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Zhang Y, Tan X, Duan X, Du X, Zheng J, Feng L, Fu H. The impact of anesthesia methods on postoperative outcomes of lower limb surgeries in elderly patients over 90 years old: A multicenter propensity-matched study. BMC Anesthesiol 2025; 25:167. [PMID: 40211153 PMCID: PMC11984253 DOI: 10.1186/s12871-025-03035-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Accepted: 03/28/2025] [Indexed: 04/12/2025] Open
Abstract
PURPOSE This study aimed to assess the impact of different anesthesia methods on postoperative outcomes of lower limb surgeries in elderly patients over 90 years old. PATIENTS AND METHODS We retrospectively reviewed the medical records of elderly patients over 90 years old who underwent lower limb surgeries at Chongqing University Center Hospital, the Affiliated Hospital of Southwest Medical University, and Chongqing General Hospital from January 2012 to December 2022. The patients were categorized into two groups based on the anesthesia method employed: the general anesthesia (GA) group and the regional anesthesia (RA) group. To minimize potential confounding, propensity score matching (PSM) was conducted in a 1:1 ratio with the caliper value set as 0.1; additionally, further univariable logistic regression was employed to compare the risk of postoperative complications and mortality between the GA and RA groups. RESULTS A total of 560 patients were included in our analysis, with 363 cases receiving general anesthesia (GA) and 197 cases receiving regional anesthesia (RA). After conducting propensity score matching (PSM), 139 pairs of data were successfully matched. Compared with the RA group, the GA group had a higher risk of postoperative complications (32.4% vs. 19.4%;OR,1.99; 95% CI, 1.15-3.44; p = 0.015), a higher risk of postoperative ICU admission (44.6% vs. 20.9%;OR,3.05; 95% CI,1.80-5.18;p < 0.001), but a lower risk of intraoperative blood transfusion (46% vs. 59%;OR,0.59; 95% CI,0.37-0.95;P = 0.031).No statistically significant differences were observed in other perioperative indices between the two groups. CONCLUSION In elderly patients over 90 years old undergoing lower limb fracture surgeries, GA is associated with a higher risk of postoperative complications and ICU admission compared to RA. Furthermore, compared with RA, GA is associated with a decreased need for intraoperative blood transfusion. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry (ChiCTR2400083103, principal investigator: Hong Fu, 14/04/2024).
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Affiliation(s)
- Yu Zhang
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Xuemei Tan
- Department of Anesthesiology, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Xiaoxia Duan
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Xiaohui Du
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jiang Zheng
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Lan Feng
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Hong Fu
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China.
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Xiao YC, Ailihemaiti A, Zheyiken J. To analyze the risk factors associated with mortality within 1 year after surgery in elderly patients with hip fracture and to assess the value of the age-corrected Charlson comorbidity index in predicting this mortality risk. Medicine (Baltimore) 2025; 104:e41263. [PMID: 39833089 PMCID: PMC11749506 DOI: 10.1097/md.0000000000041263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 11/27/2024] [Indexed: 01/22/2025] Open
Abstract
To investigate the determining risk factors for 1-year postoperative mortality in elderly patients with hip fracture and to assess the efficacy of the age-adjusted Charlson comorbidity index (ACCI) in predicting the risk of death. This study adopted a retrospective analysis method to focus on 652 elderly patients who underwent hip fracture surgery between January 2018 and November 2022 in our hospital. By systematically combing the patients' medical records, relevant data were collected and analyzed in depth for their association with morbidity and mortality rates within 1 year. In the 1-year follow-up for 652 elderly patients who underwent hip fracture surgery, the proportion of deaths due to disease amounted to 21.5% (140/652). Univariate analysis using the Cox proportional hazard model revealed that age, number of hospital days, ACCI, and the occurrence of postoperative pneumonia were significantly associated with the rate of morbidity and mortality within 1 year. Further multivariate Cox regression analysis confirmed that age (hazard ratio [HR], 1.087 [95% confidence interval [CI], 1.060-1.114]), ACCI (HR, 1.645 [95% CI, 1.548-1.747]), and postoperative pneumonia (HR, 2.353 [95% CI, 1.624-3.408]) served as independent risk factors that significantly influenced the patients' 1-year survival. The ACCI excelled in predicting the risk of 1-year postoperative mortality, with an AUC of 0.912 for its prediction model and a specificity and sensitivity of 0.834 and 0.871, respectively, when the threshold was set at 5.5. The results of this study emphasize that age, ACCI, and postoperative pneumonia are key risk factors affecting the survival of elderly patients with hip fracture at 1-year postoperatively. ACCI, as an effective predictive tool, can provide an important reference for the clinical assessment of patients' postoperative risk and help precision medical decision-making.
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Affiliation(s)
- Yu-Chen Xiao
- Traditional Chinese Medicine Hospital of Ili Kazakh Autonomous Prefecture, Yining, China
| | - Ayidan Ailihemaiti
- Traditional Chinese Medicine Hospital of Ili Kazakh Autonomous Prefecture, Yining, China
| | - Jiangannuer Zheyiken
- Traditional Chinese Medicine Hospital of Ili Kazakh Autonomous Prefecture, Yining, China
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Sanderson-Jerome C, Hariharan S. Outcome and Cost Evaluation of Hip Fractures in Elderly Patients at a Tertiary Care Hospital in the Caribbean. Cureus 2024; 16:e74586. [PMID: 39735027 PMCID: PMC11674320 DOI: 10.7759/cureus.74586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2024] [Indexed: 12/31/2024] Open
Abstract
Introduction Hip fractures in the elderly are considered one of the most common types of orthopedic injuries, associated with increased morbidity and mortality. The incidence has been increasing over the years, and its management has also caused a significant economic burden for most countries worldwide. This study aimed to determine the outcomes and economic costs associated with hip fractures in elderly patients at a tertiary care institution in Trinidad and Tobago. Methods A chart review of patients aged > 65 years admitted with a diagnosis of hip fractures for one calendar year was conducted, followed by a prospective survey to determine their current status. Demographics and clinical data were collected. Outcomes measured included the time to surgery (lead time), complications by Clavien-Dindo score, hospital length of stay and mortality, and costs of hospitalization. Results Thirty patients who fulfilled the criteria for chart review and follow-up were studied. The age of patients ranged from 65 to 117 years with a mean of 82.0 ± 10.58 (standard deviation (SD)). The mean lead time from admission to surgery was 17.2 ± 14.2 (SD) days. The mean hospital length of stay was 24.4 ± 15.6 (SD) days. The mean cost of hospitalization was found to be US $10,256 per patient. Postoperative complications were seen in 57% of patients and non-surgical complications were more frequent than surgical complications. The longer the lead time to surgery, the longer the hospital length of stay (p<0.0001); the longer the length of stay, the higher the costs (p<0.0001). The hospital mortality was 27% and one-year mortality was 50%; the lead time to surgery did not impact hospital mortality. Conclusion Prolonged lead time until surgery for elderly hip fracture patients increased their hospital length of stay and significantly increased the costs of their management, adversely affecting their outcomes, which needs to be addressed at the administrative level.
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Affiliation(s)
| | - Seetharaman Hariharan
- Anaesthesia and Intensive Care, The University of the West Indies, St Augustine, TTO
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Phruetthiphat OA, Lawanprasert A, Satravaha Y, Pinijprapa P, Songpatanasilp T, Pongchaiyakul C. Nine-year survival after intertrochanteric fracture in elderly with chronic kidney disease. Sci Rep 2024; 14:20912. [PMID: 39245762 PMCID: PMC11381514 DOI: 10.1038/s41598-024-72140-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 09/04/2024] [Indexed: 09/10/2024] Open
Abstract
The outcome of this study was to identify 9-year survivors of intertrochanteric fracture at each stage of chronic kidney disease (CKD) and to investigate the risk factors associated with mortality following surgery with proximal femoral nail anti-rotation (PFNA). 443 elderly intertrochanteric fractures underwent PFNA fixation were recruited. Mortality rate was identified until 9 years. We compared the survival time of hip fracture in each stage of CKD. A regression analysis was used to determine the association between risk factors and one-year mortality. The overall median survival time was 7.1 years. The Kaplan-Meier curve was significantly different in each CKD stage especially in CKD5. In addition, the incidence rate of mortality was highest in CKD 5 (17.4%) and the median survival time in CKD 5 was 3.3 years. The multivariate analysis demonstrated that heart disease, operative time > 60 min, presence of pulmonary embolism, and poor to fair Harris hip score were significantly increased mortality. CKD stage 5 is associated with the highest mortality rate and the shortest median time of survival during the 9-year follow up. Patients who have high risk should focus on long-term care planning, including the counseling for their healthcare providers and families.
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Affiliation(s)
- Ong-Art Phruetthiphat
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchawidhi Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.
| | | | - Yodhathai Satravaha
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Panukorn Pinijprapa
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchawidhi Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Thawee Songpatanasilp
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchawidhi Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Micicoi G, de Geofroy B, Chamoux J, Ghabi A, Gauci MO, Bernard de Dompsure R, Bronsard N, Gonzalez JF. Total blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach. Orthop Traumatol Surg Res 2024; 110:103911. [PMID: 38801888 DOI: 10.1016/j.otsr.2024.103911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 09/25/2023] [Accepted: 02/16/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Femoral neck fractures constitute a public health problem due to significant associated morbidity and mortality amongst the ageing population. Perioperative blood loss can increase this morbidity. Blood loss, as well as the influence that the surgical approach exerts on it, remains poorly evaluated. We therefore conducted a retrospective comparative study in order to: (1) compare total blood loss depending on whether the patients were operated on using an anterior or posterior approach, (2) compare the transfusion rates, operating times and hospital stays between these two groups and, (3) analyze dislocation rates. HYPOTHESIS Total blood loss is greater from an anterior approach following a hip hemiarthroplasty for femoral neck fracture, compared to the posterior approach. MATERIAL AND METHODS This retrospective single-center comparative study included 137 patients operated on by hip hemiarthroplasty between December 2020 and June 2021, and seven patients were excluded. One hundred and thirty patients were analyzed: 69 (53.1%) had been operated on via the anterior Hueter approach (AA) and 61 (46.9%) via the posterior Moore approach (PA). The analysis of total blood loss was based on the OSTHEO formula to collect perioperative "hidden" blood loss. The risk of early dislocation (less than 6 months) was also analyzed. RESULTS Total blood loss was similar between the two groups, AA: 1626±506mL versus PA: 1746±692mL (p=0.27). The transfusion rates were also similar between the two groups, AA: 23.2% versus PA: 31.1% (p=0.31) as well as the duration of hospitalization, AA: 8.5±3.2 versus PA: 8.2±3.3 days (p=0.54). The operating time was shorter in the PA group (Δ=10.3±14.1minutes [p<0.001]) with a greater risk of early dislocation when the patient was operated on by PA with AA: 9.8% versus PA: 1.4% (p=0.03). CONCLUSION This study does not demonstrate any influence of the approach (anterior or posterior) on total blood loss. Transfusion rates and length of hospitalization were similar between the groups with a slightly shorter operating time but a greater risk of early dislocations after posterior hemiarthroplasty in a population at high anesthesia-related risk. LEVEL OF PROOF III, comparative study of continuous series.
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Affiliation(s)
- Grégoire Micicoi
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France.
