• Humans
• Female
• Male
• Postoperative Complications/epidemiology
• Postoperative Complications/mortality
• Middle Aged
• Aged
• Fractures, Spontaneous/surgery
• Fractures, Spontaneous/mortality
• Fractures, Spontaneous/etiology
• Bone Neoplasms/secondary
• Bone Neoplasms/complications
• Bone Neoplasms/surgery
• Bone Neoplasms/mortality
• Fracture Fixation, Internal
• Aged, 80 and over
• Adult
• Predictive Value of Tests
• Risk Assessment
• Morbidity
• Retrospective Studies

• Humans
• Patient Readmission/statistics & numerical data
• Female
• Male
• Hip Fractures/surgery
• Aged, 80 and over
• Retrospective Studies
• Aged
• Postoperative Complications/epidemiology
• Risk Factors
• Risk Assessment

• Femur fracture
• Follow-up
• Fragility fracture
• Multi-institutional care
• Orthopaedic trauma
• Peri-implant fracture

• Critical care
• Hip fracture
• Orthopedic
• Risk factors
• Scoring system

• Humans
• Hip Fractures/surgery
• Female
• Male
• Aged, 80 and over
• Risk Assessment/methods
• Critical Care
• Aged
• Geriatric Assessment/methods
• Retrospective Studies
• Intensive Care Units
• Risk Factors
• Postoperative Care/methods

• complications
• geriatric
• hip fracture
• mortality
• non-operative
• operative
• palliative

• Humans
• Fractures, Spontaneous
• Retrospective Studies
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Risk Factors
• Morbidity
• Risk Assessment

• Humans
• Talus/surgery
• Retrospective Studies
• Fractures, Bone
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Risk Factors
• Hypertension/complications
• Hypertension/epidemiology

• Assessment
• Optimization
• Perioperative
• Prehabilitation
• Risk

• Humans
• Fractures, Bone/surgery
• Preoperative Care
• Arm Injuries
• Smoking
• Upper Extremity/surgery

• Complication
• Femoral neck fracture
• Multidisciplinary team

• AD19245017 the Guangxi Natural Science Foundation
• AD19245017 the Guangxi Natural Science Foundation
• 20Z13 the Scientific Research Foundation of Guangxi University of Science and Technology
• 20Z13 the Scientific Research Foundation of Guangxi University of Science and Technology
• Z20211376 the Scientific Research Foundation of Guangxi Health Commission
• Z20190410 the Scientific Research Foundation of Guangxi Health Commission
• Z20211376 the Scientific Research Foundation of Guangxi Health Commission

• Geriatric
• Hip fracture
• Palliative care

• Humans
• Male
• Female
• Retrospective Studies
• Palliative Care
• Hip Fractures/epidemiology
• Risk Factors
• Postoperative Complications/etiology

• Geriatric
• Hip fracture
• Post-operative care
• Post-operative complications
• Trauma

• Cox regression
• age-adjusted Charlson comorbidity index
• elderly
• hip fracture
• mortality

• Fixation failure
• hip fracture
• trochanteric fracture

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.

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.

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.

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.

• complications
• fragility fractures
• geriatric trauma
• hip fracture
• trauma surgery

To evaluate the incidence and risk factors of postoperative pneumonia (POP) in geriatric patients with a hip fracture after surgery, to design a predictive nomogram, and to validate the accuracy of the nomogram.

Retrospective study.

A tertiary hospital affiliated to a medical university.

We retrospectively studied 1285 surgical-treated geriatric patients with a hip fracture from April 2010 to April 2018.

Surgical treatment was performed on the patients of this study. The procedure methods were classified as: total hip arthroplasty, hemiarthroplasty, percutaneous fixation, intramedullary nail fixation, and plate/screw fixation.

