| 1. |
- Ademuyiwa, Adesoji O., et al.
(author)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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In: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Journal article (peer-reviewed)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 2. |
- Ahl, Rebecka, 1987-, et al.
(author)
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A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery
- 2022
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In: European Journal of Trauma and Emergency Surgery. - : Urban und Vogel Medien und Medizin Verlagsgesellsc. - 1863-9933 .- 1863-9941. ; 48:2, s. 743-751
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Journal article (peer-reviewed)abstract
- PURPOSE: Despite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery.METHODS: This is a retrospective nationwide observational cohort study. All adults [Formula: see text] 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality.RESULTS: 134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26-0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure.CONCLUSIONS: Beta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.
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| 3. |
- Antoniou, Antonis C., et al.
(author)
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Common alleles at 6q25.1 and 1p11.2 are associated with breast cancer risk for BRCA1 and BRCA2 mutation carriers
- 2011
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In: Human Molecular Genetics. - : Oxford University Press (OUP). - 0964-6906 .- 1460-2083. ; 20:16, s. 3304-3321
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Journal article (peer-reviewed)abstract
- Two single nucleotide polymorphisms (SNPs) at 6q25.1, near the ESR1 gene, have been implicated in the susceptibility to breast cancer for Asian (rs2046210) and European women (rs9397435). A genome-wide association study in Europeans identified two further breast cancer susceptibility variants: rs11249433 at 1p11.2 and rs999737 in RAD51L1 at 14q24.1. Although previously identified breast cancer susceptibility variants have been shown to be associated with breast cancer risk for BRCA1 and BRCA2 mutation carriers, the involvement of these SNPs to breast cancer susceptibility in mutation carriers is currently unknown. To address this, we genotyped these SNPs in BRCA1 and BRCA2 mutation carriers from 42 studies from the Consortium of Investigators of Modifiers of BRCA1/2. In the analysis of 14 123 BRCA1 and 8053 BRCA2 mutation carriers of European ancestry, the 6q25.1 SNPs (r(2) = 0.14) were independently associated with the risk of breast cancer for BRCA1 mutation carriers [ hazard ratio (HR) = 1.17, 95% confidence interval (CI): 1.11-1.23, P-trend = 4.5 x 10(-9) for rs2046210; HR = 1.28, 95% CI: 1.18-1.40, P-trend = 1.3 x 10(-8) for rs9397435], but only rs9397435 was associated with the risk for BRCA2 carriers (HR = 1.14, 95% CI: 1.01-1.28, P-trend = 0.031). SNP rs11249433 (1p11.2) was associated with the risk of breast cancer for BRCA2 mutation carriers (HR = 1.09, 95% CI: 1.02-1.17, P-trend = 0.015), but was not associated with breast cancer risk for BRCA1 mutation carriers (HR = 0.97, 95% CI: 0.92-1.02, P-trend = 0.20). SNP rs999737 (RAD51L1) was not associated with breast cancer risk for either BRCA1 or BRCA2 mutation carriers (P-trend = 0.27 and 0.30, respectively). The identification of SNPs at 6q25.1 associated with breast cancer risk for BRCA1 mutation carriers will lead to a better understanding of the biology of tumour development in these women.
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| 5. |
- Borg, Tomas, 1963-, et al.
(author)
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Acute total hip arthroplasty combined with internal fixation for displaced acetabular fractures in the elderly : a short-term comparison with internal fixation alone after a minimum of two years
- 2019
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In: The Bone & Joint Journal. - : British Editorial Society of Bone and Joint Surgery. - 2049-4394 .- 2049-4408. ; 101-B:4, s. 478-483
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Journal article (peer-reviewed)abstract
- AIMS: Displaced, comminuted acetabular fractures in the elderly are increasingly common, but there is no consensus on whether they should be treated non-surgically, surgically with open reduction and internal fixation (ORIF), or with acute total hip arthroplasty (THA). A combination of ORIF and acute THA, an approach called 'combined hip procedure' (CHP), has been advocated and our aim was to compare the outcome after CHP or ORIF alone.PATIENTS AND METHODS: A total of 27 patients with similar acetabular fractures (severe acetabular impaction with or without concomitant femoral head injury) with a mean age of 72.2 years (50 to 89) were prospectively followed for a minimum of two years. In all, 14 were treated with ORIF alone and 13 were treated with a CHP. Hip joint and patient survival were estimated. Operating times, blood loss, radiological outcomes, and patient-reported outcomes were assessed.RESULTS: No patient in the CHP group required further hip surgery, giving THA a survival rate of 100% (95% confidence interval (CI) 100 to 100) after three years, compared with 28.6% hip joint survival in the ORIF group (95% CI 12.5 to 65.4; p = 0.001). No dislocations or deep infections occurred in the CHP group. No patient died within the first year after index surgery, but patient survival was lower in the CHP group after three years. There were no relevant differences in patient-reported outcomes.CONCLUSION: The CHP confers a considerably reduced need of further surgery when compared with ORIF alone in elderly patients with complex acetabular fractures. These findings encourage both further use of, and larger prospective studies on, the CHP.