| | - Bernard de Geofroy
- Department of Orthopaedic and Trauma Surgery, HIA Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Julien Chamoux
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Ammar Ghabi
- Department of Orthopaedic and Trauma Surgery, HIA Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Marc-Olivier Gauci
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Régis Bernard de Dompsure
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Nicolas Bronsard
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
| | - Jean-François Gonzalez
- UR2CA, Pasteur 2 Hospital, iULS-University Institute for Locomotion and Sports, 30, voie Romaine, 06000 Nice, France; Unité de recherche clinique Côte-d'Azur (UR2CA), université Côte-d'Azur (UCA), CHU de Nice, 28, avenue de Valombrose, 06107 Nice, France
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Pean C, Chari T, Valan B, Peairs E, Poehlein E, Green CL, Taylor E, Toth A, Olson S, DeBaun M. Racial Disparities Exist in 90-Day Unplanned Return to the Emergency Department Following Orthopaedic Trauma Surgery. J Orthop Trauma 2024; 38:397-402. [PMID: 38837211 DOI: 10.1097/bot.0000000000002820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES Racial disparities in healthcare outcomes exist, including in orthopaedic trauma care. The aim of this study was to determine the impact of race, social deprivation, and payor status on 90-day emergency department (ED) revisits among orthopaedic trauma surgery patients at a Level 1 trauma academic medical center. METHODS DESIGN Retrospective chart review analysis. SETTING Level 1 trauma academic center in Durham, NC. PATIENT SELECTION CRITERIA Adult patients undergoing orthopaedic trauma surgery between 2017 and 2021. OUTCOME MEASURES AND COMPARISONS The primary outcome of this retrospective cohort study was 90-day return to the ED. Logistic regression analysis was performed for variables of interest [race, social deprivation (measured by the Area Deprivation Index), and payor status] separately and combined, with each model adjusting for distance to the hospital. Results were interpreted as odds ratios (ORs) of 90-day ED revisits comparing levels of the respective variables. Statistical significance was assessed at α = 0.05. RESULTS A total of 3120 adult patients who underwent orthopaedic trauma surgery between 2017 and 2021 were included in the analysis. Black race (OR = 1.47; 95% confidence interval [CI]: 1.17-1.84, P < 0.001) and Medicaid coverage (OR = 1.63, 95% CI: 1.20-2.21, P = 0.002) were significantly associated with higher odds of return to ED compared with non-Black or non-Medicaid-covered patients. While ethnic minority (Hispanic/Latino or non-White) was statistically significant while adjusting only for distance to the hospital (OR = 1.23, 95% CI: 1.00-1.50, P = 0.047), it was no longer significant after adjusting for the other sociodemographic variables (OR = 1.13, 95% CI: 0.91-1.39, P = 0.27). The weighted Area Deprivation Index was not associated with a difference in odds of return to ED in any adjusted models. CONCLUSIONS The results highlight the presence of racial and socioeconomic disparities in ED utilization, with Black race and Medicaid coverage significantly associated with higher odds of return to the ED. Future research should delve deeper into comprehending the root causes contributing to these racial and socioeconomic utilization disparities and evaluate the effectiveness of targeted interventions to reduce them. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christian Pean
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Tristan Chari
- Duke Margolis Center for Health Policy, Durham, NC; and
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Bruno Valan
- Duke Margolis Center for Health Policy, Durham, NC; and
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Emily Peairs
- Duke Margolis Center for Health Policy, Durham, NC; and
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Emily Poehlein
- Duke Margolis Center for Health Policy, Durham, NC; and
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Cynthia L Green
- Duke Margolis Center for Health Policy, Durham, NC; and
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Erica Taylor
- Duke Margolis Center for Health Policy, Durham, NC; and
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Alison Toth
- Duke Margolis Center for Health Policy, Durham, NC; and
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Steven Olson
- Duke Margolis Center for Health Policy, Durham, NC; and
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Malcolm DeBaun
- Duke Margolis Center for Health Policy, Durham, NC; and
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
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Adler RR, Xiang L, Shah SK, Clark CJ, Cooper Z, Mitchell SL, Kim DH, Hsu J, Sepucha K, Chunga RE, Lipsitz SR, Weissman JS, Schoenfeld AJ. Hip Fracture Treatment and Outcomes Among Community-Dwelling People Living With Dementia. JAMA Netw Open 2024; 7:e2413878. [PMID: 38814642 PMCID: PMC11140536 DOI: 10.1001/jamanetworkopen.2024.13878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/28/2024] [Indexed: 05/31/2024] Open
Abstract
Importance The decision for surgical vs nonsurgical treatment for hip fracture can be complicated among community-dwelling people living with dementia. Objective To compare outcomes of community-dwelling people living with dementia treated surgically and nonsurgically for hip fracture. Design, Setting, and Participants This retrospective cross-sectional study undertook a population-based analysis of national Medicare fee-for-service data. Participants included community-dwelling Medicare beneficiaries with dementia and an inpatient claim for hip fracture from January 1, 2017, to June 30, 2018. Analyses were conducted from November 10, 2022, to October 17, 2023. Exposure Surgical vs nonsurgical treatment for hip fracture. Main Outcomes and Measures The primary outcome was mortality within 30, 90, and 180 days. Secondary outcomes consisted of selected post-acute care services. Results Of 56 209 patients identified with hip fracture (73.0% women; mean [SD] age, 86.4 [7.0] years), 33 142 (59.0%) were treated surgically and 23 067 (41.0%) were treated nonsurgically. Among patients treated surgically, 73.3% had a fracture of the femoral head and neck and 40.2% had moderate to severe dementia (MSD). Among patients with MSD and femoral head and neck fracture, 180-day mortality was 31.8% (surgical treatment) vs 45.7% (nonsurgical treatment). For patients with MSD treated surgically vs nonsurgically, the unadjusted odds ratio (OR) of 180-day mortality was 0.56 (95% CI, 0.49-0.62; P < .001) and the adjusted OR was 0.59 (95% CI, 0.53-0.66; P < .001). Among patients with mild dementia and femoral head and neck fracture, 180-day mortality was 26.5% (surgical treatment) vs 34.9% (nonsurgical treatment). For patients with mild dementia who were treated surgically vs nonsurgically for femoral head and neck fracture, the unadjusted OR of 180-day mortality was 0.67 (95% CI, 0.60-0.76; P < .001) and the adjusted OR was 0.71 (95% CI, 0.63-0.79; P < .001). For patients with femoral head and neck fracture, there was no difference in admission to a nursing home within 180 days when treated surgically vs nonsurgically. Conclusions and Relevance In this cohort study of community-dwelling patients with dementia and fracture of the femoral head and neck, patients with MSD and mild dementia treated surgically experienced lower odds of death compared with patients treated nonsurgically. Although avoiding nursing home admission is important to persons living with dementia, being treated surgically for hip fracture did not necessarily confer a benefit in that regard. These data can help inform discussions around values and goals with patients and caregivers when determining the optimal treatment approach.
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Affiliation(s)
- Rachel R. Adler
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lingwei Xiang
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Samir K. Shah
- Division of Vascular Surgery, University of Florida, Gainesville
| | - Clancy J. Clark
- Division of Surgical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Susan L. Mitchell
- Hebrew SeniorLife, Marcus Institute for Aging Research, Boston, Massachusetts
| | - Dae Hyun Kim
- Hebrew SeniorLife, Marcus Institute for Aging Research, Boston, Massachusetts
| | - John Hsu
- Mongan Institute Health Policy Center, Mass General Research Institute, Boston, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Karen Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Richard E. Chunga
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Stuart R. Lipsitz
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Joel S. Weissman
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Andrew J. Schoenfeld
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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García-Tercero E, Belenguer-Varea Á, Villalon-Ruibio D, López Gómez J, Trigo-Suarez R, Cunha-Pérez C, Borda MG, Tarazona-Santabalbina FJ. Respiratory Complications Are the Main Predictors of 1-Year Mortality in Patients with Hip Fractures: The Results from the Alzira Retrospective Cohort Study. Geriatrics (Basel) 2024; 9:47. [PMID: 38667514 PMCID: PMC11050287 DOI: 10.3390/geriatrics9020047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/21/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction: Hip fractures pose a significant challenge for older individuals given their high incidence and one-year mortality rate. The objective of this study was to identify the primary predictors of one-year mortality in older adults hospitalized for hip fractures. Methods: We conducted a retrospective cohort study involving adults aged 70 years or older who were admitted to the hospital for fragility hip fractures between 1 January 2014 and 31 December 2021. A total of 3229 patients were recruited, with 846 (26.2%) experiencing one-year mortality. Results: Respiratory complications (HR 2.42, 95%CI 1.42-4.14; p = 0.001) were the most significant predictors of one-year mortality, followed by hospital readmission (HR 1.96, 95%CI 1.66-2.32; p < 0.001), the male sex (HR 1.88, 95%CI 1.46-2.32; p < 0.001), cardiac complications (HR 1.88, 95%CI 1.46-2.32; p < 0.001), and a diagnosis of dementia at admission (HR 1.37, 95%CI 1.13-1.66; p = 0.001). The Charlson Index and the American Society of Anesthesiologists physical status classification system also significantly increased the mortality risk. Conversely, higher hemoglobin levels at admission and elevated albumin at discharge significantly reduced the mortality risk. Conclusions: The one-year mortality rate is substantial in older adults with hip fractures who are admitted to an orthogeriatric unit. The appropriate management of anemia, nutritional disorders, and comorbidity at admission and during the follow-up could potentially mitigate long-term mortality after hip fractures.
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Affiliation(s)
- Elisa García-Tercero
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Ángel Belenguer-Varea
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Daniela Villalon-Ruibio
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Jesús López Gómez
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Rodrigo Trigo-Suarez
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Cristina Cunha-Pérez
- School of Doctorate, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, 4068 Stavanger, Norway;
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Francisco Jose Tarazona-Santabalbina
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain
- Medical School, Universidad Católica de Valencia Sant Vicent Màrtir, 46001 Valencia, Spain
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9
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Milton-Cole R, Goubar A, Ayis S, O’Connell MDL, Kristensen MT, Schuch FB, Sheehan KJ. The role of depression in the association between mobilisation timing and live discharge after hip fracture surgery: Secondary analysis of the UK National Hip Fracture Database. PLoS One 2024; 19:e0298804. [PMID: 38574013 PMCID: PMC10994389 DOI: 10.1371/journal.pone.0298804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/30/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE The aim was to compare the probability of discharge after hip fracture surgery conditional on being alive and in hospital between patients mobilised within and beyond 36-hours of surgery across groups defined by depression. METHODS Data were taken from the National Hip Fracture Database and included patients 60 years of age or older who underwent hip fracture surgery in England and Wales between 2014 and 2016. The conditional probability of postsurgical live discharge was estimated for patients mobilised early and for patients mobilised late across groups with and without depression. The association between mobilisation timing and the conditional probability of live discharge were also estimated separately through adjusted generalized linear models. RESULTS Data were analysed for 116,274 patients. A diagnosis of depression was present in 8.31% patients. In those with depression, 7,412 (76.7%) patients mobilised early. In those without depression, 84,085 (78.9%) patients mobilised early. By day 30 after surgery, the adjusted odds ratio of discharge among those who mobilised early compared to late was 1.79 (95% CI: 1.56-2.05, p<0.001) and 1.92 (95% CI: 1.84-2.00, p<0.001) for those with and without depression, respectively. CONCLUSION A similar proportion of patients with depression mobilised early after hip fracture surgery when compared to those without a diagnosis of depression. The association between mobilisation timing and time to live discharge was observed for patients with and without depression.
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Affiliation(s)
- R. Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - A. Goubar
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - S. Ayis
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - M. D. L. O’Connell
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - M. T. Kristensen
- Department of Physical- and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - F. B. Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
- Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia, Chile
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - K. J. Sheehan
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, United Kingdom
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10
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Bui M, Nijmeijer WS, Hegeman JH, Witteveen A, Groothuis-Oudshoorn CGM. Systematic review and meta-analysis of preoperative predictors for early mortality following hip fracture surgery. Osteoporos Int 2024; 35:561-574. [PMID: 37996546 PMCID: PMC10957669 DOI: 10.1007/s00198-023-06942-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/04/2023] [Indexed: 11/25/2023]
Abstract
Hip fractures are a global health problem with a high postoperative mortality rate. Preoperative predictors for early mortality could be used to optimise and personalise healthcare strategies. This study aimed to identify predictors for early mortality following hip fracture surgery. Cohort studies examining independent preoperative predictors for mortality following hip fracture surgery were identified through a systematic search on Scopus and PubMed. Predictors for 30-day mortality were the primary outcome, and predictors for mortality within 1 year were secondary outcomes. Primary outcomes were analysed with random-effects meta-analyses. Confidence in the cumulative evidence was assessed using the GRADE criteria. Secondary outcomes were synthesised narratively. Thirty-three cohort studies involving 462,699 patients were meta-analysed. Five high-quality evidence predictors for 30-day mortality were identified: age per year (OR: 1.06, 95% CI: 1.04-1.07), ASA score ≥ 3 (OR: 2.69, 95% CI: 2.12-3.42), male gender (OR: 2.00, 95% CI: 1.85-2.18), institutional residence (OR: 1.81, 95% CI: 1.31-2.49), and metastatic cancer (OR: 2.83, 95% CI: 2.58-3.10). Additionally, six moderate-quality evidence predictors were identified: chronic renal failure, dementia, diabetes, low haemoglobin, heart failures, and a history of any malignancy. Weak evidence was found for non-metastatic cancer. This review found relevant preoperative predictors which could be used to identify patients who are at high risk of 30-day mortality following hip fracture surgery. For some predictors, the prognostic value could be increased by further subcategorising the conditions by severity.
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Affiliation(s)
- Michael Bui
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands.
| | - Wieke S Nijmeijer
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609, PP, Almelo, The Netherlands
| | - Johannes H Hegeman
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609, PP, Almelo, The Netherlands
| | - Annemieke Witteveen
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
| | - Catharina G M Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
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11
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Lähdesmäki M, Ylitalo AAJ, Karjalainen L, Uimonen M, Mattila VM, Repo JP. Intramedullary Nailing of Intertrochanteric Femoral Fractures in a Level I Trauma Center in Finland: What Complications Can be Expected? Clin Orthop Relat Res 2024; 482:278-288. [PMID: 37582281 PMCID: PMC10776171 DOI: 10.1097/corr.0000000000002792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Intertrochanteric hip fractures are one of the most common fractures in older people, and the number is estimated to increase. These fractures are often treated with intramedullary nailing; however, various complications have been reported. It is important to identify the potential complications and investigate whether the choice of implant and patient-related factors are associated with the risk of complications to develop better strategies for preventing them. QUESTIONS/PURPOSES (1) In the treatment of intertrochanteric fractures with intramedullary nailing, what are the risks of major complications and 30-day mortality? (2) Which implant types are associated with greater odds of major complications? (3) Which patient-related factors are associated with increased odds of major complications? METHODS In this retrospective, comparative study, we reviewed the health records of 2397 patients with a femoral fracture treated at one Level I trauma center between January 2014 and November 2020. Of those, we considered patients who were treated with intramedullary nailing for an intertrochanteric fracture after sustaining a low-energy injury as potentially eligible. Based on this criterion, 53% (1279) were eligible; a further 47% (1118) were excluded because the fixation method was other than intramedullary nailing, the fracture pattern was other than intertrochanteric fracture, or the fracture was caused by a high-energy injury mechanism. Another 4% (97) were excluded because they had incomplete datasets because of follow-up less than 12 months, leaving 49% (1182) for analysis. During the study period, intramedullary nails were generally used to treat nearly all intertrochanteric fractures at our hospital. The risk of complications was then assessed by chart review. Acute myocardial ischemia, cutout, nail breakage, pulmonary embolism, sepsis, stroke, and wound infection were defined as major complications. Cutout, nail breakage, and wound infection were defined as major complications leading to reoperation. To examine the association of implant type and major complications, a logistic regression analysis was performed. Additionally, the risks of major complications leading to reoperation were compared between implants. Finally, a univariable logistic regression analysis was performed to examine the association between patient-related factors and major complications. RESULTS The overall proportion of patients experiencing complications was 16% (183 of 1182), and the crude percentage of 30-day mortality was 9% (107 of 1182) based on the hospital`s medical records. After controlling for patient-related factors such as disease, age, and smoking, we found that nail type was not associated with odds of major complications leading to reoperation (Gamma3: OR 0.86 [95% CI 0.44 to 1.67]; p = 0.67; Trochanteric Fixation Nail: OR 0.61 [95% CI 0.2 to 1.53]; p = 0.33; Proximal Femoral Nail Antirotation: OR 0.55 [95% CI 0.16 to 1.49]; p = 0.29) compared with the Trochanteric Fixation Nail Advanced. Anticoagulation (OR 1.70 [95% CI 1.11 to 2.59]; p = 0.01), congestive heart failure (OR 1.91 [95% CI 1.13 to 3.11]; p = 0.01), and hypertension (OR 1.67 [95% CI 1.08 to 2.63]; p = 0.02) were associated with a major complication. Liver disease (OR 5.19 [95% CI 0.78 to 20.8]; p = 0.04) was associated with a major complication leading to reoperation. CONCLUSION This study provides a better understanding of the occurrence of surgical and medical complications after intramedullary nailing of intertrochanteric fractures. The new-generation nail types are comparable options based on the risk of reoperation. Anticoagulation, congestive heart failure, and hypertension were associated with major complications, highlighting the need for careful management and monitoring of these comorbidities during intramedullary nailing procedures.Level of Evidence Level III, therapeutic study.
