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.

Heat, Heatwaves and Cardiorespiratory Hospital Admissions in Helsinki, Finland

Background: There is a lack of knowledge concerning the effects of ambient heat exposure on morbidity in Northern Europe. Therefore, this study aimed to evaluate the relationships of daily summertime temperature and heatwaves with cardiorespiratory hospital admissions in the Helsinki metropolitan area, Finland. Methods: Time series models adjusted for potential confounders, such as air pollution, were used to investigate the associations of daily temperature and heatwaves with cause-specific cardiorespiratory hospital admissions during summer months of 2001–2017. Daily number of hospitalizations was obtained from the national hospital discharge register and weather information from the Finnish Meteorological Institute. Results: Increased daily temperature was associated with a decreased risk of total respiratory hospital admissions and asthma. Heatwave days were associated with 20.5% (95% CI: 6.9, 35.9) increased risk of pneumonia admissions and during long or intense heatwaves also with total respiratory admissions in the oldest age group (≥75 years). There were also suggestive positive associations between heatwave days and admissions due to myocardial infarction and cerebrovascular diseases. In contrast, risk of arrhythmia admissions decreased 20.8% (95% CI: 8.0, 31.8) during heatwaves. Conclusions: Heatwaves, rather than single hot days, are a health threat affecting morbidity even in a Northern climate.

Trends of shoulder instability surgery in Finland: a nationwide register study

ObjectiveRate of shoulder instability surgery (SIS) has increased in different specific populations. We analysed nationwide trend of SIS in adults in Finland between 1997 and 2014.DesignA retrospective register study.SettingNational Hospital Discharge Register of Finland.ParticipantsA total of 22 550 adult patients with SIS in Finland (1997–2014).Primary and secondary outcome measuresAnalysis included appropriate diagnosis (International Classification of Diseases 10) and procedure coding combinations applicable for SIS. The primary outcome variable was the incidence of SIS per 100 000 person-years, and the secondary outcomes were the study year, sex, age groups (18–29, 30–49 and over 50 years of age) and the type of hospital (public or private).ResultsThe overall nationwide rate of SIS in adults increased 177% between 1997 and 2014 in Finland. The rate was the lowest (13/100 000 person-years) in 1997, and the peak rate (40/100 000 person-years) was noted in 2007. The increase in rate was rapid between 1997 and 2007, after which the rate became stable. During the study period, the highest increases were noted in the young adults age group (270%), and especially in the middle-aged group who were operated on in private hospitals (930%).ConclusionsThe rate of SIS increased almost threefold in Finland from 1997 to 2014. The increase was most significant in young and middle-aged adults (18–50 years), in men, and in private hospitals.

Heat, Heatwaves and Cardiorespiratory Hospital Admissions in Helsinki, Finland

There is a lack of knowledge concerning the effects of ambient heat exposure on morbidity in Northern Europe. Therefore, this study aimed to evaluate the relationships of daily summer-time temperature and heatwaves with cardiorespiratory hospital admissions in the Helsinki metropolitan area, Finland. Methods: Time-series models adjusted for potential confounders such as air pollution were used to investigate the associations of daily temperature and heatwaves with cause-specific cardiorespiratory hospital admissions, during summer months of 2001-2017. Daily number of hospitalizations was obtained from the national hospital discharge register, weather information from the Finnish Meteorological Institute. Results: Increased daily temperature was associated with decreased risk of total respiratory hospital admissions and asthma. Heatwave days were associated with 20.5% (95% CI: 6.9, 35.9) increased risk of pneumonia admissions and during long or intense heatwaves also with total respiratory admissions in the oldest age group (≥ 75 years). There were also suggestive positive associations between heatwave days and admissions due to myocardial infarction and cerebrovascular diseases. In contrast, risk of arrhythmia admissions was decreased 20.8% (95% CI: 8.0, 31.8) during heatwaves. Conclusions: Heatwaves, rather than single hot days, are a health threat affecting the morbidity even in a Northern climate.

