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Aslan YE, Avsarogullari OL, Kafadar IH, Akin S. Risk Factors and Predictors of In-Hospital Mortality in Geriatric Patients with Hip Fractures: A Retrospective Study. Niger J Clin Pract 2025; 28:99-106. [PMID: 40326942 DOI: 10.4103/njcp.njcp_542_24] [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: 08/19/2024] [Accepted: 12/16/2024] [Indexed: 05/07/2025]
Abstract
BACKGROUND Hip fractures are among the most frequent traumatic injuries in the elderly and cause significant morbidity and mortality. Elderly hip fractures are frequently admitted to the emergency department (ED). AIM This study aimed to evaluate clinically geriatric patients admitted to an ED with hip fractures and to identify risk factors and predictors for in-hospital mortality. METHODS This retrospective study included patients aged ≥65 years diagnosed with hip fractures in the ED of a tertiary university hospital between January 1, 2017 and December 31, 2018. A multiple logistic regression model was used to identify risk factors for in-hospital mortality. RESULTS Three hundred and nineteen patients with hip fractures were analyzed, 204 (63.9%) of whom were women, with a mean age of 80.82 ± 7.41 years (65-102 years). In 247 (77.4%) patients, there was at least one comorbidity, most frequently hypertension (52%) or osteoporosis (51.1%). The median number of drugs used was 5 (range 0 to 9). Intensive care was required in 198 patients (62.1%). The in-hospital mortality rate was 8.5% (27 patients). According to the multiple logistic regression model, the factors predicting in-hospital mortality were pulse rate [odds ratio (OR), 1.039; 95% confidence interval (CI): 1.002-1.078], total leukocyte count (OR, 0.803; 95% CI: 0.652-0.989), serum calcium level (OR, 0.380; 95% Cl: 0.138-0.912), venous lactate level (OR, 2.459; 95% CI: 1.029-5.878), and length of hospital stay (OR, 1.205; 95% CI: 1.052-1.381). CONCLUSION These data suggested that among geriatric hip fracture patients, increased pulse rate, elevated venous lactate level, low serum calcium level, total leukocyte count at the time of initial presentation to the ED, and prolonged duration of hospitalization were risk factors for in-hospital mortality.
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Affiliation(s)
- Y E Aslan
- Department of Emergency Medicine, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - O L Avsarogullari
- Department of Emergency Medicine, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - I H Kafadar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - S Akin
- Department of Internal Medicine, Division of Geriatrics, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
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Jürgens L, Sarabhai T, Kostev K. In-Hospital Mortality Among Elderly Patients Hospitalized for Femur Fracture with and Without Diabetes Mellitus: A Multicenter Case-Control Study. J Clin Med 2024; 13:6484. [PMID: 39518624 PMCID: PMC11546991 DOI: 10.3390/jcm13216484] [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] [Received: 10/06/2024] [Revised: 10/23/2024] [Accepted: 10/26/2024] [Indexed: 11/16/2024] Open
Abstract
Purpose: The aim of the present study was to explore whether diabetes mellitus (DM) is associated with in-hospital mortality in patients admitted for femur fractures. Methods: Our multicenter case-control study included patients aged ≥65 with a primary diagnosis of femur fracture with and without DM treated in 36 German hospitals between January 2019 and December 2023. Patients with DM were matched to patients without DM (1:3) using propensity scores based on age and sex. Multivariable logistic regression analyses were conducted to assess the associations between DM and in-hospital mortality. Results: A total of 3220 patients with diabetes and 9660 patients without diabetes were included (mean age: 83 years). The overall in-hospital mortality rate was higher in DM patients (6.4%) than in those without DM (5.4%). However, the association between DM and in-hospital mortality was not significant after adjustment for other co-diagnoses. In particular, atrial fibrillation, heart failure, and CKD attenuated the effect of DM on in-hospital mortality. Conclusions: Our data show that DM is not significantly associated with in-hospital mortality in femur fracture patients. However, the presence of other comorbidities may influence mortality outcomes, highlighting the need for early intervention and targeted treatment to improve patient outcomes.
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Affiliation(s)
- Lavinia Jürgens
- Unfallchirurgie und Orthopädie, Klinikum Neukölln, 12351 Berlin, Germany
| | - Theresia Sarabhai
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Karel Kostev
- University Hospital, Philipps-University, 35043 Marburg, Germany
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Martín-Nieto A, Chana-Valero P, Ruiz-Tovar J, Escobar-Aguilar G, Simarro-González M, Rodríguez-Bernal P, García-García E. Nutritional Status Impact on Hip Fracture Patients in a Rural Environment. Nutrients 2024; 16:3622. [PMID: 39519455 PMCID: PMC11547679 DOI: 10.3390/nu16213622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 10/15/2024] [Accepted: 10/23/2024] [Indexed: 11/16/2024] Open
Abstract
(1) Background: Hip fractures are highly prevalent traumatic events with significant functional consequences, particularly among the older population. These fractures are associated with increased mortality, postoperative complications, and functional dependence. Medical and nutritional factors such as malnutrition and sarcopenia are crucial for predicting functional outcomes and mortality in these patients. This study aimed to assess the nutritional status, vitamin D levels, and sarcopenia, as well as their relationship with mortality, mean hospital stay, and 30-day-readmission rate, in patients with hip fracture who underwent surgery in a rural hospital setting. (2) Methods: A longitudinal retrospective study involving 124 patients who underwent hip fracture surgery in 2021 was conducted. Sociodemographic, surgical, and nutritional data, including vitamin D, albumin, and blood urea nitrogen (BUN) levels, were collected. (3) Results: The average age of the sample was 89.1 years, with a postoperative 30-day-mortality rate of 8.1% and an average hospital stay of 10.4 days. Vitamin D deficiency was present in 79.7% of patients, and a high prevalence of malnutrition was indicated by low albumin and elevated BUN levels. Elevated BUN levels and low vitamin D levels were associated with higher mortality. (4) Conclusions: Adequate nutritional assessment in patients with hip fracture is vital for identifying the risks of complications and mortality. Understanding the current nutritional status and its associated complications will aid in developing strategies to improve health and reduce complications in the future.
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Affiliation(s)
- Ana Martín-Nieto
- San Juan de Dios Foundation, 28036 Madrid, Spain; (A.M.-N.); (P.C.-V.); (G.E.-A.); (M.S.-G.); (E.G.-G.)
- Health Sciences Department, San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28036 Madrid, Spain
| | - Pedro Chana-Valero
- San Juan de Dios Foundation, 28036 Madrid, Spain; (A.M.-N.); (P.C.-V.); (G.E.-A.); (M.S.-G.); (E.G.-G.)
- Health Sciences Department, San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28036 Madrid, Spain
| | - Jaime Ruiz-Tovar
- San Juan de Dios Foundation, 28036 Madrid, Spain; (A.M.-N.); (P.C.-V.); (G.E.-A.); (M.S.-G.); (E.G.-G.)
- Health Sciences Department, San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28036 Madrid, Spain
| | - Gema Escobar-Aguilar
- San Juan de Dios Foundation, 28036 Madrid, Spain; (A.M.-N.); (P.C.-V.); (G.E.-A.); (M.S.-G.); (E.G.-G.)
- Health Sciences Department, San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28036 Madrid, Spain
| | - María Simarro-González
- San Juan de Dios Foundation, 28036 Madrid, Spain; (A.M.-N.); (P.C.-V.); (G.E.-A.); (M.S.-G.); (E.G.-G.)
- Health Sciences Department, San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28036 Madrid, Spain
| | | | - Elena García-García
- San Juan de Dios Foundation, 28036 Madrid, Spain; (A.M.-N.); (P.C.-V.); (G.E.-A.); (M.S.-G.); (E.G.-G.)
- Health Sciences Department, San Juan de Dios School of Nursing and Physical Therapy, Comillas Pontifical University, 28036 Madrid, Spain
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Lee C, Wei S, McConnell ES, Tsumura H, Xue TM, Pan W. Comorbidity Patterns in Older Patients Undergoing Hip Fracture Surgery: A Comorbidity Network Analysis Study. Clin Nurs Res 2024; 33:70-80. [PMID: 37932937 DOI: 10.1177/10547738231209367] [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] [Indexed: 11/08/2023]
Abstract
Comorbidity network analysis (CNA) is a technique in which mathematical graphs encode correlations (edges) among diseases (nodes) inferred from the disease co-occurrence data of a patient group. The present study applied this network-based approach to identifying comorbidity patterns in older patients undergoing hip fracture surgery. This was a retrospective observational cohort study using electronic health records (EHR). EHR data were extracted from the one University Health System in the southeast United States. The cohort included patients aged 65 and above who had a first-time low-energy traumatic hip fracture treated surgically between October 1, 2015 and December 31, 2018 (n = 1,171). Comorbidity includes 17 diagnoses classified by the Charlson Comorbidity Index. The CNA investigated the comorbid associations among 17 diagnoses. The association strength was quantified using the observed-to-expected ratio (OER). Several network centrality measures were used to examine the importance of nodes, namely degree, strength, closeness, and betweenness centrality. A cluster detection algorithm was employed to determine specific clusters of comorbidities. Twelve diseases were significantly interconnected in the network (OER > 1, p-value < .05). The most robust associations were between metastatic carcinoma and mild liver disease, myocardial infarction and congestive heart failure, and hemi/paraplegia and cerebrovascular disease (OER > 2.5). Cerebrovascular disease, congestive heart failure, and myocardial infarction were identified as the central diseases that co-occurred with numerous other diseases. Two distinct clusters were noted, and the largest cluster comprised 10 diseases, primarily encompassing cardiometabolic and cognitive disorders. The results highlight specific patient comorbidities that could be used to guide clinical assessment, management, and targeted interventions that improve hip fracture outcomes in this patient group.
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Affiliation(s)
- Chiyoung Lee
- School of Nursing & Health Studies, University of Washington Bothell, Bothell, WA, USA
| | - Sijia Wei
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Eleanor S McConnell
- Duke University School of Nursing, Durham, NC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
| | | | - Tingzhong Michelle Xue
- Duke University School of Nursing, Durham, NC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Wei Pan
- Duke University School of Nursing, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
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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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Barceló M, Casademont J, Mascaró J, Gich I, Torres OH. Indoor falls and number of previous falls are independent risk factors for long-term mortality after a hip fracture. Aging Clin Exp Res 2023; 35:2483-2490. [PMID: 37688755 PMCID: PMC10627886 DOI: 10.1007/s40520-023-02551-3] [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: 06/08/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Hip fractures are almost always the result of a fall. Causes and circumstances of falls may differ between frail and vigorous patients. AIM To describe the circumstances of falls causing hip fractures, number of falls during the previous year, and their association with long-term mortality. PATIENTS AND METHODS The study is a retrospective review conducted in a tertiary university hospital serving a population of 425,000 inhabitants in Barcelona. All patients admitted with hip fractures with medical records describing the circumstances and number of previous falls were included. The number of falls in the previous 12 months was recorded, including the one causing the fracture. The circumstances of the index fall were dichotomized according to whether it was from the patient's own height or above; day or night; indoors or outdoors, due to intrinsic or extrinsic causes. Cumulative mortality was recorded for almost 5 years after hip fracture. RESULTS Indoor falls were strongly associated with shorter survival. Falling more than once in the previous year was also a risk factor for long-term mortality (hazard ratio 1.461, p < 0.001 and hazard ratio 1.035, p = 0.008 respectively). CONCLUSION Indoor falls and falling more than once in the previous year are long-term risk factors for mortality after hip fractures. It is always essential to take a careful patient history on admission to determine the number of falls and their circumstances, and special care should be taken to reduce mortality in patients at high risk.