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Affiliation(s)
- Miika Lähdesmäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti AJ Ylitalo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Leevi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mikko Uimonen
- Department of Surgery, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Ville M. Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Jussi P. Repo
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
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12
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Marin GH, Luzuriaga P, Giangreco L, Iusef-Venturini N, Blanco D, Dorati C, Mordujovich-Buschiazzo P. [Financial and health impact of two models of providing prostheses in a public health systemImpacto econômico e sanitário de dois modelos de fornecimento de próteses em um sistema público de saúde]. Rev Panam Salud Publica 2023; 47:e153. [PMID: 38089108 PMCID: PMC10712571 DOI: 10.26633/rpsp.2023.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/28/2023] [Indexed: 03/08/2024] Open
Abstract
Objective Compare the health outcomes and financial outcomes of two systems for the procurement of prostheses: the traditional system, in which procurement is initiated when a product is requested; and the "Prosthesis Bank" model, based on a current inventory of supplies. Methods Descriptive-analytical study of users of Ministry of Health services in the province of Buenos Aires, Argentina. The patients belonged to two study groups: 1) prostheses were provided through the traditional computerized system for hospital procurement and contracting, known as SIPACH; and 2) prostheses were provided by the Prosthesis Bank. The study was limited to endovascular prostheses (coronary stents) and hip prostheses. Official government databases were used. The study period was from 01/01/2018 to 31/10/2022. The variables analyzed were: age, sex, diagnosis, hospital, type of implant or prosthesis, date of request, date received, unit price, direct and indirect costs, average cost of daily hospitalization, cost-effectiveness, and budgetary impact. Results A total of 4 106 applications were analyzed. In the traditional system: 13.5% of patients did not get their prostheses; it took 50 days longer than with the Prosthesis Bank; and total costs were higher in SIPACH (coronary stent, +463%; hip prosthesis, +133%). The Prosthesis Bank saved USD 3.2 million annually and prevented 22 deaths through early provision of endovascular prostheses. Conclusions The Prosthesis Bank proved to be superior to the traditional model for providing prostheses, both in terms of health-by achieving better access, shortening waiting times, and avoiding deaths-and financially-by significantly reducing unit and overall prices, achieving significant savings in allocated budgets.
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Affiliation(s)
- Gustavo H. Marin
- Centro Universitario de Farmacología (CUFAR)Universidad Nacional de La Plata-CONICETLa PlataArgentinaCentro Universitario de Farmacología (CUFAR), Universidad Nacional de La Plata-CONICET, La Plata, Argentina.
| | - Pedro Luzuriaga
- Universidad Nacional de Arturo JauretcheFlorencio VarelaArgentinaUniversidad Nacional de Arturo Jauretche, Florencio Varela, Argentina.
| | - Lucia Giangreco
- Centro Universitario de Farmacología (CUFAR)Universidad Nacional de La Plata-CONICETLa PlataArgentinaCentro Universitario de Farmacología (CUFAR), Universidad Nacional de La Plata-CONICET, La Plata, Argentina.
| | - Nasim Iusef-Venturini
- Centro Universitario de Farmacología (CUFAR)Universidad Nacional de La Plata-CONICETLa PlataArgentinaCentro Universitario de Farmacología (CUFAR), Universidad Nacional de La Plata-CONICET, La Plata, Argentina.
| | - Daniela Blanco
- Centro Universitario de Farmacología (CUFAR)Universidad Nacional de La Plata-CONICETLa PlataArgentinaCentro Universitario de Farmacología (CUFAR), Universidad Nacional de La Plata-CONICET, La Plata, Argentina.
| | - Cristian Dorati
- Centro Universitario de Farmacología (CUFAR)Universidad Nacional de La Plata-CONICETLa PlataArgentinaCentro Universitario de Farmacología (CUFAR), Universidad Nacional de La Plata-CONICET, La Plata, Argentina.
| | - Perla Mordujovich-Buschiazzo
- Centro Universitario de Farmacología (CUFAR)Universidad Nacional de La Plata-CONICETLa PlataArgentinaCentro Universitario de Farmacología (CUFAR), Universidad Nacional de La Plata-CONICET, La Plata, Argentina.
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13
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Fasanya C, Lee JJ, Caronia CG, Rothburd L, Japhe T, Hahn YH, Reci D, Eckardt P. The Impact of Screening for Perioperative ICU Admission in Geriatric Hip Fracture Patients: A Retrospective Analysis. Cureus 2023; 15:e49234. [PMID: 38143658 PMCID: PMC10739485 DOI: 10.7759/cureus.49234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Hip fracture patients are a subset of trauma patients with high peri-operative mortality. To mitigate the mortality risk, the use of predictive scoring systems (e.g., RSI or Nomograms) for risk stratification and monitoring of high-risk patients in the intensive care unit (ICU) has been proposed. Screening patients for ICU admission with relatively low-cost tools may achieve high-quality, low-cost care. The aim of this study was to assess the effectiveness and feasibility of screening postoperative hip fracture patients for ICU admission. METHODS This is a retrospective single-site study comparing two groups of patients, before and after implementation of a hip fracture postoperative screening intervention in a level 1 trauma center in the United States. All hip fracture patients > 55 years of age admitted to the hospital between January 2021 and May 2023 were included. Trauma team members assessed and screened patients postoperatively in the post-anesthesia care unit (PACU), ordering standardized tests, including laboratory tests, a chest x-ray, and electrocardiogram (EKG). Assessment of the effect of the intervention included a comparison of a number of major adverse events (MAEs), mortality, planned and unplanned ICU admissions, ICU length of stay (LOS), and hospital LOS between pre- and post-intervention groups. Propensity score (PS) estimates were used to compare outcomes between the matched participants in the sample. A predictive model for ICU admission for the overall sample was estimated, and discriminative ability was assessed with an area under the curve (AUC) receiver operator characteristics (ROC) analysis. Lastly, feasibility was assessed by compliance with screening intervention and charges per patient related to the intervention. RESULTS The sample consisted of 290 patients in the pre-intervention and 180 patients in the post-intervention groups, respectively, with a mean age of 81.4 ± (9.9) years. There was a significant increase (p<0.01) in planned ICU admissions (OR=2.387, 95% CI (1.430, 3.983)) after screening protocol implementation. There was no significant difference between the pre-intervention group and post-intervention group in the number of MAEs (p=0.392), mortality (p=0.591), ICU LOS (p=0.617), and hospital LOS (p=0.151). When the PS-matched sample (n=424) was analyzed, there was a significant decrease (p=0.45) in unplanned ICU admissions (OR=6.40, 95% CI (0.81, 50.95)) after protocol implementation. Anticoagulants, emergency department (ED) respiratory rate (RR), injury severity score (ISS), number of comorbidities, substance use disorder (SAD), peripheral artery disease (PAD), and chronic obstructive pulmonary disease (COPD) were significant predictors of ICU admission (p=0.002, 0.022, 0.030, 0.034, 0.039, 0.039, and 0.042), respectively, and, demonstrated the discriminative ability between high and low risk for ICU admission (AUC=0.597, 0.587, 0.581, 0.578, 0.513, and 0.587, respectively). The screening intervention was achievable with 99% compliance (Kappa estimate 0.94) among trauma team members with an average charge of $282 per patient. CONCLUSION The addition of a postoperative screening intervention for hip fracture patients > 55 years of age is achievable and decreases unplanned ICU admissions in matched samples. Presenting clinical indicators and comorbidities are associated with ICU admission and provide sufficient discriminatory ability as criteria for ICU admission.
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Affiliation(s)
| | - John J Lee
- Orthopaedic Surgery, Good Samaritan University Hospital, West Islip, USA
| | | | | | - Tenzing Japhe
- Trauma, New York Institute of Technology, West Islip, USA
| | - Young Hee Hahn
- Trauma, New York Institute of Technology, West Islip, USA
| | - Dajana Reci
- Trauma, New York Institute of Technology, West Islip, USA
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14
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Huang JW, Yang YF, Gao XS, Zhou M, Xiao N, Kuang JX, Xu ZH. The impact of preoperative single low-dose dexamethasone on in-hospital prognosis in geriatric intertrochanteric fracture patients: Analysis of secondary outcomes in a randomized controlled trial. Surgery 2023; 174:1041-1049. [PMID: 37481423 DOI: 10.1016/j.surg.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/03/2023] [Accepted: 06/18/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Intertrochanteric fracture in the geriatric population is associated with poor prognosis, which may be attributed to consistent stress and the systemic inflammatory response. Dexamethasone is an exogenous glucocorticoid commonly used in clinical practice for broad anti-inflammatory action. The purpose is to investigate whether a single preoperative low-dose dexamethasone can improve the in-hospital prognosis in geriatric intertrochanteric fracture patients undergoing internal fixation surgery. METHODS Between June 2020 and October 2022, 219 eligible patients with intertrochanteric fractures were in this study. After meeting the inclusion and exclusion criteria, 160 patients were randomly allocated to the dexamethasone or placebo groups (80 patients who are geriatric with an intertrochanteric fracture in each group). The patients in the dexamethasone group received 10 mg (2 mL) of dexamethasone intravenously, whereas the patients in the placebo group received 2 mL of saline intravenously within 30 minutes before being sent to the operating room. The efficacy-related outcomes (the first bed-chair transfer ability, in-hospital mortality, and length of stay) and safety-related outcomes (infection events and hyperglycemia) were collected for analysis. RESULTS There were no significant differences in the baseline characteristics between the 2 groups. The dexamethasone group had a significantly higher rate of the first bed-chair transfer than the placebo group (65.0% [52/80] vs 48.8% [39/80], relative risk = 1.46, 95% confidence interval = 1.02 to 2.11; P = .038). One patient in the dexamethasone group and 7 patients in the placebo group died during hospitalization (1.3% [1/80] vs 8.8% [7/80], relative risk = 0.92, 95% confidence interval = 0.86 to 0.99; P = .07). No differences were found in the length of stay, infections, and hyperglycemia between the 2 groups. CONCLUSION A single preoperative low-dose of dexamethasone can improve the in-hospital prognosis (increase the ability of the first bed-chair transfer and potentially decrease the in-hospital mortality) in geriatric intertrochanteric fracture patients after internal fixation surgery.
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Affiliation(s)
- Jian-Wen Huang
- Department of Orthopaedic Surgery, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Yun-Fa Yang
- Department of Orthopaedic Surgery, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China.
| | - Xiao-Sheng Gao
- Department of Orthopaedic Surgery, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Mi Zhou
- Department of Orthopaedic Surgery, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Na Xiao
- Department of Orthopaedic Surgery, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Jiong-Xiang Kuang
- Department of Orthopaedic Surgery, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
| | - Zhong-He Xu
- Department of Orthopaedic Surgery, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangdong, China
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15
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Liu Z, Du Z, Lu H, Fu Z, Xu H. Delay between admission and surgery as a potential risk factor for postoperative morbidity and mortality in elderly patients with hip fractures: A retrospective study. J Orthop Sci 2023; 28:1124-1130. [PMID: 36031534 DOI: 10.1016/j.jos.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 07/03/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to assess the impact of delay between admission and surgery on the postoperative outcomes such as mortality and related complications in elderly patients with acute hip fractures. METHODS 840 patients aged ≥65 years from January 2009 to September 2015 were included in this retrospective study. According to the interval from admission to surgery, the patients were divided into four groups: group A (surgery within 24 h), group B (surgery within 24 h-48 h), group C (surgery within 48 h-72 h), and group D (surgery later than 72 h). Postoperative complications during hospitalization and mortality at different follow-up time points were compared. RESULTS A total of 763 cases were successfully followed up, with an average follow-up time of 30.4 ± 13.1 months. The mean age of the patients was 79.4 ± 6.8 years. The difference in gross postoperative complications among groups was statistically significant in terms of pressure sore (P = 0.02), respiratory complications (P = 0.001), and urological complications (P < 0.001). The multivariate logistic regression analysis identified 3 factors independently associated with the postoperative morbidity, including age (odds ratio [OR] = 1.040), postoperative drainage volume (OR = 1.002) and time from admission to surgery (OR = 1.108). The difference in postoperative mortality among groups was statistically significant at 1 year (P = 0.046) after operation. The multivariate logistic regression analysis identified that age, postoperative drainage volume and time from admission to surgery were independently associated with mortality at 1 year postsurgery. CONCLUSION The incidence of postoperative morbidity and mortality in elderly patients with hip fracture is usually the result of multiple factors, surgeons should pay attention to the patient's age, postoperative wound status and surgical delay time, which may significantly affect the outcome of the treatment.
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Affiliation(s)
- Zhongdi Liu
- Trauma Medicine Center, Peking University People's Hospital, China.
| | - Zhe Du
- Trauma Medicine Center, Peking University People's Hospital, China.
| | - Hao Lu
- Department of Trauma and Orthopedics, Peking University People's Hospital, China.
| | - Zhongguo Fu
- Department of Trauma and Orthopedics, Peking University People's Hospital, China.
| | - Hailin Xu
- Department of Trauma and Orthopedics, Peking University People's Hospital, China.
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16
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Babagoli M, Ghaseminejad Raeini A, Sheykhvatan M, Baghdadi S, Shafiei SH. Influencing factors on morbidity and mortality in intertrochanteric fractures. Sci Rep 2023; 13:12090. [PMID: 37495718 PMCID: PMC10372085 DOI: 10.1038/s41598-023-38667-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023] Open
Abstract
We aimed to evaluate the effect of the patient's clinical and paraclinical condition before and after surgery on short-term mortality and complication and long-term mortality. A retrospective cohort study was conducted and multivariate logistic regression was applied to determine the effect of demographic characteristics (sex, age, AO/OTA classification, height, weight, body mass index), medical history (hypertension, ischemic heart disease, diabetes mellitus, thyroid malfunction, cancer, osteoporosis, smoking) lab data (Complete blood cell, blood sugar, Blood Urea Nitrogen, Creatinine, Na, and K), surgery-related factors (Anesthesia time and type, implant, intraoperative blood transfusion, postoperative blood transfusion, and operation time), duration of admission to surgery and anticoagulant consumption on short-term mortality and complication and long-term mortality. Three hundred ten patients from November 2016 to September 2020 were diagnosed with an intertrochanteric fracture. 3.23% of patients died in hospital, 14.1% of patients confronted in-hospital complications, and 38.3% died after discharge till the study endpoint. ΔNumber of Neutrophiles is the primary determinant for in-hospital mortality in multivariate analysis. Age and blood transfusion are the main determinants of long-term mortality, and Na before surgery is the primary variable associated with postoperative complications. Among different analytical factors Na before surgery as a biomarker presenting dehydration was the main prognostic factor for in hospital complications. In hospital mortality was mainly because of infection and long-term mortality was associated with blood transfusion.
