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Hedberg, Jakob
Publications (10 of 36) Show all publications
Linder, G., Korsavidou Hult, N., Bjerner, T., Ahlström, H. & Hedberg, J. (2019). F-18-FDG-PET/MRI in preoperative staging of oesophageal and gastroesophageal junctional cancer. Clinical Radiology, 74(9), 718-725
Open this publication in new window or tab >>F-18-FDG-PET/MRI in preoperative staging of oesophageal and gastroesophageal junctional cancer
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2019 (English)In: Clinical Radiology, ISSN 0009-9260, E-ISSN 1365-229X, Vol. 74, no 9, p. 718-725Article in journal (Refereed) Published
Abstract [en]

AIM: To evaluate integrated 2-[F-18]-fluoro-2-deoxy-D-glucose (F-18-FDG) positron-emission tomography (PET)/magnetic resonance imaging (MRI), in comparison with the standard technique, integrated F-18-FDG-PET/computed tomography (CT), in preoperative staging of oesophageal or gastroesophageal junctional cancer.

MATERIALS AND METHODS: In the preoperative staging of 16 patients with oesophageal or gastroesophageal junctional cancer, F-18-FDG-PET/MRI was performed immediately following the clinically indicated F-18-FDG-PET/CT. MRI-sequences included T1-weighted fat-water separation (Dixon's technique), T2-weighted, diffusion-weighted imaging (DWI), and gadolinium contrast-enhanced T1-weighted three-dimensional (3D) imaging. PET was performed with F-18-FDG. Two separate teams of radiologists conducted structured blinded readings of F-18-FDG-PET/MRI or F-18-FDG-PET/CT, which were then compared regarding tumour measurements and characteristics as well as assessment of inter-rater agreement (Cohen's kappa) for the clinical tumour, nodal and metastatic (TNM) stage.

RESULTS: There were no medical complications. Comparison of tumour measurements revealed high correlations without significant differences between modalities. The maximum standardised uptake value (SUVmax) values of the primary tumour with F-18-FDG-PET/MRI had excellent correlation to those of F-18-FDG-PET/CT (0.912, Spearman's rho). Inter-rater agreement between the techniques regarding T-stage was only fair (Cohen's kappa, 0.333), arguably owing to relative over-classification of the T-stage using F-18-FDG-PET/CT. Agreements in the assessment of N- and M-stage were substantial (Cohen's kappa, 0.849 and 0.871 respectively).

CONCLUSION: Preoperative staging with F-18-FDG-PET/MRI is safe and promising with the potential to enhance tissue resolution in the area of interest. F-18-FDG-PET/MRI and F-18-FDG-PET/CT correlated well for most of the measured values and discrepancies were seen mainly in the assessment of the T-stage. These results facilitate further studies investigating the role of F-18-FDG-PET/MRI in, e.g., predicting or determining the response to neoadjuvant therapy. 

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2019
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-392125 (URN)10.1016/j.crad.2019.05.016 (DOI)000477841300010 ()31221468 (PubMedID)
Funder
Swedish Cancer Society
Available from: 2019-09-03 Created: 2019-09-03 Last updated: 2019-09-03Bibliographically approved
Claassen, Y. H., Bastiaannet, E., Hartgrink, H. H., Dikken, J. L., de Steur, W. O., Slingerland, M., . . . van de Velde, C. J. (2019). International comparison of treatment strategy and survival in metastatic gastric cancer. BJS OPEN, 3(1), 56-61
Open this publication in new window or tab >>International comparison of treatment strategy and survival in metastatic gastric cancer
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2019 (English)In: BJS OPEN, ISSN 2474-9842, Vol. 3, no 1, p. 56-61Article in journal (Refereed) Published
Abstract [en]