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| 6. |
- Borg, Tomas, 1963-, et al.
(author)
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Development of a pelvic discomfort index to evaluate outcome following fixation for pelvic ring injury
- 2015
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In: Journal of Orthopaedic Surgery. - : Sage Publications. - 1022-5536 .- 2309-4990. ; 23:2, s. 146-149
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Journal article (peer-reviewed)abstract
- PURPOSE: To develop a pelvic discomfort index (PDI) to evaluate outcome following fixation for pelvic ring injury.METHODS: 29 female and 44 male consecutive patients (mean age, 36 years) underwent internal fixation for pelvic ring injury of type B1 (n=10), B2 (n=22), B3 (n=15), C1 (n=18), C2 (n=5), and C3 (n=3), based on the AO/OTA classification. At postoperative 6, 12, and 24 months, patients were asked to assess their discomfort in the pelvis using a 14-item questionnaire. Three questions were open-ended, and responses were categorised by a single assessor. The remaining 11 questions were closed-ended and had 6 ordinal options from 'no discomfort' (score=0) to 'extremely severe discomfort' (score=5). The content validity and relevance of the 11 closed-ended questions was determined. The 14-item questionnaire was compared with the 36-item Short Form Health Survey (SF-36).RESULTS: Respectively at postoperative 6, 12, and 24 months, 78%, 71%, and 71% of the patients completed the 14-item questionnaire. Based on the factor analysis and responses to the open-ended questions, the number of items was reduced to 6 including pain, walking, mobility of the hips, loss of sensation in the legs, sexual life, and operation scar. Four factors could explain 96% of the total variance. The first factor involved the first 3 items (pain, walking, and hip motion) and addressed 'pelvis', whereas 3 factors involved the remaining items and each addressed peripheral neurology, sexual life, and operation scar. A PDI was developed using these 6 items. The PDI had high internal reliability (α=0.89), adequate content and criterion validity, and moderate correlation with the SF-36 total score or scores of physical function, bodily pain, and general health (r=0.50-0.77).CONCLUSION: The PDI provides valid, specific, and relevant information to assess outcome following fixation for pelvic ring injury.
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| 7. |
- Borg, Tomas, 1963-, et al.
(author)
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Health-related quality of life and life satisfaction in patients following surgically treated pelvic ring fractures. A prospective observational study with two years follow-up
- 2010
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In: Injury. - : Elsevier. - 0020-1383 .- 1879-0267. ; 41:4, s. 400-404
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Journal article (peer-reviewed)abstract
- BACKGROUND: Pelvic ring fractures caused by high-energy trauma are severe injuries with well described radiological and clinical outcomes, whereas description from the patient's perspective is less well documented. The purpose of this study was to investigate patient-reported outcome following surgical treatment of pelvic fractures using quality of life instruments.METHODS: All 54 patients (28 male/26 female, ages 16-68) with pelvic fractures referred to our institution for surgical treatment 2003-2005 were prospectively included. The most common trauma was motor vehicle accident (44%). Additional injuries were seen in 74% and in 31% the ISS was >or=16. There were 31 B and 23 C type fractures. Patients were followed for two years using two validated questionnaires, SF-36 and LiSat-11, the latter an instrument consisting of 11 questions for evaluation of satisfaction with different aspects of life.RESULTS: 45 patients could be followed according to the study protocol for two years while 2 were untraceable and 1 died from unrelated causes. Of 6 nonresponders, 5 were unable due to psychiatric disorder. At two years pelvic fracture patients scored lower than the reference population in both physical and mental domains (SF-36). Highest mean score, 68, was in the domain Social Function (norm 89) while lowest mean score, 38, was in the domain Role Physical (norm 86). The mean score closest to the normative was for general health with 61 for patients and 78 for the normative group. In LiSat-11 pelvic fracture patients scored lower than the reference population in all areas. Satisfaction with life as a whole was 31% compared with 60% in the normative group.CONCLUSIONS: Two years after surgical treatment of pelvic ring fractures, patients reported substantially lower quality of life for both physical and mental domains, when compared with a reference population, even when radiological and clinical outcomes were considered favourable.
