Thoracolumbar vertebral fractures in Sweden: an analysis of 13,496 patients admitted to hospital

National Longitudinal data of thoracolumbar fracture incidence, trends or mortality rates are lacking. The correlation between admissions and operations of thoracolumbar vertebral fractures has not been investigated. The aim of our nationwide population-based epidemiological study was to analyse the incidence, admissions, operations, and case fatality rate among patients with thoracolumbar vertebral fractures admitted to hospital in Sweden. The Swedish Hospital Discharge Register (SHDR) and the Cause of Death Register (CDR) were linked to determine the incidence of surgical interventions, trends, characteristics of the patients, and case fatality rate for thoracolumbar vertebral fractures based on comprehensive national data. The annual incidence of thoracolumbar fractures was on average 30 per 100,000 inhabitants and did not change considerably during the study period. Among patients younger than 60 years of age the annual incidence was 13 per 100,000 and was twice as high in men compared to women. The proportion operated on was 15%. In the age-group 60 years and older the majority were women. In this group two percent were operated on. However, males were operated on twice as often as women. The 90-day case-fatality rate after surgery was 1.4%. This information may assist health care providers in health care planning. Moreover, these data can also be used for power calculations when planning future clinical studies

Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Sweden 2000–2003, increasing incidence and regional differences

BACKGROUND: The occurrence of methicillin-resistant Staphylococcus aureus (MRSA) has gradually become more frequent in most countries of the world. Sweden has remained one of few exceptions to the high occurrence of MRSA in many other countries. During the late 1990s, Sweden experienced a large health-care associated outbreak which with resolute efforts was overcome. Subsequently, MRSA was made a notifiable diagnosis in Sweden in 2000. METHODS: From the start of being a notifiable disease in January 2000, the Swedish Institute for Infectious Disease Control (SMI) initiated an active surveillance of MRSA. RESULTS: The number of reported MRSA-cases in Sweden increased from 325 cases in 2000 to 544 in 2003, corresponding to an overall increase in incidence from 3.7 to 6.1 per 100000 inhabitants. Twenty five per cent of the cases were infected abroad. The domestic cases were predominantly found through cultures taken on clinical indication and the cases infected abroad through screening. There were considerable regional differences in MRSA-incidence and age-distribution of cases. CONCLUSION: The MRSA incidence in Sweden increased over the years 2000–2003. Sweden now poises on the rim of the same development that was seen in the United Kingdom some ten years ago. A quarter of the cases were infected abroad, reflecting that international transmission is now increasingly important in a low-endemic setting. To remain in this favourable situation, stepped up measures will be needed, to identify imported cases, to control domestic outbreaks and to prevent transmission within the health-care sector

Operative versus non-operative treatment for 2-part proximal humerus fracture: A multicenter randomized controlled trial

Background Although increasingly used, the benefit of surgical treatment of displaced 2-part proximal humerus fractures has not been proven. This trial evaluates the clinical effectiveness of surgery with locking plate compared with non-operative treatment for these fractures. Methods and findings The NITEP group conducted a superiority, assessor-blinded, multicenter randomized trial in 6 hospitals in Finland, Estonia, Sweden, and Denmark. Eighty-eight patients aged 60 years or older with displaced (more than 1 cm or 45 degrees) 2-part surgical or anatomical neck proximal humerus fracture were randomly assigned in a 1:1 ratio to undergo either operative treatment with a locking plate or non-operative treatment. The mean age of patients was 72 years in the non-operative group and 73 years in the operative group, with a female sex distribution of 95% and 87%, respectively. Patients were recruited between February 2011 and April 2016. The primary outcome measure was Disabilities of Arm, Shoulder, and Hand (DASH) score at 2-year follow-up. Secondary outcomes included Constant–Murley score, the visual analogue scale for pain, the quality of life questionnaire 15D, EuroQol Group’s 5- dimension self-reported questionnaire EQ-5D, the Oxford Shoulder Score, and complications. The mean DASH score (0 best, 100 worst) at 2 years was 18.5 points for the operative treatment group and 17.4 points for the non-operative group (mean difference 1.1 [95% CI −7.8 to 9.4], p = 0.81). At 2 years, there were no statistically or clinically significant between-group differences in any of the outcome measures. All 3 complications resulting in secondary surgery occurred in the operative group. The lack of blinding in patient-reported outcome assessment is a limitation of the study. Our assessor physiotherapists were, however, blinded. Conclusions This trial found no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years of age or older with displaced 2-part fractures of the proximal humerus. These results suggest that the current practice of performing surgery on the majority of displaced proximal 2-part fractures of the humerus in older adults may not be beneficial. Trial registration ClinicalTrials.gov NCT01246167.Peer reviewe