BackgroundIn the randomized Asian REGATTA trial, no survival benefit was shown for additional gastrectomy over chemotherapy alone in patients with advanced gastric cancer with a single incurable factor, thereby discouraging surgery for these patients. The purpose of this study was to evaluate treatment strategies for patients with metastatic gastric cancer in daily practice in five European countries, along with relative survival in each country. MethodsNationwide population-based data from Belgium, Denmark, the Netherlands, Norway and Sweden were combined. Patients with primary metastatic gastric cancer diagnosed between 2006 and 2014 were included. The proportion of gastric resections performed and the administration of chemotherapy (irrespective of surgery) within each country were determined. Relative survival according to country was calculated. ResultsOverall, 15 057 patients with gastric cancer were included. The proportion of gastric resections varied from 81 per cent in the Netherlands and Denmark to 183 per cent in Belgium. Administration of chemotherapy was 392 per cent in the Netherlands, compared with 632 per cent in Belgium. The 6-month relative survival rate was between 390 (95 per cent c.i. 378 to 402) per cent in the Netherlands and 541 (521 to 569) per cent in Belgium. ConclusionThere is variation in the use of gastrectomy and chemotherapy in patients with metastatic gastric cancer, and subsequent differences in survival.

Place, publisher, year, edition, pages
JOHN WILEY & SONS LTD, 2019
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-377218 (URN)10.1002/bjs5.103 (DOI)000457222900007 ()30734016 (PubMedID)
Available from: 2019-02-15 Created: 2019-02-15 Last updated: 2019-02-15Bibliographically approved
Elias, K., Bekhali, Z., Hedberg, J., Graf, W. & Sundbom, M. (2018). Changes in bowel habits and patient-scored symptoms after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. Surgery for Obesity and Related Diseases, 14(2), 144-149
Open this publication in new window or tab >>Changes in bowel habits and patient-scored symptoms after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch
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2018 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 14, no 2, p. 144-149Article in journal (Refereed) Published
Abstract [en]

Background: Bariatric procedures are increasingly being used, but data on bowel habits are scarce.

Objectives: To assess changes in gastrointestinal function and patient-scored symptoms after Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS).

Setting: University hospital in Sweden.

Methods: We recruited 268 adult patients (mean age of 42.5 yr, body mass index 44.8, 67.9% female) listed for RYGB and BPD/DS. Patients answered validated questionnaires prospectively concerning bowel function, the Fecal Incontinence Quality of Life Scale, and the 36-Item Short Form Health Survey before and after their operation.

Results: Postoperatively, 208 patients (78.2% of 266 eligible patients) answered the questionnaires. RYGB patients had fewer bowel motions per week (8 versus 10) and more abdominal pain postoperatively (P<.001). Postoperatively, the 35 BPD/DS patients (69% versus 23%) needed to empty their bowel twice or more than twice daily, reported more flatus and urgency, and increased need for keeping a diet (P<.001). Concerning Fecal Incontinence Quality of Life Scale, coping and behavior was slightly reduced while depression and self-perception scores were improved after RYGB. Lifestyle, coping and behavior, and embarrassment were reduced after BPD/DS (P<.05). In the 36-Item Short Form Health Survey, physical scores were markedly improved, while mental scores were largely unaffected.

Conclusion: RYGB resulted in a reduced number of bowel movements but increased problems with abdominal pain. In contrast, BPD/DS-patients reported higher frequency of bowel movements, more troubles with flatus and urgency, and increased need for keeping a diet. These symptoms affected quality of life negatively, however, general quality of life was markedly improved after both procedures. These results will be of great value for preoperative counseling.

