umu.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Nordin, Pär
Publications (10 of 39) Show all publications
Larsson, C., Hedberg, C. L., Lundgren, E., Söderström, L., Tunón, K. & Nordin, P. (2019). Anal incontinence after caesarean and vaginal delivery in Sweden: a national population-based study. The Lancet, 393(10177), 1233-1239
Open this publication in new window or tab >>Anal incontinence after caesarean and vaginal delivery in Sweden: a national population-based study
Show others...
2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10177, p. 1233-1239Article in journal (Refereed) Published
Abstract [en]

Background: Elective caesarean delivery is increasing rapidly in many countries, and one of the reasons might be that caesarean delivery is widely believed to protect against pelvic floor disorders, including anal incontinence. Previous studies on this issue have been small and with conflicting results. The aim of present study was to compare the risk of developing anal incontinence in women who had a caesarean delivery, in those who had a vaginal delivery, and in two age-matched control groups (nulliparous women and men).

Methods: In this observational population-based study, we included all women in the Swedish Medical Birth Register who gave birth by caesarean delivery or vaginal delivery during 1973-2015 in Sweden and were diagnosed with anal incontinence according to ICD 8-10 in the Swedish National Patient Register during 2001-15. Exclusion criteria were multiple birth delivery, mixed vaginal and caesarean delivery, and four or more deliveries. We compared the diagnosis of anal incontinence between women previously delivered solely by caesarean delivery and those who solely had delivered vaginally. We also compared it with two age-matched control groups of nulliparous women and men from the Swedish Total Population Register. Finally, we analysed risk factors for anal incontinence in the caesarean delivery and vaginal delivery groups.

Findings: 3 755 110 individuals were included in the study. Between 1973 and 2015, 185 219 women had a caesarean delivery only and 1 400 935 delivered vaginally only. 416 (0.22 %) of the 185 219 women in the caesarean delivery group were diagnosed with anal incontinence compared with 5171 (0.37%) of 1 400 935 women in the vaginal delivery group. The odds ratio (OR) for being diagnosed with anal incontinence after vaginal delivery compared with caesarean delivery was 1 center dot 65 (95% CI 1 center dot 49-1 center dot 82; p<0.0001). When the combination vaginal delivery and caesarean delivery was compared with the nulliparous control group, the OR of being diagnosed with anal incontinence was 2 center dot 05 (1 center dot 92-2 center dot 19; p<0.0001). For the nulliparous women compared with men, the OR for anal incontinence was 1 center dot 89 (1 center dot 75-2 center dot 05; p<0.0001). The strongest risk factors for anal incontinence after vaginal delivery were high maternal age, high birthweight of the child, and instrumental delivery. The only risk factor for anal incontinence after caesarean delivery was maternal age.

Interpretation: The risk of developing anal incontinence increases after pregnancy and delivery. Women with known risk factors for anal incontinence should perhaps be offered a more qualified post-partum examination to enable early intervention in case of injury. Further knowledge for optimal management are needed. Copyright (c) 2019 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-157949 (URN)10.1016/S0140-6736(18)32002-6 (DOI)000462038400030 ()30799061 (PubMedID)
Available from: 2019-04-17 Created: 2019-04-17 Last updated: 2019-04-17Bibliographically approved
Rutegård, M., Gümüsçü, R., Stylianidis, G., Nordin, P., Nilsson, E. & Haapamäki, M. M. (2018). Chronic pain, discomfort, quality of life and impact on sex life after open inguinal hernia mesh repair: an expertise-based randomized clinical trial comparing lightweight and heavyweight mesh. Hernia, 22(3), 411-418
Open this publication in new window or tab >>Chronic pain, discomfort, quality of life and impact on sex life after open inguinal hernia mesh repair: an expertise-based randomized clinical trial comparing lightweight and heavyweight mesh
Show others...
2018 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 22, no 3, p. 411-418Article in journal (Refereed) Published
Abstract [en]

PURPOSE: There is a paucity of high-quality evidence concerning mesh choice in open inguinal hernia repair. Using an expertise-based randomized clinical trial design, we aimed to evaluate the postoperative impact of two different mesh types on pain and discomfort, quality of life and sex life.

METHODS: , ULTRAPRO™, Ethicon). Follow-up data were collected by questionnaires and outpatient visits in the range of 1-3 years after surgery.