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Affiliation(s)
- Montserrat Barceló
- Geriatric Unit, Departament de Medicina, Internal Medicine Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas Street, no. 90, 08041, Barcelona, Spain.
| | - Jordi Casademont
- Geriatric Unit, Departament de Medicina, Internal Medicine Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas Street, no. 90, 08041, Barcelona, Spain
| | - Jordi Mascaró
- Geriatric Unit, Departament de Medicina, Internal Medicine Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas Street, no. 90, 08041, Barcelona, Spain
| | - Ignasi Gich
- Department of Clinical Epidemiology and Public Health, CIBER Epidemiología Y Salud Pública (CIBERESP), HSCSP Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Olga Herminia Torres
- Geriatric Unit, Departament de Medicina, Internal Medicine Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas Street, no. 90, 08041, Barcelona, Spain
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Hoogervorst LA, Stijnen P, Albini M, Janda N, Stewardson AJ, Patel K, Nelissen RGHH, Marang-van de Mheen P. Clinical outcomes of non-COVID-19 orthopaedic patients admitted during the COVID-19 pandemic: a multi-centre interrupted time series analysis across hospitals in six different countries. BMJ Open 2023; 13:e073276. [PMID: 37666551 PMCID: PMC10481718 DOI: 10.1136/bmjopen-2023-073276] [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: 03/02/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVES To assess across seven hospitals from six different countries the extent to which the COVID-19 pandemic affected the volumes of orthopaedic hospital admissions and patient outcomes for non-COVID-19 patients admitted for orthopaedic care. DESIGN A multi-centre interrupted time series (ITS) analysis. SETTING Seven hospitals from six countries who collaborated within the Global Health Data@Work collaborative. PARTICIPANTS Non-COVID-19 patients admitted for orthopaedic care during the pre-pandemic (January/2018-February/2020) and COVID-19 pandemic (March/2020-June/2021) period. Admissions were categorised as: (1) acute admissions (lower limb fractures/neck of femur fractures/pathological fractures/joint dislocations/upper limb fractures); (2) subacute admissions (bone cancer); (3) elective admissions (osteoarthritis). OUTCOME MEASURES Monthly observed versus expected ratios (O/E) were calculated for in-hospital mortality, long (upper-decile) length-of-stay and hospital readmissions, with expected rates calculated based on case-mix. An ITS design was used to estimate the change in level and/or trend of the monthly O/E ratio by comparing the COVID-19 pandemic with the pre-pandemic period. RESULTS 69 221 (pre-pandemic) and 22 940 (COVID-19 pandemic) non-COVID-19 orthopaedic patient admissions were included. Admission volumes were reduced during the COVID-19 pandemic for all admission categories (range: 33%-45%), with more complex patients treated as shown by higher percentages of patients admitted with ≥1 comorbidity (53.8% versus 49.8%, p<0.001). The COVID-19 pandemic was not associated with significant changes in patient outcomes for most diagnostic groups. Only for patients diagnosed with pathological fractures (pre-pandemic n=1671 and pandemic n=749), the COVID-19 pandemic was significantly associated with an immediate mortality reduction (level change of -77.7%, 95% CI -127.9% to -25.7%) and for lower limb fracture patients (pre-pandemic n=9898 and pandemic n=3307) with a significantly reduced trend in readmissions (trend change of -6.3% per month, 95% CI -11.0% to -1.6%). CONCLUSIONS Acute, subacute, as well as elective orthopaedic hospital admissions volumes were reduced in all global participating hospitals during the COVID-19 pandemic, while overall patient outcomes for most admitted non-COVID-19 patients remained the same despite the strain caused by the surge of COVID-19 patients.
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Affiliation(s)
- Lotje Anna Hoogervorst
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomedical Data Sciences & Medical Decision Making, Leiden University Medical Centre, Leiden, Netherlands
| | - Pieter Stijnen
- Department of Management Information and Reporting, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Marco Albini
- Department of Quality Monitoring, Humanitas Group, Rozzano, Italy
| | | | - Andrew J Stewardson
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
| | - Kiran Patel
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Perla Marang-van de Mheen
- Department of Biomedical Data Sciences & Medical Decision Making, Leiden University Medical Centre, Leiden, Netherlands
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Chowdary AR, Beale J, Martinez J, Aggarwal V, Mounasamy V, Sambandam S. Postoperative complications of spinal vs general anesthesia in elderly patients undergoing hip hemiarthroplasty. Arch Orthop Trauma Surg 2023; 143:5615-5621. [PMID: 37061659 DOI: 10.1007/s00402-023-04876-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/03/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION Elderly patients with hip fractures are at high risk for mortality due to postsurgical complications. Hip hemiarthroplasty is a routine procedure done in elderly patients for surgical repair of femoral neck fractures. Both general and spinal anesthesia can be used in elderly patients undergoing hemiarthroplasty. Rates of postoperative complications among the two anesthetic choices have not been directly compared. In this study, we compare the rates of postoperative complications in elderly patients (age greater than 70) undergoing hip hemiarthroplasty for femoral neck fractures using a national database. METHODS Data for the years 2015-2020 from the National Surgical Quality Improvement Program (NSQIP) were used for the study. Patients greater than 70 years of age who received a hip hemiarthroplasty with general anesthesia or spinal anesthesia were identified using CPT procedure codes. Pertinent preoperative variables and rates of postoperative complications were characterized and analyzed. RESULTS Our study found that elderly patients who received spinal anesthesia had, on average, longer length of stays but shorter operative times compared to patients who received general anesthesia. Furthermore, we found that patients who received spinal anesthesia had lower rates of systemic sepsis, cardiac arrests, and blood transfusions when compared to patients who received general anesthesia. Finally, we found that overall rates of mortality were significantly lower in the spinal anesthesia cohort compared to the general anesthesia cohort. CONCLUSION Our work suggests that patients who underwent spinal anesthesia for hip arthroplasty may have lower rates of postoperative complications. This work further highlights the role of anesthetic choice in preventing complications following hip hemiarthroplasty procedures.
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Affiliation(s)
| | - Jack Beale
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
| | - Jack Martinez
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
| | - Vikram Aggarwal
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
- Department of Orthopedics, Dallas VA Medical Center, Dallas, TX, USA
| | - Senthil Sambandam
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA.
- Department of Orthopedics, Dallas VA Medical Center, Dallas, TX, USA.
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Wang NJ, Zhang YM, Zhang BF. The Association Between Red Cell Distribution Width (RDW) and All-Cause Mortality in Elderly Patients with Hip Fractures: A Retrospective Cohort Study. Int J Gen Med 2023; 16:3555-3566. [PMID: 37609519 PMCID: PMC10441634 DOI: 10.2147/ijgm.s417079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
Background Red cell distribution width (RDW) may be related to the prognosis of hip fractures. The purpose of this study was to evaluate the association between (RDW) and all-cause mortality in elderly hip fractures. Materials and Methods Elderly patients aged ≥65 years who had a hip fracture were screened between January 1, 2015, and September 30, 2019. The age, gender of patients and other demographics, as well as history of allergy, injury mechanism, underlying illnesses at the time of admission, fracture classification, time from admission to operation, RDW, operation time, blood loss, infusion, transfusion, treatment strategy, and length in hospital stay and follow-up and other clinical characteristics were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between RDW and mortality in these patients. Analyses were performed using EmpowerStats and the R software. Results A total of 2587 patients were included in this retrospective cohort study. The mean follow-up period was 38.92 months. A total of 873 (33.75%) patients died due to all-cause mortality. The RDW was linearly associated with mortality in elderly patients with hip fractures. Linear multivariate Cox regression models showed that RDW was associated with mortality (hazard ratio [HR]=1.03, 95% confidence interval [CI]:1.02-1.05, P < 0.0001) after adjusting for confounding factors. The mortality risk increased by 3% when RDW increased by 1 fL. Conclusion RDW is associated with mortality in elderly patients with hip fractures, and RDW could be considered a predictor of mortality risk. Registration ChiCTR2200057323.
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Affiliation(s)
- Neng-Jun Wang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yu-Min Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
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Onizuka N, Farmer S, Wiseman JM, Alain G, Quatman-Yates CC, Quatman CE. Timing of Complications Following Surgery for Distal Femur Fractures in Older Adults. Geriatr Orthop Surg Rehabil 2023; 14:21514593231195539. [PMID: 37600451 PMCID: PMC10434182 DOI: 10.1177/21514593231195539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Introduction The purpose of this study was to identify the timing and nature of complications associated with distal femur fracture surgery in patients aged 65 and older using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Methods The ACS NSQIP database was queried for adults aged 65 and older who received surgical treatment for a distal femur fracture between 01 January 2015 and 31 December 2021. Cox regression models and risk tables adjusted for baseline clinical characteristics were created for 14 complications (Superficial Surgical Site Infection (SSI), Deep SSI, Organ/Space SSI, Pneumonia, Pulmonary Embolism (PE), Deep Venous Thrombosis (DVT), Urinary Tract Infection (UTI), Stroke/Cerebrovascular accident (CVA), Myocardial Infarction (MI), Renal Failure, Cardiac Arrest (CA), Re-operation, Sepsis, and Death within 30 days of surgery). Model summaries were used to identify significant variables with a Bonferroni correction applied. Results A total of 3956 adults met inclusion criteria and were included in analysis. The most common complications were UTI (5.2%), death (4.1%), and pneumonia (3.4%). Complications typically occurred within 14 days after surgery, except for SSI, which occurred between post-op days 11 and 24. Conclusions Distal femur fractures are a substantial source of morbidity and mortality in the older adult population. Our findings underscore the need for comprehensive preoperative risk assessment and patient management strategies to mitigate the impact of identified risk factors in this vulnerable population.
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Affiliation(s)
- Naoko Onizuka
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
- Park Nicollet Methodist Hospital, Saint Louis Park, MN, USA
| | - Samuel Farmer
- Division of Trauma, Department of Orthopaedics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jessica M. Wiseman
- Division of Trauma, Department of Orthopaedics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Gabriel Alain
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Catherine C. Quatman-Yates
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Sports Medicine Research Institute, Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA
| | - Carmen E. Quatman
- Division of Trauma, Department of Orthopaedics, College of Medicine, The Ohio State University, Columbus, OH, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
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11
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Jiao S, Zhou J, Feng Z, Huang J, Chen L, Li Z, Meng Q. The role of neutrophil percentage to albumin ratio in predicting 1-year mortality in elderly patients with hip fracture and external validation. Front Immunol 2023; 14:1223464. [PMID: 37622119 PMCID: PMC10445888 DOI: 10.3389/fimmu.2023.1223464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives This study aimed to investigate the association between the neutrophil percentage to albumin ratio (NPAR) on the day of admission and mortality 1 year after surgery in elderly patients with hip fractures. Methods Clinical characteristics and blood markers of inflammation were retrospectively collected from October 2016 to January 2022 in elderly patients with hip fractures at two different regional tertiary medical centers. It is divided into a training set and an external validation set. Multivariate Nomogram models such as NPAR were constructed using the least absolute shrinkage and selection operator (LASSO) regression results and multi-factor logistic regression analysis. In addition, multivariate Cox regression analysis and Kaplan-Meier survival curves were used to explore the relationship between NPAR values and mortality within 1 year in elderly patients with hip fractures. The predictive performance of the Nomogram was evaluated using the concordance index (C Index) and receiver operating characteristic curve (ROC) and validated by Bootstrap, Hosmer-Lemesow goodness of fit test, calibration curve, decision curve, and clinical impact curve analysis. Results The study included data from 1179 (mean age, 80.34 ± 8.06 years; 61.4[52.1%] male) patients from the Guangzhou Red Cross Hospital affiliated with Jinan University and 476 (mean age, 81.18 ± 8.33 years; 233 [48.9%] male) patients from the Xiaogan Central Hospital affiliated with Wuhan University of Science and Technology. The results showed that NPAR has good sensitivity and specificity in assessing patients' prognosis 1 year after surgery. Multivariate logistic regression models based on influencing factors such as NPAR have good discrimination and calibration ability (AUC=0.942, 95% CI:0.927-0.955; Hosmer-Lemeshow test: P >0.05). Kaplan-Meier survival curves for the training and validation sets showed that patients in the high NPAR group had a higher mortality rate at 1 year compared to the low NPAR group (P< 0.001). Multivariate Cox regression showed that high NPAR values were an independent risk factor for death within 1 year in elderly hip fracture patients (P< 0.001, HR =2.38,95%CI:1.84-3.08). Conclusion Our study showed that NPAR levels were significantly higher in patients who died within 1 year after surgery in both the training and validation sets. NPAR has good clinical value in assessing 1-year postoperative prognosis in elderly patients with hip fractures.