Keywords
Bowel habits, Duodenal switch, Fecal incontinence, Gastric bypass, Obesity
National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:uu:diva-333263 (URN)10.1016/j.soard.2017.09.529 (DOI)000427662500005 ()29108895 (PubMedID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2019-01-25Bibliographically approved
Linder, G., Sandin, F., Johansson, J., Lindblad, M., Lundell, L. & Hedberg, J. (2018). Patient education-level affects treatment allocation and prognosis in esophageal- and gastroesophageal junctional cancer in Sweden.. Cancer Epidemiology, 52, 91-98
Open this publication in new window or tab >>Patient education-level affects treatment allocation and prognosis in esophageal- and gastroesophageal junctional cancer in Sweden.
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2018 (English)In: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 52, p. 91-98Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Low socioeconomic status and poor education elevate the risk of developing esophageal- and junctional cancer. High education level also increases survival after curative surgery. The present study aimed to investigate associations, if any, between patient education-level and treatment allocation after diagnosis of esophageal- and junctional cancer and its subsequent impact on survival.

METHODS: A nation-wide cohort study was undertaken. Data from a Swedish national quality register for esophageal cancer (NREV) was linked to the National Cancer Register, National Patient Register, Prescribed Drug Register, Cause of Death Register and educational data from Statistics Sweden. The effect of education level (low; ≤9 years, intermediate; 10-12 years and high >12 years) on the probability of allocation to curative treatment was analyzed with logistic regression. The Kaplan-Meier-method and Cox proportional hazard models were used to assess the effect of education on survival.

RESULTS: A total of 4112 patients were included. In a multivariate logistic regression model, high education level was associated with greater probability of allocation to curative treatment (adjusted OR: 1.48, 95% CI: 1.08-2.03, p = 0,014) as was adherence to a multidisciplinary treatment-conference (adjusted OR: 3.13, 95% CI: 2.40-4.08, p < 0,001). High education level was associated with improved survival in the patients allocated to curative treatment (HR: 0.82, 95% CI: 0.69-0.99, p = 0,036).

DISCUSSION: In this nation-wide cohort of esophageal- and junctional cancer patients, including data regarding many confounders, high education level was associated with greater probability of being offered curative treatment and improved survival.

Keywords
Curative treatment, Education level, Esophageal cancer, Inequality in cancer treatment, Multi-disciplinary conference
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-346603 (URN)10.1016/j.canep.2017.12.008 (DOI)000425089700012 ()29278841 (PubMedID)
Available from: 2018-03-20 Created: 2018-03-20 Last updated: 2018-04-17Bibliographically approved
Edholm, D., Axer, S., Hedberg, J. & Sundbom, M. (2017). Laparoscopy in Duodenal Switch: Safe and Halves Length of Stay in a Nationwide Cohort from the Scandinavian Obesity Registry. Scandinavian Journal of Surgery, 106(3), 230-234
Open this publication in new window or tab >>Laparoscopy in Duodenal Switch: Safe and Halves Length of Stay in a Nationwide Cohort from the Scandinavian Obesity Registry
2017 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 106, no 3, p. 230-234Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS:

Unsatisfactory weight loss after gastric bypass or sleeve gastrectomy in super-obese patients (body mass index > 50) is a growing concern. Biliopancreatic diversion with duodenal switch results in greater weight loss, but is technically challenging to perform, especially as a laparoscopic procedure (Lap-DS). The aim of this study was to compare perioperative outcomes of Lap-DS and the corresponding open procedure (O-DS) in Sweden.

MATERIAL AND METHODS:

The data source was a nationwide cohort from the Scandinavian Obesity Surgery Registry and 317 biliopancreatic diversion with duodenal switch patients (mean body mass index = 56.7 ± 6.6 kg/m2, 38.4 ± 10.2 years, and 57% females) were analyzed. Follow-up at 30 days was complete in 98% of patients.

RESULTS:

The 53 Lap-DS patients were younger than the 264 patients undergoing O-DS (35.0 vs 39.1 years, p = 0.01). Operative time was 163 ± 38 min for lap-DS and 150 ± 31 min for O-DS, p = 0.01, with less bleeding in Lap-DS (94 vs 216 mL, p < 0.001). There was one conversion to open surgery. Patients undergoing Lap-DS had a shorter length of stay than O-DS, 3.3 versus 6.6 days, p = 0.02. No significant differences in overall complications within 30 days were seen (12% and 17%, respectively). Interestingly, the two leaks in Lap-DS were located at the entero-enteric anastomosis, while three out of four leaks in O-DS occurred at the top of the gastric tube.

