Finnish Hospital Discharge Register Research Articles

Psychiatric disorders and mortality due to external causes following diagnosis of endometriosis at a young age: a longitudinal register-based cohort study in Finland

BackgroundEndometriosis diagnosed in adults is associated with increased risk of various psychiatric disorders. However, little is known concerning psychiatric comorbidity and mortality due to external causes associated with endometriosis diagnosed at a young age. Objective(s)In this longitudinal cohort study, we investigated the link between surgical diagnosis of endometriosis at a young age, and subsequent psychiatric disorders and mortality due to external causes. Additionally, we compared the occurrence of the most common psychiatric disorders between different sites of surgically confirmed endometriosis (ovarian versus other) due to possible different pain manifestations. Study DesignWe conducted a retrospective register-based cohort study. Altogether 4532 women with surgically confirmed diagnosis of endometriosis before the age of 25 in 1987–2012 were identified from the Finnish Hospital Discharge Register and matched with women without surgically diagnosed endometriosis for age and municipality on the index day (n=9014). Women were followed from the index day until the end of 2019 for the outcomes of interest, which included nine groups of psychiatric disorders (inpatient episodes since 1987, outpatient episodes since 1998) and death due to external causes, including deaths due to accidents, suicides, and violence (Finnish Register of Causes of Death). Cox proportional hazard models were applied to assess the crude and parity-adjusted hazard ratios and 95% confidence intervals. ResultsThe cohort’s median age was 22.9 years (interquartile range: 21.3–24.1) at the beginning and 42.5 years (36.7–48.3) after a median follow-up time of 20.0 years (14.5–25.7). We observed a higher hazard of depressive, anxiety, and bipolar disorders in women with endometriosis compared to the reference cohort. These differences appeared early and remained the same during the entire follow-up, irrespective of whether assessed from the data on inpatient episodes only, or using data on both in- and outpatient episodes. The corresponding adjusted hazard ratios were 2.57 (95% confidence interval 2.11–3.14) and 1.87 (1.65–2.12) for depressive disorders, 2.40 (1.81–3.17) and 2.09 (1.84–2.37) for anxiety disorders, 1.71 (1.30–2.26) and 1.66 (1.28–2.15) for bipolar disorders, respectively. A higher hazard was seen for nonorganic sleeping disorders for the first ten years only (3.83, 2.01–7.30) when assessed using the data on both in- and outpatient episodes. When based on inpatient records, a higher hazard for alcohol/drug dependence after 15 years of follow-up (2.07, 1.21–3.54) was observed. The difference in hazard for personality disorders tended to increase during follow-up (<10 years 2.12, 1.28–3.52; 10 years or more 3.08, 1.44–6.57). Depressive and anxiety disorders occurred more frequently in women with other than ovarian endometriosis. No difference in deaths due to external causes was observed between the endometriosis and reference cohorts. Conclusion(s)Surgical diagnosis of endometriosis at young age associated with increased incidence for several psychiatric disorders. Moreover, within the endometriosis population, psychiatric comorbidity was more common in women with other than ovarian endometriosis. We speculate that chronic pain is essential in the development of these psychiatric disorders, and that early and effective pain management is important in reducing the risk of psychiatric morbidity in young women. More research concerning the associations and management of endometriosis and associated psychiatric disorders is warranted.

Atrial septal defect patients have an elevated risk for infective endocarditis

Abstract Background It has been unclear whether simple atrial septal defect (ASD) is an independent risk factor for infective endocarditis (IE). This study aimed to untangle the risk of endocarditis in a large nationwide cohort. Methods We acquired data from the Finnish hospital discharge register on all individuals with ASD diagnosis from 1969 to 2019. Patients with complex congenital cardiac abnormalities were ruled out. Five individualized controls from the general population were matched to the ASD patient's birth year, sex, and residence at the index date. All the patients with ICD-8, -9, or -10 diagnosis codes for IE were gathered from the hospital discharge registry. Results After exclusion, 8322 ASD patients and 39 237 individualized controls were enrolled in the study. Median follow-up was 21.6 years (IQR 11.8-36.9) from the first hospital contact. In total, 24 (16 male) cases of infective endocarditis among ASD patients and 10 (8 male) cases among controls were diagnosed during the follow-up. The incidence of endocarditis was 0.11 per 1000 person-years in the ASD patients and 0.011 per 1000 person-years in the controls. The adjusted risk ratio for endocarditis was 13.51 (95% CI: 6.20–29.46) in ASD patients compared to the control cohort. Patients with ASD and endocarditis had higher long-term mortality than individualized control patients (MRR 2.25, 95% CI: 1.23-4.11). Conclusions The incidence of endocarditis in atrial septal defect patients is higher than in the general population, and ASD seems to carry an increased risk of developing endocarditis.Cumulative incidence of endocarditisSurvival after endocarditis diagnosis

First live birth before surgical verification of endometriosis-a nationwide register study of 18324 women.