The primary interest of end point of this study is the development of POP during the postoperative period. The postoperative period in this study was defined as the time from 24 hours after surgery to discharge. The diagnostic criteria for pneumonia were set according to the guidelines built by the Infectious Diseases Society of America and the American Thoracic Society (Guidelines for the Management of Adults with Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia, 2005). Potential variables for developing POP were identified using logistic regression analyses initially and were further selected via the method of LASSO. Then the independent risk factors were identified by multivariable regression analyses. A predictive nomogram was built based on the multiple regression model, and the calibration abilities of the nomogram was measured by Harrel C-index, calibration plot and Hosmer–Lemeshow test, respectively. Decision curve analysis was carried out to assess the net benefit due to threshold probability and an on-line questionnaire survey was conducted among the clinicians to assess the applicability of the nomogram coherently.

Of the 1285 patients, 70 (5.4%) developed POP. COPD, number of comorbidities, ASA classification >2, preoperative dependent functional status and cognitive impairment were identified as independent risk factors of POP. The nomogram built based on the results showed good accordance between the predicted probabilities and the observed frequency. The decision curve analysis confirmed the clinical utility of the nomogram when the threshold probabilities were between 5% and 65% due to the net benefit, while the results of on-line questionnaire among 200 clinicians showed that 91.5% of the participants had a mental threshold of intervention between 5-50%.

(1). COPD, number of comorbidities, ASA classification >2, preoperative dependent functional status and cognitive impairment are independent risk factors for POP. (2). The nomogram built in this study has a good accordance between the predictive risk and the observational incidence. The results of decision curve and questionnaire among clinicians show well applicability of the nomogram.

• geriatric
• hip fracture
• nomogram
• postoperative pneumonia

• Femoral neck fractures
• Hip fractures
• Length of stay
• Mortality risk

Charlson Comorbidity Index (CCI) has been suggested to be associated with mortality in hip fracture patients, to the same extent as more expensive and time-consuming tools. However, even CCI might be too time-consuming in a clinical setting.

To investigate whether the American Society of Anaesthesiologists score (ASA score), a simple grading from the anaesthesiologist’s examination, is comparable with CCI in the association with 1-year mortality after a hip fracture.

The study population was patients 60 + years registered in the Swedish Hip Fracture Registry with a first-time hip fracture between 1997 and 2017 (N = 165,596). The outcome was 1-year mortality, and the exposures were ASA score and CCI. The association between comorbidity and mortality was described with Kaplan–Meier curves and analyzed with Cox proportional hazards models.

The Kaplan–Meier curves showed a stepwise increase in mortality for increasing values of both ASA and CCI. The Hazard Ratios (HRs) for the highest ASA (4–5) were 3.8 (95% Confidence Interval 3.5–4.2) for women and 3.2 (2.8–3.6) for men in the fully adjusted models. Adjusted HRs for the highest CCI (4 +) were 3.6 (3.3–3.9) for women and 2.5 (2.3–2.7) for men. Reference was the lowest score value for both tools. The correlation between the tools was moderate.

Both ASA and CCI show a similar stepwise association with 1-year mortality in hip fracture patients, despite measuring different factors and capturing different individuals at risk. Since the ASA score is already accessible for health care staff, it might be preferable to aid in prioritizing vulnerable hip fracture patients at risk of adverse outcomes.

The online version contains supplementary material available at 10.1007/s40520-021-01896-x.

• Geriatric
• Injury
• National register
• Older adults

• Comorbidity
• Female
• Hip Fractures
• Hospital Mortality
• Humans
• Male
• Retrospective Studies
• Risk Factors