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Affiliation(s)
- Songsong Jiao
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Jiangfei Zhou
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Zhencheng Feng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Jian Huang
- Department of Traumatic Orthopaedics, The Central Hospital of Xiaogan, Xiaogan, Hubei, China
| | - Lihong Chen
- Department of Traumatic Orthopaedics, The Central Hospital of Xiaogan, Xiaogan, Hubei, China
| | - Zhiwu Li
- Department of Orthopedics, Bijie Second People’s Hospital, Guizhou, China
| | - Qingqi Meng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
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12
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Fluck D, Lisk R, Yeong K, Mahmood R, Robin J, Fry CH, Han TS. Sex differences in clinical outcomes amongst 1105 patients admitted with hip fractures. Intern Emerg Med 2023; 18:1561-1568. [PMID: 37101056 DOI: 10.1007/s11739-023-03264-1] [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: 09/12/2022] [Accepted: 03/31/2023] [Indexed: 04/28/2023]
Abstract
Amongst hip fracture admissions, mortality is higher in men than in women. However, sex differences in other care-quality measures have not been well-documented. We aimed to examine sex differences in mortality as well as a wide range of underlying health indicators and clinical outcomes in adults ≥ 60 year of age admitted with hip fractures from their own homes to a single NHS hospital between April-2009 and June-2019. Sex differences in delirium, length of stay (LOS) and mortality in hospital, readmission, and discharge destination, were examined by logistic regression. There were 787 women and 318 men of similar mean age (± SD): 83.1 year (± 8.6) and 82.5 year (± 9.0), respectively (P = 0.269). There were no sex differences in history of dementia or diabetes, anticholinergic burden, pre-fracture physical function, American Society of Anesthesiologists grades, or surgical and medical management. Stroke and ischaemic heart disease, polypharmacy, and alcohol consumption were more common in men. After adjustment for these differences and age, men had greater risk of delirium (with or without cognitive impairment) within one day of surgery: OR = 1.75 (95%CI 1.14-2.68), LOS ≥ 3 weeks in hospital: OR = 1.52 (1.07-2.16), mortality in hospital: OR = 2.04 (1.14-3.64), and readmission once or more after 30 days of a discharge: OR = 1.53 (1.03-2.31). Men had a lower risk of a new discharge to residential/nursing care: OR = 0.46 (0.23-0.93). The present study revealed that, in addition to a greater risk of mortality than women, men also had many other adverse health outcomes. These findings, which have not been well-documented, serve to stimulate future targeted preventive strategies and research.
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Affiliation(s)
- David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Radcliffe Lisk
- Department of Orthopaedic Trauma, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Keefai Yeong
- Department of Orthopaedic Trauma, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Rashid Mahmood
- Department of Orthopaedic Trauma, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Christopher Henry Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK
| | - Thang Sieu Han
- Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK.
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, TW20 0EX, Surrey, UK.
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13
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Chen Q, Hao P, Wong C, Zhong X, He Q, Chen Y. Development and validation of a novel nomogram of 1-year mortality in the elderly with hip fracture: a study of the MIMIC-III database. BMJ Open 2023; 13:e068465. [PMID: 37202145 DOI: 10.1136/bmjopen-2022-068465] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE Hip fracture is a prevalent condition with a significant death rate among the elderly. We sought to develop a nomogram-based survival prediction model for older patients with hip fracture. DESIGN A retrospective case-control study. SETTING The data from Medical Information Mart for Intensive Care III (MIMIC-III V.1.4). PARTICIPANTS The clinical features of elderly patients with hip fracture, including basic information, comorbidities, severity score, laboratory tests and therapy, were filtered out based on the MIMIC-III V.1.4. METHODS AND MAIN OUTCOME MEASURES All patients included in the study were from critical care and randomly divided into training and validation sets (7:3). On the basis of retrieved data, the least absolute shrinkage and selection operator (LASSO) regression and multiple logistic regression analysis were used to identify independent predictive variables of 1-year mortality, and then constructed a risk prediction nomogram. The predictive values of the nomogram model were evaluated by the concordance indexes (C-indexes), receiver operating characteristic curve, decision curve analysis (DCA) and calibration curve. RESULTS A total of 341 elderly patients with hip fracture were included in this study; 121 cases died within 1 year. After LASSO regression and multiple logistic regression analysis, a novel nomogram contained the predictive variables of age, weight, the proportion of lymphocyte count, liver disease, malignant tumour and congestive heart failure. The constructed model proved satisfactory discrimination with C-indexes of 0.738 (95% CI 0.674 to 0.802) in the training set and 0.713 (95% CI 0.608 to 0.819) in the validation set. The calibration curve shows a good degree of fitting between the predicted and observed probabilities and the DCA confirms the model's clinical practicability. CONCLUSIONS The novel prediction model provides personalised predictions for 1-year mortality in elderly patients with hip fractures. Compared with other hip fracture models, our nomogram is particularly suitable for predicting long-term mortality in critical patients.
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Affiliation(s)
- Qian Chen
- Department of Orthopedics, Sun Yat-Sen University, Guangzhou, China
| | - Peng Hao
- Department of Surgical Intensive Care Unit, Sun Yat-Sen University, Guangzhou, China
| | - Chipiu Wong
- Department of Orthopedics, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoxin Zhong
- Department of Surgical Intensive Care Unit, Sun Yat-Sen University, Guangzhou, China
| | - Qing He
- Department of Surgical Intensive Care Unit, Sun Yat-Sen University, Guangzhou, China
| | - Yantao Chen
- Department of Orthopedics, Sun Yat-Sen University, Guangzhou, China
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14
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Xu L, Liu J, Han C, Ai Z. The Application of Machine Learning in Predicting Mortality Risk in Patients With Severe Femoral Neck Fractures: Prediction Model Development Study. JMIR BIOINFORMATICS AND BIOTECHNOLOGY 2022; 3:e38226. [PMID: 38935949 PMCID: PMC11135225 DOI: 10.2196/38226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/13/2022] [Accepted: 08/09/2022] [Indexed: 06/29/2024]
Abstract
BACKGROUND Femoral neck fracture (FNF) accounts for approximately 3.58% of all fractures in the entire body, exhibiting an increasing trend each year. According to a survey, in 1990, the total number of hip fractures in men and women worldwide was approximately 338,000 and 917,000, respectively. In China, FNFs account for 48.22% of hip fractures. Currently, many studies have been conducted on postdischarge mortality and mortality risk in patients with FNF. However, there have been no definitive studies on in-hospital mortality or its influencing factors in patients with severe FNF admitted to the intensive care unit. OBJECTIVE In this paper, 3 machine learning methods were used to construct a nosocomial death prediction model for patients admitted to intensive care units to assist clinicians in early clinical decision-making. METHODS A retrospective analysis was conducted using information of a patient with FNF from the Medical Information Mart for Intensive Care III. After balancing the data set using the Synthetic Minority Oversampling Technique algorithm, patients were randomly separated into a 70% training set and a 30% testing set for the development and validation, respectively, of the prediction model. Random forest, extreme gradient boosting, and backpropagation neural network prediction models were constructed with nosocomial death as the outcome. Model performance was assessed using the area under the receiver operating characteristic curve, accuracy, precision, sensitivity, and specificity. The predictive value of the models was verified in comparison to the traditional logistic model. RESULTS A total of 366 patients with FNFs were selected, including 48 cases (13.1%) of in-hospital death. Data from 636 patients were obtained by balancing the data set with the in-hospital death group to survival group as 1:1. The 3 machine learning models exhibited high predictive accuracy, and the area under the receiver operating characteristic curve of the random forest, extreme gradient boosting, and backpropagation neural network were 0.98, 0.97, and 0.95, respectively, all with higher predictive performance than the traditional logistic regression model. Ranking the importance of the feature variables, the top 10 feature variables that were meaningful for predicting the risk of in-hospital death of patients were the Simplified Acute Physiology Score II, lactate, creatinine, gender, vitamin D, calcium, creatine kinase, creatine kinase isoenzyme, white blood cell, and age. CONCLUSIONS Death risk assessment models constructed using machine learning have positive significance for predicting the in-hospital mortality of patients with severe disease and provide a valid basis for reducing in-hospital mortality and improving patient prognosis.
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Affiliation(s)
- Lingxiao Xu
- Department of Medical Statistics, Tongji University, Shanghai, China
| | - Jun Liu
- Department of Medical Statistics, Tongji University, Shanghai, China
| | - Chunxia Han
- Department of Medical Statistics, Tongji University, Shanghai, China
| | - Zisheng Ai
- Department of Medical Statistics, Tongji University, Shanghai, China
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15
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Schermann H, Ashkenazi I, Graif N, Ogawa T, Morgan S, Ben Tov T, Khoury A, Warschawski Y. Would giving priority in surgery timing to the oldest patients result in lower mortality? INTERNATIONAL ORTHOPAEDICS 2022; 46:1701-1706. [PMID: 35678841 DOI: 10.1007/s00264-022-05466-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Early hip fracture surgery in elderly patients is recognized as a positive prognostic factor. When applied as an intervention, it does not always reduce overall patient mortality. A plausible explanation for this is that not all patients equally benefit from early surgery. The purpose of the study is to investigate the effect of early surgery on mortality in patients ages 80 and older. METHODS This is a retrospective cohort of 3463 patients with hip fractures, operated upon within seven days of admission in a tertiary medical center between 2010 and 2018. Patients were divided into five groups: ages 80-84, 85-89, 90-94, 95-99, and 100 or above. Baseline characteristics were compared between groups. Mortality at one year post-operatively as a function of surgery delay was visualized for each group, using restricted spline curve analysis. RESULTS Patients with increasing age were operated on earlier, had increased co-morbidities with a higher ASA score and experienced higher mortality. Spline curve analysis in younger patients, ages 80 to 94, demonstrated an inflection point at 48 hours after admission, prior to which mortality was rising rapidly and after which it continued rising slowly. In the two oldest age cohorts, there was no increased mortality with an increasing surgical delay. CONCLUSIONS In patients ages 80-94 surgery on day one may be preferable to surgery on day two. In patients ages 95 and older, surgery time did not influence mortality. Pursuit of better patient outcomes may include prioritizing early surgery in younger patients.
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Affiliation(s)
- Haggai Schermann
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel.
| | - Itay Ashkenazi
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Nadav Graif
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Takahisa Ogawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Tomer Ben Tov
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
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16
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Feng L, Chen W, Ping P, Ma T, Li Y, Xu L, Feng Z, Zhao Y, Fu S. Preoperative malnutrition as an independent risk factor for the postoperative mortality in elderly Chinese individuals undergoing hip surgery: a single-center observational study. Ther Adv Chronic Dis 2022; 13:20406223221102739. [PMID: 35782344 PMCID: PMC9243382 DOI: 10.1177/20406223221102739] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/28/2022] [Indexed: 11/15/2022] Open
Abstract
Objective: Malnutrition is prevalent in elderly with hip fracture and higher than in community-dwelling older adults. Scarce studies have examined the association between preoperative malnutrition and postoperative mortality in elderly Chinese individuals with hip fracture. This study was designed to explore the effect of preoperative malnutrition on the postoperative long-term mortality in elderly Chinese individuals undergoing hip surgery. Methods: As a single-center observational study, this study included 263 consecutive patients above 70 years old with hip fracture and elective surgery. Preoperative nutritional status was evaluated by prognostic nutritional index (PNI). Patients were divided into one group with malnutrition (26 patients with PNI ⩽ 38) and the other group without malnutrition (169 patients with PNI > 38), respectively. Results: The overall malnutrition rate was 13.3% (26 patients). The postoperative long-term mortality rates of patients with and without malnutrition had statistically significant difference [10 patients (38.5%) and 32 patients (18.9%), p < 0.05]. Cox regression analysis showed that malnutrition (hazard ratio: 0.269, 95% confidence interval: 0.085–0.859, p < 0.05) and partial pressure of carbon dioxide (hazard ratio: 0.873, 95% confidence interval: 0.790–0.964, p < 0.05) were independent risk factors for the postoperative long-term mortality. Conclusion: This study demonstrated that preoperative malnutrition was an independent risk factor for the postoperative long-term mortality and resulted in a more than 2.5-fold increase of the postoperative long-term mortality in elderly Chinese individuals undergoing hip surgery.