First live birth before surgical verification of endometriosis-a nationwide register study of 18324 women.

Atrial septal defect patients have an elevated risk for infective endocarditis

Background. It has been unclear whether simple atrial septal defect (ASD) is an independent risk factor for infective endocarditis (IE). This study aimed to untangle the risk of endocarditis in a large nationwide cohort. Methods. We acquired data from the Finnish hospital discharge register on all individuals with ASD diagnosis from 1969 to 2019. Patients with complex congenital cardiac abnormalities were ruled out. Five individualized controls from the general population were matched to the ASD patient’s birth year, sex, and residence at the index date. All the patients with ICD-8, −9, or −10 diagnosis codes for IE were gathered from the hospital discharge registry. Results. Altogether, 8322 patients with ASD and 39,237 individualized controls were enrolled in the study. Median follow-up was 21.6 years (IQR 11.8–36.9) from the first hospital contact. In total, 24 (16 male) cases of infective endocarditis among ASD patients and 10 (8 male) cases among controls were diagnosed during the follow-up. The incidence of endocarditis was 0.11 per 1000 person-years in the patients with ASD and 0.011 per 1000 person-years in the controls. The adjusted risk ratio for endocarditis was 13.51 (95% CI: 6.20–29.46) in patients with ASD compared to the control cohort. Patients with ASD and endocarditis had higher long-term mortality than individualized control patients (MRR 2.25, 95% CI: 1.23–4.11). Conclusions. The incidence of IE in patients with ASD was higher than in the general population. Mortality associated with IE was higher in patients with ASD compared to controls.

Venous thromboembolism is rare after total hip and knee joint arthroplasty with long thromboprophylaxis in Finnish fast-track hospitals

IntroductionPharmacological thromboprophylaxis effectively prevents venous thromboembolism (VTE) after total knee (TKA) and total hip arthroplasty (THA). Less is known about the influence of fast-track arthroplasty on VTE risk. We conducted a register-based study to determine the incidence of VTE after fast-track TKA and THA in Finland using long thromboprophylaxis.Materials and methodsAll primary TKAs and THAs operated during 2015–2016 in 3 fast-track hospitals were identified from the Finnish Arthroplasty Register. Pulmonary embolism (PE) and deep vein thrombosis (DVT) diagnosed in this patient cohort within 90 days of surgery were identified from the Finnish Hospital Discharge Register. The recommended length of thromboprophylaxis was 10 to 14 days for TKA and 28 days for THA during study period.ResultsDuring the study period, 3 831 THAs, 4 394 TKAs and 286 bilateral TKAs (BTKAs) were performed. Of all these patients, 60% were females. Venous thromboembolism (VTE) incidence within 90 days of surgery was 0.3% (95% CI 0.2–0.4). These VTEs comprised 10 PEs and 15 DVTs. None of the VTE patients´ died within the 90-day period.ConclusionVTE incidence is low in Finnish fast-track TKA and THA patients with long thromboprophylaxis.

How Often Do Complications and Mortality Occur After Operatively Treated Periprosthetic Proximal and Distal Femoral Fractures? A Register-based Study.