CONCLUSION:

Lap-DS can be performed by dedicated bariatric surgeons as a single-stage procedure. The use of laparoscopic approach halved the length of stay, without increasing the risk for complications significantly. Any difference in long-term weight result is pending.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-310879 (URN)10.1177/1457496916673586 (DOI)000408224300007 ()27765899 (PubMedID)
Available from: 2016-12-20 Created: 2016-12-20 Last updated: 2017-12-13Bibliographically approved
Bekhali, Z., Hedberg, J., Hedenström, H. & Sundbom, M. (2017). Large Buffering Effect of the Duodenal Bulb in Duodenal Switch: a Wireless pH-Metric Study. Obesity Surgery, 27(7), 1867-1871
Open this publication in new window or tab >>Large Buffering Effect of the Duodenal Bulb in Duodenal Switch: a Wireless pH-Metric Study
2017 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, no 7, p. 1867-1871Article in journal (Refereed) Published
Abstract [en]

Bariatric procedures result in massive weight loss, however, not without side effects. Gastric acid is known to cause marginal ulcers, situated in the small bowel just distal to the upper anastomosis. We have used the wireless BRAVO (TM) system to study the buffering effect of the duodenal bulb in duodenal switch (DS), a procedure in which the gastric sleeve produces a substantial amount of acid. We placed a pre- and a postpyloric pH capsule in 15 DS-patients (seven men, 44 years, BMI 33) under endoscopic guidance and verified the correct location by fluoroscopy. Patients were asked to eat and drink at their leisure, and to register their meals for the next 24 h. All capsules but one could be successfully placed, without complications. Total registration time was 17.2 (1.3-24) hours prepyloric and 23.1 (1.2-24) hours postpyloric, with a corresponding pH of 2.66 (1.74-5.81) and 5.79 (4.75-7.58), p < 0.01. The difference in pH between the two locations was reduced from 3.55 before meals to 1.82 during meals, p < 0.01. Percentage of time with pH < 4 was 70.0 (19.9-92.0) and 13.0 (0.0-34.6) pre and postpylorically, demonstrating a large buffering effect. By this wireless pH-metric technique, we could demonstrate that the duodenal bulb had a large buffering effect, thus counteracting the large amount of gastric acid passing into the small bowel after duodenal switch. This physiologic effect could explain the low incidence of stomal ulcers.

Keywords
Bariatric surgery, Duodenal switch, Marginal ulcer, pH-metry
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-330035 (URN)10.1007/s11695-017-2574-0 (DOI)000404529600035 ()28176219 (PubMedID)
Available from: 2017-09-29 Created: 2017-09-29 Last updated: 2017-09-29Bibliographically approved
Sundström, J., Hedberg, J., Thuresson, M., Aarskog, P., Johannesen, K. M. & Oldgren, J. (2017). Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events: A Swedish Nationwide, Population-Based Cohort Study. Circulation, 136(13), 1183-1192
Open this publication in new window or tab >>Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events: A Swedish Nationwide, Population-Based Cohort Study
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2017 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 136, no 13, p. 1183-1192Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There are increasing concerns about risks associated with aspirin discontinuation in the absence of major surgery or bleeding. We investigated whether long-term low-dose aspirin discontinuation and treatment gaps increase the risk of cardiovascular events.

METHODS: We performed a cohort study of 601 527 users of low-dose aspirin for primary or secondary prevention in the Swedish prescription register between 2005 and 2009 who were >40 years of age, were free from previous cancer, and had >= 80% adherence during the first observed year of treatment. Cardiovascular events were identified with the Swedish inpatient and cause-of-death registers. The first 3 months after a major bleeding or surgical procedure were excluded from the time at risk.

