5). DOI:10.1002/bjs.9750 · 5.21 Impact Factor
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    ABSTRACT: Diabetes is a risk factor for postoperative morbidity, which includes total hip and knee arthroplasty. However, no previous studies have been done in a fast-track setting with optimized perioperative care, including spinal anesthesia, multimodal opioid-sparing analgesia, early mobilization, and discharge to home, which improved postoperative outcome. We performed an observational cohort study using prospective data in primary total hip and total knee arthroplasty with a standardized fast-track approach. Eight hundred ninety type 2 diabetics were successfully propensity matched with 7165 nondiabetics. Subanalyses on antihyperglycemic treatment were done using the Danish National Database of Reimbursed Prescriptions for information on dispensed prescriptions 6 months preoperatively. Length of hospital stay (LOS), 90-day readmissions, and mortality were found through the Danish National Health Registry and medical charts. Multiple logistic regression analyses on LOS > 4 days and readmissions were used to further adjust for demographics, comorbidity, and department of surgery. To further evaluate the clinical relevance of type 2 diabetes, we estimated the number of surgical type 2 diabetics needed for 1 more occurrence of LOS > 4 days or readmissions (adjusted number needed to harm [NNH]). Although more type 2 diabetics (11.3%) than nondiabetics (8.1%) had LOS > 4 days (unadjusted P = 0.001), there was no association between type 2 diabetes and LOS > 4 days when adjusting for covariates (odds ratio: 1.19 [0.93-1.54]; P = 0.172). Correspondingly, the NNH was 78 but ranged between 31 and infinity. Type 2 diabetes was not associated with 30- (1.02 [0.75-1.39]; P = 0.897) or 90-day readmissions (1.22 [0.87-1.71]; P = 0.254), and with an NNH of 957 (59-∞) and 115 (35-∞), respectively. Insulin-treated type 2 diabetes was associated with increased risk of specific "diabetes-related" morbidity (1.95 [1.13-3.35]; P = 0.016). Type 2 diabetes per se has limited influence on postoperative morbidity in fast-track total hip and knee arthroplasty.
    Anesthesia & Analgesia 01/2015; 120(1):230-8. DOI:10.1213/ANE.0000000000000451 · 3.42 Impact Factor
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    ABSTRACT: Thigh tourniquet is commonly used in total knee arthroplasty (TKA) but may contribute to pain and muscle damage. Consequently, the reduction in knee-extension strength after TKA may be caused by quadriceps muscle ischaemia underneath the cuff.
    The Knee 12/2014; 22(2). DOI:10.1016/j.knee.2014.12.010 · 1.70 Impact Factor
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    ABSTRACT: The choice of anaesthetic technique for patients undergoing joint arthroplasty is debatable. The hypothesis of this study was that general anaesthesia would generate a more favourable recovery profile than spinal anaesthesia. We randomly allocated 120 patients to either intrathecal bupivacaine or general anaesthesia with target-controlled infusion of remifentanil and propofol. Length of hospital stay assessed as meeting discharge criteria was the primary outcome parameter. Other outcome parameters were actual time of discharge, pain, use of rescue pain medication, blood loss, length of stay in the post-operative care unit, dizziness, post-operative nausea, need of urinary catheterisation and patient satisfaction. General anaesthesia resulted in slightly reduced length of hospital stay (26 vs. 30 h, P = 0.004), less nausea (P = 0.043) and dizziness (P < 0.001). General anaesthesia patients had higher pain scores during the first two post-operative hours (P < 0.001) but lower after 6 h compared with the spinal anaesthesia group (P < 0.01 and P < 0.05). General anaesthesia patients had better orthostatic function compared with spinal anaesthesia patients (P = 0.008). Patients in the spinal anaesthesia group fulfilled the discharge criteria from the post-operative care unit earlier compared with the general anaesthesia patients (P = 0.004). General anaesthesia patients requested a change in the method of anaesthesia for a subsequent operation less often than the spinal anaesthesia patients (5 vs. 13, P = 0.022). General anaesthesia resulted in a more favourable recovery profile compared with spinal anaesthesia. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
    Acta Anaesthesiologica Scandinavica 12/2014; 59(3). DOI:10.1111/aas.12456 · 2.31 Impact Factor
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    ABSTRACT: Objective. To compare 7 weeks of supervised physical rehabilitation with or without progressive strength training (PST) commenced early after fast-track total knee arthroplasty (TKA) on functional performance.Methods. Eighty-two patients with a unilateral primary TKA were randomized to 2 different interventions: 7 weeks of supervised physical rehabilitation with (PST-group) and without (CON-group) PST commenced early after fast-track TKA. The primary outcome was the maximal distance walked in 6 minutes (6-minute walk test). Secondary outcomes were lower limb strength and power, knee joint effusion and range of motion, knee pain and self-reported disability and quality of life. All outcome measures were assessed before (baseline) and 4, 8 and 26 weeks after TKA.Results. There was no statistically significant difference between the PST- and CON-group in the change score from baseline to the 8-week postoperative assessment (primary endpoint) for the 6-minute walk test with unadjusted baseline scores (mean difference between groups: -11.3 meters, 95% confidence interval -45.4 to 22.7 meters; analysis of variance (ANOVA), p=0.51). There were no statistically significant or clinically meaningful differences between groups in change scores from baseline to any other time point for all secondary outcomes. The secondary outcome, knee-extension strength did not reach the level recorded before surgery in both groups.Conclusions. Seven weeks of supervised physical rehabilitation with PST was not superior to 7 weeks of supervised physical rehabilitation without PST in improving functional performance, measured as the maximal walking distance in 6 minutes, at the primary endpoint 8 weeks after fast-track TKA. © 2014 American College of Rheumatology.
    12/2014; 66(12). DOI:10.1002/acr.22405
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    ABSTRACT: We present detailed information about early morbidity after aseptic revision knee replacement from a nationwide study. All aseptic revision knee replacements undertaken between 1st October 2009 and 30th September 2011 were analysed using the Danish National Patient Registry with additional information from the Danish Knee Arthroplasty Registry. The 1218 revisions involving 1165 patients were subdivided into total revisions, large partial revisions, partial revisions and revisions of unicondylar replacements (UKR revisions). The mean age was 65.0 years (27 to 94) and the median length of hospital stay was four days (interquartile range: 3 to 5), with a 90 days re-admission rate of 9.9%, re-operation rate of 3.5% and mortality rate of 0.2%. The age ranges of 51 to 55 years (p = 0.018), 76 to 80 years (p < 0.001) and ≥ 81 years (p < 0.001) were related to an increased risk of re-admission. The age ranges of 76 to 80 years (p = 0.018) and the large partial revision subgroup (p = 0.073) were related to an increased risk of re-operation. The ages from 76 to 80 years (p < 0.001), age ≥ 81 years (p < 0.001) and surgical time > 120 min (p < 0.001) were related to increased length of hospital stay, whereas the use of a tourniquet (p = 0.008) and surgery in a low volume centre (p = 0.013) were related to shorter length of stay. In conclusion, we found a similar incidence of early post-operative morbidity after aseptic knee revisions as has been reported after primary procedures. This suggests that a length of hospital stay ≤ four days and discharge home at that time is safe following aseptic knee revision surgery in Denmark. Cite this article: Bone Joint J 2014;96-B:1649-56. ©2014 The British Editorial Society of Bone & Joint Surgery.
    12/2014; 96-B(12):1649-56. DOI:10.1302/0301-620X.96B12.33621
  • Henrik Kehlet
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    ABSTRACT: The concept of multimodal postoperative recovery programs, i.e., Enhanced Recovery After Surgery (ERAS) programs or “fast-track surgery”, was fostered more than 15 years ago when it was realized that unimodal interventions were futile for addressing the problem of multimodal perioperative morbidity.1 Due to initial successful results, the concept has now been accepted worldwide and across most surgical specialities. During this process, the ERAS Society (http://www.erassociety.org) has played an important role in helping to provide guidelines, educational meetings, and additional support. Therefore, based on the success of ERAS programs, it might be considered acceptable to lean back and be satisfied with the recent progress. Then again, an invitation from the Journal to publish a personal editorial view on ERAS - by someone involved from the early development phase of the program - presents an opportunity for a critical reassessment of the basic ideas behind the concept and whether we ...
    Canadian Journal of Anaesthesia 11/2014; 62(2). DOI:10.1007/s12630-014-0261-3 · 2.50 Impact Factor