• Familjen Kamprads Stiftelse
• Karolinska Institute

Background: The use of risk stratification tools in identifying high-risk hip fracture patients plays an important role during treatment. The aim of this study was to compare our locally derived Combined Assessment of Risk Encountered in Surgery (CARES) score with the the American Society of Anesthesiologists physical status (ASA-PS) score and the Deyo–Charlson Comorbidity Index (D-CCI) in predicting 2-year mortality after hip fracture surgery. Methods and Material: A retrospective study was conducted on surgically treated hip fracture patients in a large tertiary hospital from Jan 2013 through Dec 2015. Age, gender, time to surgery, ASA-PS score, D-CCI, and CARES score were obtained. Univariate and multivariable logistic regression analyses were used to assess statistical significance of scores and risk factors, and area under the receiver operating characteristic (ROC) curve (AUC) was used to compare ASA-PS, D-CCI, and CARES as predictors of mortality at 2 years. Results: 763 surgically treated hip fracture patients were included in this study. The 2-year mortality rate was 13.1% (n = 100), and the mean ± SD CARES score of surviving and demised patients was 21.2 ± 5.98 and 25.9 ± 5.59, respectively. Using AUC, CARES was shown to be a better predictor of 2-year mortality than ASA-PS, but we found no statistical difference between CARES and D-CCI. A CARES score of 23, attributable primarily to pre-surgical morbidities and poor health of the patient, was identified as the statistical threshold for “high” risk of 2-year mortality. Conclusion: The CARES score is a viable risk predictor for 2-year mortality following hip fracture surgery and is comparable to the D-CCI in predictive capability. Our results support the use of a simpler yet clinically relevant CARES in prognosticating mortality following hip fracture surgery, particularly when information on the pre-existing comorbidities of the patient is not immediately available.

• ASA
• Charlson Comorbidity Index
• Combined Assessment of Risk Encountered in Surgery
• comorbidity index
• geriatric
• hip fracture
• mortality
• risk stratification

• Cement augmentation
• Cut-out risk
• Femur fracture
• Osteoporosis
• Screw mobilization

• degenerative lumbar spine disease
• discharge disposition
• driver
• lumbar fusion surgery
• nonhome discharge

• Complications
• Hip fracture
• Nutrition
• Pilot study
• Preoperative oral carbohydrate nutrition

• trauma
• risk factors
• geriatrics
• disease-free survival

• Age Factors
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• France/epidemiology
• Hip Fractures/mortality
• Hip Fractures/surgery
• Humans
• Male
• Proportional Hazards Models
• Prospective Studies
• Risk Factors
• Time-to-Treatment/statistics & numerical data

Hip fracture is a growing healthcare challenge, with 6–8% 30-day mortality and 20–30% of patients incurring major morbidity, including impaired mobilisation and ability to live independently. While observational studies have shown no benefit of general versus spinal anaesthesia on 30-day mortality, intraoperative hypotension during hip fracture surgery is associated with increased 30-day mortality regardless of anaesthetic technique. Although a recent trial on younger patients demonstrated reduced postoperative complications by maintaining intraoperative arterial blood pressure close to preoperative baseline, there are no data correlating intraoperative hypotension during hip fracture surgery with postoperative morbidity.

We evaluated the hypothesis that duration and severity of intraoperative hypotension during hip fracture surgery is associated with increased postoperative morbidity.

A retrospective analysis was carried out on n = 52 patients undergoing hip fracture surgery between January and June 2017. Measurements of patients’ intraoperative systolic arterial pressure (SAP) and mean arterial pressure (MAP) during anaesthesia, logged electronically through an anaesthesia information management system, were reviewed. We calculated the total duration of time where SAP or MAP were below pre-defined thresholds for hypotension (MAP < 75 mmHg, MAP < 55 mmHg, SAP ≤ 80% admission baseline or SAP ≤ 80% pre-induction baseline). Univariate and bivariate descriptive statistics were generated for all relevant variables. With multivariable regression models containing known predictors, cumulative duration of hypotension was correlated with postoperative comorbidities as quantified by the Clavien-Dindo and Comprehensive Complication Indices.

