Health-Related Quality of Life in severely injured patients in Finland: an observational cohort study of 325 patients with 1-year follow-up.

BACKGROUND: Major trauma has a significant effect on Health-Related Quality of Life (HR-QoL). It is unclear, however, which factors most affect HR-QoL. This study aims to evaluate HR-QoL after severe injury in Finland and determine how different injury patterns and patient-related factors, such as level of education and socioeconomic group, are associated with HR-QoL. We also assess how well different injury scoring systems associate with HR-QoL. METHODS: We retrospectively analyzed 325 severely injured trauma patients (aged ≥ 18 years, New Injury Severity Score, (NISS) ≥ 16, and alive at 1 year after injury) treated in the Intensive Care Unit (ICU) or High Dependence Unit (HDU) of Tampere University Hospital (TAUH) from 2013 through 2016. HR-QoL was assessed with the EQ-5D-3L questionnaire completed during ICU stay and 1 year after injury. HR-QOL index values and reported problems were further compared with Finnish population norms. RESULTS: The severity of the injury (measured by ISS and NISS) had no significant association with the decrease in HR-QoL. Length of ICU stay had a weak negative correlation with post-injury HR-QoL and a weak positive correlation with the change in HR-QoL. The largest mean decrease in HR-QoL occurred in patients with spinal cord injury (Spine AIS ≥ 4) (-0.338 (SD 0.136)), spine injury in general (Spine AIS ≥ 2 (-0.201 (SD 0.279)), and a lower level of education (-0.157 (SD 0.231)). Patient's age, sex, or socioeconomic status did not seem to associate with smaller or greater changes in HR-QoL. CONCLUSIONS: After serious injury, many patients have permanent disabilities which reduce HR-QoL. Injury scoring systems intended for assessing the risk for death did not seem to associate with HR-QoL and are not, therefore, a meaningful way to predict the future HR-QoL of a severely injured patient. Recovery from the injury seems to be weaker in poorer educated patients and patients with spinal cord injury, and these patients may benefit from targeted additional measures. Although there were significant differences in baseline HR-QoL levels between different socioeconomic groups, recovery from injury appears to be similar, which is likely due to equal access to high-quality trauma care.

Cumulative costs of severe traffic injuries in Finland: a 2-year retrospective observational study of 252 patients.

Road traffic injuries cause considerable financial strain on health care systems worldwide. We retrospectively analyzed injury-related costs of 252 severely injured (New Injury Severity Score, NISS ≥ 16) patients treated at Tampere University Hospital (TAUH) between 2013 and 2017, with 2-year follow-up. The costs were divided into direct treatment, indirect costs, and other costs. We analyzed various injury- and patient-related factors with costs. The total costs during the 2-year study period were 20 million euros. Median cost was 41,202 euros (Q1 23,409 euros, Q3 97,726 euros), ranging from 2,753 euros to 549,787 euros. The majority of costs (69.1%) were direct treatment costs, followed by indirect costs (28.4%). Other costs were small (5.4%). Treatment costs increased with the severity of the injury or when the injury affected the lower extremities or the face. Indirect costs were higher in working age patients and in patients with a higher level of education. The relative proportions of direct and indirect costs were constant regardless of the amount of the total costs. The largest share of costs was caused by a relatively small proportion of high-cost patients during the 1st year after injury. Combined, this makes planning of resource use challenging and calls for further studies to further identify factors for highest costs.

The incidence, trends, and costs of treatment of femoral shaft fractures among Finnish children aged 2-12 years between 1998 and 2016.

Purpose: The purpose of this study was to determine the incidence and trends of both hip spica casting and elastic stable intramedullary nailing in children aged 2-12 years who sustained femoral diaphyseal fracture between 1998 and 2016 in Finland. We also evaluated the actual hospital costs of both treatment methods as well as calculating the length of hospital stay. Methods: This study included all 2- to 12-year-old children with femoral diaphyseal fracture who were treated in Finland between 1998 and 2016. Data were collected from the National Hospital Discharge Register of Finland. Children were classified by age into five groups. The annual incidences per 100,000 persons were calculated using annual mid-year population census data obtained from Statistics Finland. Data on the annual actual daily hospital costs were collected from the Finnish Institute for Health and Welfare. Results: In total, 1064 patients aged 2-12 years who had sustained femoral diaphyseal fracture were treated with elastic stable intramedullary nailing or hip spica casting between 1998 and 2016. In children aged 4-5 years, the incidence of elastic stable intramedullary nailing increased during the study period from 5.4 per 100,000 persons in 1998 to 8.1 per 100,000 persons in 2016. Conclusions: The length of hospitalization in patients treated with elastic stable intramedullary nailing was shorter and, therefore, the total costs of hospital treatment were lower than in those children treated with hip spica cast. Level of evidence: level III.

