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Ran S, Yu Q, Fu M, Hou Z, Wang Z. Risk factors and prognosis of postoperative acute myocardial infarction in elderly hip fracture patients combined with coronary heart disease. J Orthop Surg Res 2024; 19:306. [PMID: 38773536 PMCID: PMC11106927 DOI: 10.1186/s13018-024-04757-1] [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: 03/20/2024] [Accepted: 04/21/2024] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION This article mainly studies the risk factors for postoperative acute myocardial infarction (AMI) in elderly hip fracture patients combined with coronary heart disease (CHD), constructs a prediction model, and evaluates the prognosis of all the patients. METHODS This article retrospectively collected elderly patients with hip fracture and CHD who underwent hip fracture surgery at the Third Hospital of Hebei Medical University from January 2019 to December 2021. Demographic data, laboratory indicators, and imaging examination results were collected from the medical case system. The risk factors of postoperative AMI were determined by univariate and multivariate logistic regression, and a nomogram prediction model was established. The ROC curve, calibration curve and DCA decision curve were plotted by R language software. The patients in the training set were followed up for 2 years to evaluate their survival situation. RESULTS 1094 eligible patients were divided into a training set (n = 824 from January 1, 2019 to September 31, 2021) and a validation set (n = 270 from October 1, 2021 to December 31, 2022). In the training set, women accounted for 58.6%; The average age of the patients was 79.45 years old; The main type of fracture was intertrochanteric fracture. There were 64.7% patients taken B receptor blockers; A total of 166 (20.1%) patients underwent percutaneous coronary intervention (PCI); Hypertension accounted for 55.5%; 520 (63.1%) patients had a preoperative waiting time greater than 3 days; The average hemoglobin value upon admission was 101.36 g/L; The average intraoperative bleeding volume was 212.42 ml; The average surgical time was 2.5 ± 0.3 h; Reginal anesthesia accounted for 29.7%; 63 (68.5%) AMI patients had no obvious clinical symptoms; 68 (73.9%) AMI patients did not show ST-segment elevation in ECG; The risk factors of postoperative AMI were age, hemoglobin at admission, diabetes, chronic kidney disease, intraoperative bleeding, and reginal anesthesia. The AUC of the nomogram prediction model was 0.729. The AUC in the validation set was 0.783. Survival analysis showed a significant statistical difference in 2-year mortality between patients with AMI and without AMI, among all the patients with AMI, patients with ECG ST-segment elevation has higher mortality than patients without ECG ST-segment elevation. CONCLUSION Our research results found that the incidence of postoperative AMI in elderly patients with hip fractures and CHD was 11.1%. Age, diabetes, hemoglobin at admission, regional anesthesia, chronic kidney disease, and intraoperative bleeding are risk factors. The AUC of the nomogram in training set is 0.729. The 2-year mortality rate of the patients with AMI is higher than that of patients without AMI.
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Affiliation(s)
- Saidi Ran
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Qili Yu
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - MingMing Fu
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Liu Y, Liu H, Zhang F. Development and Internal Validation of a Nomogram for Predicting Postoperative Cardiac Events in Elderly Hip Fracture Patients. Clin Interv Aging 2023; 18:2063-2078. [PMID: 38107187 PMCID: PMC10725632 DOI: 10.2147/cia.s435264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Postoperative cardiac events (PCEs) are among the main adverse events after hip fracture surgery in the elderly. Existing cardiac risk assessment tools have some limitations and are not specifically designed for elderly patients undergoing hip fracture surgery. This study aimed to develop and internally validate a nomogram for prediction of PCEs in these patients. Patients and Methods We performed a retrospective study of 992 patients aged ≥65 years undergoing hip fracture surgery in our hospital from July 2015 to December 2021. Patients' demographics and clinical data were collected. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select predictors, and multivariate logistic regression was employed to construct a nomogram. Internal validation was performed by bootstrapping. The discriminatory ability of the model was determined by the area under the receiver operating characteristic curve (AUC). The calibration and clinical utility of the model were assessed. The predictive power and clinical benefit of the nomogram were compared with the Revised Cardiac Risk Index (RCRI). Results The nomogram was constructed including seven variables: general anesthesia, the American Society of Anesthesiologists (ASA) classification, history of heart failure, history of severe arrhythmia, history of coronary artery disease, preoperative platelet count, and serum creatinine. The nomogram had an excellent predictive ability (AUC = 0.875, 95% confidence interval [CI]: 0.828-0.918). Satisfactory calibration was shown by calibration plots and the Hosmer-Lemeshow goodness-of-fit test (P = 0.520). Clinical usefulness was confirmed by decision curve analysis and clinical impact curve. The predictive power and clinical utility of the nomogram were superior to RCRI. Conclusion We developed an easy-to-use nomogram for prediction of PCEs in elderly hip fracture patients. This prediction model could effectively identify patients at high risk of PCEs and may be useful for perioperative management optimization.