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Affiliation(s)
- Mazyar Babagoli
- Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Mehrdad Sheykhvatan
- Orthopedic Surgery Research Center, Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soroush Baghdadi
- Pediatric Orthopaedic Surgery Department, Montefiore Medical Center, New York, USA
| | - Seyyed Hossein Shafiei
- Orthopedic Surgery Research Center, Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
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17
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Nishimura Y, Inagaki Y, Noda T, Nishioka Y, Myojin T, Ogawa M, Kido A, Imamura T, Tanaka Y. Risk factors for mortality after hip fracture surgery in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Arch Osteoporos 2023; 18:91. [PMID: 37418095 PMCID: PMC10329059 DOI: 10.1007/s11657-023-01293-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023]
Abstract
We investigated the risk factors for mortality of hip fracture in the elderly using the National Database of Health Insurance Claims in Japan, and survival was significantly related to sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism. PURPOSE Hip fracture is the most common fracture in the elderly and is known to have a high mortality rate. In Japan, to the best of our knowledge, no studies have reported on mortality risk factors for hip fracture using nationwide registry databases. This study aimed to determine the number of occurrences of hip fracture and factors that increase mortality using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. METHODS This study included extracted data from patients who were hospitalized and underwent surgical treatment for hip fracture between 2013 and 2021, using a nationwide health insurance claims database in Japan. Patient characteristics, such as sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism, were tabulated to obtain 1-year and in-hospital mortality rates. RESULTS Both 1-year and in-patient survival were significantly lower in men, older patients, patients who underwent surgery after 3 days of admission, and patients with trochanteric and subtrochanteric fractures, internal fixation, more preoperative comorbidities, blood transfusions, and pulmonary embolism. CONCLUSIONS Survival was significantly related to sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism. As the number of male patients with hip fracture will increase with the aging of society, medical staff must provide sufficient information before surgery to avoid postoperative mortality.
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Affiliation(s)
- Yuki Nishimura
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
| | - Yusuke Inagaki
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan.
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan.
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Munehiro Ogawa
- Department of Sports Medicine, Nara Medical University, Kashihara, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
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Gasparik AI, Lorenzovici L, Pașcanu IM, Csata Z, Poiană C, Dobre R, Bartelick MM. Predictors of mortality for patients with hip fracture: a study of the nationwide 1-year records of 24,950 fractures in Romania. Arch Osteoporos 2023; 18:69. [PMID: 37195371 DOI: 10.1007/s11657-023-01253-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/19/2023] [Indexed: 05/18/2023]
Abstract
We conducted a study evaluating incidence rates and influencing factors in Romanian hip fracture patients. Our results showed that the type of fracture and its respective surgical procedure as well as hospital characteristics correlate with mortality. Updated incidences can result in updated treatment guidelines. PURPOSE The aim of our study was to assess incidence rates for a revision-calibration of the Romanian FRAX tool and to evaluate particularities of hip fracture cases to determine patient- and hospital-related variables affecting mortality. METHODS We conducted a retrospective study using hospital reports of hip fracture codes to the National School of Statistics (NSS) from January 1, 2019, until December 31, 2019. The study population included 24,950 patients presenting to Romanian public hospitals in all 41 counties: ≥ the age of 40 with diagnostic ICD 10 codes: S72.0 femoral neck fracture, S72.1 pertrochanteric femoral fracture, and S72.2 subtrochanteric femoral fracture and procedure codes: O11104 (trochanteric/sub capital internal fixation), O12101 (hemiarthroplasty), O11808 (closed femoral reduction with internal fixation), O12103 (partial arthroplasty), O12104 (total arthroplasty). Hospital length of stay (LoS) was classified as follows: < 6, 6-9, 10-14, and ≥ 15 days. RESULTS Incidence of hip fractures was 248/100,000 among those aged 50 + and 184/100,000 within the 40 + age category. Average age of the patients was 77 years (80 for females, 71 for males); 83.7% of the patients were 65 + with equivalent urban-rural distributions. Males had a 1.7 times higher mortality risk. Each year increase in age added a mortality risk of 6.9%. In-hospital mortality was 1.34 times higher among patients living in urban areas. Hemiarthroplasty and partial/total unilateral/bilateral arthroplasty had a lower risk of mortality than trochanteric/sub capital internal fixation (p < 0.02, p < 0.033). CONCLUSION Gender, age, residence, and procedure type had significant impact on mortality. Updated incidence rates will allow the revision of Romania's FRAX model.
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Affiliation(s)
- Andrea I Gasparik
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - László Lorenzovici
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Ionela M Pașcanu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Zsombor Csata
- Faculty of Sociology and Social Work, Babeș-Bolyai University of Cluj Napoca, Cluj-Napoca, Romania
- Center for Social Sciences, Institute for Minority Studies, Budapest, Hungary
| | - Cătălina Poiană
- Carol Davila University of Medicine and Pharmacy of Bucharest, Bucharest, Romania
| | - Ramona Dobre
- Carol Davila University of Medicine and Pharmacy of Bucharest, Bucharest, Romania
| | - Miruna M Bartelick
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania.
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Gao YC, Shi L, Zhang YW, Gao W, Tian X, Cao MM, Li YJ, Chen H, Rui YF. Postoperative awake prone position in geriatric patients with hip fractures: a protocol for a randomized controlled trial on the efficacy of postoperative prone position in reducing pulmonary complications and improving oxygenation. Trials 2023; 24:280. [PMID: 37069686 PMCID: PMC10110345 DOI: 10.1186/s13063-023-07308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/11/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Postoperative pulmonary complications (PPCs) are prevalent in geriatric patients with hip fractures. Low oxygen level is one of the most important risk factors for PPCs. Prone position has been proven efficacy in improving oxygenation and delaying the progress of pulmonary diseases, especially in patients with acute respiratory distress syndrome induced by multiple etiologies. The application of awake prone position (APP) has also attracted widespread attention in recent years. A randomized controlled trial (RCT) will be carried out to measure the effect of postoperative APP in a population of geriatric patients undergoing hip fracture surgery. METHODS This is an RCT. Patients older than 65 years old admitted through the emergency department and diagnosed with an intertrochanteric or femoral neck fracture will be eligible for enrollment and assigned randomly to the control group with routine postoperative management of orthopedics or APP group with an additional prone position for the first three consecutive postoperative days (PODs). Patients receiving conservative treatment will not be eligible for enrollment. We will record the difference in the patient's room-air-breathing arterial partial pressure of oxygen (PaO2) values between the 4th POD (POD 4) and emergency visits, the morbidity of PPCs and other postoperative complications, and length of stay. The incidence of PPCs, readmission rates, and mortality rates will be followed up for 90 PODs. DISCUSSION We describe the protocol for a single-center RCT that will evaluate the efficacy of postoperative APP treatment in reducing pulmonary complications and improving oxygenation in geriatric patients with hip fractures. ETHICS AND DISSEMINATION This protocol was approved by the independent ethics committee (IEC) for Clinical Research of Zhongda Hospital, Affiliated to Southeast University, and is registered on the Chinese Clinical Trial Registry. The findings of the trial will be disseminated through peer-reviewed journals. ETHICS APPROVAL NUMBER 2021ZDSYLL203-P01 TRIAL REGISTRATION: ChiCTR ChiCTR2100049311 . Registered on 29 July 2021. TRIAL STATUS Recruiting. Recruitment is expected to be completed in December 2024.
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Affiliation(s)
- Yu-Cheng Gao
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Yuan-Wei Zhang
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Wang Gao
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Xie Tian
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Mu-Min Cao
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Ying-Juan Li
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Hui Chen
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Yun-Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China.
- Orthopaedic Trauma Institute (OTI), Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China.
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China.
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People's Republic of China.
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Page BJ, Hughes JL, Walsh JM, Stimson LN, Hammonds KP, Brennan KL, Stahl DL, Brennan ML. Association of Brain Natriuretic Peptide Levels at Time of Injury with Morbidity and Mortality in Patients with Surgically Treated Hip Fractures. JB JS Open Access 2023; 8:JBJSOA-D-22-00102. [PMID: 37025185 PMCID: PMC10072306 DOI: 10.2106/jbjs.oa.22.00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
An elevated brain natriuretic peptide (BNP) level has been shown to be associated with mortality and cardiac events in cardiac surgery, but its utility in the prediction of morbidity and mortality in hip fracture surgery is unknown. The primary aim of this study was to determine if there is a difference in BNP level at the time of injury between patients who do and do not develop complications after hip fracture surgery. The secondary aim was to determine if there is a predictive relationship between complications associated with the initial BNP level and mortality.
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Affiliation(s)
- Brian Joseph Page
- Limb Lengthening and Complex Reconstruction, Hospital for Special Surgery, New York, NY
- Orthopaedic Traumatology, Hospital for Special Surgery, New York, NY
- Email for corresponding author:
| | | | - Jon Martin Walsh
- Department of Orthopedic Surgery, Baylor Scott & White Health, Temple, Texas
| | | | | | - Kindyle Losey Brennan
- Doctor of Physical Therapy Program, Mayborn College of Health Professions, University of Mary Hardin-Baylor, Belton, Texas
| | - Daniel Lee Stahl
- Department of Orthopedic Surgery, Baylor Scott & White Health, Temple, Texas
| | - Michael Lee Brennan
- Trauma Section, Department of Orthopedic Surgery, Baylor Scott & White Health, Temple, Texas
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Leverett GD, Marriott A. Intravenous tranexamic acid and thromboembolic events in hip fracture surgery: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2023; 109:103337. [PMID: 35643364 DOI: 10.1016/j.otsr.2022.103337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Osteoporotic hip fractures are a major health problem in developed countries. Surgical management is the mainstay of treatment for these injuries, and historically presents an increased risk of thromboembolism, blood loss and blood transfusion. Despite the demonstrated safety of tranexamic acid (TXA) in elective hip arthroplasty, there is uncertainty regarding the risk of thromboembolism with the administration of TXA during hip fracture surgery. This study aims to address the following questions regarding patients undergoing traumatic hip fracture surgery: 1. Does intravenous TXA increase the risk of thromboembolic events? 2. Does intravenous TXA reduce peri-operative blood loss? 3. Does intravenous TXA increase the risk of non-thromboembolic complications or post-operative mortality? METHODS A literature search of Ovid MEDLINE, Embase, PubMed, the Cochrane Register of Controlled Trials and CINAHL was conducted, assessing results from database inception until the 11th May, 2021. We included randomised controlled trials that investigated perioperative administration of intravenous TXA in patients undergoing hip fracture surgery, compared to a control cohort. We excluded articles published in a language other than English, evaluated elective hip arthroplasty, or did not report thromboembolic events. Included trials were analysed using RevMan v5.3. RESULTS Sixteen articles encompassing 1491 patients met inclusion criteria. The risk difference of thromboembolic events in the TXA group was 0.02 (95%C.I. -0.01-0.04; p=0.17). TXA reduced post-operative transfusion rates by 42% (range: 28-54%, p<0.0001). The mean haemoglobin was higher in the TXA group on post-operative day one (0.77g/dL, p<0.0001), day two (0.56g/dL, p<0.0001) and day three (0.42g/dL, p<0.0001). There was no statistically significant difference in non-thromboembolic complications or post-operative mortality across the two cohorts. DISCUSSION There is no conclusive evidence from the current published literature that peri-operative intravenous TXA administration increases the risk of thromboembolic events after hip fracture surgery. This meta-analysis reinforces that TXA is effective in reducing post-operative transfusions and haemoglobin decline after hip fracture surgery. This study found that TXA did not increase non-thromboembolic complications or post-operative mortality. Further large-scale studies evaluating thromboembolic complications as a primary outcome are required to definitively establish the safety of TXA in hip fracture surgery. LEVEL OF EVIDENCE I; meta-analysis of randomised controlled trials.
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Affiliation(s)
- Gregory D Leverett
- Department of Anaesthesia and Perioperative Medicine, Eastern Health, Victoria, Australia; Department of Medicine and Veterinary Science, University of Edinburgh, Edinburgh, Scotland.
| | - Andrew Marriott
- Department of Anaesthetics, Perioperative and Pain Medicine, Barwon Health, Victoria, Australia; Clinical Associate Professor, School of Medicine, IMPACT SRC, Deakin University, Victoria, Australia
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22
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Timing of Adverse Events Within 90 Days of Hip Fracture Surgery: A Database Study. J Am Acad Orthop Surg 2023; 31:245-251. [PMID: 36821080 DOI: 10.5435/jaaos-d-22-00368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 10/23/2022] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Hip fracture surgery is associated with notable morbidity. Understanding the timing of adverse events can inform strategies for prevention and management. Owing to database limitations, many studies have limited postoperative follow-up to 30 days. However, adverse events may not have plateaued by this time. This study evaluated adverse events after hip fracture surgery out to 90 days. METHODS Hip fracture surgeries in patients 65 years or older were identified in the 2010 to 2020 Q3 M91Ortho PearlDiver data set using administrative codes. The 90-day incidence and time of diagnosis of 10 common adverse events were determined and used to calculate median, interquartile range, and middle 80% for time of diagnosis. The number of events occurring before and after 30 days was also determined. RESULTS A total of 258,834 hip fracture surgery patients were identified. On average, 70% of adverse events occurred in postoperative days 0 to 30 and 30% occurred in days 31 to 90. The percentage of events in days 31 to 90 ranged from 8% (transfusion) to 42% (wound dehiscence). Compared with patients with a 0- to 30-day adverse event, those with 31- to 90-day adverse events had higher average Elixhauser Comorbidity Index scores (8.6 vs. 7.8, P < 0.001) and a slightly greater proportion of men (31.5% vs. 30.2%, P < 0.001).For specific adverse events, the time of diagnosis (median; interquartile range; middle 80%) were as follows: transfusion (2 days; 1 to 4 days; 1 to 24 days), acute kidney injury (5; 2 to 26; 1 to 55), cardiac event (9; 3 to 35; 1 to 64), urinary tract infection (13; 3 to 39; 1 to 65), hematoma (14; 6 to 28; 3 to 52), pneumonia (15; 5 to 39; 2 to 66), venous thromboembolism (16; 5 to 40; 2 to 64), surgical site infection (23; 14 to 37; 7 to 56), sepsis (24; 9 to 48; 3 to 71), and wound dehiscence (26; 15 to 41; 7 to 64). DISCUSSION Nearly one-third of 90-day adverse events after hip fracture surgery were found to occur after postoperative day 30. An understanding of the timing of adverse events is important for improving patient counseling and optimizing patient care.