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Affiliation(s)
- Long Feng
- Department of Anesthesiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Wenji Chen
- Department of Rheumatology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Ping Ping
- Main Station of Drug Instrument Supervision and Inspection, Joint Logistic Support Force of Chinese People's Liberation Army, Beijing, China
| | - Tao Ma
- Department of Anesthesiology, Chinese People's Liberation Army Rocket Force Characteristic Medical Center, Beijing, China
| | - Yang Li
- Department of Anesthesiology and Operation Center, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Longhe Xu
- Department of Anesthesiology and Operation Center, The Third Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zeguo Feng
- Department of Anesthesiology and Operation Center, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Shihui Fu
- Department of Cardiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
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17
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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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The effects of dementia on the prognosis and mortality of hip fracture surgery: a systematic review and meta-analysis. Aging Clin Exp Res 2021; 33:3161-3172. [PMID: 33913118 DOI: 10.1007/s40520-021-01864-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Dementia is a common mental disorder that affects the life quality in elders. Recently, emerging studies reported the negative impacts of dementia on prognosis after hip surgeries. However, the integrated and reliable role of dementia in hip surgery is not illustrated. METHODS We searched the relevant literatures before June 2020 and extracted the data that met the inclusion criteria. The influence of dementia on postoperative walking ability, complications including infection, cardiovascular complications, hip dislocation, delirium, and respiratory complications, and survival rate at different periods were evaluated. Qualitative and quantitative analysis were conducted using Review Manager Version 5.3. RESULTS The meta-analysis enrolled a total of 30 studies with 1,037,049 patients. The pooled results revealed that there were significant negative impacts of dementia on the recovery of postoperative walking ability, postoperative infection, hip dislocation, delirium and respiratory complications and mortality at different periods. CONCLUSIONS Dementia is a crucial risk factor for the poor prognosis after hip fracture surgery. Therefore, when making clinical strategies for hip fracture patients with dementia, countermeasures for possible complications should be generated.
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19
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Demirel E, Şahin A. Predictive Value of Blood Parameters and Comorbidities on Three-Month Mortality in Elderly Patients With Hip Fracture. Cureus 2021; 13:e18634. [PMID: 34765379 PMCID: PMC8576146 DOI: 10.7759/cureus.18634] [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] [Accepted: 10/09/2021] [Indexed: 11/05/2022] Open
Abstract
Background Knowing the factors that increase the risk of death in patients with hip fractures will help us to take precautions and intervene when necessary in the pre- and postoperative periods. Therefore, it is important to have inexpensive and practical biomarkers that can predict postoperative complications and mortality. The present study aimed to identify the factors that contribute to early mortality in elderly patients with hip fractures in the first three months after trauma, as well as the parameters that may be determinants of mortality. Methods The data of 1,015 patients over 65 years of age with femoral neck and intertrochanteric fractures admitted between January 2009 and January 2020 were retrospectively reviewed. A total of 763 patients who met the inclusion criteria were included in the study. Our study was designed to include 110 (14.4%) patients in Group 1 who were determined to have died within three months after the diagnosis of hip fracture and 653 (85.6%) patients in Group 2 who were determined not to have died within one year after the trauma. Age, gender, comorbid diseases, American Society of Anesthesiologists (ASA) score, type of anesthesia, operation time, type of implant used, time until surgery, and some biochemical blood values were compared between the two groups. Our data were analyzed statistically using the IBM Statistical Product and Service Solutions (SPSS) software for Windows, v. 25.0 (IBM SPSS Statistics for Windows, Armonk, NY). Results Of all of the patients, 370 (48.5%) were female and 393 (51.5%) were male. The patients who survived had an average age of 76.08, while the patients who died had an average age of 80.57. The mean age among the groups is significantly higher in patients who died. High creatinine, alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and low albumin values were found to be associated with mortality. Conclusion It has been determined that advanced age, delayed operation time, high ASA score, and the number of comorbid diseases are associated with mortality in elderly patients with hip fractures, and biomarkers, such as creatinine, ALT, and LDH, can be used as markers for early mortality. With the increase of studies of similar nature, it will be possible to calculate a systematic risk map for mortality in elderly patients with a proximal femur fracture.
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Affiliation(s)
- Esra Demirel
- Department of Orthopedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum, TUR
| | - Ali Şahin
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, TUR
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Ogawa T, Schermann H, Kobayashi H, Fushimi K, Okawa A, Jinno T. Age and clinical outcomes after hip fracture surgery: do octogenarian, nonagenarian and centenarian classifications matter? Age Ageing 2021; 50:1952-1960. [PMID: 34228781 DOI: 10.1093/ageing/afab137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND older patients with hip fractures are arbitrarily classified as octogenarians, nonagenarians and centenarians. We have designed this study to quantify in-hospital mortality and complications among each of these groups. We hypothesised that the associations between age and in-hospital mortality and complications are continuously increasing, and that these risks increase rapidly when patients reach a certain age. METHODS this research is a retrospective cohort study using nationwide database between 2010 and 2018. Patients undergoing hip fracture surgery, and aged 60 or older, were included. The associations between patient age, in-hospital mortality and complications were visualised using the restricted cubic spline models, and were analysed employing multivariable regression models. Then, octogenarians, nonagenarians and centenarians were compared. RESULTS among a total of 565,950 patients, 48.7% (n = 275,775) were octogenarians, 23.0% (n = 129,937) were nonagenarians and 0.7% (n = 4,093) were centenarians. The models presented three types of association between age, in-hospital mortality and complications: (i) a continuous increase (mortality and respiratory complications); (ii) a mild increase followed by a steep rise (intensive care unit admission, heart failure, renal failure and surgical site hematoma) and (iii) a steep increase followed by a limited change (coronary heart disease, stroke and pulmonary embolisms). CONCLUSION we identified three types of association between age and clinical outcomes. Patients aged 85-90 may constitute the upper threshold for age categorisations, because the risk of in-hospital complications changed dramatically at that stage. This information can improve clinical awareness of various complications and support collective decision-making.
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Affiliation(s)
- Takahisa Ogawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Haggai Schermann
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Hiroki Kobayashi
- Department of Medicine, Harvard Medical School, Section on Genetics and Epidemiology, Research Division, Joslin Diabetes Center, Boston, USA
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
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21
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Chiang MH, Lee HJ, Kuo YJ, Chien PC, Chang WC, Wu Y, Chen YP. Predictors of In-Hospital Mortality in Older Adults Undergoing Hip Fracture Surgery: A Case-Control Study. Geriatr Orthop Surg Rehabil 2021; 12:21514593211044644. [PMID: 34631200 PMCID: PMC8495513 DOI: 10.1177/21514593211044644] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/19/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Although surgery has been proven to improve the long-term survival of older adults with hip fracture, in-hospital mortality directly resulting from repair of hip fracture is undesirable. This study aimed to identify potential prognostic factors that predict in-hospital mortality risk in elderly patients following hip fracture surgery. Materials and Methods: This case–control study comprehensively collected data from older adults with hip fracture admitted to a single medical centre. Age was selected as the cross-matching factor. Univariate and binary multivariate logistic regression models were used to estimate the odds ratios with 95% confidence intervals. A receiver operating characteristic curve was constructed to quantify the discrimination power of the model. Results: Among a total of 841 older adults who received hip fracture surgery, 17 died during hospitalisation, yielding a 2.0% in-hospital mortality rate. Using a binary multivariate logistic regression model to perform a comparison with 51 age-matched patients in survival groups, the model revealed that estimated glomerular filtration rate (eGFR) and malignant cancer history were the only 2 factors significantly correlated with in-hospital mortality. The prognostic values for the eGFR and malignant cancer history were acceptable, with areas under the curve of .76 and .67, respectively. Conclusion: The prevalence of in-hospital mortality following hip fracture is low. After adjustment for age, eGFR and malignant cancer history were identified as factors significantly correlated with in-hospital mortality. The findings of this study could assist in the early screening and detection of patients with high in-hospital mortality risks.
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Affiliation(s)
- Ming-Hsiu Chiang
- Department of General Medicine, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| | - Huan-Ju Lee
- Department of Orthopedics, Taipei Medical University Shuan Ho Hospital, New Taipei City, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pei-Chun Chien
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chun Chang
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yueh Wu
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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22
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Causes of death among 93.637 hip fracture patients- data based on the Danish National Registry of causes of death. Eur J Trauma Emerg Surg 2021; 48:1861-1870. [PMID: 34590173 DOI: 10.1007/s00068-021-01791-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Excess mortality among hip fracture patients is well documented. Less is known, however, about the causes of death in this group of patients, although existing literature suggests that bronchopneumonia and cardiovascular diseases constitute the leading causes of death. In this study, we investigated the causes of death in Danish hip fracture patients, who died within 30-days after sustaining a hip fracture, with a focus on differences in causes of death between men and women and between different age groups. Furthermore, the frequency of potentially preventable causes of death such as pneumonia, urinary tract infections and thromboembolic events was examined. METHODS All Danish patients aged 18 or more suffering from a hip fracture in the period 2002-2012 were examined for inclusion into the study. Data were collected from the Danish National Patient registry. The last month of 2012 being December was left out since we were looking at 30-days mortality. Logistic regression analysis was used to test the association between 30-day mortality with each of the causes of death adjusted for age, sex and CCI in multivariable models with results presented as odds ratios (OR) with 95% confidence intervals. RESULTS During this period, 93,637 patients sustained a hip fracture. Of these, 9504 patients died within 30-days and were included in the study. For patients dead within 30-days after sustaining a hip fracture, the two leading medical causes of death were cardiovascular disease (21.1%) and pneumonia (10.5%) when looking at both genders. A frequent cause of death especially in the younger age group of women less than 50 years old were infections (other than pneumonia) (18.2%) especially urinary tract infections. Pulmonary embolism accounted for 3.9% of causes of deaths in hip fracture patients. CONCLUSION In this study, cardiovascular disease and pneumonia were overall the leading medical causes of death in patients dead within 30-days after sustaining a hip fracture. Apart from pneumonia, another potentially preventable infection in younger female hip fracture patients was urinary tract infections. Pulmonary embolism, another potentially preventable cause of death might be underreported in Danish death certificates.
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23
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Mateos-Nozal J, Sanchez Garcia E, Romero Rodríguez E, Cruz-Jentoft AJ. Oropharyngeal dysphagia in older patients with hip fracture. Age Ageing 2021; 50:1416-1421. [PMID: 33744920 DOI: 10.1093/ageing/afab032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND oropharyngeal dysphagia (OD) and hip fracture are common problems in older patients, both associated with important complications. OBJECTIVE the aim of this study was to measure the prevalence and identify the main risk factors of dysphagia in older patients with hip fracture. DESIGN a prospective study in an orthogeriatric unit of a university hospital over 10 months. METHODS a total of 320 patients (mean age 86.2 years, 73.4% women) were assessed for dysphagia within 72 hours post-surgery using the Volume-Viscosity Swallow Test. Geriatric assessment, hip fracture management and complications were examined to determine their relationship with the presence of OD. RESULTS dysphagia was present in 176 (55%) patients. Multivariate logistic regression analysis showed that the presence of delirium during hospitalization and the inability to perform instrumental activities of daily living before admission were associated with OD. CONCLUSIONS the prevalence of OD is high in hip fracture patients. Objective dysphagia assessment should be routinely included as part of the geriatric assessment of such patients.
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Affiliation(s)
- Jesús Mateos-Nozal
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
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Tang PL, Lin HS, Hsu CJ. Predicting in-hospital mortality for dementia patients after hip fracture surgery - A comparison between the Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index. J Orthop Sci 2021; 26:396-402. [PMID: 32482586 DOI: 10.1016/j.jos.2020.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/22/2020] [Accepted: 04/09/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Considerable in-hospital mortality was reported in geriatric patients with dementia sustaining femoral neck or inter-trochanteric fracture. We intended to establish a predictive model of in-hospital mortality for dementia patients after hip fracture surgery. METHODS We collected 8080 registrants ≧ 65 years old from the subset (LHID2000) of the National Health Insurance Research Database (NHIRD) that met the following inclusion criteria:1. Admitted with the ICD of hip fracture; 2. Underwent operation of hip fracture during the same hospitalization; 3. Co-existing diagnosis of dementia (ICD-9-CM codes 290). The co-morbidity was recorded according to validated Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) from the diagnoses of hospitalization. The main outcome measure was in-hospital mortality that was defined as death being reported during hospitalization. The comparison of predictability was conducted by Receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) among different predictive models. RESULTS The Charlson Comorbidity Index (CCI) score and Elixhauser Comorbidity Index (ECI) score showed similar ability in predicting in-hospital mortality (AUC = 0.653, 95% CI = 0.611-0.695 for CCI; AUC = 0.624, 95% CI = 0.582-0.665 for ECI, p = 0.0717). By adding age grouping (≥80 yrs = 1, 65-80 yrs = 0) and gender difference (Male = 1, Female = 0), these two models were shifted to models CCI_new1 and ECI_new1. Consequently, the AUC greatly increased in the CCI_new1 (AUC = 0.682, 95% CI = 0.643-0.722). It therefore provided better prediction of in-hospital mortality than ECI_new1 (AUC = 0.651, 95% CI = 0.611-0.691) (p = 0.0444). CONCLUSIONS Utilizing the CCI with addition of grouping for age and gender provides a better prediction for in-hospital mortality than the ECI among elderly patients with concomitant dementia and hip fracture who underwent surgical intervention.
