Severe birth injuries in neonates and associated risk factors for injury in mothers with different types of diabetes in Finland

Objective To examine severe birth-related injuries in neonates among mothers with different types of diabetes. Methods Retrospective cohort study based on Finnish Medical Birth Register data from 2004 to 2017. The study included singleton neonates born vaginally with cephalic presentation (n = 623 649) after 35(+0) weeks of gestation. The primary outcome variable was severe birth injury. Incidences, crude and adjusted odds ratios, and probabilities in regression analysis were calculated for different types of diabetes. Results There were 1952/623 649 (0.3%) severe birth injuries of which brachial plexus injury occurred most frequently. The injury incidence was highest in neonates of women with type 1 or type 2 diabetes, 42/1659 (2.5%) and 10/548 (1.8%), respectively. For gestational diabetes, the injury incidence was comparable to non-diabetic women: 422/77 810 (0.5%) and 1478/543 632 (0.3%), respectively. Shoulder dystocia, high birthweight, and vacuum-assisted delivery were associated with the highest probability for injury. Birthweight and obesity had a stronger impact on injury risk in women with pregestational diabetes compared to other pregnancies. Conclusion Neonates of women with pregestational diabetes have a higher risk for severe birth injury than other neonates. The injury risk in neonates delivered by women with gestational diabetes or non-diabetic women is generally low.Peer reviewe

Regional variations in lumbar spine surgery in Finland

Introduction: The regional variation in spine surgery rates has been shown to be large both within and between countries. This variation has been reported to be less in studies from countries with spine registers. The aim of this study was to describe the regional variation in lumbar spine surgery in Finland. Materials and methods: This is a retrospective register study. Data from the Finnish National Hospital Discharge Register (NHDR) were used to calculate and compare the rates of lumbar disc herniation (LDH), decompression, and fusion surgeries in five University Hospital catchment areas, covering the whole Finnish population, from January 1, 1997, through December 31, 2018. Results: A total of 138,119 lumbar spine operations (including LDH, decompression, and fusion surgery) were performed in Finland between 1997 and 2018. The regional differences in the rate of LDH surgery were over fourfold (18 vs. 85 per 100,000 person years), lumbar decompression surgery over threefold (41 vs. 129 per 100,000 person years), and lumbar fusion surgery over twofold (14 vs. 34 per 100,000 person years) in 2018. The mean age of the patients increased in all regions during the study period. Conclusions: In Finland, the regional variations in spine surgeries were vast. In a country with a publicly funded healthcare system, this finding was surprising. The recently created national spine register may serve to shed more light on the reasons for this regional variation.publishedVersionPeer reviewe

Incidence of fracture hospitalization and surgery during pregnancy in Finland—1998–2017 : a retrospective register-based cohort study

Introduction: The aim of this study was to assess the incidence of all major fractures and surgery during pregnancy and the outcomes of pregnancy in Finland between 1998 and 2017. Materials and methods: A retrospective cohort study using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register. As participants we included all women aged between 15 and 49 years from January 1, 1998 to December 31, 2017 and their ≥ 22-week pregnancies. Results: Of a total 629,911 pregnancies, 1813 pregnant women were hospitalized with a fracture diagnosis, yielding an incidence of 247 fractures/100,000 pregnancy-years. Of these, 24% (n = 513/2098) were treated operatively. The most common fractures were fractures of the tibia, ankle, and the forearm, which made up half of all fractures. The incidence of pelvic fractures was 6.8/100,000 pregnancy-years, with an operation rate of 14%. The stillbirth rate of all fracture patients was low at 0.6% (n = 10/1813), although this was 1.5-fold the overall stillbirth rate in Finland. Lumbosacral and comminuted spinopelvic fractures resulted in preterm delivery in 25% (n = 5/20) of parturients, with a stillbirth rate of 10% (n = 2/20). Conclusion: The incidence of fracture hospitalization during pregnancy is lower than in the general population, and fractures in this population are more often treated conservatively. A higher proportion of preterm deliveries and stillbirths occurred in women with lumbosacral and comminuted spinopelvic fractures. Maternal mortality and stillbirth rates remain low among women with fractures leading to hospitalization or surgery during pregnancy.Peer reviewe

Incidence of lumbar discectomy during pregnancy and within 12 months post-partum in Finland between 1999 and 2017 : a retrospective register-based cohort study