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Affiliation(s)
- Yuanmei Liu
- Department of Geriatrics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
| | - Huilin Liu
- Department of Geriatrics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
| | - Fuchun Zhang
- Department of Geriatrics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
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Zhang Y, Liu Y, Fu M, Wang Z, Hou Z. Characteristics of Preoperative Acute Myocardial Infarction in Elderly Hip Fracture Patients and Construction of a Clinical Prediction Model: A Retrospective Cohort Study. Clin Interv Aging 2023; 18:1985-1994. [PMID: 38050621 PMCID: PMC10693827 DOI: 10.2147/cia.s428092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/07/2023] [Indexed: 12/06/2023] Open
Abstract
Background The prognosis of elderly patients with acute myocardial infarction (AMI) is poor, and this study aimed to investigate the characteristics and predictors of preoperative AMI in elderly hip fracture patients and to propose a valid clinical prediction model. Methods We collected clinical data of older hip fracture patients from January 2019 to December 2020. The data collected include demographic and clinical characteristics, underlying diseases and laboratory results. In AMI patients, we further collected type of myocardial infarctions, clinical symptoms, electrocardiogram (ECG), Killip class and diagnosis method. The prediction model was constructed by using Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses. In addition, the constructed prediction model was transformed into a nomogram. The performance of the model was evaluated using the area under receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). Bootstrapping was used for validation. Results There are 40 (4.2%) cases developed AMI in all 958 patients. There were 685 (71.5%) female patients and 273 (28.5%) male patients. Among 40 AMI patients, 38 (95.0%) had Type 2 myocardial infarction (T2MI) and 2 (5.0%) had Type 1 myocardial infarction (T1MI). The majority of these ECG were ST segment depression (57.5%). Most elderly AMI patients (67.5%) presented asymptomatic. Predictors for preoperative AMI were higher age (OR 2.386, 95% CI 1.126-5.057), diabetes (OR 5.863, 95% CI 2.851-12.058), Hb≤100 g/L (OR 3.976, 95% CI 1.478-10.695), CRP≥40 mg/L (OR 6.998, 95% CI 2.875-17.033), and ALB≤35 g/L (OR 2.166, 95% CI 1.049-4.471). Good discrimination and calibration effect of the model was showed. Interval validation could still achieve the C-index value of 0.771. DCA demonstrated this nomogram has good clinical utility. Conclusion This model has a good predictive effect on preoperative AMI in elderly patients with hip fracture, which can help to better plan clinical evaluation.
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Affiliation(s)
- Yaqian Zhang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Yan Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Mingming Fu
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, Hebei, People’s Republic of China
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Modifiable factors associated with postoperative atrial fibrillation in older patients with hip fracture in an orthogeriatric care pathway: a nested case–control study. BMC Geriatr 2022; 22:845. [DOI: 10.1186/s12877-022-03556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Few data are available regarding post-operative atrial fibrillation (POAF) in non-cardiothoracic surgery, particularly orthopedic surgery. Hence, given the frequent incidence of POAF after surgery and its marked impact, we need to identify modifiable factors associated with POAF after hip fracture surgery in older patients.