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Affiliation(s)
- Pei-Ling Tang
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan.
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan.
| | - Chien-Jen Hsu
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Nursing, Fooyin University, Kaohsiung, Taiwan.
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25
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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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Ogawa T, Yoshii T, Higuchi M, Morishita S, Fushimi K, Fujiwara T, Okawa A. Seasonality of mortality and in-hospital complications in hip fracture surgery: Retrospective cohort research using a nationwide inpatient database. Geriatr Gerontol Int 2021; 21:398-403. [PMID: 33768645 DOI: 10.1111/ggi.14153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/21/2021] [Accepted: 03/03/2021] [Indexed: 12/24/2022]
Abstract
AIM Among older patients undergoing hip fracture surgery, previous studies have shown a seasonal variation of in-hospital surgical complications. However, little is known about seasonal effects on mortality and systemic complications after hip fracture surgery. In the present study, we evaluated whether mortality and in-hospital systemic complications are influenced by seasonal differences. METHODS We enrolled patients from a nationwide database who underwent hip fracture surgery between 2010 and 2018. The primary outcome was in-hospital mortality. The secondary outcomes were in-hospital systemic complications. The association between the seasonality and in-hospital outcomes was investigated using multivariable Cox, logistic regression and causal mediation analysis. RESULTS With 425 856 patients (mean age 83.5 years; 79% women), overall in-hospital mortality was 5324 (1.2%). Fall and winter were associated with a higher mortality than spring (hazard ratio [HR] 1.16; P < 0.001; HR 1.14; P = 0.001, respectively). Across all the seasons, there were 36 834 overall systemic complications (8.6%), with respiratory infection being the most frequent (18 637 [4.4%]). Among these complications, only respiratory infection showed seasonal variation, with a higher prevalence in fall and winter. The mediated effect of respiratory infection on mortality was significantly higher in fall and winter compared with spring (fall, HR 1.06, proportion mediated 36.7%; winter, HR 1.14, proportion mediated 55.0%; all P < 0.001). CONCLUSIONS We found a significantly higher mortality in fall and winter after hip fracture surgery. Specifically, in winter, the increased in-hospital death was largely attributed to the increased incidence of respiratory infection. Geriatr Gerontol Int 2021; 21: 398-403.
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Affiliation(s)
- Takahisa Ogawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaya Higuchi
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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27
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Proximal femur fracture, analysis of epidemiology, complications, and mortality: A cohort with 380 patients. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.787253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pang C, Aqil A, Mannan A, Thomas G, Hossain FS. Hip fracture patients admitted to hospital on weekends are not at increased risk of 30-day mortality as compared with weekdays. J Orthop Traumatol 2020; 21:23. [PMID: 33263820 PMCID: PMC7710845 DOI: 10.1186/s10195-020-00558-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 10/29/2020] [Indexed: 11/27/2022] Open
Abstract
Background Hip fractures remain a major health concern owing to the increasing elderly population and their association with significant morbidity and mortality. The effects of weekend admission on mortality have been studied since the late 1970s. Despite most studies showing that mortality rates are higher for patients admitted on a weekend, the characteristics of the admitted patients have remained unclear. We aim to investigate this ‘weekend effect’ at our hospital in patients presenting with a hip fracture. Methods Patients undergoing acute hip fracture surgery were identified from the local National Hip Fracture Database. Patient demographics, fracture type, co-morbidities and admission blood parameters were examined. The outcome analysed was 30-day mortality. The data were analysed with regard to day of admission, i.e. weekday (Monday to Friday) or weekend (Saturday and Sunday). Results A total of 894 patients were included. Results demonstrated that 30-day mortality was similar on the weekend compared with the weekday (6.96% versus 10.39%, OR 0.65, 95% CI 0.36–1.14, p = 0.128) for patients who sustained an acute hip fracture. The total number of deaths within 30 days was 85 (69 weekday versus 16 weekend). This remained non-significant after adjusting for several variables: age and sex only (OR = 0.65, 95% CI 0.37–1.16, p = 0.146), age, sex, and care variables (OR = 0.59, 95% CI 0.33–1.06, p = 0.080), age, sex, and blood test results (OR = 0.62, 95% CI 0.35–1.12, p = 0.111), and all covariates (OR = 0.69, 95% CI 0.29–1.62, p = 0.392). In the fully adjusted model, the following variables were independent predictors of mortality: sex (male) (OR = 1.93, 95% CI 1.11–3.35, p = 0.019) and ASA > 2 (OR = 2.6, 95% CI 1.11–6.11, p = 0.028) and age (1.08, 95% CI 1.04–1.13, p < 0.001). Conclusion The evidence for a ‘weekend effect’ in patients with a hip fracture is absent in this study. However, we have shown other factors that are associated with increased mortality such as increased age, male sex and higher ASA grade. Level of evidence Level 3.
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Affiliation(s)
- Calver Pang
- Division of Surgery and Interventional Science, Royal Free Hospital, University College London, 9th Floor, 10 Pond Street, London, NW3 2PS, UK.
| | - A Aqil
- Yorkshire and Humber Deanery, Yorkshire, UK
| | - A Mannan
- Harrogate and District NHS Foundation Trust, Lancaster Park Road, Harrogate, HG2 7SX, UK
| | - G Thomas
- Airedale NHS Foundation Trust, Skipton Road, Steeton, Keighley, BD20 6TD, UK
| | - F S Hossain
- Manor Hospital, Walsall Healthcare NHS Trust, Moat Road, Walsall, WS2 9PS, UK
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Szulc P. Impact of Bone Fracture on Muscle Strength and Physical Performance-Narrative Review. Curr Osteoporos Rep 2020; 18:633-645. [PMID: 33030682 DOI: 10.1007/s11914-020-00623-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Low muscle strength and poor physical performance are associated with high risk of fracture. Many studies assessed clinical and functional outcomes of fractures. Fewer studies analyzed the impact of fractures on muscle strength and physical performance. RECENT FINDINGS Vertebral fractures (especially multiple and severe ones) are associated with back pain, back-related disability, lower grip strength, lower strength of lower limbs, lower gait speed, and poor balance. Patients with hip fracture have slower gait and lower quadriceps strength. Non-vertebral fractures were associated with lower strength of the muscles adjacent to the fracture site (e.g., grip strength in the case of distal radius fracture, knee extensors in the case of patellar fracture) and poor physical function dependent on the muscles adjacent to the fracture site (e.g., limited range of motion of the shoulder in the case of humerus fracture, gait disturbances in the case of the ankle fracture). Individuals with a fracture experience a substantial deterioration of muscle strength and physical performance which exceeds that related to aging and is focused on the period close to the fracture occurrence. After fracture, muscle strength increased and physical performance improved. The rate of normalization depended partly on the therapeutic approach and on the rehabilitation program. A subgroup of patients, mainly the elderly, never returns to the pre-fracture level of physical performance. The permanent decline of physical function after fracture may be related to the limitation of movements due to pain, low physical activity, poor health before the fracture, and reduced efficacy of retraining after immobilization.
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Affiliation(s)
- Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
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Huang J, Lyu H, Huo K, Do Prado LB, Tang C, Wang Z, Li Q, Wong J, Su H. Bone Fracture Enhanced Blood-Brain Barrier Breakdown in the Hippocampus and White Matter Damage of Stroke Mice. Int J Mol Sci 2020; 21:ijms21228481. [PMID: 33187248 PMCID: PMC7697771 DOI: 10.3390/ijms21228481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Tibia fracture (BF) before stroke shortly causes long-term post-stroke memory dysfunction in mice. The mechanism is unclear. We hypothesize that BF enhances neuroinflammation and blood brain barrier (BBB) breakdown in the hippocampus and white matter (WM) damage. Methods: Mice were assigned to groups: BF, stroke, BF+stroke (BF 6 h before stroke) and sham. BBB integrity was analyzed 3 days after the surgeries and WM injury was analyzed 3 days and 8 weeks after the surgeries. Results: Stroke and BF+stroke groups had more activated microglia/macrophages and lower levels of claudin-5 in the ipsilateral hippocampi than the BF group. BF+stroke group had the highest number microglia/macrophages and the lowest level of claudin-5 among all groups and had fewer pericytes than BF group. Stroke and BF+stroke groups had smaller WM areas in the ipsilateral basal ganglia than the sham group 8 weeks after the injuries. The BF+stroke group also had smaller WM areas in the ipsilateral than sham and BF groups 3 days after the injuries and in the contralateral basal ganglia than stroke and BF groups 8 weeks after the injuries. Conclusions: BF exacerbates neuroinflammation and BBB leakage in the hippocampus and WM damage in basal ganglia, which could contribute to the long-lasting memory dysfunction in BF+stroke mice.
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Affiliation(s)
- Jinhao Huang
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA; (J.H.); (H.L.); (K.H.); (L.B.D.P.); (C.T.); (Z.W.); (Q.L.); (J.W.)
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA
| | - Haiyan Lyu
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA; (J.H.); (H.L.); (K.H.); (L.B.D.P.); (C.T.); (Z.W.); (Q.L.); (J.W.)
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA
| | - Kang Huo
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA; (J.H.); (H.L.); (K.H.); (L.B.D.P.); (C.T.); (Z.W.); (Q.L.); (J.W.)
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA
| | - Leandro B. Do Prado
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA; (J.H.); (H.L.); (K.H.); (L.B.D.P.); (C.T.); (Z.W.); (Q.L.); (J.W.)
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA
| | - Chaoliang Tang
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA; (J.H.); (H.L.); (K.H.); (L.B.D.P.); (C.T.); (Z.W.); (Q.L.); (J.W.)
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA
| | - Zhanqiang Wang
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA; (J.H.); (H.L.); (K.H.); (L.B.D.P.); (C.T.); (Z.W.); (Q.L.); (J.W.)
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA
| | - Qifeng Li
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA; (J.H.); (H.L.); (K.H.); (L.B.D.P.); (C.T.); (Z.W.); (Q.L.); (J.W.)
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA
| | - Julia Wong
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA; (J.H.); (H.L.); (K.H.); (L.B.D.P.); (C.T.); (Z.W.); (Q.L.); (J.W.)
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA
| | - Hua Su
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143, USA; (J.H.); (H.L.); (K.H.); (L.B.D.P.); (C.T.); (Z.W.); (Q.L.); (J.W.)
- Center for Cerebrovascular Research, University of California, San Francisco, CA 94143, USA
- Correspondence: ; Tel.: +1-628-206-3162
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Bell JJ, Pulle RC, Lee HB, Ferrier R, Crouch A, Whitehouse SL. Diagnosis of overweight or obese malnutrition spells DOOM for hip fracture patients: A prospective audit. Clin Nutr 2020; 40:1905-1910. [PMID: 32994070 DOI: 10.1016/j.clnu.2020.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIMS Crude diagnostic parameters such as BMI limit recognition of malnutrition in overweight and obese patients. This study applied a robust malnutrition diagnostic measure to investigate whether malnutrition impacts clinical outcomes in overweight or obese hip fracture inpatients. METHODS A prospective, consecutive 12-month audit of inpatients admitted to a dedicated hip fracture unit with a BMI of ≥25 for surgical intervention. Univariate and logistic regression analyses were performed to investigate the relationship of demographics (age, gender), comparative measures (type of fracture, Charlson Comorbidity Index (CCI) on admission, time to surgery, type of surgery and anaesthesia, nutrition status) and outcome measures (delirium, time to mobilise post-operatively, length of stay, 12-month mortality). Malnutrition was defined using the International Classification of Diseases, Tenth Revision - Australian Modification protein-energy malnutrition criteria. RESULTS 127 overweight or obese hip fracture patients for surgical intervention were included in analyses. Patients were predominantly older females (median 81.0, range 48-97 years; 66.9%). Malnutrition prevalence was not infrequent (18.3%) despite the median BMI of 28.3 (range 25.0-63.9). Mortality at 12-months (17.3%) was lower than routinely reported across broader hip fracture populations. Logistic regression modelling demonstrated that malnutrition increased the likelihood of 12-month mortality (OR: 4.47, 95% CI 1.27-15.77; p = 0.020), post-operative delirium (OR: 3.64, 95% CI 1.00 to 13.33; p = 0.051), and delayed post-operative mobility (OR: 3.29, 95% CI 1.05 to 10.31; p = 0.041), in overweight or obese hip fracture patients. Length of stay demonstrated poor association with all predictor measures. CONCLUSION Hip fracture patients who are both overweight or obese, and malnourished, have significantly and substantially worse clinical outcomes than their well-nourished, albeit overweight or obese, counterparts. Comprehensive nutrition assessment measures should be applied to all hip fracture inpatients to ensure appropriate clinical nutrition care is appropriately directed.