RESULTS: During a median of 3.0 years of follow-up, 62 690 cardiovascular events occurred. Patients who discontinued aspirin had a higher rate of cardiovascular events than those who continued (multivariable-adjusted hazard ratio, 1.37; 95% confidence interval, 1.34-1.41), corresponding to an additional cardiovascular event observed per year in 1 of every 74 patients who discontinue aspirin. The risk increased shortly after discontinuation and did not appear to diminish over time.

CONCLUSIONS: In long-term users, discontinuation of low-dose aspirin in the absence of major surgery or bleeding was associated with a >30% increased risk of cardiovascular events. Adherence to low-dose aspirin treatment in the absence of major surgery or bleeding is likely an important treatment goal.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2017
Keywords
aspirin, cohort studies, primary prevention, secondary prevention
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-336817 (URN)10.1161/CIRCULATIONAHA.117.028321 (DOI)000411567600004 ()28947478 (PubMedID)
Funder
AstraZeneca
Available from: 2017-12-20 Created: 2017-12-20 Last updated: 2017-12-20Bibliographically approved
Linder, G., Hedberg, J., Björck, M. & Sundbom, M. (2017). Perfusion of the gastric conduit during esophagectomy. Diseases of the esophagus, 30(1), 143-149
Open this publication in new window or tab >>Perfusion of the gastric conduit during esophagectomy
2017 (English)In: Diseases of the esophagus, ISSN 1120-8694, E-ISSN 1442-2050, Vol. 30, no 1, p. 143-149Article in journal (Refereed) Published
Abstract [en]

In esophageal cancer surgery, perfusion of the gastric conduit is a critical issue. Measurement of gastric intramucosal pH (pHi ) is a method to identify anaerobic metabolism as a sign of impaired perfusion. In this study we aimed to monitor changes in the perfusion of the gastric conduit at key steps during and after esophagectomy. pHi was measured per- and postoperatively using intermittent gastric tonometry in 32 patients undergoing open, 65%, or video-assisted thoracoscopic esophagectomy for esophageal cancer. Measurements focused on the surgical steps when the vascular supply to the gastric conduit was altered. A tonometry catheter was successfully placed in all patients and a decrease in pHi (mean ± SD) was observed from baseline to after the division of the short gastric vessels (7.33 ± 0.07 to 7.29 ±  0.07, P  = 0.005). A further reduction after the ligation of the left gastric artery (7.26 ± 0.08, P  < 0.001) and after final linear stapling the gastric conduit (7.15 ± 0.13, P  < 0.001) was observed. Two hours after surgery, pHi increased (7.24 ± 0.09, P  = 0.002). In contrast to open surgery, a trend towards less reduction in pHi was seen in thoracoscopic surgery. Patients with anastomotic leaks had lower pHi on the first postoperative day (7.12 ± 0.05 vs. 7.27 ± 0.08, P  = 0.040). It can be concluded that each surgical step altering the vascular supply to the gastric conduit resulted in detectable changes, however transient, in pHi . Patients with low pHi on the first postoperative day were more prone to have clinically relevant anastomotic leaks.

National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-308550 (URN)10.1111/dote.12537 (DOI)000399668800029 ()27766735 (PubMedID)
Available from: 2016-11-28 Created: 2016-11-28 Last updated: 2018-03-20Bibliographically approved
Skogar, M., Holmbäck, U., Hedberg, J., Risérus, U. & Sundbom, M. (2017). Preserved Fat-Free Mass after Gastric Bypass and Duodenal Switch. Obesity Surgery, 27(7), 1735-1740
Open this publication in new window or tab >>Preserved Fat-Free Mass after Gastric Bypass and Duodenal Switch
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2017 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, no 7, p. 1735-1740Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Concerns for the possibility of an excessive loss of fat-free mass (FFM) and resting metabolic rate (RMR) after bariatric surgery, such as Roux-en-Y gastric bypass (RYGB) and duodenal switch (BPD/DS), have been raised.