On lumbar spinal stenosis and disc herniation surgery

Patients with spinal stenosis and disc herniation are most common in spine surgery. Few population based studies of these patients have been made and no studies of their health related quality of life (HRQOL) by the EQ-5D has been published. The aim of this thesis is to analyse incidence, readmission, reoperation and mortality in Swedish patients operated on spinal stenosis or disc herniation in the lumbar spine during 19871999 and report the EQ-5D outcome data between 2001-2002. The spinal stenosis cohort and disc herniation cohorts consist of 10,494 and 25,247 patients and the final EQ-5D analysis of 230 and 263 patients. Information from the Swedish Hospital Discharge Register and the Swedish Death Register were linked to analyse the outcomes. A quality register study based on prospectively collected EQ-5D data from the National Swedish Registry for Lumbar Spine surgery was also performed. The mean annual incidence per 100,000 inhabitants of spinal stenosis and disc herniation surgery during the study period was 10 and 24, respectively. The mean age at surgery for spinal stenosis increased from 60 to 67 years but was constant at 42 years for disc herniation. The 30 day mortality rate was 3.5 and 0.5 per 1000 operations, respectively. The mortality rate declined despite ageing spinal stenosis patients. The length of stay after surgery was reduced to half. Patients operated on for spinal stenosis and disc herniation have a risk of being reoperated after one and ten years of 2-3 %, and 10- 11 %, respectively. The reoperation rate decreased over time. During the 13 years, 78 % of the disc herniation patients had only one hospitalisation (the operation). The risk of being readmitted was constant over time. Preoperatively the HRQOL was low, poorer than among previously reported for patients with stroke or depression. Patients operated on for spinal stenosis and disc herniation experienced an improved health related quality of life and their EQ5-D score increased from 0.29 to 0.70 and 0.36 to 0.64 one year after surgery. Four out of ten reported considerable improvement while a similar proportion of patients with high preoperative scores were slightly improved. A third group (20 %) was unchanged with low EQ-5D scores, and 45% perceived a decline in their HRQOL. The majority of patients approached but did not reach the level reported by the matched population sample. The studies indicate factors such as male sex, age over 80, fusion procedure, smoking, hospital stays before surgery or long hospital stays at surgery, severe back pain, long duration of pain, short walking ability were risks for a less favourable outcome. The EQ-5D instrument increases the awareness of the importance of health related quality of life when considering surgery and when evaluating treatment. Future studies need to elucidate the gender differences, impact of smoking cessation programs and the cost utility of spine surgery

Mortality, risk factors and causes of death in Swedish patients with open tibial fractures - a nationwide study of 3, 777 patients

Abstract Background Open tibial fractures are serious, complicated injuries. Previous studies suggested an increased risk of death, however, this has not been studied in large population-based settings. We aimed to analyze mortality including causes of death in all patients with open tibial fractures in Sweden. Moreover, we wanted to compare mortality rates with the Swedish population and determine whether treatment-related or demographic variables were independently associated with death. Method We searched the Swedish National Hospital Discharge Register for all patients with open tibial fracture between 1998 and 2010. We collected the following variables: age, gender, length of stay, mechanism of injury and treatment rendered. We then cross-referenced the Swedish Cause of Death Register to determine the cause of death, if applicable. We compared mortality in the study population with population-based mortality data from Statistics Sweden and determined whether variables were independently associated with death using regression analysis. Results Of the 3777 open tibial fractures, 425 (11.3%) patients died. The most common causes of death for elderly patients were cardiovascular and respiratory disease. Patients aged 15–39 years succumbed to external causes (accidents, suicides or poisoning). Increasing age (OR 25.7 (95% CI 11.8–64.8) p < 0.001), length of hospital stay (HR 1.01, (95% CI 1.01–1.02,) p < 0.001), limb amputation (OR 4.8 (95% CI 1.86–11.1) p < 0.001) and cause of the accident were independently associated with an increased mortality. Conclusion Patients with open tibial fractures have an increased risk of death compared with the general population in all age- and gender-groups. External causes of death are over-represented and indicate a subgroup with a risky behaviour among younger males. Elderly patients have an increased risk of dying comparable to hip fracture patients. They are at risk for cardiovascular and respiratory failure and should be treated with urgency, emphasizing the need for specialized geriatric trauma units

Det är obalansen som är problemet

Debatten har länge rasat om sjukskrivningarnas kostnader, men sett över en längretid är det arbetslöshetens kostnader som ökat. Det visar en forskarstudie om bruk av offentliga försörjningssystem som tagits fram på initiativ av de samverkande myndigheterna i Västmanland. Den redovisar hur de offentliga försörjningsinkomsterna har utvecklats efter 1990 och hur de är sammansatta och fördelade i befolkningen