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Affiliation(s)
- Jack J Bell
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, 4072, Australia.
| | - Ranjeev C Pulle
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia
| | - Hui Bing Lee
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland, 4059, Australia
| | - Rebecca Ferrier
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia
| | - Alisa Crouch
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia
| | - Sarah L Whitehouse
- Orthopaedic Research Unit, The Prince Charles Hospital and Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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32
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Gabbert T. A Vital Specialty for the Twenty-First Century. Nurs Clin North Am 2020; 55:xi-xii. [DOI: 10.1016/j.cnur.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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33
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Loncar G, Cvetinovic N, Lainscak M, Isaković A, von Haehling S. Bone in heart failure. J Cachexia Sarcopenia Muscle 2020; 11:381-393. [PMID: 32087616 PMCID: PMC7113538 DOI: 10.1002/jcsm.12516] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022] Open
Abstract
There is an increasing interest in osteoporosis and reduced bone mineral density affecting not only post-menopausal women but also men, particularly with coexisting chronic diseases. Bone status in patients with stable chronic heart failure (HF) has been rarely studied so far. HF and osteoporosis are highly prevalent aging-related syndromes that exact a huge impact on society. Both disorders are common causes of loss of function and independence, and of prolonged hospitalizations, presenting a heavy burden on the health care system. The most devastating complication of osteoporosis is hip fracture, which is associated with high mortality risk and among those who survive, leads to a loss of function and independence often necessitating admission to long-term care. Current HF guidelines do not suggest screening methods or patient education in terms of osteoporosis or osteoporotic fracture. This review may serve as a solid base to discuss the need for bone health evaluation in HF patients.
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Affiliation(s)
- Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg-August University, Goettingen, Germany
| | - Natasa Cvetinovic
- Department of Cardiology, University Clinical Hospital Center 'Dr. Dragisa Misovic-Dedinje', Belgrade, Serbia
| | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg-August University, Goettingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
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34
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Pallardo Rodil B, Gómez Pavón J, Menéndez Martínez P. Hip fracture mortality: Predictive models. Med Clin (Barc) 2020; 154:221-231. [PMID: 31859006 DOI: 10.1016/j.medcli.2019.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 12/18/2022]
Abstract
The preoperative estimation of the risk of mortality after a hip fracture is very useful to plan time of surgery and perioperative care, inform patients and families about the prognosis and allows comparisons between different units. Different models have been developed to stratify mortality risk, but they show heterogeneity in terms of type of population and variables included, monitoring the time and statistical methods used, which makes it difficult to establish comparisons between them. The vast majority of them are awaiting external validation in populations different from those in which they were originally proposed. So far, the Nottingham Hip Fracture Score (NHFS) and the Orthopaedic Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (O-POSSUM) are the most commonly used models. The NHFS is simpler and faster to apply, and by not including intraoperative variables can be used at the time of admission.
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Affiliation(s)
- Beatriz Pallardo Rodil
- Unidad de Ortogeriatría, Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, España
| | - Javier Gómez Pavón
- Unidad de Ortogeriatría, Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, España.
| | - Pablo Menéndez Martínez
- Unidad de Ortogeriatría, Servicio de Traumatología Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, España
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35
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Kristiansson J, Hagberg E, Nellgård B. The influence of time-to-surgery on mortality after a hip fracture. Acta Anaesthesiol Scand 2020; 64:347-353. [PMID: 31652349 DOI: 10.1111/aas.13494] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/30/2019] [Accepted: 10/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The effect of time-to-surgery on mortality in acute hip fracture (AHF) patients has been debated and studies are inconsistent regarding from what time limit mortality starts to increase. At Sahlgrenska University Hospital/Mölndal, surgery is recommended within 24 hours leaving little time for pre-operative optimization. However, internationally the definition of early surgery varies between 24 and 48 hours and over. This retrospective study was initiated to investigate the relation between time-to-surgery and 30-day mortality. METHOD Data of AHF patients from January 2007 through December 2016 were collected. The variables analysed were: age, gender, American Society of Anesthesiologists physical status classification, surgical method (prosthesis or osteosynthesis) and time-to-surgery, along with 30-day mortality. Primary outcome was 30-day mortality related to time-to-surgery divided into groups. Secondary outcome was 30-day mortality related to time-to-surgery analysed hour-by-hour. RESULTS From 10,844 eligible patients, 9,270 patients were included into the study. Mean time-to-surgery was 19.4 hours and overall 30-day mortality was 7.6%. Adjusted Cox regression analysis revealed an increased mortality rate in patients with time-to-surgery >48 hours. In the hour-by-hour analysis, significant mortality increase was observed at 39 hours of time-to-surgery. Patients with time-to-surgery >24 hours did not have increased mortality compared to patients with time-to-surgery <24 hours. CONCLUSION In AHF patients, a time-to-surgery exceeding 39-48 hours was associated with increased mortality. Patients with surgeries performed before 39-48 hours did not have increased mortality and this time may, in some patients, be used for optimization prior surgery even if time-to-surgery exceeds 24 hours.
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Affiliation(s)
- Johan Kristiansson
- Department of Anaesthesiology and Intensive Care Sahlgrenska University Hospital
- Institution of Clinical Sciences Sahlgrenska Academy University of Gothenburg
| | - Eva Hagberg
- Department of Clinical Physiology Sahlgrenska University Hospital Mölndal Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care Sahlgrenska University Hospital
- Institution of Clinical Sciences Sahlgrenska Academy University of Gothenburg
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36
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Xu BY, Yan S, Low LL, Vasanwala FF, Low SG. Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC Musculoskelet Disord 2019; 20:568. [PMID: 31775693 PMCID: PMC6882152 DOI: 10.1186/s12891-019-2950-0] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/14/2019] [Indexed: 12/17/2022] Open
Abstract
Background Hip fracture is an important and prevalent medical condition associated with adverse outcomes. The aim of this article is to systematically review and summarise the predictors of poor functional outcomes and mortality for patients with hip fractures. Methods We conducted a systemic literature search using PubMed, EMBASE and Cochrane Library. We included English peer-reviewed cohort studies that examined predictors of poor functional outcomes (such as independence in Activities of Daily Living) and mortality for patients with hip fracture published in the past 15 years (from 1 Jan 2004 up to 30 May 2019). Two independent researchers evaluated the articles for eligibility. Consensus on the eligibility was sought and a third researcher was involved if there was disagreement. A standardised form was used to extract relevant data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Results We retrieved 4339 and included 81 articles. We identified two emerging predictors of poor functional outcomes and mortality for patients with hip fractures: low hand grip strength and frailty in line with an emerging concept of “physical performance”. The predictors identified in this systematic review can be grouped into 1) medical factors, such as presence of co-morbidities, high American Society of Anesthesiologists (ASA) grade, sarcopenia, 2) surgical factors including delay in operation (e.g. > 48 h), type of fracture s, 3) socio-economic factors which include age, gender, ethnicity, and 4) system factors including lower case-volume centers. Conclusions This systematic review identified multiple significant predictors of poor functional outcomes and mortality, with the hand grip strength and frailty being important emerging predictors in the most recent literature. These predictors would further inform healthcare providers of their patients’ health status and allow for early intervention for modifiable predictors.
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Affiliation(s)
- Bang Yu Xu
- Department of Post Acute and Continuity Care, SingHealth Community Hospital - Sengkang, 1 Anchorvale St, Singapore, 544835, Singapore.
| | - Shi Yan
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Lian Leng Low
- Department of Family Med & Continuing Care, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Farhad Fakhrudin Vasanwala
- Department of Post Acute and Continuity Care, SingHealth Community Hospital - Sengkang, 1 Anchorvale St, Singapore, 544835, Singapore
| | - Sher Guan Low
- Department of Post Acute and Continuity Care, SingHealth Community Hospital - Sengkang, 1 Anchorvale St, Singapore, 544835, Singapore
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Auais M, Al-Zoubi F, Matheson A, Brown K, Magaziner J, French SD. Understanding the role of social factors in recovery after hip fractures: A structured scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1375-1387. [PMID: 31446636 PMCID: PMC7039329 DOI: 10.1111/hsc.12830] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 05/25/2023]
Abstract
Poor recovery among older adults with hip fractures can occur despite successful surgical repair and rehabilitation, suggesting other factors might play a role in recovery, such as social factors. The aim of this scoping review was to provide an overview of the literature on the role of social factors in older adult's recovery after hip fracture. This review followed the York Framework and its modifications and recent reporting guidelines. Two independent researchers searched main medical databases (CINAHL, EMBASE, Medline, PsycINFO and the Cochrane libraries) from inception to June 2017, for studies investigating social factors and recovery post hip fracture. Studies were excluded if they were qualitative, perspective papers or if participants were < 65 years or they were not living in the community. We screened 2,503 unique abstracts in total and 19 studies fulfilled the inclusion criteria. Social factors investigated in the included studies were social support, socioeconomic factors and living arrangement. We classified outcomes in the studies into three subgroups: physical functional recovery, mortality and other outcomes (pain, hospital length of stay and quality of life). We found evidence that social support and socioeconomic factors (e.g. socioeconomic status) were significantly associated with an increase in functional recovery, a decrease in mortality and other outcomes, but conflicting evidence was found for the effect of one's living arrangement. Only two included studies were randomised controlled trials. To conclude, social factors, such as social support and socioeconomic status, affect physical functional recovery and mortality in older adults with hip fractures. However, this is an under researched area that lacks rigorously designed studies and would benefit from more studies with rigorous designs.
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Affiliation(s)
- Mohammad Auais
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Fadi Al-Zoubi
- School of Physical and Occupational Therapy, Montreal, QC, Canada
| | - Alyssa Matheson
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Kelcie Brown
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Jay Magaziner
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Simon D. French
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
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38
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Meng D, Bai X, Wu H, Yao S, Ren P, Bai X, Lu C, Song Z. Patient and Perioperative Factors Influencing the Functional Outcomes and Mortality in Elderly Hip Fractures. J INVEST SURG 2019; 34:262-269. [PMID: 31462097 DOI: 10.1080/08941939.2019.1625985] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study aimed to evaluate the functional outcomes and mortality following hip fracture surgery in elderly patients, and to identify the associated risk factors. Between January 2016 and December 2017, 480 consecutive patients were finally included for data analyses. The Harris score and Barthel index were used to evaluate the hip function and ability to perform activities of daily living (ADL). Univariate and multivariate logistics regression analyses were performed to determine the independent risk factors for mortality, poor hip function or poor ability to perform ADL. The mortality rate was 15.6% (75/480). In the survivors, poor outcome developed in 133 (32.8%) patients and poor ADL was in 72 (17.8%) patients. The independent factors that influenced mortality were advanced age (p = 0.033), male gender (0.031), living in rural area (p < 0.001), self-reported diabetes (p = 0.005), tumor (p = 0.024), preoperative delay >7 days (p = 0.020), postoperative drainage use (p = 0.034), WBC > 10 × 109/L (p = 0.005), reduced RBC (p = 0.011), PLT < 100 × 109/L (p < 0.001), ALB < 35 g/L (p < 0.001) and CK > 200 U/L (p = 0.003). The independent factors that influenced the hip function were male gender (p = 0.009), WBC > 10 × 109/L (p < 0.001), lower HBG (p = 0.005), and ALB < 35 g/L (p < 0.001). The independent factors that influenced the ability to perform ADL were diagnosis of trochanteric fracture (p = 0.048), preoperative delay > 7 days (p = 0.027), postoperative drainage use (p = 0.010), elevated WBC (p = 0.020), lower HGB (p < 0.001), PLT < 100 × 109/L (p = 0.002), and ALB < 35 g/L (p < 0.001). Although most of risk factors were not modifiable, they aid in patient individual risk evaluation, risk stratification, and counseling patients or relatives.