Methods
We conducted a nested case–control study in the unit for perioperative geriatric care of an academic hospital in Paris from July 1, 2009 to December 31, 2019, enrolling all consecutive patients aged ≥ 70 years with hip fracture surgery and no history of permanent AF before admission (retrospective analysis of prospectively collected data). Patients with and without POAF were matched 1:5 on 5 baseline characteristics (age, hypertension, diabetes, coronary artery disease, cardiac failure).
Results
Of the 757 patients included, 384 were matched, and 64 had POAF. The incidence of POAF was 8.5%. The mean age was 86 ± 6 years, 298 (78%) patients were female, and the median Charlson Comorbidity Index was 6 (interquartile range 4–8). The median time from surgery to the occurrence of POAF was 2 days (1–4). On multivariable conditional logistic regression analysis (matched cohort), the modifiable factors present at admission associated with POAF were time to surgery > 48 h (odds ratio [OR] = 1.66, 95% confidence interval [1.01–2.81]) and > 2 units of packed red blood cells (OR = 3.94, [1.50–10.03]).
Conclusions
This study provides new information about POAF in older patients with hip fracture surgery, a surgical emergency whose complexity requires multidisciplinary care.
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Chaudhry YP, MacMahon A, Rao SS, Sterling RS, Oni JK, Khanuja HS. Incidence, mortality, and complications of acute myocardial infarction with and without percutaneous coronary intervention in hip fracture patients. Injury 2021; 52:2344-2349. [PMID: 33663802 DOI: 10.1016/j.injury.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a common cause of death following hip fracture surgery. This study aimed to determine the incidence and timing of perioperative AMI treated with percutaneous coronary intervention (PCI) in hip fracture patients, and to compare in-hospital mortality and complications between hip fracture patients who did not have an AMI, those who sustained a perioperative AMI and did not undergo PCI, and those who sustained an AMI and underwent PCI. METHODS The National Inpatient Sample (NIS) was queried from 2010 through the third quarter of 2015 to identify all patients undergoing hip fracture surgery. Patients were stratified into three cohorts: perioperative AMI but no PCI (no PCI cohort), perioperative AMI with PCI (PCI cohort), and no perioperative AMI or PCI (no AMI cohort). Patient demographics, comorbidities, in-hospital mortality, and complications were compared between cohorts. Multivariable logistic regression adjusting for age, sex, procedure, and Elixhauser score was used to assess the relative odds of in-hospital mortality for each cohort. RESULTS A total of 1,535,917 hip fracture cases were identified, with 1.9% in the no PCI cohort, 0.01% in the PCI cohort, and 98.0% in the no AMI cohort. In-hospital mortality was lower in the PCI cohort than in the no PCI cohort (8.8% vs. 14%), and was greater for both than in the no AMI cohort (1.6%, p < 0.001 for all). Both the no PCI cohort (OR, 6.1; 95% CI, 5.6-6.6) and PCI cohort (OR, 4.1; 95% CI, 2.8-6.0) had increased adjusted odds of in-hospital mortality compared to the no AMI cohort. The PCI cohort had a higher rate of bleeding complications than both other cohorts, and the no PCI cohort had a higher rate of transfusion than both other cohorts. CONCLUSIONS Perioperative AMI both with and without PCI independently increases the risk of mortality in hip fracture patients, with the highest risk of mortality in those with AMI without PCI. Providers should understand the increased morbidity and mortality associated with AMI in hip fracture patients, as well as the risks and benefits of perioperative PCI, in order to better counsel and manage these patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yash P Chaudhry
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Aoife MacMahon
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Sandesh S Rao
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Robert S Sterling
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Julius K Oni
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.Caroline St., Baltimore, MD 21287, USA.