Intensive care unit admissions with and without COVID-19 in Finland from 2017 to 2021: a retrospective register-based study.

BACKGROUND: After the COVID-19 pandemic started, critical care resources were expanded in Finland to manage a possible surge in patients requiring intensive care. The aim of this study was to evaluate the incidence of overall ICU admissions, patient diagnoses, characteristics, and length of stay during the pandemic. METHODS: This retrospective hospital register-based study was conducted in two large and one mid-size Finnish public hospitals. The required data were collected from ICU patient information systems and all adult patients were included. Monthly and yearly incidences with 95% confidence intervals (CI) were counted per 100 000 persons-years by Poisson exact method and compared by incidence rate ratios (IRR). RESULTS: A total of 4407 admissions to ICUs for any cause occurred during 2020. In 2021, this figure was 4931. During the reference years (2017-2019), the mean number of admissions to ICU was 4781. In 2020 and 2021, the proportion of patients requiring intensive care due to COVID-19 was only 3%. The incidence of all-cause ICU admissions decreased during the lockdown in 2020 when compared to the reference years. Before the start of the lockdown in February 2020, the IRR of all-cause ICU admissions was 1.02 (CI: 0.89 to 1.18). During the lockdown period, however, the IRR of all-cause ICU admissions decreased to 0.78 (CI: 0.67 to 0.90) in March. When the lockdown ended, the incidence rebounded to the same level as before the lockdown. However, in 2021, the incidence of ICU admissions remained at the same level when compared to the reference years. The most prominent changes occurred in the incidence of diseases of the nervous system, which includes epilepsy and seizures and transient cerebral ischemic attacks, in diseases of the respiratory system, and neoplasms. CONCLUSIONS: According to the findings of this study, the incidence of all-cause ICU admissions decreased after the lockdown was implemented in 2020. Furthermore, the percentage of patients requiring intensive care due to COVID-19 in Finland was only 3% in 2020 and 2021. These findings may serve to help in the planning and allocating of ICU resources during future pandemics.

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.

Incidence of ankle arthrodesis and total ankle replacement between 1997 and 2018: A nationwide registry study in Finland.

BACKGROUND: Surgical treatment options for end-stage ankle osteoarthritis (OA) include ankle arthrodesis (AA) and total ankle replacement (TAR). We investigated the national incidence of AA and TAR and assessed trends in the surgical management of ankle OA in Finland between 1997 and 2018. METHODS: The Finnish Care Register for Health Care was used to calculate the incidence of AA and TAR based on sex and different age groups. RESULTS: The mean age (SD) of patients was similar, 57.8 (14.3) years for AA and 58.1 (14.0) for TAR. TAR showed a 3-fold increase from 0.3 per 100 000 person-years in 1997 to 0.9 per 100 000 person-years in 2018. The incidence of AA operations decreased during the study period from 4.4 per 100 000 person-years in 1997 to 3.8 per 100 000 person-years in 2018. TAR utilization increased notably at the expense of AA between 2001 and 2004. CONCLUSION: TAR and AA are both widely used procedures in the treatment of ankle OA, with AA being the favored option for most patients. The incidence of TAR has remained constant for the past 10 years, indicating appropriate treatment indications and utilization.

Incidence of Peripheral Nerve Decompression Surgery During Pregnancy and the First Year After Delivery in Finland From 1999 to 2017: A Retrospective Register-Based Cohort Study.

PURPOSE: We aimed to report the incidence of peripheral nerve decompression surgery during pregnancy and 12 months after delivery in Finland from 1999 to 2017. METHODS: Using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register, all women of potentially childbearing age (15-49 years) who underwent peripheral nerve decompression surgery or had a pregnancy ending in delivery from January 1, 1999, to December 31, 2017, were included. Incidence rates and incidence rate ratios for operations were calculated for both childbearing women and the age-adjusted general female population. RESULTS: In total, 308 women underwent carpal tunnel release (CTR) during pregnancy, and an additional 675 women underwent CTR within 12 months after delivery. The incidence of CTR during pregnancy was 38 per 100,000 person-years, with an incidence rate ratio of 0.5 (95% CI, 0.4-0.6), when compared with that in the general population. Women who were active smokers before becoming pregnant were more likely to undergo CTR during pregnancy (odds ratio, 2.4; 95% CI, 1.8-3.0). The highest rates of CTR were observed during the first trimester. The incidence of CTR in the first postpartum year increased steadily during the first 4 months to 79 per 100,000 person-years. During the latter 8 months, incidences were similar to those in the general population (incidence rate ratio, 1.0; 95% CI, 0.9-1.2). Women who smoked were more likely to undergo CTR during the first postpartum year (odds ratio, 1.6; 95% CI, 1.3-1.9). CONCLUSIONS: Carpal tunnel release is performed more rarely during pregnancy than in the age-matched general population. Postpartum incidences increased toward the end of the first year, reaching those observed in the general population after the first 4 months. Smoking before pregnancy is associated with increased incidences of CTR both during pregnancy and the first year after delivery. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