RESULTS: Some 412 patients were randomized and 363 patients were analysed. There was no difference in pain between groups after surgery but a statistically significant difference concerning awareness of a groin lump and groin discomfort, favouring the lightweight group 1 year after surgery. No differences in quality of life between groups could be detected but both groups had a substantially better quality of life postoperatively, as compared to before surgery. In the analysis of impact on sex life, no differences between mesh groups were found.

CONCLUSION: The Lichtenstein operation performed for primary inguinal hernia improves quality of life for most of the male patients, independently of the type of mesh used. The lightweight mesh group experienced less awareness of a groin lump and groin discomfort 1 year postoperatively. ClinicalTrials.gov Identifier: NCT00451893.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Groin hernia repair, Lichtenstein operation, Patient-reported outcome measures
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-146882 (URN)10.1007/s10029-018-1734-z (DOI)000432794700005 ()29353339 (PubMedID)
Available from: 2018-04-20 Created: 2018-04-20 Last updated: 2018-06-27Bibliographically approved
Nilsson, H., Holmberg, H. & Nordin, P. (2018). Groin hernia repair in women - A nationwide register study. American Journal of Surgery, 216(2), 274-279
Open this publication in new window or tab >>Groin hernia repair in women - A nationwide register study
2018 (English)In: American Journal of Surgery, ISSN 0002-9610, E-ISSN 1879-1883, Vol. 216, no 2, p. 274-279Article in journal (Refereed) Published
Abstract [en]

Introduction: The aim of this study was to investigate reoperation for recurrence in men and women with respect to method of repair, hernia anatomy and year of operation. Method: Since 1992, groin hernia repairs performed in Sweden are prospectively registered in the Swedish Hernia Register, (SHR). Reoperations are noted, regardless of where the reoperation is performed. Risk of reoperation for recurrence is calculated for men and women with respect of method of repair, hernia anatomy and year of operation. Results: Out of 221 108 eligible operations registered between 1992-2013,17 545 (8%) were performed on women. The risk of being operated for recurrence after laparoscopic surgery was lowered in women, RR 0,4(95%CI 0.3-0.7) and increased in men, RR 2.3(95% CI 2.0-2.7), compared to the Lichtenstein technique. Discussion: The reoperation for recurrence rate differed significantly between men and women. As regards the technique used for primary repair, laparoscopic groin hernia repair lowered the risk of reoperation for recurrence in women whereas it doubled the risk in men.

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-150653 (URN)10.1016/j.amjsurg.2017.07.027 (DOI)000439107000016 ()28784237 (PubMedID)
Available from: 2018-08-28 Created: 2018-08-28 Last updated: 2019-05-17Bibliographically approved
Lundström, K.-J., Holmberg, H., Montgomery, A. & Nordin, P. (2018). Patient-reported rates of chronic pain and recurrence after groin hernia repair. British Journal of Surgery, 105(1), 106-112
Open this publication in new window or tab >>Patient-reported rates of chronic pain and recurrence after groin hernia repair
2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 1, p. 106-112Article in journal (Refereed) Published
Abstract [en]

Background: The effectiveness of different procedures in routine surgical practice for hernia repair with respect to chronic postoperative pain and reoperation rates is not clear.

Methods: This was prospective cohort study based on a unique combination of patient-reported outcomes and national registry data. Virtually all patients with a groin hernia repair in Sweden between September 2012 and April 2015 were sent a questionnaire 1 year after surgery. Persistent pain, defined as at least "pain present, cannot be ignored, and interferes with concentration on everyday activities' in the past week was the primary outcome. Reoperation for recurrence recorded in the register was the secondary outcome.

Results: In total, 22 917 patients (response rate 75.5 per cent) who had an elective unilateral groin hernia repair were analysed. Persistent pain present 1 year after hernia repair was reported by 15.2 per cent of patients. The risk was least for endoscopic total extraperitoneal (TEP) repair (adjusted odds ratio (OR) 0.84, 95 per cent c.i. 0.74 to 0.96), compared with open anterior mesh repair. TEP repair had an increased risk of reoperation for recurrence (adjusted OR 2.14, 1.52 to 2.98), as did open preperitoneal mesh repair (adjusted OR 2.34, 1.42 to 3.71) at 2.5-year follow-up. No other methods of repair differed significantly from open anterior mesh repair.