Publication Stats

31k Citations
2,752.50 Total Impact Points


  • 1996–2015
    • IT University of Copenhagen
      København, Capital Region, Denmark
  • 2014
    • University of Southern Denmark
      • Institute of Regional Health Research
      Odense, South Denmark, Denmark
  • 2000–2014
    • Copenhagen University Hospital
      København, Capital Region, Denmark
  • 2009–2013
    • Køge Sygehus
      Kjoge, Zealand, Denmark
  • 2008–2013
    • Region Hovedstaden
      Hillerød, Capital Region, Denmark
  • 1985–2013
    • Copenhagen University Hospital Hvidovre
      • • Department of Anesthesiology
      • • Department of Gynecology and Obstetrics
      • • Department of Pathology
      Hvidovre, Capital Region, Denmark
  • 1988–2012
    • University of Copenhagen Herlev Hospital
      Herlev, Capital Region, Denmark
  • 1984–2012
    • Bispebjerg Hospital, Copenhagen University
      • Department of Surgery
      Copenhagen, Capital Region, Denmark
  • 1997–2011
    • Aarhus University Hospital
      Aarhus, Central Jutland, Denmark
  • 1981–2011
    • Rigshospitalet
      • • Department of Anaesthesiology
      • • Surgical Pathophysiology Unit
      København, Capital Region, Denmark
  • 2002–2010
    • University of Texas Southwestern Medical Center
      • Department of Anesthesiology and Pain Management
      Dallas, TX, United States
    • Hospital for Special Surgery
      New York, New York, United States
  • 2005–2009
    • Sundhedsstyrelsen
      København, Capital Region, Denmark
    • University of Iowa
      • Department of Anesthesia
      Iowa City, Iowa, United States
  • 2004–2009
    • Lund University
      • Department of Health Sciences
      Lund, Skane, Sweden
    • University of Pennsylvania
      Filadelfia, Pennsylvania, United States
    • Texas A&M University - Galveston
      Galveston, Texas, United States
  • 1985–2009
    • Herlev Hospital
      Herlev, Capital Region, Denmark
  • 2007
    • Cornell University
      • Department of Anesthesiology
      Итак, New York, United States
    • University of Texas at Dallas
      Richardson, Texas, United States
    • University of Geneva
      • Division of Anaesthesiology
      Genève, GE, Switzerland
  • 2006
    • Aarhus University
      Aarhus, Central Jutland, Denmark
  • 2001
    • Harvard Medical School
      • Department of Surgery
      Boston, Massachusetts, United States
    • University of Münster
      Muenster, North Rhine-Westphalia, Germany
  • 2000–2001
    • University of Rochester
      • Department of Anesthesiology
      Rochester, New York, United States
  • 1990
    • University of Cincinnati
      Cincinnati, Ohio, United States
    • København Zoo
      København, Capital Region, Denmark
  • 1987
    • Glostrup Hospital
      Glostrup, Capital Region, Denmark