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.

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.

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, whereas pregnancy may promote caution in physicians contemplating surgical care. PURPOSE: We aimed to report the incidence of lumbar discectomy during pregnancy and 12 months postpartum 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 with the age-adjusted values of the age-matched female general population. The effect of smoking on the risk of lumbar discectomy was analyzed using age-adjusted odds ratios. RESULTS: In total, 91 discectomies were performed during pregnancy and 508 within 12 months postpartum. The total incidence of lumbar discectomy during pregnancy was 11 operations per 100,000 person-years with an IRR of 0.2 (95% CI 0.1-0.2) when compared with 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 1.2-3.2). Caesarean section was more common after lumbar discectomy (22%). No perinatal mortality was observed. During the first-year postpartum the rate of lumbar discectomy increased to 47 per 100 000 person-years with an IRR of 0.7 (95% CI 0.6-0.8). 90-day reoperation rates were higher than in the general population with an IRR of 1.7 (95% CI 1.1- 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. Postpartum 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.

Ultrasonic scissors decrease postoperative bleeding complications in mastectomy: A retrospective multicenter cohort study on 728 patients.

INTRODUCTION: The aim of this study was to evaluate the rate of postoperative bleeding complications (primary outcome) and any other surgical complications (secondary outcome) in mastectomy between two surgical instruments, ultrasonic SonoSurg® scissors (US) and traditional electrocautery (EC). MATERIALS AND METHODS: In total 728 patients undergoing mastectomy in two adjacent university hospitals were retrospectively evaluated in terms of postoperative bleeding episodes, surgical site infections, skin flap necrosis, and any reoperations for 30 postoperative days. A propensity score matching was performed to acquire balanced groups. Patients consuming medications affecting hemostasis were excluded from the study. A multivariable logistic regression analysis was conducted to define the odds ratio (OR) for each complication separately. A cost analysis was performed. RESULTS: The rate of postoperative bleeding complications was significantly lower in patients operated with US (0.3% vs 11.5%, OR 0.020, 95% CI 0.034-0.14) when compared to EC. The rate of surgical site infections (OR 0.65, 95% CI 0.35-1.23) was similar with both instruments, but there were less skin flap necroses (OR 0.35, 95% CI 0.13-0.98) in US group. For any reoperation, the OR for US was 0.13 (95% CI 0.046-0.39), mainly due to the lower number of acute bleeding complications. Even though the US instrument is more expensive than EC, the total cost of the treatment is lower in patients operated with US (3419 vs. 3475 euro). CONCLUSIONS: US seems to be associated with a lower risk of bleeding complications in mastectomy.

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

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.

Birth injury in breech delivery: a nationwide population-based cohort study in Finland.

PURPOSE: Previous studies have examined the optimal mode of breech delivery extensively, but there is a scarcity of publications focusing on the birth injuries of neonates born in breech presentation. This study aimed to examine birth injury in breech deliveries. METHODS: In this retrospective register-based nationwide cohort study, data on birth injuries in vaginal breech deliveries with singleton live births were compared to cesarean section with breech presentation and cephalic vaginal delivery between 2004 and 2017 in Finland. The data were retrieved from the National Medical Birth Register. Primary outcome variables were severe and mild birth injury. Incidences of birth injuries in different gestational ages and birthweights were calculated in different modes of delivery. Crude odds ratios of risk factors for severe birth injury were analyzed. RESULTS: In vaginal breech delivery (n = 4344), there were 0.8% of neonates with severe birth injury and 1.5% of neonates with mild birth injury compared to 0.06% and 0.2% in breech cesarean section (n = 16,979) and 0.3% and 1.9% in cephalic vaginal delivery (n = 629,182). Brachial plexus palsy was the most common type of injury in vaginal breech delivery. Increasing gestational age and birthweight had a stronger effect on the risk for injury among cephalic vaginal deliveries than among vaginal breech deliveries. CONCLUSION: Birth injuries were rare in vaginal breech deliveries. The incidence of severe birth injury was two times higher in vaginal breech delivery compared to cephalic vaginal delivery. Brachial plexus palsy was the most common type of injury in vaginal breech delivery.