Conclusion: The risk of significant pain 1year after groin hernia repair in routine surgical practice was 15.2 per cent. This figure was lower in patients who had surgery by an endoscopic technique, but at the price of a significantly higher risk of reoperation for recurrence.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-143624 (URN)10.1002/bjs.10652 (DOI)000418390500012 ()29139566 (PubMedID)
Available from: 2018-01-30 Created: 2018-01-30 Last updated: 2019-05-17Bibliographically approved
Löfgren, J., Matovu, A., Wladis, A., Ibingira, C., Nordin, P., Galiwango, E. & Forsberg, B. C. (2017). Cost-effectiveness of groin hernia repair from a randomized clinical trial comparing commercial versus low-cost mesh in a low-income country. British Journal of Surgery, 104(6), 695-703
Open this publication in new window or tab >>Cost-effectiveness of groin hernia repair from a randomized clinical trial comparing commercial versus low-cost mesh in a low-income country
Show others...
2017 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 104, no 6, p. 695-703Article in journal (Refereed) Published
Abstract [en]

BackgroundOver 200 million people worldwide live with groin hernia and 20 million are operated on each year. In resource-scarce settings, the superior surgical technique using a synthetic mesh is not affordable. A low-cost alternative is needed. The objective of this study was to calculate and compare costs and cost-effectiveness of inguinal hernia mesh repair using a low-cost versus a commercial mesh in a rural setting in Uganda. MethodsThis is a cost-effectiveness analysis of a double-blinded RCT comparing outcomes from groin hernia mesh repair using a low-cost mesh and a commercially available mesh. Cost-effectiveness was expressed in US dollars (with euros in parentheses, exchange rate 30 December 2016) per disability-adjusted life-year (DALY) averted and quality-adjusted life-year (QALY) gained. ResultsThe cost difference resulting from the choice of mesh was $1247 (Euro1181). In the low-cost mesh group, the cost per DALY averted and QALY gained were $168 (Euro159) and $76 (Euro72) respectively. The corresponding costs were $582 (Euro551) and $333 (Euro315) in the commercial mesh group. A sensitivity analysis was undertaken including cost variations and different health outcome scenarios. The maximum costs per DALY averted and QALY gained were $1484 (Euro1405) and $847 (Euro802) respectively. ConclusionRepair using both meshes was highly cost-effective in the study setting. A potential cost reduction of over $120 (nearly Euro120) per operation with use of the low-cost mesh is important if the mesh technique is to be made available to the many millions of patients in countries with limited resources. Trial registration number: ISRCTN20596933 (). Mosquito mesh is cost-efficient

National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-134698 (URN)10.1002/bjs.10483 (DOI)000399452300008 ()28206682 (PubMedID)
Available from: 2017-06-30 Created: 2017-06-30 Last updated: 2018-06-09Bibliographically approved
Nordin, P., Ahlberg, J., Johansson, H., Holmberg, H. & Hafstrom, L. (2017). Risk factors for injuries associated with damage claims following groin hernia repair. Hernia, 21(2), 215-221
Open this publication in new window or tab >>Risk factors for injuries associated with damage claims following groin hernia repair
Show others...
2017 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 21, no 2, p. 215-221Article in journal (Refereed) Published
Abstract [en]

Surgical repair of groin hernia should be carried out with minimal complication rates, and it is important to have regular quality control and accurate means of assessment. The Swedish healthcare system has a mutual insurance company (LA-F) that receives claims from patients who have suffered healthcare-related damage or malpractice. The Swedish Hernia Register (SHR) currently covers around 98% of all Swedish groin hernia operations. The aim of this study was to analyse damage claims following groin hernia repair surgery and link these with entries in the SHR, in order to identify risk factors and causes of injuries and malpractice associated with hernia repair. Data on all 48,574 groin hernia operations registered in the SHR between 2008 and 2010 were compared and linked with data on claims made to the Swedish National Patient Injury Insurance (LA-F). Of the 130 damage claims received by LA-F, 26 dealt with bleeding, 20 with testicular injury and 7 with intestinal lesions. Eighty (62%) of the complications were considered malpractice according to the Swedish Patient Injury Act. Acute and recurrent surgery, sutured repair and general anaesthesia were associated with a significantly increased risk for a damage claim independently the patients were compensated or not. Females filed claims in greater proportion than males. There was no significant difference in background factors between claims accepted by LA-F and compensated and those who were rejected compensation. Risk factors for filing a damage claim included acute surgery, operation for recurrence, sutured repair and general anaesthesia, whereas local anaesthesia reduced the risk.