Surgery for patellar dislocation has evolved towards anatomical reconstructions with assessment and treatment of anatomical risk factors

Purpose Increasing knowledge on the treatment of patellar dislocation has resulted in the development of new surgical techniques for patella stabilisation. National incidence and trends in surgery for patellar dislocation were examined using data from the Finnish National Hospital Discharge Register (NHDR). The hypothesis was that an increased understanding of the pathophysiology of patellar instability has increased the popularity of reconstructing damaged structures and modification of anatomical risk factors. Methods Data from the years 1997–2016 were collected from the NHDR database using ICD-10 diagnostic codes and the Nomesco Classification of Surgical Procedures (NCSP) codes. Surgical procedures were categorised into subgroups representing the main surgical approaches of patellar dislocation. Total incidence of surgery for patellar dislocation and change in incidence during the study period were calculated. Results A total of 9702 operations for patellar dislocation were performed during the study period. Median (IQR) patient age at time of primary surgery was 23 (18–34) years. The total incidence of surgeries remained stable across the study period at of 8.9 per 100,000 person-years. Incidences of ligament reconstruction, femoral osteotomies and osteochondral fragment reimplantation operations multiplied during the study period. Ligament reconstruction procedures were the most performed operations at the end of the study period. Conclusion The incidence of surgical procedures for patellar dislocation remained unchanged during the years 1997–2016. Ligament reconstruction procedures increased in popularity. Surgical techniques have shifted towards the reconstruction of damaged structures and the modification of congenital anatomical risk factors for patellar dislocation. Diversified surgical techniques have enabled the tailoring and combining of stabilizing procedures according to the patient’s individual anatomy.

Heat, heatwaves and cardiorespiratory hospital admissions in Helsinki, Finland

Background There is a lack of knowledge concerning the effects of heat on morbidity in Northern Europe. Therefore, this study aimed to evaluate the relationships of daily summer-time temperature and heatwaves with cardiorespiratory hospital admissions in Helsinki, Finland. Methods Time-series models adjusted for potential confounders such as air pollution were used to investigate the associations of daily temperature and heatwaves with cause-specific cardiorespiratory hospital admissions, during the summer months of 2000-2017. Daily number of hospitalizations was obtained from the national hospital discharge register, weather information from the Finnish meteorological institute. Results Heatwave-days were associated with an increased risk of pneumonia (RR: 1.17, 95%CI: 1.04-1.31), any respiratory disease in some age groups, and myocardial infarction (RR: 1.54, 95% CI: 1.12-2.12) among person 65-74 years of age. In addition, high effect estimates were observed for many types of cardiorespiratory diseases in association with heatwaves in some age-groups. In contrast, risk of arrhythmia was decreased during heatwaves (RR: 0.81, 95% CI: 0.70-0.93). Conclusions We found no associations and even protective associations between daily mean temperature and cardiorespiratory hospital admissions. However, our results suggest that heatwaves are a serious health threat affecting the morbidity even in the Northern climate Key messages Heatwaves are associated with increased risk of cardio-respiratory hospital admissions. There is a need to adapt to climate change in the public health sector also in Northern Europe to protect vulnerable population groups.

Regional drinking water composition effects on hip fracture risk: a spatial analysis of nationwide hospital admissions in Portugal, from 2000 to 2010

Geographical variation on hip fractures (HF) may be related to the geographical variation of drinking water composition (DWC); minerals in drinking water may contribute to its fragility. We aim to investigate the effects of DWC on HF risk in Portugal (2000-2010). From National Hospital Discharge Register we selected admissions of patients aged ≥50 years, diagnosed with HF caused by low/moderate energy traumas. Water components and characteristics were selected at the municipality level. A spatial generalized additive model with a negative binomial distribution as a link function was used to estimate the association of HF with variations in DWC. There were 96,905HF (77.3% in women). The spatial pattern of HF risk was attenuated after being adjusted for water parameters. Results show an indirect association between calcium, magnesium, and iron and HF risk but no clear relation between aluminum, cadmium, fluoride, manganese, or color and HF risk. Regarding pH, the 6.7pH and 7pH interval seems to pose a lower risk. Different dose-response relationships were identified. The increase of calcium, magnesium, and iron values in DWC seems to reduce regional HF risk. Long-term exposure to water parameters, even within the regulatory limits, might increase the regional HF risk.

