| 1. |
- Bayadsi, Haytham, 1987-, et al.
(författare)
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The correlation between small papillary thyroid cancers and gamma radionuclides Cs-137, Th-232, U-238 and K-40 using spatially-explicit, register-based methods
- 2023
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Ingår i: Spatial and Spatio-Temporal Epidemiology. - : Elsevier. - 1877-5845 .- 1877-5853. ; 47
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Tidskriftsartikel (refereegranskat)abstract
- A steep increase of small papillary thyroid cancers (sPTCs) has been observed globally. A major risk factor for developing PTC is ionizing radiation. The aim of this study is to investigate the spatial distribution of sPTC in Sweden and the extent to which prevalence is correlated to gamma radiation levels (Caesium-137 (Cs-137), Thorium-232 (Th-232), Uranium-238 (U-238) and Potassium-40 (K-40)) using multiple geospatial and geo-statistical methods. The prevalence of metastatic sPTC was associated with significantly higher levels of Gamma radiation from Th-232, U-238 and K-40. The association is, however, inconsistent and the prevalence is higher in densely populated areas. The results clearly indicate that sPTC has causative factors that are neither evenly distributed among the population, nor geographically, calling for further studies with bigger cohorts. Environ-mental factors are believed to play a major role in the pathogenesis of the disease.
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| 2. |
- Fränneby, Ulf, et al.
(författare)
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Self-reported adverse events after groin hernia repair, a study based on a national register.
- 2008
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Ingår i: Value in Health. - : Wiley. - 1098-3015 .- 1524-4733. ; 11:5, s. 927-932
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: In most clinics, follow-up after inguinal hernia surgery is not a routine procedure and complications may pass unnoticed, thus impairing quality assessment. The aim of this study was to investigate the frequency, spectrum, and risk factors of short-term adverse events after groin hernia repair. METHODS: All patients aged 15 years or older with a primary unilateral inguinal or femoral hernia repair recorded in the Swedish Hernia Register (SHR) between November 1 and December 31, 2002 were sent a questionnaire asking about complications within the first 30 postoperative days. RESULTS: Of the 1643 recorded patients, 1448 (88.1%) responded: 1341 (92.6%) were men and 107 (7.4%) women, mean age 59 years. There were 195 (11.9%) nonresponders. Postoperative complications reported in the questionnaire were hematoma in 203 (14.0%) patients, severe pain in 168 (11.6%), testicular pain in 120 (8.3%), and infection in 105 (7.3%). Adverse events were reported in the questionnaire by 391 (23.8%) patients, whereas only 85 (5.2%) were affected according to the SHR. Risk factors for postoperative complications were age below the median (59 years) among the studied hernia patients (OR 1.36; 95% CI 1.06-1.74) and laparoscopic repair (OR 2.66; 95% CI 1.17-6.05). CONCLUSION: Questionnaires provide valuable additional information concerning postoperative complications. We recommend that they become an integrated part of routine postoperative assessment.
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| 3. |
- Axman, Erik, et al.
(författare)
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Assessing the Validity and Cover Rate of the National Swedish Hernia Register
- 2021
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Ingår i: CLINICAL EPIDEMIOLOGY. - : Dove Press. - 1179-1349. ; 13, s. 1129-1134
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To assess the validity and cover rate of the Swedish hernia register. Material and Methods: Since the start of the Swedish Hernia register an annual review of randomly selected hospitals has been carried out, and since 2013 in a more standardized form to allow a systematic data collection and evaluation. 10% of all clinics were randomly selected each year in a specific region of Sweden, ensuring a systematic validation of all regions from north to south. Data from 2013 to 2018 were analyzed regarding data quality and from 2014 to 2018 regarding cover rate. All operations registered at the validated clinics were compared with the Swedish Hernia Register to assess cover rate. Fifty operations were randomly selected at each clinic and data in the Swedish Hernia register were compared with the medical records to evaluate data quality. Results: Fifty-five clinics was evaluated and a total of 73,764 variables were compared with the medical records. Cover rate between 2014 and 2018 was 97%. The proportion of correct variables was 98% between 2013 and 2018. Most frequent errors were ASA score, date at which the patient was put on the waiting list and postoperative complications. Conclusion: This unique validation of a national hernia register shows a high cover rate and good quality of data. Efforts to maintain and improve national registers are of great importance. Research with data from the Swedish hernia register should be evaluated on the basis of the results presented in this study.