Smoking is associated with an increased risk for fractures in women after childbirth: a nationwide population-based cohort study in Finland.

BACKGROUND AND PURPOSE: Smoking weakens bone health and increases the risk of fractures. We investigated the incidence of fractures in smoking, fertile-aged women and compared it with that of non-smoking, fertile-aged women using data from nationwide registers. PATIENTS AND METHODS: We conducted a retrospective register-based nationwide cohort study from 1998 to 2018. We identified all women smoking during pregnancy from the Medical Birth Register and compared these with non-smokers. We gathered fractures for both groups from the Care Register for Health Care. Pregnancies with missing smoking or socioeconomic status were excluded. A Cox regression model was used to analyze adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for fractures during the 5-year follow-up starting from delivery. The model was adjusted for the age of the mother at the time of delivery and socioeconomic status. RESULTS: The smoking group included 110,675 pregnancies and the non-smoking group 628,085 pregnancies. The overall fracture rate was higher in smokers after 1-year follow-up (aHR 1.7, CI 1.5-2.0) and 5-year follow-up (aHR 1.7, CI 1.6-1.8). After 5-year follow-up, the fracture rates for polytraumas (aHR 2.3, CI 1.4-3.7), inpatient admitted fractures (aHR 2.0, CI 1.7-2.4), and non-admitted fractures (aHR 1.8, CI 1.7-1.9) were all higher among smoking women. CONCLUSION: Smoking in fertile-aged women was associated with a higher risk of fractures during the 1-year and 5-year follow-up after giving birth, also after adjusting for age and socioeconomic status. Whether the increased fracture risk is caused by direct effects of smoking on bone health or riskier behavior remains uncertain.

Pregnancy and delivery after spine fracture or surgery: A nationwide population-based register study in Finland.

BACKGROUND: The incidences of spine fractures and fusion surgeries have increased. A few studies have reported an increased rate of caesarean sections (CS) in women who have undergone spine surgery but have not reported on the health of neonates. OBJECTIVE: We report the incidence of spine fractures, spine fracture surgeries and fusion surgery for other reasons and the effect of these injuries and procedures on later pregnancy outcomes in Finland. METHODS: Data on all fertile-aged women (1998-2018) who had undergone spine fracture or spine fusion surgery were retrieved from the Care Register for Healthcare and combined with data from the National Medical Birth Register. Women with spine fracture or spine surgery before pregnancy were compared with women without previous spine fracture or surgery. We calculated incidences of spine fracture, spine fracture surgery and fusion surgery for other reasons with 95% confidence intervals (CI). We used multivariable logistic regression to evaluate CS and neonatal health. Results are reported as adjusted odds ratios (AOR). RESULTS: The main finding of our study was the increasing incidence (156%) of spine fusion surgeries for other reasons in fertile-aged women. A total CS rate (including elective and unplanned CS) in the spine fracture group was 19.7% (AOR 1.26, CI 1.17-1.34), in fusion surgery for other reasons group 25.3% (AOR 1.37, CI 1.30-1.49) and 15.9% in the control group. The rate for neonates requiring intensive care in the spine fracture group was 12.2% (AOR 1.18, CI 1.08-1.29), in fusion surgery for other reasons group 13.6% (AOR 1.12, CI 1.02-1.23) and 10.0% in the control group. CONCLUSIONS: The incidence of fusion surgery for other reasons increased during our study period. The rate of CS was higher in women with preceding spine fracture or fusion surgery. Our results suggest that vaginal delivery after fractures of the spine is both possible and safe for mother and neonate.

Delay in the initiation of adjuvant chemotherapy in patients with breast cancer with mastectomy with or without immediate breast reconstruction.