­­Lyme borreliosis in Finland: A register-based linkage study

Background: In Finland, the routine surveillance of Lyme borreliosis (LB) is laboratory-based. In addition, we have well established national health care registers where countrywide data from patient visits in public health care units are collected. In our previous study based on these registers, we reported an increasing incidence of both microbiologically confirmed and clinically diagnosed LB cases in Finland during the past years. Here, we evaluated our register data, refined LB incidence estimates provided in our previous study, and evaluated treatment practices considering LB in the primary health care. Methods: Three national health care registers were used. The Register for Primary Health Care Visits (Avohilmo) and the National Hospital Discharge Register (Hilmo) collect physician-recorded data from the outpatient and inpatient health care visits, respectively, whereas the National Infectious Diseases Register (NIDR) represents positive findings in LB diagnostics notified electronically by microbiological laboratories. We used a personal identification number in register-linkage to identify LB cases on an individual level in the study year 2014. In addition, antibiotic purchase data was retrieved from the Finnish Social Insurance Institution in order to evaluate the LB treatment practices in the primary health care in Finland.Results: Avohilmo was found to be useful in monitoring clinically diagnosed LB (i.e. EM infections), whereas Hilmo did not add much value next to existing laboratory-based surveillance of disseminated LB. However, Hilmo gave valuable information about uncertainties related to physician-based surveillance of disseminated LB and the total annual number of EM infections in our country. Antibiotic purchases associated with the LB-related outpatient visits in the primary health care indicated a good compliance with the recommended treatment guidelines. Conclusions: In 2018, Avohilmo was introduced in the routine surveillance of LB in Finland next to laboratory-based surveillance of disseminated LB.

Decreasing trend in the incidence of serious pneumonias in Finnish children with juvenile idiopathic arthritis

Objectives Children with juvenile idiopathic arthritis (JIA) may be predisposed to serious pneumonia due to modern disease-modifying anti-rheumatic treatment. In this nationwide retrospective study with clinical data, we describe the pneumonia episodes among children with JIA. Methods Patients under 18 years of age with JIA and pneumonia during 1998–2014 were identified in the National Hospital Discharge Register in Finland. Each individual patient record was reviewed, and detailed data on patients with JIA and pneumonia were retrieved, recorded, and analyzed. If the patient was hospitalized or received intravenous antibiotics, the pneumonia was considered serious. Results There were 157 episodes of pneumonia among 140 children with JIA; 111 episodes (71%) were serious (80% in 1998–2006 and 66% in 2007–2014). The mean age of the patients was 9 years. Forty-eight percent had active JIA and 46% had comorbidities. Disease-modifying anti-rheumatic drugs (DMARD) were used at the time of 135 episodes (86%): methotrexate (MTX) by 62% and biologic DMARDs (bDMARD) by 30%. There was no significant difference in the use of bDMARDs, MTX and glucocorticoids between the patient groups with serious and non-serious pneumonia episodes. During six of the episodes, intensive care was needed. Two patients (1.3%) died, the remaining ones recovered fully. Conclusions Although the incidence of pneumonia and the use of immunosuppressive treatment among children with JIA increased from 1998 to 2014, the proportion of serious pneumonias in these patients decreased. There was no significant difference in the use of anti-rheumatic medication between patients with serious and non-serious pneumonia.Key Points• The incidence of serious pneumonias decreased from 1998 to 2014 among children with juvenile idiopathic arthritis (JIA).• There was no significant difference in the use of the disease-modifying anti-rheumatic medication between JIA patients with serious and non-serious pneumonias.• Active JIA, comorbidities, and combination medication were associated with nearly half of the pneumonias.

Increased incidence of distal humeral fracture surgery and decreased incidence of respective corrective osteotomy among Finns aged 0 to 18 years between 1987 and 2016: a population-based study

PurposePrevious studies on paediatric and adolescent distal humeral fractures have reported an increase in surgical treatment activity. This increase could be hypothesized to reduce the incidence of corrective osteotomies. The aim of this study was to determine the incidence and trends of the primary surgical treatment of distal humeral fractures and corrective osteotomies in children and adolescents.MethodsAll Finns 18 years of age or younger who underwent treatment for distal humeral fracture between 1987 and 2016 were included in this population-based study. Surgical treatment data were obtained from the National Hospital Discharge Register of Finland. In calculating annual surgery incidence rates, the annual mid-year populations were obtained from the Official Statistics Finland. Surgical treatment was categorized into four groups; reposition and casting, osteosynthesis, external fixation and corrective osteotomy.ResultsDuring the 30-year study period, 9017 surgical procedures were performed in Finland with the primary or secondary diagnosis code being a distal humeral fracture. Of these, 6961 (77.2%) were osteosynthesis and the incidence of osteosynthesis (per 100 000 person-years) increased fourfold from 8.2 in 1987 to 34.1 in 2016. In the same 30-year study period, the total number of corrective osteotomies was low (151) with annual variation from one to 16. The incidence of corrective osteotomies (per 100 000 person-years) decreased sevenfold from 0.7 to 0.1.ConclusionThe incidence of surgical treatment with osteosynthesis in distal humeral fractures increased fourfold in Finland between 1987 and 2016. During the same time period, the number of corrective osteotomies diminished significantly.Level of EvidenceIV