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| 4. |
- Dahlstrand, Ursula, et al.
(författare)
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Emergency femoral hernia repair : a study based on a national register.
- 2009
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Ingår i: Annals of Surgery. - : Lippincott, Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 249:4, s. 672-676
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the characteristics of femoral hernias and outcome of femoral repairs, with special emphasis on emergency operations. BACKGROUND: Femoral hernias account for 2% to 4% of all groin hernias. However, the lack of large-scale studies has made it impossible to draw conclusions regarding the best management of these hernias. METHODS: The study is based on patients 15 years or older who underwent groin hernia repair 1992 to 2006 at units participating in the Swedish Hernia Register. RESULTS: Three thousand nine hundred eighty femoral hernia repairs were registered, 1490 on men and 2490 on women: 1430 (35.9%) patients underwent emergency surgery compared with 4.9% of the 138,309 patients with inguinal hernias. Bowel resection was performed in 22.7% (325) of emergent femoral repairs and 5.4% (363) of emergent inguinal repairs. Women had a substantial over risk for undergoing emergency femoral surgery compared with men (40.6% vs. 28.1%). An emergency femoral hernia operation was associated with a 10-fold increased mortality risk, whereas the risk for an elective repair did not exceed that of the general population. In elective femoral hernias, laparoscopic (hazard ratio, 0.31; 95% confidence interval, 0.15-0.67) and open preperitoneal mesh (hazard ratio, 0.28; confidence interval, 0.12-0.65) techniques resulted in fewer re-operations than suture repairs. CONCLUSIONS: Femoral hernias are more common in women and lead to a substantial over risk for an emergency operation, and consequently, a higher rate of bowel resection and mortality. Femoral hernias should be operated with high priority to avoid incarceration and be repaired with a mesh.
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| 5. |
- Fränneby, Ulf, et al.
(författare)
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Validation of an Inguinal Pain Questionnaire for assessment of chronic pain after groin hernia repair.
- 2008
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Ingår i: British Journal of Surgery. - : Wiley. - 0007-1323 .- 1365-2168. ; 95:4, s. 488-493
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Long-term pain is an important outcome after inguinal hernia repair. The aim of this study was to test the validity and reliability of a specific Inguinal Pain Questionnaire (IPQ). METHODS: The study recruited patients aged between 15 and 85 years who had undergone primary inguinal or femoral hernia repair. To test the validity of the questionnaire, 100 patients received the IPQ and the Brief Pain Inventory (BPI) 1 and 4 weeks after surgery (group 1). To test reliability and internal consistency, 100 patients received the IPQ on two occasions 1 month apart, 3 years after surgery (group 2). Non-surgery-related pain was analysed in group 3 (2853 patients). RESULTS: A significant decrease in IPQ-rated pain intensity was observed in the first 4 weeks after surgery (P < 0.001). Significant correlations with corresponding BPI pain intensity items corroborated the criterion validity (P < 0.050). Logical incoherence did not exceed 5.5 per cent for any item. Values for kappa in the test-retest in group 2 were higher than 0.5 for all but three items. Cronbach's alpha was 0.83 for questions on pain intensity and 0.74 for interference with daily activities. CONCLUSION: This study found good validity and reliability for the IPQ, making it a useful instrument for assessing pain following groin hernia repair.
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| 6. |
- Magnusson, Niklas, 1975-, et al.