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GREVE K, EK S, BARTHA E, MODIG K, HEDSTRÖM M. Waiting more than 24 hours for hip fracture surgery is associated with increased risk of adverse outcomes for sicker patients: a nationwide cohort study of 63,998 patients using the Swedish Hip Fracture Register. Acta Orthop 2023; 94:87-96. [PMID: 36847752 PMCID: PMC9972166 DOI: 10.2340/17453674.2023.9595] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Waiting time to surgery is a modifiable risk factor in hip fracture surgery. However, there is no consensus regarding the acceptable duration of waiting time. We used the Swedish Hip Fracture Register RIKSHÖFT and 3 administrative registers to explore the association between time to surgery and adverse outcomes after discharge. PATIENTS AND METHODS 63,998 patients ≥ 65 years, admitted to a hospital between January 1, 2012, and August 31, 2017 were included. Time to surgery was divided into < 12, 12-24, and > 24 hours. Diagnoses investigated were atrial fibrillation/flutter (AF), congestive heart failure (CHF), pneumonia, and "acute ischemia" (a combination of stroke/intracranial bleeding, myocardial infarction, and acute kidney injury). Crude and adjusted survival analyses were performed. Time spent in hospital following the initial hospitalization was described for the 3 groups. RESULTS Waiting > 24 hours was associated with an increased risk of AF (HR 1.4, 95%CI 1.2-1.6), CHF (HR 1.3, CI 1.1-1.4) and "acute ischemia" (HR 1.2, CI 1.01-1.3). However, stratifying for ASA grade revealed that these associations were present only in patients with ASA 3-4. There was no association between waiting time and pneumonia after the initial hospitalization (HR 1.1, CI 0.97-1.2), but one was found with pneumonia during hospital stay OR 1.2 (CI 1.1-1.4). Time in hospital after the initial hospitalization was similar over the waiting time groups. CONCLUSION The associations between waiting > 24 hours for hip fracture surgery and AF, CHF, and acute ischemia suggest that shorter waiting time may reduce adverse outcomes for the sicker patients.
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Affiliation(s)
- Katarina GREVE
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm,Function Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm
| | - Stina EK
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm
| | - Erzsébet BARTHA
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm,Function Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm
| | - Karin MODIG
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm
| | - Margareta HEDSTRÖM
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm,Trauma and Reparative Medicine Theme (TRM), Karolinska University Hospital, Stockholm, Sweden
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Preoperative Comorbidities Associated With Early Mortality in Hip Fracture Patients: A Multicenter Study. J Am Acad Orthop Surg 2023; 31:81-86. [PMID: 36580049 DOI: 10.5435/jaaos-d-21-01055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 08/05/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Multiple comorbidities in hip fracture patients are associated with increased mortality and complications. The goal of this study was to characterize the relationship between specific patient factors including comorbidities and outcomes in geriatric hip fractures, including length of stay, unplanned ICU admission, discharge disposition, complications, and mortality. METHODS This is a retrospective review of a trauma database from five Level 1 and Level 2 trauma centers of patients with hip fractures of the femoral neck and intertrochanteric region who underwent treatment using hip pinning, hemiarthroplasty, total hip arthroplasty, cephalomedullary nailing, or dynamic hip screw fixation. Mortality was the primary outcome variable (including in-hospital mortality, 30-day mortality, 60-day mortality, and 90-day mortality). Secondary outcome variables included in-hospital adverse events, unplanned transfer to the ICU, postoperative length of stay, and discharge disposition. Regression analyses were used for evaluation of relationships between comorbidities as independent variables and primary and secondary outcomes as dependent variables. RESULTS Two thousand three hundred patients were included. The mortality was 1.8%, 7.0%, 10.9%, and 14.1% for in-hospital, 30-day, 60-day, and 90-day mortality, respectively. Diabetes and cognitive impairment present on admission were associated with mortality at all-time intervals. COPD was the only comorbidity that signaled in-hospital adverse event with an odds ratio of 1.67 (P = 0.012). No patient factors, time to surgery, or comorbidities signaled unplanned ICU transfer. Patients with renal failure and COPD had longer hospital stays after surgery. CONCLUSION Geriatric hip fractures continue to have high short-term morbidity and mortality. Identifying patients with increased odds of early mortality and adverse events can help teams optimize care and outcomes. Patients with diabetes, cognitive impairment, renal failure, and COPD may benefit from continued and improved medical optimization during the perioperative period as well as being more closely managed by a medicine team without delaying time to the operating room.
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Gao Y, Zhang Y, Shi L, Gao W, Li Y, Chen H, Rui Y. What are Risk Factors of Postoperative Pneumonia in Geriatric Individuals after Hip Fracture Surgery: A Systematic Review and Meta-Analysis. Orthop Surg 2023; 15:38-52. [PMID: 36519396 PMCID: PMC9837248 DOI: 10.1111/os.13631] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Postoperative pneumonia (POP) is a common postoperative complication. Negative consequences associated with POP included prolonged hospital length of stay, more frequent intensive care unit (ICU) stays, and a higher rate of sepsis, readmission, and mortality. This meta-analysis aimed to assess the incidence and risk factors associated with POP after hip fracture surgery in elderly patients. PubMed, Web of Science, and Cochrane Library were searched (up to March 31, 2022). All studies on the risk factors for POP after hip fracture surgery in elderly patients, published in English, were reviewed. The qualities of the included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled, and a meta-analysis was performed. Ten studies, including 12,084 geriatric patients undergoing hip fracture surgery, were included. Of these 12,084 patients, POP occurred in 809 patients. The results indicated that age (mean difference [MD] = 4.95, 95% confidence interval [CI]: 3.22-6.69), male (odds ratio [OR] = 1.41, 95% CI: 1.02-1.93), the American Society of Anaesthesiologists classification ≥3 (OR = 3.48, 95% CI: 1.87-6.47), dependent functional status (OR = 5.23, 95% CI: 2.18-12.54, P = 0.0002), smoking (OR = 1.33, 95% CI: 1.07-1.65), chronic obstructive pulmonary disease (OR = 3.76, 95% CI: 2.07-6.81), diabetes mellitus (OR = 1.19, 95% CI: 1.01-1.40), coronary heart disease (OR = 1.74, 95% CI: 1.23-2.46), arrhythmia (OR = 1.47, 95% CI: 1.01-2.14), cerebrovascular disease (OR = 1.88, 95% CI: 1.56-2.27), dementia (OR = 2.36, 95% CI: 1.04-5.36), chronic renal failure (OR = 1.85, 95% CI: 1.29-2.67), hip arthroplasty (OR = 1.30, 95% CI: 1.08-1.56), delayed surgery (OR = 6.40, 95% CI: 3.00-13.68), preoperative creatinine (MD = 5.32, 95% CI: 0.55-10.08), and preoperative serum albumin (MD = -3.01, 95% CI: -4.21 - -1.80) were risk factors for POP. Related prophylactic measures should be provided in geriatric patients with the above-mentioned risk factors to prevent POP after hip fracture surgery.
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Affiliation(s)
- Yu‐Cheng Gao
- Department of Orthopaedics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina
- School of MedicineSoutheast UniversityNanjingChina
- Orthopaedic Trauma Institute (OTI)Southeast UniversityNanjingChina
- Trauma Center, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Yuan‐Wei Zhang
- Department of Orthopaedics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina
- School of MedicineSoutheast UniversityNanjingChina
- Orthopaedic Trauma Institute (OTI)Southeast UniversityNanjingChina
- Trauma Center, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina
- School of MedicineSoutheast UniversityNanjingChina
- Orthopaedic Trauma Institute (OTI)Southeast UniversityNanjingChina
- Trauma Center, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Wang Gao
- Department of Orthopaedics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina
- School of MedicineSoutheast UniversityNanjingChina
- Orthopaedic Trauma Institute (OTI)Southeast UniversityNanjingChina
- Trauma Center, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Ying‐Juan Li
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina
- Department of Geriatrics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Hui Chen
- Department of Orthopaedics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina
- School of MedicineSoutheast UniversityNanjingChina
- Orthopaedic Trauma Institute (OTI)Southeast UniversityNanjingChina
- Trauma Center, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Yun‐Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina
- School of MedicineSoutheast UniversityNanjingChina
- Orthopaedic Trauma Institute (OTI)Southeast UniversityNanjingChina
- Trauma Center, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
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Purcell K, Tiedemann A, Kristensen MT, Cunningham C, Hjermundrud V, Ariza-Vega P, Perracini M, Sherrington C. Mobilisation and physiotherapy intervention following hip fracture: snapshot survey across six countries from the Fragility Fracture Network Physiotherapy Group. Disabil Rehabil 2022; 44:6788-6795. [PMID: 34514916 DOI: 10.1080/09638288.2021.1974107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Hip fracture guidelines recommend early mobilisation, multidisciplinary care, physiotherapy and fall prevention interventions. This study documents mobilisation practices and physiotherapy interventions provided post-hip fracture in six countries. MATERIALS AND METHODS Physiotherapists from orthopaedic wards in Denmark, Australia, Spain, Brazil, Norway and Ireland provided information regarding mobilisation and physiotherapy for 10 consecutive hip fracture patients (>60 years), between 2014 and 2018. RESULTS Physiotherapists (n = 107) entered data on 426 patients. Two-thirds of patients (283, 66%) attempted standing 0-1 days after surgery (range: 0% of patients in Spain to 92% in Norway). Fewer patients (199, 47%) attempted walking on day 0-1 (range: 0% Spain/Brazil to 69% Norway). Physiotherapy to mobilise every weekday was provided to 356 patients (84%, range: 60% Ireland to 100% Spain). On weekends, physiotherapy to mobilise was limited (175, 40%, range: 0% Spain to 81% Brazil) but 298 patients (70%) mobilised with non-physiotherapy staff (range: 0% Spain to 96% Denmark/Ireland). Physiotherapy treatments included mobility, gait training, and range-of-motion exercises. Referral to fall prevention interventions was low (93, 22%, range: 0% Spain to 76% Ireland). CONCLUSION Stronger compliance with guideline recommendations on early mobilising, weekend mobilising and referral to fall prevention interventions post hip-fracture is needed in some countries.Implications for rehabilitation This study provides a snapshot of mobilisation and physiotherapy practice for hip fracture patients in six countries. The results suggest a need to improve systems and approaches in some countries to enhance compliance with recommendations specifically relating to: • early attempts at standing and walking post-surgery. • opportunities to mobilise on weekends (with physiotherapist and/or other staff). • broader range of multidisciplinary care e.g., geriatric review, occupational therapy and nutrition advice. • use of standardised tests by physiotherapists post-surgery. • referral to fall prevention interventions.
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Affiliation(s)
- Kate Purcell
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Morten Tange Kristensen
- Departments of Physical Therapy and Orthopedic Surgery, Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Amager - Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Vegar Hjermundrud
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Patrocinio Ariza-Vega
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain.,Physical Medicine and Rehabilitation Service, Biohealth Research Institute, Virgen de las Nieves University Hospital, Granada, Spain
| | - Monica Perracini
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
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De Luca A, Murena L, Zanetti M, De Colle P, Ratti C, Canton G. Should the early surgery threshold be moved to 72 h in over-85 patients with hip fracture? A single-center retrospective evaluation on 941 patients. Arch Orthop Trauma Surg 2022; 143:3091-3101. [PMID: 35788762 DOI: 10.1007/s00402-022-04509-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/10/2022] [Indexed: 11/02/2022]
Abstract
AIM Aim of the study was to assess whether early surgery and other clinical and orthogeriatric parameters could affect mortality rate in hip fracture patients aged > 85. MATERIALS AND METHODS Data regarding a 42-month period were retrospectively obtained from the institutional medical records and registry data. Gender, age, fracture pattern, surgical technique, type of anesthesia, timing of surgical intervention (within 24, 48 or 72 h from admission), days of hospitalization, mortality rate divided in intra-hospital, at 30 days and at 1 year were collected for the whole population. Some additional data were collected for an orthogeriatric subgroup. RESULTS 941 patients were considered, with a mean age of 89 years. Surgery was performed within 24, 48 and 72 h in 24.4%, 54.5% and 66.1% of cases, respectively. Intra-hospital mortality rate resulted to be 3.4%, while mortality at 30 days and 1 year resulted to be 4.5% and 31%, respectively. Early surgery within 48 and 72 h were significantly associated with a lower intra-hospital and 30-day mortality rate. In the orthogeriatric subgroup (394 patients), a significant association with a higher mortality rate was found for general anesthesia, number of comorbidities, ADL (Activities of Daily Living) < 3, transfer to other departments. CONCLUSIONS In over-85 hip fracture patients, the threshold for early surgery might be moved to 72 h to allow patients pre-operative stabilization and medical optimization as intra-hospital and 30-day mortality rates remain significantly lower. Advanced age, male sex, number of comorbidities, pre-operative dependency in ADL, general anesthesia, length of hospitalization and transfer to other departments were significantly related to mortality rate.
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Affiliation(s)
- Alessandro De Luca
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy. .,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy. .,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.
| | - Luigi Murena
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Michela Zanetti
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Paolo De Colle
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Chiara Ratti
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Gianluca Canton
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
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Lian T, Brandrud A, Mariero L, Nordsletten L, Figved W. 60% Reduction of reoperations and complications for elderly patients with hip fracture through the implementation of a six-item improvement programme. BMJ Open Qual 2022; 11:bmjoq-2022-001848. [PMID: 35851037 PMCID: PMC9297208 DOI: 10.1136/bmjoq-2022-001848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/03/2022] [Indexed: 11/03/2022] Open
Abstract
IntroductionHip fractures are common, serious and costly fractures in the elderly population. Several guidelines seeking to ensure best practice have been introduced. Although our institution complied with national guidelines for early surgery of hip fractures, no assessment of other evidence-based measures existed. We wanted to assess, test, implement and measure the impact of a quality improvement (QI) programme consisting of key elements proven to be important in the treatment of hip fractures.MethodsWe formed a multidisciplinary QI team, consisting of several specialists in different fields. The QI team assessed multiple possible process measures for inclusion in the programme and selected six measurable interventions for implementation: early surgery, correct administration of prophylactic antibiotics, surgery using proven methods and expertise, a multidisciplinary patient pathway and secondary fracture prevention. The improvement process was monitored by a statistical process control chart (SPC). Complications, reoperations and mortality were compared before (n=293) and after (n=182) the intervention.ResultsThe SPC analyses indicated increasing adherence with all interventions throughout the improvement programme, and sustainability 7 years later. The last four periods showed a stable adherence above 90%. We found 60% reduction in major complications after the implementation of the improvement programme, from 19.1% to 7.7% (HR: 0.38 (95% CI: 0.23 to 0.61, p=0.0007). The need for reoperations due to complications fell from 12.6% to 4.9% (HR: 0.37 (95% CI: 0.21 to 0.67, p=0.0054). We did not find a difference in post-operative mortality after the implementation of the QI programme (HR: 0.95 (95% CI: 0.74 to 1.2, p=0.645).ConclusionOur multiprofessional improvement programme achieved almost full adherence within 2 years and was sustainable 7 years later. The quality and safety of the care process were improved and led to a substantial and sustainable decrease in complications and reoperations.