The incidence of periprosthetic femoral fractures is increasing because of an increasing number of primary THAs and TKAs. High rates of complications and mortality are associated with periprosthetic fractures, but few studies have evaluated and compared the population-based incidences of these events after fractures. (1) What is the annual incidence of periprosthetic fractures treated with surgery in one hospital district in Finland? (2) How are those incidences changing over time? (3) What is the risk of complications, reoperations, and death after those injuries? This register-based study evaluated 2259 patients who underwent revision THA or TKA or any surgery for a femoral fracture between January 2004 and December 2016 at the only hospital in our district where these types of operations are performed. During the study period, the diagnosis and operation codes of the operated-on patients varied greatly, and they were somewhat inaccurate. We thus evaluated radiographs of all 2259 patients one by one, and created inclusion and exclusion criteria based on radiologic findings and medical records. Of those, 12% (279 of 2259) had periprosthetic fractures that met the inclusion criteria, and from these, we formed two study groups (periprosthetic proximal femur fractures, n = 171; periprosthetic distal femur fractures, n = 108). Eighty-eight percent (1980 of 2259) of the patients were excluded because they were treated for a condition other than periprosthetic femoral fracture. The follow-up period ended in December 2019 or at the time the patient died. To evaluate the population-based incidence, we drew the number of individuals with THA or TKA in the hospital district from the Finnish Arthroplasty Register and the Finnish Hospital Discharge Register. The characteristics of patients with operatively treated periprosthetic femoral fractures were evaluated in terms of age, gender, fracture type, implant type, and time from the index operation to periprosthetic fracture. The annual incidences of periprosthetic femoral fractures are summarized per 1000 person-years of individuals living with an implanted THA or TKA and per 100,000 individuals per year living in our hospital district. The risks of death, complications, and reoperations were evaluated for both groups, and comparisons were made in terms of patient characteristics. The mean annual incidence of operatively treated periprosthetic proximal femur fractures per 1000 people living with THA implants was 2.3 ± 0.9 (95% confidence interval 1.8 to 2.7) per year, and for those with periprosthetic distal femur fractures with TKA implants, it was 1.3 ± 0.6 (95% CI 1.0 to 1.7). There was an increasing trend in the incidence of periprosthetic proximal femur fractures from 1.6 to 3.8 (95% CI 1.8 to 2.8) per 1000 arthroplasties, and it increased from 0.4 to 1.7 (95% CI 2.4 to 4.4) for periprosthetic distal femur fractures between 2004 and 2016. The mean population-based incidence of periprosthetic proximal femur fractures per 100,000 person-years was 5.3 ± 2.2 (95% CI 4.1 to 6.4) per year, and for periprosthetic distal femur fractures, it was 3.4 ± 1.7 (95% CI 2.5 to 4.4). The incidence of periprosthetic proximal femur fractures related to 100,000 person-years increased from 3.2 to 8.9 (95% CI 3.9 to 6.6), while the incidence of periprosthetic distal femur fractures increased from 1.3 to 4.4 (95% CI 2.4 to 4.8) during the study period. The cumulative incidence of major complications after periprosthetic proximal femur fracture was 8.8% at 1 year (95% CI 5.1% to 13.6%) and 12.3% at 10 years (95% CI 7.5% to 18.4%), and after periprosthetic distal femur fracture, it was 7.4% at 1 year (95% CI 3.5% to 13.4%) and 9.3% at 10 years (95% CI 4.7% to 15.7%). The cumulative incidence of reoperation after periprosthetic proximal femur fracture was 10.5% at 1 year (95% CI 6.5% to 15.7%) and 13.5% at 10 years (95% CI 8.9% to 19.1%), and for periprosthetic distal femur fracture, it was 8.3% at 1 year (95% CI 4.1% to 14.5%) and 13.8% at 10% years (95% CI 7.8% to 21.4%). The cumulative incidence of death after periprosthetic proximal femur fracture was 8.2% at 1 year (95% CI 4.7% to 12.9%) and 47.3% at 10 years (95% CI 38.1% to 55.9%), and after periprosthetic distal femur fractures, it was 14.8% at 1 year (95% CI 8.8% to 22.2%) and 67.8% at 10 years (95% CI 56.3% to 76.9%). The increased use of THA and TKA has led to an increase in the incidence of operatively treated periprosthetic fractures, which means there will be more revisions in the future. Older age, frailty of these patients, and often-complicated fracture patterns are related to a high rate of complications, reoperations, and mortality. Healthcare systems must prepare for a large increase in revisions for periprosthetic fracture, which are morbid events for patients and costly ones for healthcare systems. Level III, therapeutic study.

Association Between Alcohol Use Disorders and Dementia in 262,703 Dementia-free Finnish Adults: Is Cardiovascular Disease a Mediator?

The possible mediating role of cardiovascular disease (CVD) in the relationship between alcohol use disorders (AUD) and the risk of early-onset (<age 65)and late-onset (≥age 65)dementia lacks formal investigation. Using linked Finnish national register data, a population-based cohort study of 262,703 dementia-free Finnish men and women aged 40 + at baseline (December 31, 1999)was established. AUD and CVD in 1988-2014, and incident dementia in 2000-2014 were identified from Finnish Hospital Discharge Register and/or Drug Reimbursement Register. Causal association and mediation were assessed using mediational g-formula. AUD was associated with a substantial increase in the risk of early-onset dementia in both men (hazard ratio: 5.67, 95% confidence interval: 4.37-7.46) and women (6.13, 4.20-8.94) after adjustments for confounding; but the elevated risk for late-onset dementia was smaller (men: 2.01, 1.80-2.25; women: 2.03, 1.71-2.40). Mediational g-formula results showed that these associations were causal in men with no mediation by CVD as the virtually identical total effect of AUD (early-onset: 5.26, 3.48-7.48; late-onset: 2.01, 1.41-2.87) and direct effect of AUD (early-onset: 5.24, 3.38-7.64; late-onset: 2.19, 1.61-2.96) were found with no indirect effect via CVD. In women, the results were similar for late-onset dementia (total effect: 2.80, 1.70-4.31; direct effect: 2.92, 1.86-4.62) but underpowered for early-onset dementia. AUD increased dementia risk, particularly the risk of early-onset dementia. This elevated risk of dementia associated with AUD was not mediated by CVD. Clinicians should consider the increased risk of dementia in the management of middle-aged and older adults with a history and/or current AUD.