(författare)
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The time profile of groin hernia recurrences
- 2010
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 14:4, s. 341-344
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: If the pathogeneses of the development of a recurrence varies following the different methods of hernia repair, the time required to develop a recurrence could be expected to vary. The aim of the study was to identify risk factors affecting the time interval between the primary repair and the reoperation.METHODS: Data from the Swedish Hernia Register were used. Each year of the 5-year follow-up period was treated as a separate subgroup and merged together into one large group. For each risk factor, we performed a Cox proportional hazard analysis, testing for interactions between the year and the risk factor, with reoperation as the endpoint.RESULTS: Altogether, 142,578 repairs were recorded, of which 7.7% were performed on women. The mean age of the cohort was 59 years. The overall recurrence rate in the 5-year period was 4.3%. Multivariate analysis showed that recurrence following surgery for recurrent hernia occurred relatively early (P < 0.05).Recurrence also appeared early if postoperative complications were registered (P < 0.05). Recurrence after suture repair or laparoscopic repair appeared relatively early compared to recurrence following open mesh repair (P < 0.05). In a separate analysis, a relatively higher risk for early recurrence was seen for all sutured repairs compared to all mesh repairs (P < 0.05).CONCLUSIONS: The pathogenesis behind the development of recurrence probably differs depending on the technique applied during the hernia repair. The higher proportion of early recurrences following laparoscopic repair, suture repair and recurrent repair may be explained by the high proportion of technical failures.
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| 7. |
- Rosemar, Anders, 1958, et al.
(författare)
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Effect of body mass index on groin hernia surgery.
- 2010
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Ingår i: Annals of Surgery. - : Lippincott, Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 252:2, s. 397-401
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyze the effect of underweight, overweight, and obesity in relation to clinical characteristics, the risk of postoperative complications, 30-day mortality, and reoperations for recurrence after groin hernia surgery. SUMMARY OF BACKGROUND DATA: Groin hernia surgery is one of the most frequent operations performed in general surgery. Several studies have demonstrated a protective effect of overweight and obesity on the risk of developing primary groin hernia. However, obesity has also been suggested to increase the risk for recurrence of groin hernia. METHODS: Through the Swedish Hernia Register, 49,094 primary groin hernia operations were identified between January 1, 2003 and December 31, 2007. Patients were divided into 4 body mass index (BMI) groups: BMI 1, <20 kg/m2; BMI 2, 20 to 25 kg/m2; BMI 3, 25-30 kg/m2; and BMI 4, >30 kg/m2. RESULTS: Of the 49,094 patients, 3.5% had a BMI <20 kg/m2 and 5.2% were obese. Altogether, women constituted only 7.7% of the studied group, but among patients with BMI <20 kg/m2 that had surgical procedures for femoral hernia, 81.4% were women. The relation between BMI and postoperative complications was U-shaped and after adjustment for age, gender, and emergency procedure, patients with BMI <20 and >25 had a significant increased risk when compared with patients with BMI from 20 to 25. Reoperation for recurrence of groin hernia has an increased hazard ratio of 1.20 (95% confidence interval, 1.00-1.40) in overweight, which was particularly evident after open suture and preperitoneal mesh techniques. CONCLUSIONS: In this large and unselected population of patients with a first surgical procedure for groin hernia a relative dominance of female and femoral hernias presented as an emergency condition was observed in the low BMI group. The prevalence of obesity was markedly low. Both lean and obese patients had an increased risk for postoperative complications.
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| 8. |
- Sevonius, Dan, et al.
(författare)
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Repeated groin hernia recurrences.
- 2009
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Ingår i: Annals of Surgery. - : Lippincott, Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 249:3, s. 516-518
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the characteristics of patients undergoing multiple groin hernia repairs and to identify strategies that prevent further recurrence. SUMMARY BACKGROUND DATA: Although relatively infrequent, recurrent groin hernias where several repairs have previously been undertaken constitutes a major problem in hernia surgery. Low numbers and heterogeneity have made it difficult to perform large prospective studies on this group. METHODS: The study was designed as an observational population-based register study. All repairs for recurrent hernia recorded in the Swedish Hernia Register (SHR) 1992-2006 were identified. Risk for reoperation by number of previous repairs, with adjustment for gender and age, and risk for reoperation by unit responsible for previous repair were determined using Cox proportional hazard analysis. RESULTS: There were 12,104 cases of hernia repaired once, 2 repairs in 4199 cases, 3 repairs in 310 cases, 4 repairs in 32 cases, and 5 repairs in 3 cases. The risk for further reoperation increased with the number of previous repairs (P < 0.001). The hazard ratios for reoperation following open preperitoneal mesh repair and laparoscopic repair decreased; whereas, the hazard ratio for sutured repair increased with the number of previous repairs. The difference between Lichtenstein repair and laparoscopic repair was significant for the first 2 repairs (P < 0.05). CONCLUSION: Laparoscopic preperitoneal repair provides the best surgical outcome in repeated groin hernia recurrence.