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Wahlsten LR, Zareini B, Smedegaard L, Gislason GH, Palm H, Brorson S. A medical history of arterial thrombosis is a strong predictor of post-operative myocardial infarction and stroke in patients with hip fractures-a nationwide cohort study. Age Ageing 2021; 50:1252-1260. [PMID: 33507243 DOI: 10.1093/ageing/afaa279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Hip fractures lead to a substantial burden of disease and mortality among the elderly. Myocardial infarction (MI) and stroke are serious and overlooked complications, and their impact on mortality and morbidity may be underestimated. We investigated; 90-day absolute risk of stroke and MI following hip fracture surgery, and ii) anamnestic risk factors associated with elevated risk of postoperative MI and stroke. METHODS All Danish patients aged ≥60 undergoing first time hip fracture surgery in 2000-2017 were identified. Outcomes were MI or stroke 90 days after surgery. We performed gender-stratified cumulative incidence functions and multivariate Cox regression models adjusted for age and comorbidities. RESULTS 124,660 patients were included. Incidence of MI was 2.2% and 1.3%, and incidence of stroke was 3.5% and 2.5%, in men and women, respectively. The most important risk factor for MI and stroke was a previous event. Hazard ratio (HR) of MI associated with previous MI was 2.43 (95% Confidence Interval (CI) 2.02-2.92) in men and 2.65 (95% CI 2.23-3.16) in women, while the HR of stroke associated with previous stroke was 4.17 (95% CI 3.73-4.67) and 3.73 (95% CI 3.43-4.08), respectively. Other risk factors of MI were; sex, age, and a history of heart failure, hypertension, peripheral artery disease or diabetes. For postoperative stroke; sex age, and atrial fibrillation were important risk factors. CONCLUSION MI and stroke after hip fractures are overlooked and serious complications. Persons with elevated risk can be identified at admission, based on their medical history.
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Affiliation(s)
- Liv Riisager Wahlsten
- Department of Orthopaedics, Copenhagen University Hospital Herlev-Gentofte, Hellerup 2900, Denmark
| | - Bochra Zareini
- Department of Cardiology, Research 1, Copenhagen University Hospital Herlev-Gentofte, Hellerup 2900, Denmark
| | - Lærke Smedegaard
- Department of Cardiology, Research 1, Copenhagen University Hospital Herlev-Gentofte, Hellerup 2900, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Research 1, Copenhagen University Hospital Herlev-Gentofte, Hellerup 2900, Denmark
| | - Henrik Palm
- Department of Orthopaedics, Copenhagen University Hospital Bispebjerg, Copenhagen 2400, Denmark
| | - Stig Brorson
- Department of Orthopaedic Surgery, Zealand University Hospital, Køge 4600, Denmark
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Hu W, Zhao K, Chen Y, Wang J, Zheng M, Zhao Y, Zhao Q, Zhao X. Characteristics and long-term mortality of patients with ST-elevation or non-ST-elevation myocardial infarction after orthopaedic surgery. J Int Med Res 2021; 49:300060521992995. [PMID: 33706564 PMCID: PMC8165859 DOI: 10.1177/0300060521992995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the clinical characteristics and long-term mortality of
patients with ST-elevation myocardial infarction (STEMI) and
non-ST-elevation myocardial infarction (NSTEMI) after orthopaedic
surgery. Methods This retrospective, single-centre study enrolled patients that underwent
inpatient orthopaedic surgery from 2009 to 2017 in Beijing Jishuitan
Hospital. The patients were screened for a cardiac troponin I elevation and
fulfilled the Fourth Universal Definition of Myocardial Infarction within 30
days of surgery. Results A total of 180 patients that developed perioperative myocardial infarction
(MI) were included in the study. Among them, 14 patients (7.8%) were
classified as STEMI, and 166 (92.2%) had NSTEMI. Compared with those with
NSTEMI, STEMI patients had significantly higher 30-day and long-term
mortality rates (50.0% versus 5.4%; 71.4% versus 22.3%; respectively).
Multivariate Cox regression model analysis among the entire cohort
demonstrated that STEMI (hazard ratio [HR] 5.78, 95% confidence interval
[CI] 2.50, 13.38) and prior MI (HR 2.35, 95% CI 1.02, 5.38) were the most
significant independent predictors of long-term mortality. Conclusion Perioperative MI after orthopaedic surgery was associated with a high
mortality rate. STEMI was independently associated with a significant
increase in short- and long-term mortality.