Decreased burden of revision hip replacements despite substantial rise in prevalence: a register-based analysis in Finland.

Background and purposeWhile the incidence of THR operations has been established, little is known about the prevalence or the ratio of the annual number of revision THRs to the total number of THRs in the general population. By combining data from nationwide registers, we calculated the annual prevalence of THRs and the revision burden caused by THR survivors in Finland.Patients and methodsAll primary THRs performed between 1980 and 2020 were identified from the Finnish Arthroplasty Register (FAR). Patient deaths were extracted from the Finnish Digital and Population Data Services Agency and THR revisions and removals from the FAR and the Finnish Hospital Discharge Register. We analyzed annual THR prevalence by dividing the number of THRs by the population aged 40 or older and the revision burden factor (RBF) by dividing the annual number of revisions by the total number of primary and revision THRs in the population. The proportions of bilateral implants and patients with THRs performed more than 10 years earlier (older THRs) were identified.ResultsTHR prevalence in Finland increased rapidly, reaching 3.6% in 2020. Between 2010 and 2020, the number of THRs increased by 50% and the prevalence of THRs by 38%. In 2020, the proportion of bilateral THRs had risen to 29% and the proportion of patients with older THRs to 36%. The RBF decreased between 1996 and 2020 from 3.1% to 1.3% (age- and sex-adjusted proportion ratio PR 0.42 [95% CI 0.39–0.45]).InterpretationDespite the decrease in the RBF, the rapidly increasing prevalence of THRs potentially increases the number of revisits and revisions and thus poses a challenge for healthcare in the future.

Surgically confirmed endometriosis in adolescents in Finland-A register-based cross-sectional cohort study.

Increasing awareness of endometriosis in adolescents requires data on the nature of the disease and its management. Our objective was to investigate the subtypes of surgically confirmed endometriosis in adolescents (aged <20 years) and trends in the incidence rates and endometriosis-related procedures during the study period, 1987-2012. In this register-based cohort study, we identified 526 adolescents receiving their initial surgical diagnosis of endometriosis between 1987 and 2012 from the Finnish Hospital Discharge Register. The age-specific incidence rate of surgically confirmed endometriosis was calculated by dividing the number of adolescents during specific periods by person-years. We calculated the relative differences in incidence rates between the periods using crude incidence ratios. Adolescents were divided into three age groups, <17, 17-18, and 19 years, which comprised 8.2% (43/526), 39.7% (209/526), and 52.1% (274/526) of the study cohort, respectively. Peritoneal endometriosis and ovarian endometriosis were the most common types (379/526 [72%] and 119/526 [23%], respectively). The incidence rate of surgically confirmed endometriosis per 100 000 person-years varied from 5.63 (95% confidence interval [CI] 4.24-7.33) to 11.42 (95% CI 9.64-13.44). The incidence rate in 2001-2005 was significantly higher and was 1.6- to 2.0-fold that of the periods 1987-1990 and 2006-2012, respectively. Comparing the periods in which International Classification of Diseases, Ninth Revision (ICD-9; 1987-1995) and Tenth Revision (ICD-10; 1996-2012) codes were used, the use of laparoscopy (78.2% vs 88.9%), day surgery (10.3% vs 31.6%), and procedures for ovarian (18.8% vs 34.1%) and deep (0.6% vs 10.8%) endometriosis increased. The types of endometriosis and procedures did not differ between the age groups. Peritoneal endometriosis was the most common type of endometriosis overall and by age group. During the 26-year period, the incidence rate of initial surgical diagnosis of endometriosis peaked in 2001-2005 and decreased thereafter. The proportion of procedures performed for ovarian and deep endometriosis increased, as did the use of laparoscopy and day surgery.

Incidence and mortality of alcohol-related dementia and Wernicke-Korsakoff syndrome: A nationwide register study.