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| 9. |
- Larsson, Charlotta, 1981-
(författare)
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Surgical complications after vaginal and caesarean delivery
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Obstetric anal sphincter injuries (OASIS) after vaginal delivery are the most common cause of anal incontinence in women. Symptoms range from faecal urgency and soiling to inability to control flatus and passive faecal incontinence. OASIS are also associated with urinary incontinence, perineal pain, and sexual dysfunction. Apart from being a challenge to diagnose and treat, these conditions often result in social stigma and embarrassment, and in many cases have a great impact on emotional and physical health.Caesarean section has developed over several hundred years, from a procedure with 100 % mortality for both mother and child, to routine surgery that is rapidly increasing in many countries. However, both caesarean section and vaginal delivery are associated with complications that can affect the woman for the rest of her life. The aim of this thesis was primarily to investigate surgical complications after delivery.Methods: Papers I-III were population-based cohort-studies utilising national registries to examine the risk for anal incontinence, cardiovascular complications, and other surgical complications such as bowel obstruction, incisional hernia, and abdominal pain. Paper IV was a diagnostic cohort study comparing the traditional clinical method using inspection and palpation, to a new method with three-dimensional endoanal ultrasound (3D-EAUS) to diagnose anal sphincter injuries after delivery.Results: The risk for being diagnosed with anal incontinence after vaginal delivery was almost twice that after caesarean section. On the other hand, caesarean section was associated with a greater risk for serious cardiovascular complications, bowel obstruction, and incisional hernia. High maternal age, overweight and smoking were all risk factors for complications. Instrumental delivery, in particular, increased the risk for anal incontinence. In Study IV, more sphincter injuries were diagnosed using the 3D-EAUS than by clinical examination. However, some injuries diagnosed clinically could not be identified with 3D-EAUS.Conclusions: Both vaginal and caesarean delivery are associated with certain risks. Although the increased risk for cardiovascular complications, bowel obstruction, and incisional hernia must be taken into consideration, there seem to be a gain in reducing the risk for anal incontinence, when performing a caesarean section on the right indication. 3D-EAUS assessment of the anal sphincters after delivery is a new technique that with further improvement could be an important tool in the prevention of anal incontinence.
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| 10. |
- Nilsson, Hanna, et al.
(författare)
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Incidence of groin hernia repair after radical prostatectomy : a population-based nationwide study
- 2014
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Ingår i: Annals of Surgery. - 0003-4932 .- 1528-1140. ; 259:6, s. 1223-1227
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the incidence of groin hernia repair after radical prostatectomy for prostate cancer compared with the incidence in a control population without prostate cancer in a nationwide, population-based study.Background: Recent reports indicate an increase in the incidence of groin hernia repair after radical prostatectomy. Inadequate knowledge of the incidence of groin hernia in the general population makes this information hard to interpret.Methods: Information was retrieved from the Prostate Cancer Database (PCBaSe) and Swedish Hernia Register for events between 1998 and 2010. The incidence of groin hernia surgery was calculated for a group of men treated with radical prostatectomy (open and minimally invasive) and for a group treated with radiation therapy, and these were compared with the incidence in a control cohort of men matched for age and county of residence. Multivariate analysis was used to assess the hazard ratio (HR) of groin hernia repair according to age, tumor risk category, and Charlson Comorbidity Index.Results: A total of 28,608 cases and 105,422 controls were included in the study. Men treated with radical prostatectomy and radiation therapy had a significantly higher incidence of groin hernia repair than the control cohort: HR: 3.95 (95% confidence interval: 3.70-4.21) for retropubic prostatectomy, HR: 3.37 (95% confidence interval: 2.95-3.87) for minimally invasive prostatectomy, and HR: 1.84 (95% confidence interval: 1.66-2.04) for radiation therapy.Conclusions: An almost 4-fold increase in groin hernia repair was observed after radical prostatectomy compared with controls, and men who received radiation therapy had an almost 2-fold increase in incidence. As well as postoperative changes in the abdominal wall, increased vigilance for groin hernia seems to be important for the increased incidence of groin hernia repair seen after radical prostatectomy or radiation therapy for prostate cancer.
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