BACKGROUND CONTEXT: Both lumbar disc herniation in the general population and lower back pain in the pregnant population are known to be common conditions. The physiological and anatomical of the mother predispose to increased strain of the lumbar disc, while pregnancy may promote caution in physicians contemplating surgical care. PURPOSE: We aimed to report the incidence of lumbar discectomy during pregnancy and 12 months post-partum in Finland between 1999 and 2017. STUDY DESIGN: Retrospective register-based cohort study. PATIENT SAMPLE: Using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register, all women aged 15 to 49 years with a lumbar discectomy or pregnancy ending in delivery from 1st January, 1999 to 31st December, 2017 were included. OUTCOME MEASURES: Incidence rates and their 95% confidence intervals were calculated for lumbar discectomy. Incidence rate ratios (IRR) were calculated between the study population and the control population. The effect of smoking on surgery risk was reported using odds ratios. METHODS: A retrospective statistical analysis was performed to identify patients undergoing lumbar discectomy during pregnancy or the first 12 months after delivery. Incidence rates were compared to the age-adjusted values of the age-matched female general population. The effect of smoking on the risk of lumbar discectomy was analysed using age-adjusted odds ratios. RESULTS: In total, 91 discectomies were performed during pregnancy and 508 within 12 months post-partum. The total incidence of lumbar discectomy during pregnancy was 11 operations per 100 000 person-years with an incidence rate ratio (IRR) of 0.2 (95% CI 0.1 to 0.2) when compared to the age-adjusted female general population. Women with active smoking before pregnancy were at a higher risk for lumbar discectomy during pregnancy (OR 2.0, 95% CI 1.2 to 3.2). Caesarean section was more common after lumbar discectomy (22%). No perinatal mortality was observed. During the first year post-partum the rate of lumbar discectomy increased to 47 per 100 000 person-years with an IRR of 0.7 (95% CI 0.6 to 0.8). 90-day reoperation rates were higher than in the general population with an IRR of 1.7 (95% CI 1.1 to 2.7). CONCLUSIONS: Lumbar discectomy during pregnancy is rare, but smoking increases the risk. Lumbar discectomy during pregnancy seems to be safe for the neonate. Post-partum incidences increased towards the end of the first year, but remained below the rates in the general population with a higher risk for short-term reoperation.publishedVersionPeer reviewe

Incidence of femoral fractures in children and adolescents in Finland and Sweden between 1998 and 2016 : A binational population-based study

Background and objective: Femoral fractures in children have significant impact for patients, family, and trauma resources as they usually require hospitalization and surgical treatment. The aim of this study was to determine the incidence and trends of femoral fractures among children and adolescents hospitalized between 1998 and 2016 in Finland and Sweden. Methods: All patients younger than 17 years of age in Finland and Sweden with a femoral fracture treated surgically between 1998 and 2016 were included in the study. Data were collected from National Hospital Discharge Registries. Patients were classified by gender and age into four groups. The annual incidences per 100,000 were calculated using annual mid-year population census data obtained from the Official Statistics of Finland and Sweden. Results: In total, 6410 patients younger than 17 years of age diagnosed with femoral fracture were included in this study. The total incidence per 100,000 femoral fractures was 13.3 in Finland and 11.0 in Sweden. The incidence of femoral fractures decreased during the study period in all age groups, except for teenage Finnish girls. Most of the fractures were located in femoral shaft. Fractures of the upper and distal femur were rare. Male predominance was detected in all age groups older than 1 year. Conclusions: The incidence of femoral fractures decreased in all age groups except in teenage Finnish girls. Majority of femoral fractures were located in femoral shaft with male predominance. In children younger than 1 year of age, female predominance was found.publishedVersionPeer reviewe

Mortality following proximal humerus fracture—a nationwide register study of 147,692 fracture patients in Sweden

Summary: Little is known about survival after proximal humerus fracture. In this manuscript, we found the mortality to be high (almost four times higher than in age- and sex-matched controls). While frailty hip fracture has gained attention, we hope our manuscript will shed light on frailty proximal humerus fracture patients. Introduction: Proximal humerus fractures (PHF) are common and occur mostly after the 6th decade of life. While mortality following PHF has been reported previously, mortality data after longer follow-up on a national level is lacking. Methods: We obtained data from the Swedish Hospital Discharge Register (SHDR), on all adult patients (≥ 18 years) with a diagnosis of PHF (S42.2, S42.20, or S42.21) for the period between 2001 and 2016. We used the Swedish Cause of Death Register (SCDR) to investigate mortality in the fracture cohort. We compared the mortality of fracture patients with age- and sex-matched population-based mortality data obtained from Statistics Sweden. Results: A total of 147 692 PHF patients were identified, with a male to female ratio of 1:3. The mean age was 69 years (range, 18 to 111). Most patients were treated non-surgically (n = 126,487, 86%). The crude mortality rate was 2.2% at 1 month, 4.1% at 3 months, 8.5% at 12 months, and 24% at 48 months after sustaining a PHF. Mortality increased with age; however, the standardized mortality rate (SMR) was highest among young patients. SMR was 5.4 in the 18- to 39-year age group, 3.9 in the 40- to 64-year age group, 1.8 in the 65–79-year age group, and 1.2 in the ≥ 80-year-old population. The age-adjusted SMR was 3.9 in the whole adult PHF population. Conclusion: The mortality rate and SMR suggest that PHF patients are heterogeneous. Some older PHF patients may benefit from specialized care (e.g., orthogeriatric), and this should be evaluated in future studies.publishedVersionPeer reviewe