BackgroundEpidemiological data on alcohol‐related cognitive disorders are scarce. Up‐to‐date population‐based incidence and mortality rates for Wernicke‐Korsakoff syndrome (WKS) and alcohol‐related dementia (ARD) are necessary to understand the burden of these diseases.MethodsWe collected diagnostic data from the Finnish Hospital Discharge Register and mortality data from Statistics Finland for all persons aged ≥40 years who had received a diagnosis of WKS (n = 1149) or ARD (n = 2432) between 1998 and 2015 in Finland. We calculated the incidences and mortality in relation to the age‐, sex‐ and calendar year‐matched general population. Causes of death were ascertained from death certificates.ResultsFor WKS, the incidence per 100,000 person‐years (95% confidence interval (CI)) was 3.7 (3.4–3.9) in men and 1.2 (1.1–1.3) in women. For ARD, the incidence was 8.2 (7.9–8.6) in men and 2.1 (1.9–2.3) in women. The incidence of WKS peaked in people aged 50–59 years and the incidence of ARD in people aged 70–79 years. The standardized mortality ratio (95% CI) was 5.67 (5.25–6.13) in WKS patients and 5.41 (5.14–5.70) in ARD patients. Most of the excess mortality resulted from alcohol‐related causes.ConclusionsTo our knowledge, this is the first study describing population‐based incidence and mortality rates, sex‐segregated data and causes of death in patients with WKS or ARD. Our results establish a point of reference for the incidence of WKS and ARD and show the high mortality and poor prognosis of these disorders.

New theory about the pathophysiology of preeclampsia derived from the paradox of positive effects of maternal smoking.

The aim of this study was to evaluate if maternal height affects the link between the inverse association on smoking during pregnancy and preeclampsia. The study population consisted of all women with singleton pregnancies (n = 803 698) in Finland during the years 2004-2018, excluding women with unknown smoking and diagnosis of prepregnancy chronic hypertension. Information on smoking and background factors were derived from the Finnish Medical Birth Register. Smoking was categorized in three classes: no, quitted in the first trimester and continued throughout the pregnancy. Information on preeclampsia was derived from the Finnish Hospital Discharge Register and the Finnish Medical Birth Register. Multiple logistic regression models were used to estimate first the association between smoking and preeclampsia, and finally whether maternal height modified the association. In the standard comparison, we found evidence of an association between preeclampsia and continued smoking [adjusted odds ratio = 0.74, 95% confidence interval (95% CI) = 0.67-0.81], but no association was found between quitted smoking and preeclampsia. Thus, the interaction of continued smoking and maternal height by z-scores was estimated. Among taller mothers, continued smoking was associated with a higher risk for preeclampsia than in smoking mothers with average height (β = 0.33, SE = 0.14, P = 0.02). Our results partly challenge the smoking-preeclampsia paradox: smoking seems not to protect tall mothers against preeclampsia. We speculate the findings through a new theory about the pathophysiology of preeclampsia. It seems that tall pregnant smokers must raise their blood pressure aggressively to ensure perfusion in the dysfunctional placenta.

Low incidence of clinically relevant bleeding complications after fast-track arthroplasty: a register study of 8,511 arthroplasties.

Background and purposeFast-track total joint replacement (TJR) has become increasingly common. Routine thromboprophylaxis for pulmonary embolism and deep venous thrombosis prevention lasts from 2 to 5 weeks. This retrospective registry study focused on clinically relevant bleeding complications 90 days after fast-track primary TJR.Patients and methodsAll primary fast-track total hip (THA) and knee arthroplasties (TKA) performed between 2015 and 2016 were extracted from the Finnish Arthroplasty Register and Finnish Hospital Discharge Register. Type of arthroplasty and indication for the operation were combined with diagnoses of clinically relevant bleeding complications within 90 days of surgery. The incidence of these bleedings was the primary outcome measure.ResultsOf the total of 8,511 patients (mean age 67 years (SD 10); 60% female), 45% underwent unilateral THA, 52% unilateral TKA, and 3% bilateral TKA. The incidence of clinically relevant bleeding complications within 90 days was 1% (95% CI 0.8–1.3). No difference was observed in bleeding incidence between the groups. The 87 bleedings comprised 57 operative site bleedings, 17 gastrointestinal bleedings, 6 intracranial non-traumatic bleedings, 5 bleedings from the nose or another undetermined site, and 2 intraocular bleedings. 1 death due to intracranial bleeding was recorded, and hence clinically relevant bleeding-specific 90-day mortality was 0.01%.InterpretationThe incidence of clinically relevant bleeding complications was low. However, they cause patient discomfort, increase the use of healthcare services, and can be life-threatening and even fatal.