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Affiliation(s)
- Defei Meng
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, People's Republic of China
| | - Xiaoyi Bai
- Department of Geratology, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Haotian Wu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, People's Republic of China
| | - Shuangquan Yao
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, People's Republic of China
| | - Pengcheng Ren
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, People's Republic of China
| | - Xiaodong Bai
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, People's Republic of China
| | - Chongyao Lu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, People's Republic of China
| | - Zhaohui Song
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, People's Republic of China
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Ram GG, Govardhan P. In-Hospital Mortality following Proximal Femur Fractures in Elderly Population. Surg J (N Y) 2019; 5:e53-e56. [PMID: 31317068 PMCID: PMC6635113 DOI: 10.1055/s-0039-1692995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/22/2019] [Indexed: 11/30/2022] Open
Abstract
Context
In India, hip fracture crude incidence above the age of 50 years was 129 per 100,000.
Aims
The aim of this study is to analyze the in-hospital mortality following proximal femur fractures in elderly Indian population.
Methods and Material
The study was done in Sri Ramachandra Medical Center, Chennai, India. Patient's records were retrospectively evaluated for a period of 3 years from January 1, 2015 to January 1, 2018. The inclusion criteria were patients both male and female aged more than 65 years admitted with the diagnosis of neck of femur or intertrochanteric or subtrochanteric fractures. The exclusion criteria were patients having any associated fracture or previous hip fracture history or diagnosed primary or secondary malignancies. To evaluate any surgical delay two groups were formed. After eliminating cases based on exclusion criteria, we had 270 patients for evaluation.
Statistical Analysis Used
The collected data were analyzed with IBM.SPSS statistics software 23.0 Version. To describe about the data descriptive statistics frequency analysis, percentage analysis were used for categorical variables and the mean and standard deviation (SD) were used for continuous variables. To find the significant difference between the bivariate samples, Student's
t
-test and analysis of variance (ANOVA) were used. The
p
-value of 0.05 is considered as significant level.
Results
We had a total of 24 mortalities with 15 males and 9 females. The in-hospital mortality of patients who underwent replacement surgeries for proximal femur fractures was 14 in our study. Sixteen of the in-hospital mortality patients had low Parker's mobility score. Twenty patients had mortality when surgery was delayed more than 48 hours.
Conclusions
In-hospital mortality in elderly patients having proximal femur fracture increases significantly if the patient was having low-preoperative mobility status, if surgery was delayed more than 48 hours, and if patient undergoes replacement surgeries.
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Affiliation(s)
- Ganesan G Ram
- Department of Orthopaedics, Sri Ramachandra Medical College, Porur, Chennai, India
| | - Praveen Govardhan
- Department of Orthopaedics, Sri Ramachandra Medical College, Porur, Chennai, India.,Department of Orthopaedics, Vasanthi Orthopaedic Hospital, Arumbakkam, Chennai, India
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40
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Bai J, Zhang P, Liang X, Wu Z, Wang J, Liang Y. Association between dementia and mortality in the elderly patients undergoing hip fracture surgery: a meta-analysis. J Orthop Surg Res 2018; 13:298. [PMID: 30470251 PMCID: PMC6260652 DOI: 10.1186/s13018-018-0988-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/26/2018] [Indexed: 01/11/2023] Open
Abstract
Objective This study was designed to verify the association between dementia and mortality in the elderly undergoing hip fracture surgery, and assessed the mortality of patients with dementia after hip fracture surgery. Material and methods PubMed, Embase, and Web of Science were searched until April, 2018 without language restrictions. Two reviewers selected related studies, assessed study quality, and extracted data independently. Risk ratios (RRs) with 95% confidence intervals (CI) were derived using random-effects model throughout all analyses. The endpoints included 30-day, 6-month, 1-year, and more than 1-year mortality. This meta-analysis was performed following PRISMA statement and carried out by using stata14.0 software. Results Dementia significantly increased postoperative mortality of patients suffered from hip fracture in 30-day [RR = 1.57, 95% CI (1.29, 1.90), P<0.00], 6-month [RR = 1.97, 95% CI (1.47, 2.63), P<0.00], 1-year [RR = 1.77, 95% CI (1.54, 2.04), P<0.00], and more than 1-year follow up [RR = 1.60, 95% CI (1.30, 1.96), P<0.00] respectively. The mortality of dementia patients after hip fracture surgery in 30-day [ES = 12%, 95% CI (8%, 15%)], 6-month [ES = 32%, 95% CI (17%, 48%)], 1-year [ES = 39%, 95% CI (35%, 43%)], and more than 1-year follow up [ES = 45%, 95% CI (32%, 58%)]. Conclusions Our meta-analysis demonstrated that the mortality of patients with dementia suffered from hip fracture surgery is 12%, 32%, 39%, and 45%, and dementia increased 1.57, 1.97, 1.77, and 1.60-fold mortality in patients undergoing hip fracture surgery in 30-day, 6-month, 1-year, and more than 1-year follow up respectively.
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Affiliation(s)
- Jianzhong Bai
- Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Pei Zhang
- Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Xinyu Liang
- Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Zhipeng Wu
- The second XiangYa hospital, Central South University, Changsha, 410011, China
| | - Jingcheng Wang
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China.
| | - Yuan Liang
- Clinical Medical College of Yangzhou University, Yangzhou, 225001, China.
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Kusumastuti S, Rozing MP, Lund R, Mortensen EL, Westendorp RGJ. The added value of health indicators to mortality predictions in old age: A systematic review. Eur J Intern Med 2018; 57:7-18. [PMID: 30017559 DOI: 10.1016/j.ejim.2018.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Numerous risk prediction models use indicators of health to predict mortality in old age. The added value to mortality predictions based on demographic variables is unknown. OBJECTIVE To evaluate the accuracy of health indicators in predicting all-cause mortality among individuals aged 50+ using area under receiver operating characteristic curve (AUC). Specifically, to assess the added value of health indicators relative to demographic variables. METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. There were no restrictions on study designs, follow-up duration, language, or publication dates. We also examined the quality of studies using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies. RESULTS Out of 804 studies investigating all-cause mortality in older persons, 16 studies were eligible. In community-dwelling populations, the accuracy of demographic variables and health indicators combined ranged from AUC 0.71 to 0.82, indicating modest ability to predict mortality. Age contributed the most to mortality prediction (AUC 0.65 to 0.78) and compared to age and sex, the added values of genetics, physiology, functioning, mood, cognition, nutritional status, subjective health, disease, frailty, and lifestyle ranged from AUC 0.01 to 0.10. The lack of validation samples made it difficult to assess their true added value. Findings were similar in institutionalized populations. Heterogeneity of the studies prevented us from performing a meta-analysis. CONCLUSION Age and sex contributed the most to mortality predictions in old age while the added value of health indicators is likely to be limited.
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Affiliation(s)
- Sasmita Kusumastuti
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.
| | - Maarten Pieter Rozing
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lund
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark; Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark; Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Bennett A, Li H, Patel A, Kang K, Gupta P, Choueka J, Feierman DE. Retrospective Analysis of Geriatric Patients Undergoing Hip Fracture Surgery: Delaying Surgery Is Associated With Increased Morbidity, Mortality, and Length of Stay. Geriatr Orthop Surg Rehabil 2018; 9:2151459318795260. [PMID: 30245906 PMCID: PMC6146322 DOI: 10.1177/2151459318795260] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction: Hip fractures are common in elderly patients. However, this population frequently presents with significant medical comorbidities requiring extensive medical optimization. Methods: This study sought to elucidate optimal time to surgery and evaluate its effect on postoperative morbidity, mortality, and length of stay (LOS). We performed a retrospective analysis of data collected from 2008 to 2010 on 841 patients who underwent hip fracture surgery. Patients were classified based on time to surgery and were also classified and analyzed according to the American Society of Anesthesiologists (ASA) physical classification system. Results: Patients with a delay of greater than 48 hours had a significant increase in overall LOS, postoperative days, and overall postoperative complications. Patients classified as ASA 4 had an odds ratio for postoperative morbidity of 3.32 compared to the ASA 1 and 2 group (P = .0002) and 2.26 compared to the ASA 3 group (P = .0005). Delaying surgery >48 hours was also associated with increased in-hospital mortality compared to 24 to 48 hours (P = .0197). Increasing ASA classification was also associated with significantly increased mortality. Patients classified as ASA 4 had 5.52 times the odds of ASA 1 and 2 (P = .0281) of in-hospital mortality. Those classified ASA 4 had 2.97 times the odds of ASA 3 (P = .0198) of an in-house mortality. Anesthetic technique (spinal vs general) and age were not confounding variables with respect to mortality or morbidity. Discussion: Surgical timing and ASA classification were evaluated with regard to LOS, number postoperative days, morbidity, and mortality. Conclusions: Delaying surgery >48 hours, especially in those with increased ASA classification, is associated with an increase in overall LOS, postoperative days, morbidity, and mortality. However, rushing patients to surgery may not be beneficial and 24 to 48 hours of preoperative optimization may be advantageous.
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Affiliation(s)
- Andrew Bennett
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Hsin Li
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Aakash Patel
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Kevin Kang
- Department of Orthopedics, Maimonides Medical Center, Brooklyn, NY, USA
| | - Piyush Gupta
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jack Choueka
- Department of Orthopedics, Maimonides Medical Center, Brooklyn, NY, USA
| | - Dennis E Feierman
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
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Edelmuth SVCL, Sorio GN, Sprovieri FAA, Gali JC, Peron SF. Comorbidades, intercorrências clínicas e fatores associados à mortalidade em pacientes idosos internados por fratura de quadril. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Montomoli J, Erichsen R, Gammelager H, Pedersen AB. Liver disease and mortality among patients with hip fracture: a population-based cohort study. Clin Epidemiol 2018; 10:991-1000. [PMID: 30174458 PMCID: PMC6110281 DOI: 10.2147/clep.s168237] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose The aim of this study was to examine the prognostic impact of liver disease on mortality following hip fracture (HF). Patients and methods This nationwide cohort study, based on prospectively collected data retrieved from Danish registries, included all patients diagnosed with incident HF in Denmark during 1996-2013. Patients were classified based on the coexisting liver disease at the time of HF, ie, no liver disease, noncirrhotic liver disease, and liver cirrhosis. We computed 30-day and 31-365-day mortality risks. To compare patients with and without liver disease, we computed mortality adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) using Cox regression controlled for potential confounders. Results Among 152,180 HF patients, 2,552 (1.7%) patients had noncirrhotic liver disease and 1,866 (1.2%) patients had liver cirrhosis. Thirty-day mortality was 9.4% among patients with noncirrhotic liver disease, 12.6% among patients with liver cirrhosis patients, and 9.7% among patients without liver disease. Compared to patients without liver disease, crude and adjusted HRs within 30 days following HF were, respectively, 0.96 (95% CI: 0.85-1.10) and 1.24 (95% CI: 1.09-1.41) for patients with noncirrhotic liver disease and 1.30 (95% CI: 1.14-1.48) and 2.25 (95% CI: 1.96-2.59) for those with liver cirrhosis. Among patients who survived 30 days post-HF, the 31-365-day mortality was 18.5% among patients with noncirrhotic liver disease, 26.4% among patients with liver cirrhosis, and 19.4% among patients without liver disease. Corresponding crude and adjusted HRs were, respectively, 0.95 (95% CI: 0.86-1.04) and 1.08 (95% CI: 0.99-1.20) for patients with noncirrhotic liver disease and 1.40 (95% CI: 1.27-1.54) and 1.91 (95% CI: 1.72-2.12) for those with liver cirrhosis. Conclusion Liver disease patients, especially those with liver cirrhosis, had increased 30-day mortality and 31-365-day mortality following HF, compared to patients without liver disease.