BACKGROUND: Patients with breast cancer undergoing mastectomy should be offered the option of immediate breast reconstruction (IBR). The aim of this retrospective study was to assess whether there is a delay in the initiation of adjuvant chemotherapy in patients undergoing mastectomy with or without IBR. METHOD: The study included patients aged 70 years or younger with clinically node-negative breast cancer who underwent unilateral mastectomy with IBR (IBR group) or mastectomy alone (no-IBR group) followed by adjuvant chemotherapy at the Helsinki University Hospital between January 2012 to July 2018. RESULTS: A total of 645 patients were included; 186 in the IBR group and 459 in the no-IBR group. Sixty-six (35.5 per cent) patients in the IBR group and 102 (22.2 per cent) patients in the no-IBR group received their first chemotherapy cycle later than 6 weeks after surgery (P < 0.001). The respective numbers for later than 8 weeks were 17 (9.1 per cent) and 14 (3.1 per cent) (P = 0.001). Among all 645 patients, postoperative complications were a significant risk factor for a delay in the initiation of chemotherapy. Sixty-seven (39.9 per cent) patients with and 101 (21.2 per cent) patients without complications had a delay in chemotherapy (P < 0.001). The delay in chemotherapy was due to complications in 39 (59.1 per cent) in the IBR group and in 28 (27.5 per cent) in the no-IBR group (P < 0.001). CONCLUSION: Patients undergoing mastectomy alone were more likely to receive adjuvant chemotherapy within 6 weeks after surgery compared with the IBR patients. IBR significantly increased the risk of postoperative complications in comparison with mastectomy alone. The complications, in turn, were a significant risk factor for delay in adjuvant chemotherapy.

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. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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 10000 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.

Birth rate after major trauma in fertile-aged women: a nationwide population-based cohort study in Finland.

BACKGROUND: To date, only a few small studies have assessed the effects of major orthopedic traumas on the subsequent birth rate in fertile-aged woman. We assessed the incidences of traumatic brain injury (TBI) and fractures of the spine, pelvis, and hip or thigh and evaluated their association with the birth rate in fertile-aged woman. METHODS: In this retrospective register-based nationwide cohort study, data on all fertile-aged (15-44 years of age) women who sustained a TBI or fracture of the spine, pelvis, hip or thigh between 1998 and 2013 were retrieved from the Care Register for Health Care. A total of 22,780 women were included in TBI group, 3627 in spine fracture group, 1820 in pelvic fracture group, and 1769 in hip or thigh fracture group. The data were subsequently combined with data from the National Medical Birth Register. We used Cox regression model to analyze the hazard for a woman to give birth during 5-year follow-up starting from a major trauma. Women with wrist fractures (4957 women) formed a reference group. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: During 5-year follow-up after major trauma, 4324 (19.0%) women in the TBI group, 652 (18.0%) in the spine fracture group, 301 (16.5%) in the pelvic fracture group, 220 (12.4%) in the hip or thigh fracture group, and 925 (18.7%) in the wrist fracture group gave birth. The cumulative birth rate was lower in the hip or thigh fracture group in women aged 15-24 years (HR 0.72, CI 0.58-0.88) and 15-34 years (HR 0.65, CI 0.52-0.82). Women with pelvic fracture aged 25-34 years also had a lower cumulative birth rate (HR 0.79, CI 0.64-0.97). For spine fractures and TBIs, no reduction in cumulative birth rate was observed. Vaginal delivery was the primary mode of delivery in each trauma group. However, women with pelvic fractures had higher rate of cesarean section (23.9%), when compared to other trauma groups. CONCLUSIONS: Our results suggest that women with thigh, hip, or pelvic fractures had a lower birth rate in 5-year follow-up. Information gained from this study will be important in clinical decision making when women with previous major trauma are considering becoming pregnant and giving birth.

To date, only a few small studies have assessed the effects of major orthopedic traumas on the subsequent birth rate in fertile-aged woman. We assessed the incidences of traumatic brain injury (TBI) and fractures of the spine, pelvis, and hip or thigh and evaluated their association with the birth rate in fertile-aged woman.Data on all fertile-aged (15­44 years of age) women who sustained a TBI or fracture of the spine, pelvis, hip or thigh between 1998 and 2013 were retrieved from the Care Register for Health Care and the data was then subsequently combined with data from the National Medical Birth Register.A total of 22,780 women were included in TBI group, 3627 in spine fracture group, 1820 in pelvic fracture group, 1769 in hip or thigh fracture group, and 4957 in wrist fracture group, which was used as control group. Of these, 4324 (19.0%) women in the TBI group, 652 (18.0%) in the spine fracture group, 301 (16.5%) in the pelvic fracture group, 220 (12.4%) in the hip or thigh fracture group, and 925 (18.7%) in the wrist fracture group gave birth during the 5-year follow-up.Our results suggest that women with thigh, hip, or pelvic fractures had a lower birth rate in 5-year follow-up. Information gained from this study will be important in clinical decision making when women with previous major trauma are considering becoming pregnant and giving birth.