Mean age (± SD) was 78 ± 13 years, 75% were female, 87% were ASA II or III and 60% underwent spinal anaesthesia. Mean Comprehensive Complication Index was 20.4 ± 19.2. Lowest absolute SAP and MAP values were 82 ± 18 mmHg and 55 ± 12 mmHg respectively. Cumulative time of SAP < 80% pre-induction value adjusted to gender, age and the Charlson Comorbidity Index was associated with progression to a higher Clavien-Dindo classification (odds ratio 1.020 per additional minute; 95% CI 1.008–1.035; P = 0.003).

In this exploratory retrospective analysis, the cumulative time of hypotension during hip fracture surgery correlated with extensive postoperative morbidity when adjusting to other known predictors. Intraoperative cumulative time of hypotension may be a good candidate for larger prediction studies as a predictor of postoperative complications. A randomised controlled trial evaluating the effect of actively minimising intraoperative hypotension on postoperative morbidity in hip fracture patients seems warranted.

• Anaesthesia, general
• Anaesthesia, spinal
• Hip fracture, outcome
• Hip fracture, surgery

• Age
• Clientele
• Comorbidities
• Femur fracture, proximal
• Length of stay

The postoperative mortality rate following a femoral neck fracture remains high. The Surgical Apgar Score (SAS), based on intraoperative blood loss, the lowest mean arterial pressure, and the lowest heart rate, was created to predict 30-day postoperative major complications. Here, we evaluated the relationship between the SAS and postoperative complications in patients who underwent femoral neck surgeries.

We retrospectively collected data from patients with femoral neck surgeries performed in 2012–2017 at Kumamoto Central Hospital. The variables required for the SAS and the factors presumably associated with postoperative complications including the patients’ characteristics were collected from the medical charts. Intergroup differences were assessed with the χ² test with Yates’ correlation for continuity in category variables. The Mann-Whitney U test was used to test for differences in continuous variables. We assessed the power of the SAS value to distinguish patients who died ≤ 90 days post-surgery from those who did not, by calculating the area under the receiver operating characteristic curve (AUC).

We retrospectively examined the cases of 506 patients (94 men, 412 women) aged 87 ± 6 (range 70–102) years old. The 90-day mortality rate was 3.4% (n = 17 non-survivors). There were significant differences between the non-survivors and survivors in body mass index (BMI), the presence of moderate to severe valvular heart disease, albumin concentration, the American Society of Anesthesiologists (ASA) classification, and the SAS. The 90-day mortality rate in the SAS ≤ 6 group (n = 97) was 10.3%, which was significantly higher than that in the SAS ≥ 7 group (n = 409), 1.7%. The AUC value to predict the 90-day mortality was 0.70 for ASA ≥ 3 only, 0.71 for SAS ≤ 6 only, 0.81 for SAS ≤ 6 combined with ASA ≥ 3, and 0.85 for SAS ≤ 6 combined with albumin concentration < 3.5 g/dl, BMI ≤ 20, and the presence of moderate to severe valvular heart disease.

Our results suggest that the SAS is useful to evaluate postoperative complications in patients who have undergone a femoral neck surgery. The ability to predict postoperative complications will be improved when the SAS is used in combination with the patient’s preoperative physical status.

• Femoral neck surgery
• Postoperative mortality
• Surgical Apgar Score

To analyze comorbidities and clinical complications, and to determine the factors associated with mortality rates of elderly patients admitted with a hip fracture in a tertiary public hospital.

Sixty-seven medical records were reviewed in a retrospective cohort study, including patients equal to or older than 65 years admitted to this institution for hip fracture between January 2014 and December 2014. The evaluated items constituted were the following: interval of time between fracture and hospital admission, time between admission and surgical procedure, comorbidities, clinical complications, type of orthopedic procedure, surgical risk, cardiac risk, and patient outcome.