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Affiliation(s)
- Jonathan Montomoli
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark,
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark,
| | - Henrik Gammelager
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark,
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark,
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Comorbidities, clinical intercurrences, and factors associated with mortality in elderly patients admitted for a hip fracture. Rev Bras Ortop 2018; 53:543-551. [PMID: 30245992 PMCID: PMC6148078 DOI: 10.1016/j.rboe.2018.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/26/2017] [Indexed: 11/22/2022] Open
Abstract
Objective 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. Methods 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. Results 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). Conclusion Patients with hip fractures generally present comorbidities, are susceptible to clinical complications, and have an 11.9% mortality rate.
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Sanz-Reig J, Salvador Marín J, Ferrández Martínez J, Orozco Beltrán D, Martínez López J, Quesada Rico J. Prognostic factors and predictive model for in-hospital mortality following hip fractures in the elderly. Chin J Traumatol 2018; 21:163-169. [PMID: 29784590 PMCID: PMC6033736 DOI: 10.1016/j.cjtee.2017.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/23/2017] [Accepted: 12/04/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The incidence of hip fractures is increasing within the aging population. Our objective was to identify and quantify the risk factors and develop a predictive model for the in-hospital mortality among hip fracture patients older than 65 years. METHODS This is a prospective study conducted on 331 hip fracture patients older than 65 years admitted to our hospital from 2011 to 2014. Patients' demographics, prehospitalization residential status, prefracture comorbidity data, anti-aggregant and anticoagulant medication, preoperative hemoglobin value, type of fractures, type of treatments, time to surgery, and complications were recorded. RESULTS The average age was 83 years, 73% female, and 57% of them sustained a femoral neck fracture. In 62.8% of patients, the number of pre-fracture baseline comorbidities was ≥2. The in-hospital mortality rate was 11.4%. In multivariate analysis, age over 90 years, congestive heart failure, asthma, rheumatologic disease, lung cancer, and not taking antiaggregant medication were independently associated with in-hospital mortality. A formula and risk stratification scoring for predicting the risk for in-hospital mortality was developed. Risk-adjustment model based on these variables had acceptable accuracy for predicting in-hospital mortality (c-statistic 0.77). CONCLUSION Advanced age, and five prefracture comorbidities have a strong association with in-hospital mortality in a hip fracture patient older than 65 years old. Our predictive model was specifically designed for the old hip fracture population. It has an accuracy similar to other risk models. The specificity, positive predictive value, and negative predictive value are high. In addition, it could discriminate a high risk patient from a low risk patient for in-hospital mortality.
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Affiliation(s)
- J. Sanz-Reig
- Department of Orthopedic Surgery, Sant Joan d' Alacant University Hospital, Alicante, Spain,Corresponding author.
| | - J. Salvador Marín
- Department of Orthopedic Surgery, Sant Joan d' Alacant University Hospital, Alicante, Spain
| | - J. Ferrández Martínez
- Department of Orthopedic Surgery, Sant Joan d' Alacant University Hospital, Alicante, Spain
| | | | - J.F. Martínez López
- Department of Orthopedic Surgery, Sant Joan d' Alacant University Hospital, Alicante, Spain
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Fisher A, Fisher L, Srikusalanukul W, Smith PN. Usefulness of simple biomarkers at admission as independent indicators and predictors of in-hospital mortality in older hip fracture patients. Injury 2018; 49:829-840. [PMID: 29559183 DOI: 10.1016/j.injury.2018.03.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/07/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The data on predictive value of the routinely obtained preoperative biochemical parameters in hip fracture (HF) patients are limited. The aims of this study were to examine in older HF patients (1) the relationships between a broad set of routine laboratory parameters at admission and in-hospital mortality, and (2) evaluate the prognostic value the biomarkers and clinical characteristics (alone or in combination) provide to predict a fatal outcome. PATIENTS AND METHODS In 1820 consecutive patients with low-trauma osteoporotic HF aged >60 years (mean age 82.8 ± 8.1 years; 76.4% women; 65% community-dwelling) 35 laboratory variables along with 20 clinical and socio-demographic characteristics at admission were analysed. The validation cohort included data on 455 older (≥60 years of age) HF patients (mean age 82.1 ± 8.0 years, 72.1% women). RESULTS The mortality rate was 6% (n = 109). On univariate analysis 14 laboratory and 8 clinical parameters have been associated with in-hospital mortality. Multiple regression analyses determined 7 variables at admission as independent indicators of a fatal outcome: 4 biomarkers (albumin <33 g/L; alanine aminotransferase/gamma-glutamyl transferase ratio [GGT/ALT] >2.5; parathyroid hormone [PTH] >6.8 pmol/L; 25(OH)vitamin D < 25 nmol/L) and 3 pre-fracture clinical conditions (history of myocardial infarction, chronic kidney disease [GFR <60 ml/min/1.73 m2] and chronic obstructive pulmonary disease); the area under the receiver operating characteristic curve (AUC) was 0.75 (95%CI 0.70-0.80). The risk of in-hospital death was 1.6-2.6 times higher in subjects with any of these risk factors (RFs), and increased by 2.6-6.0-fold in patients with any two RFs (versus no RFs). The mortality rate increased stepwise as the number of RFs increased (from 0.43% -none RF to 16.8%- ≥4RF). The prognostic value of a single RF was low (AUC ≤0.635) but combination of 2 or more RFs improved the prediction significantly; AUC reached 0.84(95%CI 0.77-0.90) when ≥4 RFs (versus 0-1RF) were present. In the validated and main cohorts the number of predicted by 1, 2, 3 or ≥4 RFs and observed deaths were practically similar. CONCLUSIONS In HF patients, seven easily identifiable at admission characteristics, including 4 biomarkers, are strong and independent indicators of in-hospital mortality and can be used for risk stratification and individualised management.
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Affiliation(s)
- Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra, Australia; Department of Orthopaedic Surgery, The Canberra Hospital, ACT Health, Canberra, Australia; Australian National University Medical School, Canberra, ACT, Australia.
| | - Leon Fisher
- Frankston Hospital, Peninsula Health, Melbourne, Australia
| | - Wichat Srikusalanukul
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra, Australia
| | - Paul N Smith
- Department of Orthopaedic Surgery, The Canberra Hospital, ACT Health, Canberra, Australia; Australian National University Medical School, Canberra, ACT, Australia
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Abstract
OBJECTIVES To estimate 1-year mortality rates in elderly patients who undergo operative treatment for distal femur fractures and identify potential risk factors for mortality. DESIGN Retrospective chart review. SETTING Level 1 and Level 2 trauma centers. PATIENTS/PARTICIPANTS Two hundred eighty-three elderly patients (average age 76.0 years ± 9.8) who sustained distal femur fractures between 2002 and 2012. INTERVENTION Fracture fixation of the distal femur. MAIN OUTCOME MEASURE Survival up to 1 year after surgery. RESULTS The 1-year mortality rate for distal femur fractures in elderly patients was 13.4%. There were no statistically significant differences in overall mortality between native bone and periprosthetic fractures, intramedullary nail or open reduction internal fixation, or across Orthopaedic Trauma Association fracture classifications. Overall patient mortality was significantly higher at 30 days (P = 0.036), 6 months (P = 0.019), and 1 year (P = 0.018), when surgery occurred more than 2 days from the injury. Mean Charlson Comorbidity Index scores were significantly lower in survivors versus nonsurvivors at all time intervals (30 days, P = 0.023; 6 months, P = 0.001 and 1 year P ≤ 0.001). A time to surgery of more than 2 days, regardless of baseline illness, did not result in improved survivability at 1 year. CONCLUSIONS Overall mortality for distal femur fractures was 13.4% in the elderly population. A surgical treatment more than 2 days after injury was associated with increased patient mortality. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Zou D, Luo M, Han Z, Zhan L, Zhu W, Kang S, Bao C, Li Z, Nelson J, Zhang R, Su H. Activation of Alpha-7 Nicotinic Acetylcholine Receptor Reduces Brain Edema in Mice with Ischemic Stroke and Bone Fracture. Mol Neurobiol 2017; 54:8278-8286. [PMID: 27914011 PMCID: PMC5457363 DOI: 10.1007/s12035-016-0310-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/21/2016] [Indexed: 01/30/2023]
Abstract
Stroke is an important risk factor for bone fracture. We showed previously that bone fracture at the acute stage of ischemic stroke worsens, and activation of α-7 nicotinic acetylcholine receptor (α-7 nAchR) improves, stroke recovery by attenuating inflammation. We hypothesized that activation of α-7 nAchR also improves the blood-brain barrier (BBB) integrity. Permanent distal middle cerebral artery occlusion (pMCAO) was performed on C57BL/6J mice followed by tibia fracture 1 day later. Mice were treated with 0.8 mg/kg PHA 568487 (PHA, α-7 nAchR-specific agonist), 6 mg/kg methyllycaconitine (MLA, α-7 nAchR antagonist), or saline 1 and 2 days after pMCAO. Brain water content, the expression of monoamine oxidase B (MAO-B), and tight junction protein (claudin-5) were assessed. We found that tibia fracture increased water content in the ischemic stroke brain (p = 0.006) and MAO-B-positive astrocytes (p < 0.001). PHA treatment reduced water content and MAO-B-positive astrocytes and increased claudin-5 expression in stroke and stroke + tibia fracture mice (p < 0.05), while MLA had the opposite effect. Our findings suggest that in addition to inhibiting inflammation, activation of α-7 nAchR also reduces brain edema, possibly through diminished astrocyte oxidative stress and improved BBB integrity. Thus, the α-7 nAchR-specific agonist could be developed into a new therapy for improving recovery of patients with stroke or stroke + bone fracture.
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Affiliation(s)
- Dingquan Zou
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, CA, 94143, USA
- Department of Anesthesiology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Man Luo
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, CA, 94143, USA
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Zhenying Han
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Lei Zhan
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Wan Zhu
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Shuai Kang
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Chen Bao
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Zhao Li
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Jeffrey Nelson
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Rui Zhang
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Hua Su
- Department of Anesthesia and Perioperative Care, Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, CA, 94143, USA.
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Zheng JQ, Lai HJ, Zheng CM, Yen YC, Lu KC, Hu CJ, Lee HH, Wang YH. Association of stroke subtypes with risk of hip fracture: a population-based study in Taiwan. Arch Osteoporos 2017; 12:104. [PMID: 29167998 DOI: 10.1007/s11657-017-0390-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 10/12/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Stroke is a critical issue of physical disability. This study aimed to investigate the association of stroke subtypes and hip fracture by using the Taiwan National Health Insurance Research Database. Significantly higher risks of hip fracture were found for female gender and intracerebral hemorrhagic stroke patients. INTRODUCTION Previous studies reported the increased hip fracture (HF) after acute stroke. Increased falling tendency immobilization-related sarcopenia and underlying comorbidities are related to HF in stroke patients. In the present study, we explored the association of different stroke subtypes and several comorbidities with poststroke HF. METHODS A population-based study was conducted using National Health Insurance Research Database (NHIRD) of Taiwan. First, we identified 17,168 patients diagnosed as having a stroke between January 1, 2002, and December 31, 2010. Then, we randomly selected 51,504 controls that never had a stroke and matched these controls to stroke patients in a 1:3 ratio by age (± 1 year old) and gender. Cox proportional hazards model was used to estimate hazard ratio (HR) and 95% confidence interval (CI). RESULTS Stroke patients had a significantly higher risk of HF (HR = 1.69). Female and male stroke patients had incidence rate ratios (IRRs) of 2.05 and 1.82 for HF, respectively. Significantly increased IRRs of 1.82, 1.52, and 2.63 for HF were found for stroke patients with 0, 1, and ≥ 2 comorbidities, respectively. All stroke patients, ischemic stroke patients, and intracerebral hemorrhagic (ICH) patients had HF risks of 1.65, 1.60, and 2.34, respectively. CONCLUSION Overall, stroke significantly increases the incidence of HF, and the risk of HF is significantly higher in ICH patients and female gender. We should identify stroke patients at risk of HF and pay more attention to prevent them from fall in poststroke long-term care.
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Affiliation(s)
- Jing-Quan Zheng
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan
- Division of Critical Care, Department of Critical Care Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hui-Ju Lai
- Division of Critical Care, Department of Critical Care Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Cai-Mei Zheng
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Nephrology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yu-Chun Yen
- Biostatistics Research Center, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Cheng Lu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan
- Division of Nephrology, Department of Medicine, Cardinal-Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsun-Hua Lee
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan.
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan.
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Yuan-Hung Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan.
- Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
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