Risk of total knee replacement after proximal tibia fracture: a register-based study of 7,841 patients.

Background and purposePost-traumatic knee osteoarthritis following proximal tibia fracture (PTF) is a common complication that may lead to total knee replacement as secondary treatment (TKRS). We determined the risk of TKRS following PTF, whether treated nonoperatively or operatively, and compared the results with a 38-fold control group without prior PTF.Patients and methodsWe identified all patients over 18 years of age in Finland with PTF treated during the period 2009–2018 from the Finnish Hospital Discharge Register (FHDR) and Finnish Arthroplasty Register (FAR). Age, sex, treatment method, follow-up time, and possible TKRS were recorded.Results7,701 patients were treated for PTF during the period 2009–2018. Over the 5.1-year (SD 3.1) follow-up, TKRS was performed in 340 (4.3%) patients with a prior PTF after a mean of 2.1 (SD 2.0) years post-fracture. TKRS was needed in 138 (3.7%, HR 1.8) patients in the nonoperatively treated group and in 202 (5.0%, HR 3.2) patients in the operatively treated group. Operative treatment, female sex, and high age were identified as risk factors for TKRS. The incidence of TKRS was highest during the first 2 years after fracture and remained elevated throughout the follow-up.InterpretationPatients with a prior PTF had a 1.8- to 3.2-fold higher risk of TKRS compared with controls during the first 5 years post-fracture. Risk of TKRS was associated with an operatively treated PTF, female sex, and high age. The patients in the operative group likely sustained more complex fractures, while female sex and age may be explained by more osteoporotic bone quality.

Endogenous erythropoietin at birth is associated with neurodevelopmental morbidity in early childhood

BackgroundNew biomarkers that predict later neurodevelopmental morbidity are needed. This study evaluated the associations between umbilical cord serum erythropoietin (us-EPO) and neurodevelopmental morbidity by the age of 2–6.5 years in a Finnish cohort.MethodsThis study included 878 non-anomalous children born alive in 2012 to 2016 in Helsinki University Hospitals and whose us-EPO concentration was determined at birth. Data of these children were linked to data from the Finnish Medical Birth Register and the Finnish Hospital Discharge Register. Neurodevelopmental morbidity included cerebral palsy, epilepsy, intellectual disability, autism spectrum disorder, sensorineural defects, and minor neurodevelopmental disorders.ResultsIn the cohort including both term and preterm children, us-EPO levels correlated with gestational age (r = 0.526) and were lower in premature children. High us-EPO levels (>100 IU/l) were associated with an increased risk of severe neurodevelopmental morbidity (OR: 4.87; 95% CI: 1.05–22.58) when adjusted for the gestational age. The distribution of us-EPO levels did not differ in children with or without the later neurodevelopmental diagnosis.ConclusionsAlthough high us-EPO concentration at birth was associated with an increased risk of neurodevelopmental morbidity in early childhood, the role of us-EPO determination in clinical use appears to be minor.ImpactWe determined whether endogenous umbilical cord serum erythropoietin would be a new useful biomarker to predict the risk of neurodevelopmental morbidity.This study evaluated the role of endogenous erythropoietin at birth in neurodevelopmental morbidity with a study population of good size and specific diagnoses based on data from high-quality registers.Although high umbilical cord serum erythropoietin concentration at birth was associated with an increased risk of neurodevelopmental morbidity in early childhood, the clinical value of erythropoietin determination appears to be minor.

High incidence of inguinal hernias among patients with congenital abdominal wall defects: a population-based case\u2013control study

The aim of this nationwide population-based case–control study was to assess the incidence of inguinal hernia (IH) among patients with congenital abdominal wall defects. All infants born with congenital abdominal wall defects between Jan 1, 1998, and Dec 31, 2014, were identified in the Finnish Register of Congenital Malformations. Six controls matched for gestational age, sex, and year of birth were selected for each case in the Medical Birth Register. The Finnish Hospital Discharge Register was searched for relevant diagnosis codes for IH, and hernia incidence was compared between cases and controls. We identified 178 infants with gastroschisis and 150 with omphalocele and selected randomly 1968 matched, healthy controls for comparison. Incidence of IH was significantly higher in gastroschisis girls than in matched controls, relative risk (RR) 7.20 (95% confidence interval [CI] 2.25–23.07). In boys with gastroschisis, no statistically significant difference was observed, RR 1.60 (95% CI 0.75–3.38). Omphalocele was associated with higher risk of IH compared to matched controls, RR 6.46 (95% CI 3.90–10.71), and the risk was equally elevated in male and female patients.Conclusion: Risk of IH is significantly higher among patients with congenital abdominal wall defects than in healthy controls supporting hypothesis that elevated intra-abdominal pressure could prevent natural closure of processus vaginalis. Parents should be informed of this elevated hernia risk to avoid delays in seeking care. We also recommend careful follow-up during the first months of life as most of these hernias are diagnosed early in life.What is Known:• Inguinal hernia is one of the most common disorders encountered by a pediatric surgeon.• Prematurity increases the risk of inguinal hernia.What is New:• Children with congenital abdominal wall defects have a significantly higher risk of inguinal hernia than general population.• Families should be informed of this elevated hernia risk to avoid delays in seeking care.

