| 1. |
- Jansson, Karl-Åke, et al.
(författare)
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Olycksfall och trauma
- 2009
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Ingår i: Prehospital akutsjukvård. - : Stockholm: Liber. - 9789147084487 ; , s. 375-407
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 2. |
- Jansson, Karl-Åke
(författare)
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On lumbar spinal stenosis and disc herniation surgery
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients with spinal stenosis and disc herniation are most common in spine surgery. Few population based studies of these patients have been made and no studies of their health related quality of life (HRQOL) by the EQ-5D has been published. The aim of this thesis is to analyse incidence, readmission, reoperation and mortality in Swedish patients operated on spinal stenosis or disc herniation in the lumbar spine during 19871999 and report the EQ-5D outcome data between 2001-2002. The spinal stenosis cohort and disc herniation cohorts consist of 10,494 and 25,247 patients and the final EQ-5D analysis of 230 and 263 patients. Information from the Swedish Hospital Discharge Register and the Swedish Death Register were linked to analyse the outcomes. A quality register study based on prospectively collected EQ-5D data from the National Swedish Registry for Lumbar Spine surgery was also performed. The mean annual incidence per 100,000 inhabitants of spinal stenosis and disc herniation surgery during the study period was 10 and 24, respectively. The mean age at surgery for spinal stenosis increased from 60 to 67 years but was constant at 42 years for disc herniation. The 30 day mortality rate was 3.5 and 0.5 per 1000 operations, respectively. The mortality rate declined despite ageing spinal stenosis patients. The length of stay after surgery was reduced to half. Patients operated on for spinal stenosis and disc herniation have a risk of being reoperated after one and ten years of 2-3 %, and 10-11 %, respectively. The reoperation rate decreased over time. During the 13 years, 78 % of the disc herniation patients had only one hospitalisation (the operation). The risk of being readmitted was constant over time. Preoperatively the HRQOL was low, poorer than among previously reported for patients with stroke or depression. Patients operated on for spinal stenosis and disc herniation experienced an improved health related quality of life and their EQ5-D score increased from 0.29 to 0.70 and 0.36 to 0.64 one year after surgery. Four out of ten reported considerable improvement while a similar proportion of patients with high preoperative scores were slightly improved. A third group (20 %) was unchanged with low EQ-5D scores, and 45% perceived a decline in their HRQOL. The majority of patients approached but did not reach the level reported by the matched population sample. The studies indicate factors such as male sex, age over 80, fusion procedure, smoking, hospital stays before surgery or long hospital stays at surgery, severe back pain, long duration of pain, short walking ability were risks for a less favourable outcome. The EQ-5D instrument increases the awareness of the importance of health related quality of life when considering surgery and when evaluating treatment. Future studies need to elucidate the gender differences, impact of smoking cessation programs and the cost utility of spine surgery.
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| 3. |
- Weiss, Rüdiger J., et al.
(författare)
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Decreasing incidence of tibial shaft fractures between 1998 and 2004 : information based on 10,627 Swedish inpatients
- 2008
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Ingår i: Acta Orthopaedica. - Lund : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 79:4, s. 526-533
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose There is a lack of national epidemiological data on the characteristics of patients with tibial shaft fractures. We therefore analyzed data on Swedish patients with tibial shaft fractures in this nationwide population study based on data from 1998 through 2004. Methods Data on all patients with tibial shaft fractures were extracted from the Swedish National Hospital Discharge Register. Results We identified 10,627 hospital admissions for tibial shaft fractures, corresponding to an annual incidence rate of 17 per 100,000 person-years (pyr). The number of hospital admissions decreased by 12% during the period 1998-2004, mostly from a reduction in male incidence. The median (SD) age at admission was 28 (22) years for men and 51 (26) years for women. The two major mechanisms of injury were falls on the same level (48%) and transport accidents (21%). Surgical procedures were dominated by osteosynthesis with nail (48%), followed by closed reduction and plaster cast (27%), and external fixation (12%). 12% of all tibial shaft fractures were classified as open, corresponding to an incidence rate of 2.3 per 100,000 pyr, which declined during 1998-2004. Interpretation This nationwide study of tibial shaft fractures shows a falling off of fracture incidence, a finding that can be used to advantage by healthcare providers. In a recent review, the annual incidence of tibial shaft fractures was reported to be 22 per 100,000 inhabitants (Court-Brown and Caesar 2006). To date, rather few epidemiological studies have been undertaken to examine the incidence of this injury (Knowelden et al. 1964, Bengner et al. 1990, Donaldson et al. 1990, Court-Brown and McBirnie 1995, Emami et al. 1996, Singer et al. 1998, van Staa et al. 2001), and with varying results. Most of the earlier epidemiological studies were retrospective or case series from single hospitals, and prior to the present study no analyses on a nationwide basis had been undertaken.Basic epidemiological data on frequency and distribution, mechanisms of injury, surgical procedures, and on temporal variations are of importance in assisting the planning and delivery of healthcare. The purpose of this investigation was to provide an update on incidence, admissions, causes of fracture, and operation of these fractures on a nationwide basis in Sweden during the period 1998-2004.
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| 4. |
- Weiss, Rüdiger J., et al.
(författare)
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National data of 6409 Swedish inpatients with femoral shaft fractures : stable incidence between 1998 and 2004
- 2009
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Ingår i: Injury. - : Elsevier BV. - 0020-1383 .- 1879-0267. ; 40:3, s. 304-308
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Femoral shaft fractures are commonly thought to be primarily associated with high-energy trauma in young persons. Only limited attention has been given to low-energy violence as a cause of these fractures among the elderly. National epidemiological data on characteristics of patients with femoral shaft fractures are lacking, so the purpose of this study was to analyse the incidence, admissions, causes of fracture and operations for these fractures on a nationwide basis in Sweden during 1998-2004. PATIENTS AND METHODS: Data on all femoral shaft fractures were extracted from the Swedish National Hospital Discharge Registry. Sex- and age-specific fracture incidence, hospital admissions, mechanisms of injury and surgical procedures were analysed using descriptive analysis, linear-regression analysis and other methods as appropriate. RESULTS: Over a period of 7 years, 6409 patients with femoral shaft fractures were identified, corresponding to an annual incidence of 10 per 100,000 person-years. Men had a younger median age (27 years, IQR 12-68) than women (79 years, IQR 62-86) (p<0.001). Females (54%) generated more admissions than males (46%). The incident rate ratio between men and women was 0.9 (p<0.001). Most hospital admissions were generated among females by the 80-89 years age-group and among males <10 years of age. 2% of the fractures were open fractures. The total number of hospital admissions was stable during 1998-2004. The two major mechanisms of injury were falls on the same level (50%) and transport accidents (17%). A significant number of fractures occurred among elderly patients after low-energy trauma. Osteosynthesis with femoral nail (54%) was the preferred operation, followed by osteosynthesis with plate and screws (16%), skeletal traction (14%) and external fixation (6%). DISCUSSION: This nationwide study on femoral shaft fractures provides an update on incidence, admissions, external causes and surgical procedures. This information assists health-care providers in planning hospital beds, surgical interventions and risk preventions. Moreover, these data can be used for power calculations for further clinical studies.
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