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Affiliation(s)
- Tom Lian
- Orthopedic Surgery, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aleidis Brandrud
- Department of Research and Innovation, Vestre Viken Hospital Trust, Drammen, Norway
| | - Lars Mariero
- Oslo Office, Boston Consulting Group, Oslo, Norway
| | - Lars Nordsletten
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Wender Figved
- Orthopedic Surgery, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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29
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Fuchs JR, Gibly RF, Erickson CB, Thomas SM, Hadley Miller N, Payne KA. Analysis of Physeal Fractures from the United States National Trauma Data Bank. CHILDREN 2022; 9:children9060914. [PMID: 35740851 PMCID: PMC9221780 DOI: 10.3390/children9060914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 01/08/2023]
Abstract
Background: Pediatric long-bone physeal fractures can lead to growth deformities. Previous studies have reported that physeal fractures make up 18–30% of total fractures. This study aimed to characterize physeal fractures with respect to sex, age, anatomic location, and Salter–Harris (SH) classification from a current multicenter national database. Methods: A retrospective cohort study was performed using the 2016 United States National Trauma Data Bank (NTDB). Patients ≤ 18 years of age with a fracture of the humerus, radius, ulna, femur, tibia, or fibula were included. Results: The NTDB captured 132,018 patients and 58,015 total fractures. Physeal fractures made up 5.7% (3291) of all long-bone fractures, with males accounting for 71.0% (2338). Lower extremity physeal injuries comprised 58.6% (1929) of all physeal fractures. The most common site of physeal injury was the tibia comprising 31.8% (1047), 73.9% (774) of which were distal tibia fractures. Physeal fractures were greatest at 11 years of age for females and 14 years of age for males. Most fractures were SH Type II fractures. Discussion and Conclusions: Our analysis indicates that 5.7% of pediatric long-bone fractures involved the physis, with the distal tibia being the most common. These findings suggest a lower incidence of physeal fractures than previous studies and warrant further investigation.
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Affiliation(s)
- Joseph R. Fuchs
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (J.R.F.); (R.F.G.); (C.B.E.); (S.M.T.); (N.H.M.)
- McGaw Medical Center, Northwestern University, Chicago, IL 60611, USA
| | - Romie F. Gibly
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (J.R.F.); (R.F.G.); (C.B.E.); (S.M.T.); (N.H.M.)
- Division of Orthopaedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Christopher B. Erickson
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (J.R.F.); (R.F.G.); (C.B.E.); (S.M.T.); (N.H.M.)
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Stacey M. Thomas
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (J.R.F.); (R.F.G.); (C.B.E.); (S.M.T.); (N.H.M.)
| | - Nancy Hadley Miller
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (J.R.F.); (R.F.G.); (C.B.E.); (S.M.T.); (N.H.M.)
- Musculoskeletal Research Center, Children’s Hospital Colorado, Aurora, CO 80045, USA
| | - Karin A. Payne
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (J.R.F.); (R.F.G.); (C.B.E.); (S.M.T.); (N.H.M.)
- Gates Center for Regenerative Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Correspondence:
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30
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Villacres Mori B, Young JR, Lakra A, Chisena E. Team Approach: Management of Geriatric Acetabular Fractures. JBJS Rev 2022; 10:01874474-202205000-00009. [PMID: 35613307 DOI: 10.2106/jbjs.rvw.22.00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Geriatric acetabular fractures are defined as fractures sustained by patients who are ≥60 years old. With the rapidly aging American populace and its increasingly active lifestyle, the prevalence of these injuries will continue to increase. » An interdisciplinary approach is necessary to ensure successful outcomes. This begins in the emergency department with hemodynamic stabilization, diagnosis of the fracture, identification of comorbidities and concomitant injuries, as well as early consultation with the orthopaedic surgery service. This multifaceted approach is continued when patients are admitted, and trauma surgery, geriatrics, and cardiology teams are consulted. These teams are responsible for the optimization of complex medical conditions and risk stratification prior to operative intervention. » Treatment varies depending on a patient's preinjury functional status, the characteristics of the fracture, and the patient's ability to withstand surgery. Nonoperative management is recommended for patients with minimally displaced fractures who cannot tolerate the physiologic stress of surgery. Percutaneous fixation is a treatment option most suited for patients with minimally displaced fractures who are at risk for displacing the fracture or are having difficulty mobilizing because of pain. Open reduction and internal fixation is recommended for patients with displaced acetabular fractures who are medically fit for surgery and have a displaced fracture pattern that would do poorly without operative intervention. Fixation in combination with arthroplasty can be done acutely or in delayed fashion. Acute fixation combined with arthroplasty benefits patients who have poorer bone quality and fracture characteristics that make healing unlikely. Delayed arthroplasty is recommended for patients who have had failure of nonoperative management, have a fracture pattern that is not favorable to primary total hip arthroplasty, or have developed posttraumatic arthritis.
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31
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McDonald CL, Cohen BH, Medina Pérez G, Modest JM, Kuris EO, Born C. Pre-Operative Medications as a Predictor for Post-Operative Complications Following Geriatric Hip Fracture Surgery. Geriatr Orthop Surg Rehabil 2022; 13:21514593221091062. [PMID: 35450299 PMCID: PMC9016589 DOI: 10.1177/21514593221091062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Fragility hip fractures are a common orthopedic injury seen in Emergency
Departments, with variable outcomes that can range from average to
devastating. Currently, few reliable metrics to predict which patients will
suffer post-operative complications exist. The aim of this study was to
determine if the number and type of pre-operative medications can help
predict post-operative complications. Methods A prospectively collected database of hip fracture patients was
retrospectively reviewed. Patients with isolated greater trochanteric
fractures, periprosthetic fractures, or re-fractures were excluded.
Pre-operative baseline characteristics as well as number and type of
post-operative complications were reviewed. Any complication within 6 months
of surgery and complications that could be directly attributable to the
surgical procedure within 2 years of surgery were examined. Major
complications (return to the operating room, deep infection, pulmonary,
cardiac, and hematologic) and minor medical complications were assessed. A
multivariate regression model was performed to identify independent risk
factors. Results Three-hundred ninety-one patients were included. A majority were aged 80–90
and female, and lived at home prior to presentation. Overall, 33.7% of
patients suffered a complication within a 2-year follow-up period. Mortality
rates were 5.4%, 10.0%, and 14.9% over 30 days, 1 year, and 2 years,
respectively. After assessing this relationship while controlling for age,
sex, injury type, pre-operative residence, ambulatory status, ASA score, and
CCI score, the relationship remained significant for both an increased
number of complications (P = .048) and a higher likelihood
of having a complication (P = .008). Cardiovascular
(P = .003), pulmonary (P = .001), gout
(P = .002), or diabetes (P = .042)
medications were associated with a higher likelihood for experiencing a
complication. Conclusions Our study suggests that there is a strong and linear relationship between the
number and type of pre-operative medications taken and risk of
post-operative complications. This exists for up to 8 medications, at which
point further increase does not contribute to an increased risk of
complication. This relationship exists even after controlling for
confounding variables and can be used by surgeons to better counsel patients
and families regarding their specific risk for suffering perioperative
complications.
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Affiliation(s)
- Christopher L McDonald
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Brian H Cohen
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Giancarlo Medina Pérez
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Jacob M Modest
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Eren O Kuris
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Christopher Born
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Increased risk of hip fracture mortality associated with intraoperative hypotension in elderly hip fracture patients is related to under resuscitation. J Clin Orthop Trauma 2022; 26:101783. [PMID: 35242530 PMCID: PMC8857490 DOI: 10.1016/j.jcot.2022.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND As the US and world population ages, hip fractures are increasingly more common. The mortality associated with these fractures remains high both in the immediate postoperative period and at one year. Perioperative resuscitation in this population is of key interest to prevent organ injury and mortality. Our objectives were to evaluate the effect of fluid resuscitation and hemodynamic status in the form of mean arterial pressure (MAP) on inpatient mortality of hip fracture patients. METHODS An institutional database was queried to compare elderly hip fracture patients that sustained in-hospital mortality to a matched control cohort. Pre-, intra-, and post-operative intravenous fluid (IVF) administration and MAP were extracted from the electronic medical record. Time from hospital presentation to the OR was also recorded. RESULTS 1,114 total hip fractures were identified during the two-year study period, 16 of which suffered inpatient mortalities. The mortality cohort was then matched with a control of 394 hip fracture patients for the same period based on age, sex, and Charlson Comorbidity Index (CCI). Conditional logistical regression analysis found odds ratios (OR) indicating that longer time between presentation and surgery (OR per additional hour: 1.05; 95% CI: 1.01-1.08) and lower intraoperative minimum MAP (OR per 5 mmHg decrease: 0.77; 95% CI: 0.61-0.97) were associated with significantly increased odds of mortality. There was also a marginal relationship between greater intraoperative IVF administration and reduced odds of mortality (OR per 500 cc additional fluid: 0.61; 95% CI: 0.37-1.00). CONCLUSION Extended time from presentation to surgery and intraoperative hypotension were associated with increased likelihood of inpatient mortality in an elderly hip fracture cohort, with a possible additional effect of under-resuscitation. Further investigation into a safe intraoperative minimum MAP should be pursued. LEVEL OF EVIDENCE Level III.
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Ross MR, Hurst PM, Asti L, Cooper JN. Impact of Medicaid expansion on young adult firearm and motor vehicle crash trauma patients. Surg Open Sci 2022; 8:9-19. [PMID: 35243283 PMCID: PMC8881723 DOI: 10.1016/j.sopen.2022.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The Affordable Care Act Medicaid expansion has increased insurance coverage and reduced some disparities in care and outcomes among trauma patients, but its impact on subsets of trauma patients with particular mechanisms of injury are unclear. This study evaluated the association of the Affordable Care Act Medicaid expansion with insurance coverage, trauma care, and outcomes among young adults hospitalized for firearm- or motor vehicle crash-related injuries. MATERIALS AND METHODS We used statewide hospital discharge data from 5 Medicaid expansion and 5 nonexpansion states to compare changes in insurance coverage and outcomes among firearm and motor vehicle crash trauma patients aged 19-44 from before (2011-2013) to after (2014-2017) Medicaid expansion. We examined difference in differences overall, by race/ethnicity, and by zip-code-level median income quartile. RESULTS Medicaid expansion was associated with a decrease in the proportion of young adult motor vehicle crash and firearm trauma patients who were uninsured (motor vehicle crash: difference in differences - 12.7 percentage points, P < .001; firearm: difference in differences - 30.7 percentage points, P < .001). Medicaid expansion was also associated with increases in the percentage of patients discharged to any rehabilitation (motor vehicle crash: difference in differences 1.78 percentage points, P = .001; firearm: difference in differences 2.07 percentage points, P = .02) and inpatient rehabilitation (motor vehicle crash: difference in differences 1.21 percentage points, P = .001; firearm: difference in differences 1.58 percentage points, P = .002). Among patients with firearm injuries, Medicaid expansion was associated with a reduction in in-hospital mortality (difference in differences - 1.55 percentage points, P = .002). CONCLUSION In its first 4 years, the Affordable Care Act Medicaid expansion increased insurance coverage and access to rehabilitation among young adults hospitalized for firearm- or motor vehicle crash-related injuries while reducing inpatient mortality among firearm trauma patients.
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Affiliation(s)
- Michael R. Ross
- The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States,Medical Student Research Program, The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States
| | - Philip M. Hurst
- The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States,Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205, United States
| | - Lindsey Asti
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205, United States,Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205, United States
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205, United States,Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205, United States,Department of Pediatrics, College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, United States,Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Ave Columbus, OH 43210, United States,Corresponding author at: The Ohio State University, 700 Children's Drive Columbus, OH 43205, United States. Tel.: + 1(614)355-4526.
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Length of hospital stay and mortality of hip fracture surgery in patients with Coronavirus disease 2019 (COVID-19) infection. CURRENT ORTHOPAEDIC PRACTICE 2022; 33:172-177. [PMID: 35222789 PMCID: PMC8862679 DOI: 10.1097/bco.0000000000001087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Salvador-Marín J, Ferrández-Martínez FJ, Lawton CD, Orozco-Beltrán D, Martínez-López JF, Kelly BT, Marzo-Campos JC. Efficacy of a multidisciplinary care protocol for the treatment of operated hip fracture patients. Sci Rep 2021; 11:24082. [PMID: 34916570 PMCID: PMC8677748 DOI: 10.1038/s41598-021-03415-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
To assess the effects of a multidisciplinary care protocol on cost, length of hospital stay (LOS), and mortality in hip-fracture-operated patients over 65 years. Prospective cohort study between 2011 and 2017. The unexposed group comprised patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. Variables analyzed were demographics, medical comorbidities, treatment, blood parameters, surgical delay, LOS, re-admissions, mortality, and a composite outcome considering in-hospital mortality and/or LOS > 10 days. We performed a Poisson regression and cost analysis. The cohort included 681 patients: 310 unexposed and 371, exposed. The exposed group showed a shorter surgical delay (3.0 vs. 3.6 days; p < 0.001), and a higher proportion received surgery within 48 h (46.1% vs. 34.2%, p = 0.002). They also showed lower rates of 30-day readmission (9.4% vs. 15.8%, p = 0.012), 30-day mortality (4.9% vs. 9.4%, p = 0.021), in-hospital mortality (3.5% vs. 7.7%; p = 0.015), and LOS (8.4 vs. 9.1 days, p < 0.001). Multivariable analysis showed a protective effect of the protocol on the composite outcome (risk ratio 0.62, 95% CI 0.48-0.80, p < 0.001). Hospital costs were reduced by EUR 112,153.3. A multidisciplinary shared care protocol was associated with a reduction in the LOS, surgical delay, 30-day readmissions, and in-hospital and 30-day mortality, in hip-fracture-operated patients.