Long-term hospital admissions and surgical treatment of children with congenital abdominal wall defects: a population-based study

Congenital abdominal wall defects, namely, gastroschisis and omphalocele, are rare congenital malformations with significant morbidity. The long-term burden of these anomalies to families and health care providers has not previously been assessed. We aimed to determine the need for hospital admissions and the requirement for surgery after initial admission at birth. For our analyses, we identified all infants with either gastroschisis (n=178) or omphalocele (n=150) born between Jan 1, 1998, and Dec 31, 2014, in the Register of Congenital Malformations. The data on all hospital admissions and operations performed were acquired from the Finnish Hospital Discharge Register between Jan 1, 1998, and Dec 31, 2015, and compared to data on the whole Finnish pediatric population (0.9 million) live born 1993−2008. Patients with gastroschisis and particularly those with omphalocele required hospital admissions 1.8 to 5.7 times more than the general pediatric population (p<0.0001). Surgical interventions were more common among omphalocele than gastroschisis patients (p=0.013). At the mean follow-up of 8.9 (range 1.0–18.0) years, 29% (51/178) of gastroschisis and 30% (45/150) of omphalocele patients required further abdominal surgery after discharge from the neonatal admission.Conclusion: Patients with gastroschisis and especially those with omphalocele, are significantly more likely than the general pediatric population to require hospital care. Nevertheless, almost half of the patients can be treated without further surgery, and redo abdominal surgery is only required in a third of these children.What is Known:• Gastroschisis and omphalocele are congenital malformations with significant morbidity• There are no reports on the long-term need for hospital admissions and surgery in these childrenWhat is New:• Patients with abdominal wall defects are significantly more likely than the general pediatric population to require hospital care• Almost half of the patients can be treated without further surgery, and abdominal redo operations are only required in a third of these children

Decreasing Incidence of Lumbar Discectomy Surgery in Finland in 1997-2018.

Retrospective register study. The aim of this study was to assess the incidence and trends of lumbar disc surgeries in Finland from 1997 through 2018. The evidence on lumbar spine discectomy has shifted from supporting surgical treatment toward nonoperative treatment. Still, the incidence of lumbar discectomy operations increased until the 1990 s. In the United States, the incidence began to decline after a downward turn in 2008, yet recent trends from countries with public and practically free health care are not widely known. Data for this study were obtained from the Finnish nationwide National Hospital Discharge Register. The study population covered all patients 18 years of age or older in Finland during a 22-year period from January 1, 1997, to December 31, 2018. A total of 65,912 lumbar discectomy operations were performed in Finland from 1997 through 2018. The annual population-based incidence of lumbar discectomy decreased 29% during the 22-year period, from 83 per 100,000 person-years in 1997 to 58 per 100,000 person-years in 2018. In addition, the incidence of microdiscectomy increased 12%, from 41 per 100,000 person-years in 1997 to 47 per 100,000 person-years in 2018, whereas the incidence of open discectomy decreased 71%, from 41 per 100,000 person-years in 1997 to 12 per 100,000 person-years in 2018. The total reoperation rate for microendoscopic, microscopic, and open discectomy surgeries was 16.3%, 15.3%, and 14.9%, respectively. The nationwide incidence of lumbar discectomy decreased in Finland from 1997 through 2018. Additionally, the incidence of open discectomy is decreasing rapidly, whereas the incidence of microsurgical techniques is increasing.Level of Evidence: 3.