OBJECTIVES: This study aims to examine body composition and RMR in patients after RYGB and BPD/DS and in non-operated controls.

METHODS: Body composition and RMR were studied with Bod Pod and indirect calorimetry in weight-stable RYGB (n = 15) and BPD/DS patients (n = 12) and compared with non-operated controls (n = 17). All patients were 30-55 years old and weight stable with BMI 28-35 kg/m(2).

RESULTS: FFM% was 58% (RYGB), 61% (BPD/DS), and 58% (controls). Body composition did not differ after RYGB and BPD/DS compared to controls, despite 27 and 40% total body weight loss, respectively. No difference in RMR or RMR/FFM was observed (1539, 1617, and 1490 kcal/24 h; and 28.9, 28.4, and 28.8 kcal/24 h/kg).

CONCLUSION: Weight-stable patients with BMI 28-35 kg/m(2) after RYGB and BPD/DS have a body composition and RMR similar to that of non-operated individuals within the same BMI interval.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-310894 (URN)10.1007/s11695-016-2476-6 (DOI)000404529600016 ()27885535 (PubMedID)
Available from: 2016-12-20 Created: 2016-12-20 Last updated: 2019-02-25Bibliographically approved
Lagerros, Y. T., Brandt, L., Hedberg, J., Sundbom, M. & Bodén, R. (2017). Suicide, Self-harm, and Depression After Gastric Bypass Surgery: A Nationwide Cohort Study. Annals of Surgery, 265(2), 235-243
Open this publication in new window or tab >>Suicide, Self-harm, and Depression After Gastric Bypass Surgery: A Nationwide Cohort Study
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2017 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 265, no 2, p. 235-243Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to examine risk of self-harm, hospitalization for depression and death by suicide after gastric bypass surgery (GBP).

SUMMARY OF BACKGROUND DATA: Concerns regarding severe adverse psychiatric outcomes after GBP have been raised.

METHODS: This nationwide, longitudinal, self-matched cohort encompassed 22,539 patients who underwent GBP during 2008 to 2012. They were identified through the Swedish National Patient Register, the Prescribed Drug Register, and the Causes of Death Register. Follow-up time was up to 2 years. Main outcome measures were hazard ratios (HRs) for post-surgery self-harm or hospitalization for depression in patients with presurgery self-harm and/or depression compared to patients without this exposure; and standardized mortality ratio (SMR) for suicide post-surgery.

RESULTS: A diagnosis of self-harm in the 2 years preceding surgery was associated with an HR of 36.6 (95% confidence interval [CI] 25.5-52.4) for self-harm during the 2 years of follow up, compared to GBP patients who had no self-harm diagnosis before surgery. Patients with a diagnosis of depression preceding GBP surgery had an HR of 52.3 (95% CI 30.6-89.2) for hospitalization owing to depression after GBP, compared to GBP patients without a previous diagnosis of depression. The SMR for suicide after GBP was increased among females (n = 13), 4.50 (95% CI 2.50-7.50). The SMR among males (n = 4), was 1.71 (95% CI 0.54-4.12).

CONCLUSIONS: The increased risk of post-surgery self-harm and hospitalization for depression is mainly attributable to patients who have a diagnosis of self-harm or depression before surgery. Raised awareness is needed to identify vulnerable patients with history of self-harm or depression, which may be in need of psychiatric support after GBP.

Keywords
bariatric surgery, depression, epidemiology, obesity, psychiatric disorders, self-injurious behavior, suicide
National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:uu:diva-308552 (URN)10.1097/SLA.0000000000001884 (DOI)000392295200005 ()27387654 (PubMedID)
Funder
Stockholm County CouncilThe Karolinska Institutet's Research FoundationNovo NordiskAstraZeneca
Available from: 2016-11-28 Created: 2016-11-28 Last updated: 2017-11-29Bibliographically approved
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