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Affiliation(s)
- Jorge Salvador-Marín
- Orthopedic Surgery and Traumatology Service, Sant Joan d'Alacant University Hospital, Alicante, Spain
| | | | - Cort D Lawton
- Hospital for Special Surgery, Sports Medicine Institute, 535 East 70th Street, New York, NY, 10021, USA
| | | | | | - Bryan T Kelly
- Hospital for Special Surgery, Sports Medicine Institute, 535 East 70th Street, New York, NY, 10021, USA
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Sheehan KJ, Goubar A, Martin FC, Potter C, Jones GD, Sackley C, Ayis S. Discharge after hip fracture surgery in relation to mobilisation timing by patient characteristics: linked secondary analysis of the UK National Hip Fracture Database. BMC Geriatr 2021; 21:694. [PMID: 34911474 PMCID: PMC8672496 DOI: 10.1186/s12877-021-02624-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background Early mobilisation leads to a two-fold increase in the adjusted odds of discharge by 30-days compared to late mobilisation. Whether this association varies by patient characteristics identified as reasons for delayed mobilisation is unknown. Methods Audit data was linked to hospitalisation records for 133,319 patients 60 years or older surgically treated for hip fracture in England or Wales between 2014 and 2016. Adjusted proportional odds regression models tested whether the cumulative incidences of discharge differed between those mobilised early and those mobilised late for subgroups defined by dementia, delirium, hypotension, prefracture ambulation, and prefracture residence, accounting for the competing risk of death. Results Overall, 34,253 patients presented with dementia, 9818 with delirium, and 10,123 with hypotension. Prefracture, 100,983 were ambulant outdoors, 30,834 were ambulant indoors only, 107,144 were admitted from home, and 23,588 from residential care. 1502 had incomplete data for ambulation and 2587 for prefracture residence. 10, 8, 8, 12, and 12% fewer patients with dementia, delirium, hypotension, ambulant indoors only prefracture, or admitted from residential care mobilised early when compared to those who presented without dementia, delirium, hypotension, with outdoor ambulation prefracture, or admitted from home. The adjusted odds ratios of discharge by 30-days postoperatively among those who mobilised early compared with those who mobilised late were 1.71 (95% CI 1.62–1.81) for those with dementia, 2.06 (95% CI 1.98–2.15) without dementia, 1.56 (95% CI 1.41–1.73) with delirium, 2.00 (95% CI 1.93–2.07) without delirium, 1.83 (95% CI, 1.66–2.02) with hypotension, 1.95 (95% CI, 1.89–2.02) without hypotension, 2.00 (95% CI 1.92–2.08) with outdoor ambulation prefracture, 1.80 (95% CI 1.70–1.91) with indoor ambulation only prefracture, 2.30 (95% CI 2.19–2.41) admitted from home, and 1.64 (95% CI 1.51–1.77) admitted from residential care, accounting for the competing risk of death. Conclusion Irrespective of dementia, delirium, hypotension, prefracture ambulation or residence, early compared to late mobilisation increased the likelihood of hospital discharge by 30-days postoperatively. However, fewer patients with dementia, delirium, or hypotension, poorer prefracture ambulation, or from residential care mobilised early. There is a need reduce this care gap by ensuring sufficient resource to enable all patients to benefit from early mobilisation. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02624-w.
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Affiliation(s)
- Katie J Sheehan
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King's College London, 2nd Floor Addison House, Guy's Campus, London, SE1 1UL, UK.
| | - Aicha Goubar
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King's College London, 2nd Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Finbarr C Martin
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King's College London, 2nd Floor Addison House, Guy's Campus, London, SE1 1UL, UK.,Guy's and St. Thomas's National Health Service Foundation Trust, London, UK
| | - Chris Potter
- Guy's and St. Thomas's National Health Service Foundation Trust, London, UK
| | - Gareth D Jones
- Guy's and St. Thomas's National Health Service Foundation Trust, London, UK
| | - Catherine Sackley
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King's College London, 2nd Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Salma Ayis
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King's College London, 2nd Floor Addison House, Guy's Campus, London, SE1 1UL, UK
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Fu H, Liang B, Qin W, Qiao X, Liu Q. Development of a prognostic model for 1-year survival after fragile hip fracture in Chinese. J Orthop Surg Res 2021; 16:695. [PMID: 34838076 PMCID: PMC8626932 DOI: 10.1186/s13018-021-02774-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background No prognostic model for the survival of fragile hip fracture has been developed for Asians. The goal of this study was to develop a simple and practical prognostic model to predict survival within 1 year after fragile hip fracture in Asians. Methods A single-center retrospective cohort study was designed. Under a multivariable Cox proportional hazards regression model, we used the preoperative characteristics of patients to predict survival within 1 year after hip fracture. We built a full model and then used the least absolute shrinkage and selection operator (LASSO) method to further shrink the model coefficients and achieved variable screening. Finally, we obtained a LASSO model. The model performance was evaluated with Nagelkerke’s R2 and the concordance (c) statistic. We assessed the internal validity with a bootstrapping procedure of 1 000 repetitions. Results A total of 735 eligible patients were admitted to our department for hip fracture from January 2015 to December 2020, but 11 (1.5%) patients were lost to follow-up. Among the remaining patients, 68 (9.3%) died within 1 year after hip fracture. We identified 12 candidate predictors from the preoperative characteristics of the patients. The last model contained nine predictors: surgery, age, albumin, sex, serum creatinine, malignancy, hypertension, ability to live independently, and cardiovascular and cerebrovascular diseases. Among them, surgery, age, and albumin are effective predictors of survival. The discrimination c statistic of the model is 0.814 (95% confidence interval 0.762–0.865); the corrected value through internal validation is 0.795. Conclusions This prognostic model can accurately predict a 1-year survival rate for patients with fragile hip fractures. This information can help clinicians develop a reasonable and personalized treatment plan.
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Affiliation(s)
- Hairui Fu
- Department of Orthopedics, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.,Department of Orthopedics, Affiliated Fenyang Hospital of Shanxi Medical University, Fenyang, 032200, China
| | - Bin Liang
- Department of Orthopedics, Affiliated Fenyang Hospital of Shanxi Medical University, Fenyang, 032200, China
| | - Wei Qin
- Department of Medical Record Management, Affiliated Fenyang Hospital of Shanxi Medical University, Fenyang, 032200, China
| | - Xiaoxiong Qiao
- Information Center, Affiliated Fenyang Hospital of Shanxi Medical University, Fenyang, 032200, China
| | - Qiang Liu
- Department of Orthopedics, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
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Ledford CK, VanWagner MJ, Spaulding AC, Spencer-Gardner LS, Wilke BK, Porter SB. Outcomes of Femoral Neck Fracture Treated With Hip Arthroplasty in Solid Organ Transplant Patients. Arthroplast Today 2021; 11:212-216. [PMID: 34660866 PMCID: PMC8503575 DOI: 10.1016/j.artd.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Solid organ transplant (SOT) patients have increased risk of complications, infection, and mortality after elective total hip arthroplasty (THA). The study aims to compare SOT recipients' clinical outcomes to a matched group of nontransplant patients after nonelective THA and hemiarthroplasty for acute femoral neck fracture (FNF). Methods A retrospective review identified 31 SOT patients undergoing hip arthroplasty (24 hemiarthroplasty and 7 THA) for FNF and were matched 1:1 to non-SOT patients based on age, sex, body mass index, surgical procedure, and year of surgery. Patient survivorship, perioperative outcomes, complications, and reoperations were compared. The mean follow-up was 3 years. Results The estimated survivorship free from mortality for SOT and non-SOT patients at 1- year was not different (77% and 84%, respectively, P = .52). The 90-day readmission rate was significantly higher with 8 (26%) in the SOT cohort and none in the non-SOT group (P < .01). Major medical complications occurred in 16% of SOT patients compared to 5% in controls (P = .21). Three (10%) reoperations/revisions were required for SOT patients and none in non-SOT group (P = .24). Conclusion SOT recipients undergoing nonelective hip arthroplasty for FNF demonstrated increased readmission rates compared to matched controls. For this rare clinical scenario, diligent perioperative care by surgeons and multidisciplinary transplant specialists is necessary to mitigate increased risk of SOT patients.
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Affiliation(s)
- Cameron K Ledford
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Aaron C Spaulding
- Division of Health Delivery Research, Mayo Clinic, Jacksonville, FL, USA
| | | | - Benjamin K Wilke
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Steven B Porter
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
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Comparação epidemiológica entre as fraturas de fêmur proximal atendidas em um hospital secundário e um terciário. SCIENTIA MEDICA 2021. [DOI: 10.15448/1980-6108.2021.1.39421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objetivo: comparar a ocorrência de fraturas de fêmur proximal atendidas em um hospital secundário e em um terciário.Método: a amostra deste estudo foi composta por todos os pacientes que apresentaram fratura de fêmur proximal atendidos em dois serviços hospitalares, no período de 2015 a 2017, sendo realizada a avaliação dos prontuários.Resultados: embora um maior número de cirurgias tenha sido realizado no hospital terciário, os pacientes atendidos no hospital secundário apresentaram maior número de complicações, provavelmente em decorrência de mais tempo de espera pelo procedimento, incluindo as cirurgias que precisaram ser remarcadas. É provável, também, que esse fato tenha implicado em maior tempo de internação e necessidade de encaminhamento para UTI no período pós-operatório imediato, fenômenos também observados no hospital secundário.Conclusão: estes resultados chamam atenção para a necessidade de reformulação dos protocolos de atendimento a pacientes com fratura proximal de fêmur, visando sanar os problemas aqui apresentados.
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Comparação epidemiológica entre as fraturas de fêmur proximal atendidas em um hospital secundário e um terciário. SCIENTIA MEDICA 2021. [DOI: 10.15448/1980-6108.2021.139421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objetivo: comparar a ocorrência de fraturas de fêmur proximal atendidas em um hospital secundário e em um terciário.Método: a amostra deste estudo foi composta por todos os pacientes que apresentaram fratura de fêmur proximal atendidos em dois serviços hospitalares, no período de 2015 a 2017, sendo realizada a avaliação dos prontuários.Resultados: embora um maior número de cirurgias tenha sido realizado no hospital terciário, os pacientes atendidos no hospital secundário apresentaram maior número de complicações, provavelmente em decorrência de mais tempo de espera pelo procedimento, incluindo as cirurgias que precisaram ser remarcadas. É provável, também, que esse fato tenha implicado em maior tempo de internação e necessidade de encaminhamento para UTI no período pós-operatório imediato, fenômenos também observados no hospital secundário.Conclusão: estes resultados chamam atenção para a necessidade de reformulação dos protocolos de atendimento a pacientes com fratura proximal de fêmur, visando sanar os problemas aqui apresentados.
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Salvador Marín J, Ferrández Martínez F, Fuster Such C, Seguí Ripoll J, Orozco Beltrán D, Carratalá Munuera M, Martínez López J, Marzo Campos J. Factores de riesgo para el ingreso prolongado y mortalidad intrahospitalaria en la fractura del fémur proximal en pacientes mayores de 65 años. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recot.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Salvador Marín J, Ferrández Martínez F, Fuster Such C, Seguí Ripoll J, Orozco Beltrán D, Carratalá Munuera M, Martínez López J, Marzo Campos J. Risk factors for high length of hospital stay and in-hospital mortality in hip fractures in the elderly. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Flikweert ER, Wendt KW, Diercks RL, Izaks GJ, Stewart R, Stevens M, Reininga IHF. A comprehensive multidisciplinary care pathway for hip fractures better outcome than usual care? Injury 2021; 52:1819-1825. [PMID: 33947587 DOI: 10.1016/j.injury.2021.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hip fracture surgery is among the most performed surgical procedures in elderly patients. Mortality rates are high, however, and patients often fail to live independently following a hip fracture. To improve outcome, multidisciplinary care pathways have been initiated, but longer-term results are lacking. Aim of this study was to compare functional outcome and living situation six months after hip fracture treatment with and without a care pathway. PATIENTS AND METHODS A multicentre prospective controlled trial was conducted with three hospitals: in one hospital patients were treated with a care pathway, in the other hospitals patients received usual care. All patients aged ≥ 60 years with a hip fracture were asked to participate. Besides basic characteristics, health-related quality of life (EQ-5D) and performance scores of activities of daily living (Katz Index and Lawton IADL) were assessed. Differences in scores were analysed using linear regression. Propensity score adjustment was used to correct for differences between the care pathway and the usual care group. Missing data were imputed. RESULTS No differences in rate of return to prefracture ADL level were found between patients in the care pathway group and the usual care group. The percentage of participants in the same situation as before the fracture was the same in both treatment groups (81%). There were no significant differences in quality of life, activities of daily living or mortality (15% vs 10%, p = 0.17), but hospital stay in the care pathway group was significantly shorter (median 7 vs 10 days). DISCUSSION Treatment of elderly patients with a hip fracture is commonly organised in care pathways. Although short-term advantages are reported, positive effects on longer-term functional results could not be proven in our study. This study confirmed a shorter hospital stay in the care pathway group, which potentially may lead to a reduction in costs. CONCLUSIONS Functional outcome and living situation six months after a hip fracture is the same for patients treated with or without a care pathway.
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Affiliation(s)
- Elvira R Flikweert
- Department of Surgery-Traumatology University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands.
| | - Klaus W Wendt
- Department of Surgery-Traumatology University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands
| | - Ronald L Diercks
- Department of Orthopedic Surgery University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands
| | - Gerbrand J Izaks
- University Center for Geriatric Medicine University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands
| | - Roy Stewart
- Department of Health Sciences, Community and Occupational Medicine University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands
| | - Inge H F Reininga
- Department of Surgery-Traumatology University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands
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Trauma patients with tibia/fibula fractures are associated with an increased risk of torso, severe head, and severe spine injuries compared to patients with femur fractures. Injury 2021; 52:1346-1350. [PMID: 32988617 DOI: 10.1016/j.injury.2020.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/21/2020] [Accepted: 09/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although previous studies have demonstrated an association between lower extremity fractures and concomitant torso (thorax and abdomen) injuries in trauma patients, they do not compare different types of fractures. Therefore, we investigated the risk of associated torso injuries between femur and tibia/fibula fractures, hypothesizing that trauma patients with femur fractures are at higher risk of torso injuries compared to patients with tibia/fibula fractures. METHODS The Trauma Quality Improvement Program database (2010-2016) was queried for patients presenting with either femur or tibia/fibula fractures. Patients with ground-level falls and penetrating injuries were excluded. Univariable and multivariable logistic regression analyses were performed. RESULTS From 162,354 patients, 104,075 (64.1%) patients had femur fractures and 58,279 (35.9%) had tibia/fibula fractures. Compared to those with femur fractures, patients with tibia/fibula fractures had a higher incidence of torso injuries (32.2% vs. 17.7%, p<0.001). The tibia/fibula fracture group was also associated with an increased risk of torso (OR 2.22, CI 2.17-2.27, p<0.001), severe (abbreviated injury scale grade > 3) head (OR 2.38, CI 2.30-2.46, p<0.001), and severe spine injuries (OR 2.33, CI 2.07-2.62, p<0.001) compared to the femur fracture group. Additionally, patients with tibia/fibula fractures had a higher rate of deep vein thrombosis (2.5% vs. 1.8%, p<0.001) than patients with femur fractures. CONCLUSIONS Contrary to previous studies, we demonstrate patients with tibia/fibula fractures have a higher associated risk of torso, severe head and severe spine injuries than patients with femur fractures. Therefore, trauma surgeons should manage tibia/fibula fracture patients with similar clinical vigilance as femur fracture patients.