National trends in lumbar spine decompression and fusion surgery in Finland, 1997–2018

Background and purpose — During recent years, spine surgery techniques have advanced, the population has become older, and multiple high-quality randomized controlled trials that support surgical treatment for degenerative spinal stenosis and spondylolisthesis have been published. We assess the incidence and trends in spine fusion and decompression surgery in Finland between 1997 and 2018. Patients and methods — We used nationwide data from the Finnish nationwide National Hospital Discharge Register. The study population covered all patients aged 20 years or over in Finland (5.5 million inhabitants) during a 22-year period from 1997 through 2018. All patients who underwent spinal decompression were included. Patients with both decompression and fusion codes were analyzed as fusions. Results — 76,673 lumbar spine decompressions and fusions were performed during the study period. The incidence of lumbar spine decompressions increased from 33 (95% CI 23–45) per 100,000 person-years in 1997 to 77 (CI 61–95) per 100,000 person-years in 2018. The incidence of lumbar spine fusions increased from 9 (CI 5–17) per 100,000 person-years in 1997 to 30 (CI 21–43) per 100,000 person-years in 2018. The increase in incidence of lumbar spinal fusions was highest among women aged over 75 years, with a 4-fold increase. Interpretation — The incidence of lumbar spine fusions and decompressions increased between 1997 and 2018 in Finland. These findings may be the result of the emergence of advanced surgical techniques but may also be the result of an aging population and increased evidence supporting the surgical treatment of various spinal pathologies.

Rising trends in the incidence of shoulder dystocia and development of a novel shoulder dystocia risk score tool: a nationwide population-based study of 800484 Finnish deliveries.

Shoulder dystocia has remained an unpredictable and feared emergency in obstetrics. Some risk factors have been identified but nevertheless there is a lack of risk evaluation tools in clinical practice. The aim of this study was to evaluate the incidence and risk factors of shoulder dystocia in the Finnish population and to develop a shoulder dystocia risk score tool. This retrospective, population-based study included all deliveries in Finland between 2004 and 2017 (n=800484). The annual numbers of shoulder dystocia diagnoses were gathered from nationwide Finnish Medical Birth Register and Hospital Discharge Register. The incidence of shoulder dystocia was calculated in subgroups according to the mode of delivery, maternal diabetes status, body mass index (BMI), age, parity and gestational age. Based on these numbers, a shoulder dystocia risk score tool was created. The overall incidence of shoulder dystocia was 0.18%. It increased significantly during the study period from 0.10% to 0.32% (P<.001). More specifically, the incidence increased significantly in all analyzed subgroups except for women with BMI <18.5 or age <20years. To evaluate the importance of risk factors, practical and simple shoulder dystocia risk score tool was created. Instrumental vaginal delivery, maternal diabetes of any kind, BMI ≥25, age ≥40years and gestational age ≥41weeks were associated with higher shoulder dystocia risk compared with non-diabetic, non-obese and younger women with spontaneous deliveries before 41weeks of gestation. In our risk score tool, cases with shoulder dystocia had a significantly higher number of risk points than those without it (15.2 vs 10.4, P<.001). The risk was significantly high when the scores were ≥18 points (relative risk 9.54, 95% confidence interval 8.61-10.57). The incidence of shoulder dystocia in Finland increased during the study period but it is still low compared with previous studies from other countries. In clinical daily practice, the new shoulder dystocia risk score tool helps to evaluate the individual risk profile of the parturient. According to this risk score tool, the highest risk was found with the combination of instrumental vaginal delivery, maternal diabetes, BMI ≥25, age ≥40years and gestational age ≥41weeks.

Distal Biceps Tendon Rupture Surgery: Changing Incidence in Finnish and Swedish Men Between 1997 and 2016

Distal biceps tendon rupture is a relatively rare injury usually occurring with excess external extension force applied to a flexed elbow. The aim of this study was to examine the incidence of distal biceps tendon rupture surgery in the Finnish and Swedish adult population between the years 1997 and 2016. A secondary aim was to investigate the distal biceps rupture incidence in the Swedish population in 2001 to2016. We assessed the number and rate of distal biceps tendon rupture surgery using the Finnish and Swedish Hospital Discharge Register as databases. The study included the entire Finnish and Swedish adult population aged 18 years and older between January 1, 1997 and of December 31,2016. During the study period, 2,029 patients had a distal biceps tendon rupture in Finland, and the corresponding figure was 2,000 in Sweden. The rate of distal biceps tendon rupture surgery increased steeply, but equally, in both countries, in Finnish men from 1.3 per 100,000 person-years in 1997 to 9.6 in 2016, and in Swedish men from 0.2 in 1997 to 5.6 in 2016. The incidence of distal biceps tendon rupture in Sweden increased in men from 1.6 to 10.0 per 100,000 person-years from 2001 to2016. There was a 7-fold and a 28-fold increase in the incidence of distal biceps tendon rupture surgery in Finnish and Swedish men during 1997 to 2016. The incidence of distal biceps tendon rupture rose 6-fold in Swedish men in 2001 to2016. Prognostic IV.