Late-in-life surgery associated with Creutzfeldt-Jakob disease: a methodological outline for evidence-based guidance

Emerging Themes in Epidemiology

Jesus de Pedro-Cuesta³  Javier Almazán³  Kåre Mølbak⁴  Henning Laursen⁶  Miguel Calero¹  Åke Siden⁵  Alberto Rábano²  Ignacio Mahillo-Fernandez³  Mabel Cruz⁵ 

[1] Department of Spongiform Encephalopathies, National Microbiology Center, Ctra. Majadahonda-Pozuel1o, Km. 2,200, Majadahonda, 28220, Spain;Neuropathology Laboratory, Alzheimer’s Disease Center, Reina Sofia Foundation and Carlos III Institute of Health, Valderrebollo 5, Madrid, 28031, Spain;Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Carlos III Institute of Health, C/ Sinesio Delgado 6, Madrid 28029, Spain;Department of Epidemiology, Statens Serum Institut, Artillerivej, 5, Copenhagen, DK-2300, Denmark;Department of Clinical Neurosciences, Neurology Division, Karolinska Institutet, Stockholm, SE-141 86, Sweden;Neuropathology Laboratory, 6301. H:S Rigshospitalet, Blegdamsvej, 9, Copenhagen, DK-2100, Denmark

关键词: Surgical procedures;    Safety;    Public health;    Methods;    Guidelines;    Epidemiology;    Creutzfeldt-Jakob disease;    Care;    Etiology;   

Others  :  803775
DOI  :  10.1186/1742-7622-10-5

 received in 2013-02-05, accepted in 2013-05-09,  发布年份 2013

【 摘 要 】

Background

There is increasing epidemiological evidence of etiological links between general surgery and sporadic Creutzfeldt-Jakob disease (sCJD) with long incubation periods. The purpose of this study was to identify specific surgical procedures potentially associated with sCJD to be targeted for preventive presurgical-intervention guidance.

Results

We propose a three-step clinical guidance outline where surgical procedures associated with sCJD clinical onset – potentially more contaminant - are taken into account. Data on hospital discharges and surgical procedures were obtained from Danish and Swedish national in-patient hospital registries for 167 sCJD cases, onset 1987–2003, and for 835 matched and 2,224 unmatched population controls. Surgery was allocated to different life-time periods as previously reported, and frequencies were compared using logistic regression analysis. In the year preceding clinical onset, persons with sCJD underwent a statistically significant higher number of minor surgical interventions (OR (95% CI): 17.50 (3.64-84.24)), transluminal endoscopies (OR: 2.73 (1.01–7.37)) and gastrointestinal operations (OR: 3.51 (1.21–10.19)) compared to matched controls. Surgical discharges clustered towards clinical onset. These differences increased during the clinical period, with statistically significant higher frequencies for both endoscopies and minor surgery (OR: 13.91 (5.87-32.95), and for main surgical procedures (OR: 2.10 (1.00-4.39)), particularly gastrointestinal surgery (OR: 6.00 (1.83-19.66)), and surgery contacting skeletal muscle. Comparisons with unmatched controls yielded similar results for neurosurgery in the clinical period (OR: 19.40 (2.22-168.34)).

Conclusions

These results suggest that some types of surgical procedures are associated with sCJD, after clinical onset or particularly just before onset. Selective planning of such surgery to minimize instrument/device contamination or quarantining might be feasible. Conditional to progress in sCJD etiological research, results are relevant for guidance development.

【 授权许可】

   
2013 Cruz et al.; licensee BioMed Central Ltd.

【 图 表 】

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