Incidence of obese parturients and the outcomes of their pregnancies : A nationwide register study in Finland

Objectives: We analyzed the incidence of obese and severely obese parturients and the impact of maternal obesity on mode of delivery, perinatal and neonatal mortality, and neonatal health. Study design: We included all singleton births from the medical birth register of Finland from 2004 to 2018 (n = 792 437). Maternal body mass index (BMI) was categorized into three classes: non-obese (BMI < 30 kg/m2), obese (BMI 30 – 39.9 kg/m2), and morbidly obese (BMI 40 kg/m2 or more). The yearly incidence of obese and severely obese parturients per 10 000 births was calculated. Logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: Between 2004 and 2018, the incidence of obese and morbidly obese parturients increased by 44% and 103%, respectively. Cesarean section rates were 23.6% and 30%, respectively (aOR 1.63 CI 1.61 – 1.66 and 2.33 CI: 2.23 – 2.44). Neonates born to morbidly obese parturients had an increased need for intensive care unit treatment (aOR 2.21 CI: 2.10 – 2.32), higher perinatal mortality (aOR 1.65 CI: 1.28 – 2.14), and higher neonatal mortality (aOR 1.68 CI: 1.04 – 2.72). The need for neonatal intensive care (aOR 1.50 CI: 1.47 – 1.53), perinatal mortality (aOR 1.25 CI: 1.13 – 1.39), and neonatal mortality (aOR 1.33 CI: 1.09 – 1.62) increased also among obese parturients. Conclusions: We report a worrying increase in obese and morbidly obese parturients. Neonates born to these parturients were more likely delivered by cesarean sections and had higher rates of perinatal and neonatal mortality, and intensive care unit treatment. This highlights the importance of preventing obesity among fertile-aged females.publishedVersionPeer reviewe

Incidence of Fracture Hospitalization and Surgery in Women Increases Steadily During the Puerperal and Lactation Period : A Retrospective Register-Based Cohort Study in Finland From 1999 to 2018

This retrospective cohort study assesses the incidences of major fractures and surgery in women during the puerperium and the lactation period in Finland between January 1, 1999, and December 31, 2018. Using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register, all women aged between 15 and 49 years with a fracture hospitalization within 12 months of delivery between 1999 and 2018 were included. During the study period, a total of 3140 fractures after delivery and 152,800 fractures of the female normal population of similar age were hospitalized. The incidence rate after delivery increased from 219/100,000 person-years during the first 4 months to 310 fractures/100,000 person-years during the latter 8 months of the first year after delivery. Altogether, 29% (n = 904/3140) of these fractures were treated operatively. The most common fractures were ankle and distal radius fractures, which made up one-third of all fractures. The incidence of pelvic fracture hospitalization was 15/100,000 person-years at 4 months after delivery, with an operation rate of 22%. Over half of all fractures occurred between 6 and 12 months after delivery (mean 6.6 months). The incidence of fracture hospitalization after delivery increased steadily during the puerperium and the lactation periods but remained lower than in the general population (age-adjusted incidence 554/100,000 person-years) with an incidence rate ratio of 0.51. However, a higher proportion of pelvic fractures were observed in the first months after delivery. Surgical rates were in line with the general population. Fractures of the wrist and ankle made up most of the fractures.publishedVersionPeer reviewe

Incidence changes in risk factors associated with the decreasing number of birth-related clavicle fractures in Finland : A nationwide retrospective birth cohort from 2004 to 2017

Background A clavicle fracture is one of the most common birth injuries. The objective of this study was to examine whether the decreased incidence of birth-related clavicle fractures in Finland is because of temporal changes in their predisposing factors. Methods For this nationwide population-based study, we used the Finnish Medical Birth Register and the Care Register for Health Care databases. The study population included all singleton, live-born newborn born spontaneously or by vacuum-assisted delivery, in cephalic presentation >= 37(+0) weeks of gestation. The incidences of clavicle fractures, pregnancy characteristics, and risk assessments for fracture were calculated and compared between two time periods: 2004-2010 and 2011-2017. Results A total of 629 457 newborn were born vaginally between 2004 and 2017. The clavicle fracture incidence decreased from 17.6/1000 to 6.2/1000 live births. Shoulder dystocia, diabetes, and birthweight >= 4000 g were the strongest predisposing factors. The incidence of birthweight >= 4000 g decreased, meanwhile type 1 diabetes and shoulder dystocia remained stable and gestational diabetes, type 2 diabetes, and maternal obesity increased in the later study period. The incidence of clavicle fractures without known predisposing factors declined. Simultaneously, the cesarean birth rate remained stable (13.2%-13.1%), although the rate of vacuum-assisted deliveries increased (8.5%-9.5%). Discussion The incidence of clavicle fractures decreased, even though the incidence of most risk factors remained stable or increased, and the cesarean birth rate remained stable. This decline may be related to the reduction of fracture incidence among deliveries without known risk factors, and the decrease in birthweight >= 4000 g.Peer reviewe