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| 8. |
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| 9. |
- Borg, Tomas, 1963-, et al.
(author)
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Outcome 5 years after surgical treatment of acetabular fractures : a prospective clinical and radiographic follow-up of 101 patients
- 2015
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In: Archives of Orthopaedic and Trauma Surgery. - : Springer. - 0936-8051 .- 1434-3916. ; 135:2, s. 227-233
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Journal article (peer-reviewed)abstract
- INTRODUCTION: The aim of this study was to evaluate functional outcome after surgically treated acetabular fracture using radiography and patient-reported outcome measures, and to determine predictors of hip joint failure 5 years post-surgery.PATIENTS AND METHODS: All patients with acetabular fractures treated with open reduction and internal fixation (ORIF) at our unit are prospectively entered into a local register. 101 acetabular fractures in 112 patients treated from 2004 to 2007 were eligible for analysis 5 years after surgery. Radiographs and questionnaires regarding physical function (Short Form[SF]-36) and pelvic discomfort index (PDI, 100 % = worst outcome) were obtained. The primary outcome measure was "joint failure" defined as either secondary total hip arthroplasty (THA) or a Girdlestone situation. Univariable analysis was used to compare patients with joint failure to those without, and binary logistic regression analysis was performed to identify risk factors of joint failure.RESULTS: 77 % of 101 followed patients had a preserved hip joint 5 years after surgery, and failure of the hip joint most often occurred within the first 2 years after injury. Patients with preserved hip joints had higher scores in the SF-36 physical function domain (median 75 vs. 48; p = 0.004) and better PDI (28 vs. 43 %, p = 0.03). Femoral head impaction was associated with an increased risk of joint failure [relative risk (RR) = 15.2, 95 % CI 3-95; p = 0.002], as was an age of ≥60 years at the time of injury (RR = 4.2, CI 1.3-15; p = 0.02).CONCLUSIONS: Patients with failed hip joints after surgery for acetabular fracture have inferior global and disease-specific functional outcomes, even after secondary arthroplasty surgery. We suggest that patients with predictors of joint failure could benefit from other treatment strategies than ORIF, and primary insertion of THA may be an alternative treatment strategy for this subgroup.
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| 10. |
- Borg, Tomas
(author)
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Pelvic Ring Injuries and Acetabular Fractures : Quality of Life Following Surgical Treatment
- 2011
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Doctoral thesis (other academic/artistic)abstract
- The overall aim was to study outcome following surgery of the injured pelvis with focus on assessment from the patient’s perspective. All adult patients operatively treated for pelvic ring injuries or acetabular fractures at the Department of Orthopaedics, Uppsala University, starting 2003 were prospectively included and followed with quality of life (QoL) instruments for 2 years. The most common trauma mechanism was motor vehicle accident (MVA). Study I included 54 patients with pelvic ring injuries during the three-year period 2003-2005. The two instruments, SF-36 and LiSat-11, were used. In 45 responders lower than normative QoL and life satisfaction prevailed at two years after the injury. Study II included 12 patients with pelvic ring injuries or acetabular fractures sustained following a jump from height in an attempt to commit suicide. At four years all patients were still alive and SCID-interviews performed by a psychiatrist revealed low recurrence of self-destructive behaviour and high QoL in the younger patients. Study III included 136 patients with acetabular fractures where 52 had elementary and 84 associated fracture patterns. Fracture reduction was 0-1 mm in 106 patients and 2 mm or more in 30. QoL was significantly higher in patients with anatomically reduced fractures. Physical SF-36 domains improved with time, albeit QoL was lower than norm. Study IV had the aim to construct a condition-specific outcome instrument for patients with acetabular fractures. Closed and open questions were sent to 127 consecutive acetabular fracture patients at 6, 12 and 24 months following surgery. Responses were validated through factor analysis, scree tests, item reduction and principal component analysis which resulted in a multi-item verbal descriptive scale (VDS) with six condition-specific questions related to “Pain”, “Walking”, “Hip motion”, “Leg numbness”, “Sexual life”, “Operation scar” and a global question concerning impact on daily life activities for acetabular fracture assessment.
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