The average patients’ age in the sample was 77.6 years, with a predominance of the female gender. Most patients (50.7%) had two or more comorbidities. The main clinical complications during hospitalization included cognitive behavioral disorders, respiratory infection and of the urinary tract. The times between fracture and admission and between admission and surgery were more than seven days in most of cases. The mortality rate during hospitalization was 11.9%, and was directly connected to the presence of infections during hospital stay (p = 0.006), to time between admission and surgery longer than seven days (p = 0.005), to the Goldman Cardiac Risk Index class III (p = 0.008), and to age equal to or greater than 85 years (p = 0.031).

Patients with hip fractures generally present comorbidities, are susceptible to clinical complications, and have an 11.9% mortality rate.

• Elderly
• Hip fractures
• Orthopedic surgery

• complication
• femoral neck fracture
• hip fracture
• intertrochanteric fracture
• pneumonia
• risk reduction

• anticoagulation
• economics of medicine
• geriatric trauma
• hip fracture
• surgical outcomes

• Electronic medical records
• Hip fracture
• Prediction
• Re-admission
• Risk factors

• Attribute reduction
• Discretization
• Geriatric hip surgery
• Indiscernibility
• Rehabilitation
• Salvati-Wilson’s score

• Comorbidity
• Erythrocyte indices
• Hand strength
• Hip fractures
• Prediction
• Proximal femur

• Hip fracture
• Osteoporosis
• Post-operative mortality
• Surgery

• Assessment
• Elderly
• Hip fracture
• Morbidity
• Mortality
• Orthogeriatrics
• Osteoporosis
• Preoperative assessment

• Complications
• Economic effects
• Hospital bed capacity
• Length of stay
• Resources

• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip/economics
• Arthroplasty, Replacement, Hip/mortality
• Cost of Illness
• Female
• Germany/epidemiology
• Health Care Costs/statistics & numerical data
• Hip Fractures/economics
• Hip Fractures/mortality
• Hip Fractures/surgery
• Hospital Bed Capacity/economics
• Hospital Bed Capacity/statistics & numerical data
• Humans
• Length of Stay/economics
• Length of Stay/statistics & numerical data
• Male
• Postoperative Complications/economics
• Postoperative Complications/mortality
• Risk Factors
• Survival Rate

• Hip fracture
• Risk factors
• Serious adverse events
• Time to surgery

• Age Factors
• Aged
• Aged, 80 and over
• Deglutition Disorders/complications
• Deglutition Disorders/diagnosis
• Female
• Hip Fractures/surgery
• Humans
• Male
• Pneumonia/etiology
• Referral and Consultation
• Respiratory Aspiration/diagnosis
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Speech-Language Pathology

The poor outcome after a hip fracture is not fully understood.

The aim of the study was to describe the prevalence of co-morbidities, complications and causes of death and to investigate factors that are able to predict mortality in old people with femoral neck fracture.

Data was obtained from a randomized, controlled trial with a 3-year follow-up at Umeå University Hospital, Sweden, which included 199 consecutive patients with femoral neck fracture, aged ≥70 years. The participants were assessed during hospitalization and in their homes 4, 12 and 36 months after surgery. Medical records and death certificates were analysed.

Multivariate analysis revealed that cancer, dependence in P-ADL (Personal Activities of Daily Living), cardiovascular disease, dementia at baseline or pulmonary emboli or cardiac failure during hospitalization were all independent predictors of 3-year mortality. Seventy-nine out of 199 participants (40 %) died within 3 years. Cardiovascular events (24 %), dementia (23 %), hip-fracture (19 %) and cancer (13 %) were the most common primary causes of death. In total, 136 participants suffered at least one urinary tract infection; 114 suffered 542 falls and 37 sustained 56 new fractures, including 13 hip fractures, during follow-up.

Old people with femoral neck fracture have multiple co-morbidities and suffer numerous complications. Thus randomized intervention studies should focus on prevention of complications that might be avoidable such as infections, heart diseases, falls and fractures.

• Cause of death
• Complications
• Hip fracture

• Elderly
• Frailty
• Hip fractures
• Post-operative complications