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Dobre R, Niculescu DA, Cirstoiu C, Popescu G, Poiana C. Mortality rates and risk factors after low-trauma hip fracture in the largest university center in Romania. Arch Osteoporos 2021; 16:64. [PMID: 33834297 DOI: 10.1007/s11657-021-00934-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/31/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We calculated in-hospital, 30-day, and 1-year mortality rates and analyzed potential mortality risk factors in 2742 patients with low-trauma hip fractures. We found a high mortality rate at 30 days and 1 year after hip fracture. The high mortality can be explained by a very high number of conservatively treated fractures. PURPOSE Data on mortality after low-trauma hip fracture in Romania is scarce and comes from a single-hospital study. Our aim was to calculate mortality rates and risk factors in all patients admitted for low-trauma hip fracture in the largest university medical center of Romania. METHODS We retrospectively analyzed the charts of all patients (>40 years old) admitted for hip fracture in a 12-month period in hospitals with an Orthopedic Department in Bucharest, Romania, and surrounding Ilfov County and calculated the crude in-hospital, 30-day, and 1-year mortality rates after low-trauma hip fractures. A number of potential clinical risk factors for mortality were evaluated. RESULTS We analyzed 2742 low-trauma hip fractures. The in-hospital, 30-day, and 1-year all-cause mortality rates were 4.26% (n=117), 9.59% (n=263), and 29.72% (n=815) respectively. Four hundred and fifty (16.41%) fractures were managed conservatively with a 1-year mortality HR of 3.05 (p<0.001) compared to surgically treated fractures. The 1-year mortality rate in conservatively treated fractures was 56.44% compared to 24.47% in surgically treated fractures. Age, male sex, length of stay in hospital, day of surgery, post-surgical complications, and late surgery were significantly associated (p<0.001) with mortality after hip fracture. The lowest 1-year mortality rate was in surgically treated patients with a length of stay in hospital between 6 and 10 days. CONCLUSION We found a high mortality rate at 30 days and 1 year after low-trauma hip fracture. The high mortality rates can be attributable, in part, to the high number of conservatively treated fractures.
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Affiliation(s)
- Ramona Dobre
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania. .,Department of Endocrinology, National Institute of Endocrinology CI Parhon, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania.
| | - Dan Alexandru Niculescu
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania.,Department of Endocrinology, National Institute of Endocrinology CI Parhon, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania
| | - Catalin Cirstoiu
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 169 Splaiul Independenței, 050098, Bucharest, Romania.,Bucharest Emergency University Hospital, 169 Splaiul Independenței, 050098, Bucharest, Romania
| | - Gheorghe Popescu
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 8 Calea Floreasca, 014461, Bucharest, Romania.,Bucharest Clinical Emergency Hospital, 8 Calea Floreasca, 014461, Bucharest, Romania
| | - Catalina Poiana
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania.,Department of Endocrinology, National Institute of Endocrinology CI Parhon, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania
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Non-operative predictors for subsequent interventions after intracapsular femoral neck fractures in elderly: A comprehensive analysis of the Hungarian nationwide health insurance database. Injury 2021; 52 Suppl 1:S31-S36. [PMID: 32067768 DOI: 10.1016/j.injury.2020.02.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the correlation between non-operative prognostic factors and non-prosthetic fracture-related treatments following internal fixation of intracapsular femoral neck fractures in elderly patients. DESIGN AND SETTING Retrospective observational cohort study. Comprehensive analysis of the Hungarian nationwide health insurance database. PARTICIPANTS Data of in-patient records with S7200 ICD-10 codes were collected from the Hungarian National Health Insurance Fund Administration (HNHIFA) and from the health care provider institutes. The patients with femoral neck fractures in the year of 2000, following reduction and internal fixation aged 60 years or older were evaluated. The secondary, non-prosthetic fracture related treatments during the 8 year follow-up period were registered. MAIN OUTCOME MEASURES Of the prognostic factors, age, gender, type of fracture, season and day of the primary surgery, length of waiting time to the operation and the accompanied diseases were evaluated as risk factors for all type of fracture-related further interventions, with the exception of arthroplasties. RESULTS A total of 2895 patients with intracapsular femoral neck fractures met the study criteria. The mean age was 77.96 years (SD: 8.54). The cohort of the patients was observed for a total of 10,077.8 person-years. The non-prosthetic fracture related treatment was performed in 265 patients (9,2%); the median of the time elapsed to the secondary definitive treatment was 3.5 months. With Cox regression analysis, significant correlation was revealed between the incidence of non-prosthetic treatment and younger age (year, HR = 0.977, p = 0.002), surgical delay (12-24 h vs 0-6 h, HR = 1.518, p = 0.023; 24h+ vs 0-6 h, HR = 1.372, p = 0.050), season of primary osteosynthesis (fall vs summer, HR = 0.636, p = 0.012), and type of femoral neck fracture (intracapsular displaced vs intracapsular undisplaced, HR = 1.340, p = 0,047). There was no significant effect of the day of primary surgery, the gender and the presence of co-morbidities on the incidence of further surgical interventions. CONCLUSION The summertime primary surgical intervention, delay of surgery longer than 12 h and type of femoral neck fracture are independent predictors of non-prosthetic further treatment of femoral neck fractures in elderly patients. LEVEL OF EVIDENCE Level IV, evidence from cohort studies.
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Walking Greater Than 5 Feet After Hip Fracture Surgery Is Associated With Fewer Complications, Including Death. J Am Acad Orthop Surg 2021; 29:213-218. [PMID: 32694327 DOI: 10.5435/jaaos-d-19-00320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/16/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Hip fractures in the elderly are associated with notable morbidity. The influence of postoperative ambulation on outcomes is not well described. We hypothesized that patients who mobilize faster after surgical intervention would demonstrate fewer postoperative complications. METHODS A retrospective review was performed on patients with hip fractures from October 2015 through September 2017. All ambulatory patients at least 65 years old (y/o), with a low-energy mechanism of injury, and who underwent surgical treatment were included. Physical therapy notes were used to track postoperative ambulation, and medical records were reviewed for 90-day postoperative complications. RESULTS One hundred sixty-three patients were included (64 femoral neck, 88 intertrochanteric, and 11 subtrochanteric fractures). Eighty patients had postoperative complication(s). Walking >5 feet by 72 hours postoperatively was associated with decreased morbidity (complication rate: 31% versus 77% (≤5 feet ambulation), P < 0.001). Walking >5 feet by 72 hours postoperatively decreased the likelihood of myocardial infarction (P = 0.003), pneumonia (P = 0.021), intensive care unit admission (P < 0.001), and death or hospice transfer (P < 0.001). DISCUSSION Ambulating >5 feet within 72 hours postoperatively is associated with a lower postoperative complication rate. To our knowledge, this study is the first to quantify the relationship between postoperative hip fracture mobilization and morbidity and mortality. LEVEL OF EVIDENCE Prognostic, Level III.
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Sheehan KJ, Goubar A, Almilaji O, Martin FC, Potter C, Jones GD, Sackley C, Ayis S. Discharge after hip fracture surgery by mobilisation timing: secondary analysis of the UK National Hip Fracture Database. Age Ageing 2021; 50:415-422. [PMID: 33098414 PMCID: PMC7936027 DOI: 10.1093/ageing/afaa204] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 02/06/2023] Open
Abstract
Objective To determine whether mobilisation timing was associated with the cumulative incidence of hospital discharge by 30 days after hip fracture surgery, accounting for potential confounders and the competing risk of in-hospital death. Method We examined data for 135,105 patients 60 years or older who underwent surgery for nonpathological first hip fracture between 1 January 2014 and 31 December 2016 in any hospital in England or Wales. We tested whether the cumulative incidences of discharge differed between those mobilised early (within 36 h of surgery) and those mobilised late, accounting for potential confounders and the competing risk of in-hospital death. Results A total of 106,722 (79%) of patients first mobilised early. The average rate of discharge was 39.2 (95% CI 38.9–39.5) per 1,000 patient days, varying from 43.1 (95% CI 42.8–43.5) among those who mobilised early to 27.0 (95% CI 26.6–27.5) among those who mobilised late, accounting for the competing risk of death. By 30-day postoperatively, the crude and adjusted odds ratios of discharge were 2.36 (95% CI 2.29–2.43) and 2.08 (95% CI 2.00–2.16), respectively, among those who first mobilised early compared with those who mobilised late, accounting for the competing risk of death. Conclusion Early mobilisation led to a 2-fold increase in the adjusted odds of discharge by 30-day postoperatively. We recommend inclusion of mobilisation within 36 h of surgery as a new UK Best Practice Tariff to help reduce delays to mobilisation currently experienced by one-fifth of patients surgically treated for hip fracture.
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Affiliation(s)
- Katie J Sheehan
- Faculty of Life Science and Medicine, Department of Population Health Sciences, School of Population Health & Environmental Sciences, King’s College London, London, UK
| | - Aicha Goubar
- Faculty of Life Science and Medicine, Department of Population Health Sciences, School of Population Health & Environmental Sciences, King’s College London, London, UK
| | - Orouba Almilaji
- Faculty of Life Science and Medicine, Department of Population Health Sciences, School of Population Health & Environmental Sciences, King’s College London, London, UK
| | - Finbarr C Martin
- Faculty of Life Science and Medicine, Department of Population Health Sciences, School of Population Health & Environmental Sciences, King’s College London, London, UK
- Guy’s and St. Thomas’ National Health Service Foundation Trust London, London, UK
| | - Chris Potter
- Guy’s and St. Thomas’ National Health Service Foundation Trust London, London, UK
| | - Gareth D Jones
- Guy’s and St. Thomas’ National Health Service Foundation Trust London, London, UK
| | - Catherine Sackley
- Faculty of Life Science and Medicine, Department of Population Health Sciences, School of Population Health & Environmental Sciences, King’s College London, London, UK
| | - Salma Ayis
- Faculty of Life Science and Medicine, Department of Population Health Sciences, School of Population Health & Environmental Sciences, King’s College London, London, UK
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Mufarrih SH, Qureshi NQ, Masri B, Noordin S. Outcomes of total hip arthroplasty using dual-mobility cups for femoral neck fractures: a systematic review and meta-analysis. Hip Int 2021; 31:12-23. [PMID: 32513027 DOI: 10.1177/1120700020926652] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Femoral neck fractures (FNFs), with up to 15% mortality, are prominent orthopaedic emergencies. After treating FNFs, dislocation is another challenge increasing morbidity, mortality and treatment costs substantially. The emerging dual-mobility cup (DMC) may decrease dislocation rates following total hip arthroplasty (THA) for FNFs. We performed a systematic review of literature reporting dislocation and mortality rates with DMC-THA for the treatment of FNFs. METHODS 2 authors independently searched PubMed (MEDLINE), Google Scholar and Cochrane library for studies reporting dislocation and mortality rates for FNFs treated with DMC-THA since inception up to January 2019. Data on outcomes of interest was extracted from all studies and assessed for eligibility for a meta-analysis. RESULTS Out of 522 search results, 18 studies were included in the systematic review and 4 in the meta-analysis. The mean rate of dislocation following DMC-THA for FNFs was found to be 1.87% ± 2.11, with a 1-year mortality rate of 14.0% ± 10.55. Results of meta-analysis showed that dislocation and 1-year postoperative mortality rates were significantly lower for DMC-THA with a risk ratio 0.31 (95% CI, 0.16-0.59; I2 = 0%, p = 0.0003) and 0.55 (0.40, 0.77; I2 = 0%, p = 0.003) respectively when compared to biploar hemiathroplasty (BHA). CONCLUSIONS The mean dislocation and mortality rates in DMC-THA are lower than previously reported rates for THA with single cup and comparable to unipolar and bipolar hemiarthroplasty. Further research involving randomised control trials to assess differences in outcomes, longevity and cost-effectiveness needs to be conducted to make recommendations for the use of DMC in treating FNFs.
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Affiliation(s)
- Syed H Mufarrih
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Nada Q Qureshi
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Bassam Masri
- Department of Orthopaedics at the University of British Columbia, BC, Canada.,Department of Orthopaedics at Vancouver Acute (Vancouver General and University Hospitals), Vancouver, BC, Canada
| | - Shahryar Noordin
- Orthopaedic Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Who Did the Arthroplasty? Hip Fracture Surgery Reoperation Rates are Not Affected by Type of Training-An Analysis of the HEALTH Database. J Orthop Trauma 2020; 34 Suppl 3:S64-S69. [PMID: 33027168 DOI: 10.1097/bot.0000000000001931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study compares outcomes for patients with displaced femoral neck fractures undergoing hemiarthroplasty (HA) or total hip arthroplasty (THA) by surgeons of different fellowship training. DESIGN Retrospective review of HEALTH trial data. SETTING Eighty clinical sites across 10 countries. PATIENTS/PARTICIPANTS One thousand four hundred forty-one patients ≥50 years with low-energy hip fractures requiring surgical intervention. INTERVENTION Patients were randomized to either HA or THA groups in the initial data set. Surgeons' fellowship training was ascertained retrospectively, and outcomes were compared. MAIN OUTCOME MEASUREMENTS The main outcome was an unplanned secondary procedure at 24 months. Secondary outcomes included death, serious adverse events, prosthetic joint infection (PJI), dislocation, discharge disposition, and use of ambulatory devices postoperatively. RESULTS There was a significantly higher risk of PJI in patients treated by surgeons without fellowship training in arthroplasty (P = 0.01), surgeons with unknown fellowship training (P = 0.03), and surgeons with no fellowship training (P = 0.02) than those treated by an arthroplasty-trained surgeon. There were significantly higher odds of being discharged to a facility rather than home in patients who underwent surgery by a surgeon with no fellowship training compared with arthroplasty-fellowship-trained surgeons (P = 0.03). CONCLUSIONS Arthroplasty for hip fracture can be performed by all orthopaedic surgeons with equivalent reoperation rates. Infection prevention strategies and use of "care pathways" by arthroplasty-fellowship-trained surgeons may account for the lower risk of PJI and higher rate of discharge to home. The authors advocate for the use of evidence-based infection prevention initiatives and standardized care pathways in this patient population. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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