Place, publisher, year, edition, pages
SPRINGER, 2017
Keywords
Groin hernia repair, Damage claims, Malpractice
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-134823 (URN)10.1007/s10029-017-1585-z (DOI)000398700900008 ()28181088 (PubMedID)
Available from: 2017-05-24 Created: 2017-05-24 Last updated: 2019-05-17Bibliographically approved
Löfgren, J., Nordin, P., Ibingira, C., Matovu, A., Galiwango, E. & Wladis, A. (2016). A Randomized Trial of Low-Cost Mesh in Groin Hernia Repair. New England Journal of Medicine, 374(2), 146-153
Open this publication in new window or tab >>A Randomized Trial of Low-Cost Mesh in Groin Hernia Repair
Show others...
2016 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 374, no 2, p. 146-153Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The most effective method for repair of a groin hernia involves the use of a syn-thetic mesh, but this type of mesh is unaffordable for many patients in low- and middle-income countries. Sterilized mosquito meshes have been used as a lower-cost alternative but have not been rigorously studied.METHODS: We performed a double-blind, randomized, controlled trial comparing low-cost mesh with commercial mesh (both lightweight) for the repair of a groin hernia in adult men in eastern Uganda who had primary, unilateral, reducible groin hernias. Surgery was performed by four qualified surgeons. The primary outcomes were hernia recurrence at 1 year and postoperative complications.RESULTS: A total of 302 patients were included in the study. The follow-up rate was 97.3% after 2 weeks and 95.6% after 1 year. Hernia recurred in 1 patient (0.7%) assigned to the low-cost mesh and in no patients assigned to the commercial mesh (abso-lute risk difference, 0.7 percentage points; 95% confidence interval [CI], −1.2 to 2.6; P = 1.0). Postoperative complications occurred in 44 patients (30.8%) assigned to the low-cost mesh and in 44 patients (29.7%) assigned to the commercial mesh (absolute risk difference, 1.0 percentage point; 95% CI, −9.5 to 11.6; P = 1.0).CONCLUSIONS: Rates of hernia recurrence and postoperative complications did not differ signifi-cantly between men undergoing hernia repair with low-cost mesh and those un-dergoing hernia repair with commercial mesh.

National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:umu:diva-107657 (URN)10.1056/NEJMoa1505126 (DOI)000367996700009 ()26760085 (PubMedID)
Note

Originally published in manuscript form with title "Low cost mesh in groin hernia repair - A double-blinded, randomized trial"

Available from: 2015-08-25 Created: 2015-08-25 Last updated: 2018-06-07Bibliographically approved
Schollin-Borg, M., Nordin, P., Zetterström, H. & Johansson, J. (2016). Blood Lactate Is a Useful Indicator for the Medical Emergency Team. Critical Care Research and Practice, Article ID 5765202.
Open this publication in new window or tab >>Blood Lactate Is a Useful Indicator for the Medical Emergency Team
2016 (English)In: Critical Care Research and Practice, ISSN 2090-1305, E-ISSN 2090-1313, article id 5765202Article in journal (Refereed) Published
Abstract [en]

Lactate has been thoroughly studied and found useful for stratification of patients with sepsis, in the Intensive Care Unit, and trauma care. However, little is known about lactate as a risk-stratification marker in the Medical Emergency Team-(MET-) call setting. We aimed to determine whether the arterial blood lactate level at the time of a MET-call is associated with increased 30-day mortality. This is an observational study on a prospectively gathered cohort at a regional secondary referral hospital. All MET-calls during the two-year study period were eligible. Beside blood lactate, age and vital signs were registered at the call. Among the 211 calls included, there were 64 deaths (30.3%). Median lactate concentration at the time of the MET-call was 1.82 mmol/L (IQR 1.16-2.7). We found differences between survivors and nonsurvivors for lactate and oxygen saturation, a trend for age, but no significant correlations between mortality and systolic blood pressure, respiratory rate, and heart rate. As compared to normal lactate (<2.44 mmol/L), OR for 30-day mortality was 3.54 (p < 0.0006) for lactate 2.44-5.0 mmol/L and 4.45 (p < 0.0016) for lactate >5.0 mmol/L. The present results support that immediate measurement of blood lactate in MET call patients is a useful tool in the judgment of illness severity.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2016
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-119091 (URN)10.1155/2016/5765202 (DOI)000372258000001 ()
Available from: 2016-04-15 Created: 2016-04-11 Last updated: 2018-06-07Bibliographically approved
Gutlic, N., Rogmark, P., Nordin, P., Petersson, U. & Montgomery, A. (2016). Impact of mesh fixation on chronic pain in total extraperitoneal inguinal hernia repair (TEP): a nationwide register-based study. Annals of Surgery, 263(6), 1199-1206
Open this publication in new window or tab >>Impact of mesh fixation on chronic pain in total extraperitoneal inguinal hernia repair (TEP): a nationwide register-based study
Show others...
2016 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 263, no 6, p. 1199-1206Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Mesh fixation is used to prevent recurrence at the potential risk for chronic pain in TEP. The aim was to compare the impact of permanent fixation (PF) with no fixation (NF)/nonpermanent fixation (NPF) of mesh on chronic pain after TEP repair for primary inguinal hernia.

METHODS: Men, 30 to 75 years old, consecutively registered in the Swedish Hernia Register for a TEP primary repair in 2005 to 2009, were included in a mail survey using SF-36 and the Inguinal Pain Questionnaire (IPQ). Primary endpoint was IPQ question "Did you have pain during past week that could not be ignored." Risk factors for chronic pain and recurrent operations were analyzed.

RESULTS: A total of 1110 patients were included (325 PF, 785 NF/NPF) with 7.7% reporting pain at median 33 months follow-up. No difference regarding primary endpoint pain (P < 0.462), IPQ and SF-36 subscales were seen. Recurrent operation was carried out in 1.4% during 7.5 years follow-up with no difference between PF- and NF-groups including subgroups of medial hernias. All SF-36 subscale-scores were equal to or better than the Swedish norm. A postoperative complication was a risk factor for chronic pain (OR 2.44, 95% CI 1.23-5.25, P < 0.023).

CONCLUSIONS: The TEP procedure for primary inguinal hernia repair in men is associated with a low frequency of chronic pain and recurrent operations, with no difference between permanent fixation and no/nonpermanent fixation of mesh in a nationwide population-based study. TEP without fixation reduces costs and is safe for all patients.

Place, publisher, year, edition, pages
Philadelphia: Lippincott Williams & Wilkins, 2016
Keywords
chronic pain, inguinal hernia, mesh fixation, register study, TEP
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-135216 (URN)10.1097/SLA.0000000000001306 (DOI)000377765400033 ()26135697 (PubMedID)
Available from: 2017-05-22 Created: 2017-05-22 Last updated: 2018-06-09Bibliographically approved
Nilsson, H., Angeras, U., Sandblom, G. & Nordin, P. (2016). Serious adverse events within 30 days of groin hernia surgery. Hernia, 20(3), 377-385
Open this publication in new window or tab >>Serious adverse events within 30 days of groin hernia surgery
2016 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 20, no 3, p. 377-385Article in journal (Refereed) Published
Abstract [en]

To analyze severe complications after groin hernia repair with respect to age, ASA score, hernia anatomy, method of repair and method of anesthesia, using nationwide registers. The annual rate of 20 million groin hernia operations throughout the world renders severe complications, although rare, important both for the patient, the clinician, and the health economist. Two nationwide registers, the Swedish Hernia Register and the National Swedish Patient Register were linked to find intraoperative complications, severe cardiovascular events and severe surgical adverse events within 30 days of groin hernia surgery. 143,042 patients, 8 % women and 92 % men, were registered between 2002 and 2011. Intraoperative complications occurred in 801 repair, 592 patients suffered from cardiovascular events and 284 patients from a severe surgical event within 30 days of groin hernia surgery. Emergency operation was a risk factor for both cardiovascular and severe surgical adverse events with odds ratios for cardiovascular events of 3.1 (2.5-4.0) for men and 2.8 (1.4-5.5) for women. Regional anesthesia was associated with an increase in cardiovascular morbidity compared with local anesthesia, odds ratio 1.4 (1.1-1.9). In men, bilateral hernia and sliding hernia approximately doubled the risk for severe surgical events; odds ratio 1.9 (1.1-3.5) and 2.2 (1.6-3.0), respectively. Methods other than open anterior mesh repair increased the risk for surgical complications. Awareness of the increased risk for cardiovascular or surgical complications associated with emergency surgery, bilateral hernia, sliding hernia, and regional anesthesia may enable the surgeon to further reduce their incidence.

Keywords
Postoperative complication, Groin hernia operation, Inguinal hernia, Femoral hernia, Sliding hernia, lateral hernia
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-123053 (URN)10.1007/s10029-016-1476-8 (DOI)000376913500005 ()26983833 (PubMedID)
Available from: 2016-08-15 Created: 2016-06-27 Last updated: 2018-06-07Bibliographically approved
Organisations

Search in DiVA

Show all publications