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Affiliation(s)
- Wenlan Hu
- Department of Cardiology, Beijing Jishuitan Hospital, Beijing, China
| | - Kaiping Zhao
- Department of Medical Record Management and Statistics, Beijing Jishuitan Hospital, Beijing, China
| | - Youzhou Chen
- Department of Cardiology, Beijing Jishuitan Hospital, Beijing, China
| | - Jihong Wang
- Department of Cardiology, Beijing Jishuitan Hospital, Beijing, China
| | - Mei Zheng
- Department of Cardiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ying Zhao
- Department of Cardiology, Beijing Jishuitan Hospital, Beijing, China
| | - Qiong Zhao
- Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Xingshan Zhao
- Department of Cardiology, Beijing Jishuitan Hospital, Beijing, China
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Rostagno C, Cartei A, Rubbieri G, Ceccofiglio A, Magni A, Forni S, Civinini R, Boccaccini A. Perioperative Myocardial Infarction/Myocardial Injury Is Associated with High Hospital Mortality in Elderly Patients Undergoing Hip Fracture Surgery. J Clin Med 2020; 9:jcm9124043. [PMID: 33327599 PMCID: PMC7765049 DOI: 10.3390/jcm9124043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/26/2022] Open
Abstract
Cardiovascular complications in patients undergoing non-cardiac surgery are associated with longer hospital stays and higher in-hospital mortality. The aim of this study was to assess the incidence of in-hospital myocardial infarction and/or myocardial injury in patients undergoing hip fracture surgery and their association with mortality. Moreover, we evaluated the prognostic value of troponin increase stratified on the basis of peak troponin value. The electronic records of 1970 consecutive hip fracture patients were reviewed. Patients <70 years, those with myocardial infarction <30 days, and those with sepsis or active cancer were excluded from the study. Troponin and ECG were obtained at admission and then at 12, 24, and 48 h after surgery. Echocardiography was made before and within 48 h after surgery. Myocardial injury was defined by peak troponin I levels > 99th percentile. A total of 1854 patients were included. An elevated troponin concentration was observed in 754 (40.7%) patients in the study population. Evidence of myocardial ischemia, fulfilling diagnosis of myocardial infarction, was found in 433 (57%). ECG and echo abnormalities were more frequent in patients with higher troponin values; however, mortality did not differ between patients with and without evidence of ischemia. Peak troponin was between 0.1 and 1 µg/L in 593 (30.3%). A total of 191 (10%) had peak troponin I ≥ 1 µg/L, and 98 died in hospital (5%). Mortality was significantly higher in both groups with troponin increase (HR = 1.37, 95% CI 1.1–1.7, p < 0.001 for peak troponin I between 0.1 and 1 µg/L; HR = 2.28, 95% CI 1.72–3.02, p < 0.0001 for peak troponin ≥1 µg/L) in comparison to patients without myocardial injury. Male gender, history of coronary heart disease, heart failure, and chronic kidney disease were also associated with in-hospital mortality. Myocardial injury/infarction is associated with increased mortality after hip fracture surgery. Elevated troponin values, but not ischemic changes, are related to early worse outcome.
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Affiliation(s)
- Carlo Rostagno
- SODc Medicina Interna e Post-Chirurgica, AOU Careggi, 50136 Firenze, Italy
| | - Alessandro Cartei
- SODc Medicina Interna e Post-Chirurgica, AOU Careggi, 50136 Firenze, Italy
| | - Gaia Rubbieri
- SODc Medicina Interna e Post-Chirurgica, AOU Careggi, 50136 Firenze, Italy
| | - Alice Ceccofiglio
- SODc Medicina Interna e Post-Chirurgica, AOU Careggi, 50136 Firenze, Italy
| | - Agnese Magni
- SODc Medicina Interna e Post-Chirurgica, AOU Careggi, 50136 Firenze, Italy
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Tan L, Fu J, Feng F, Liu X, Cui Z, Li B, Han Y, Zheng Y, Yeung KWK, Li Z, Zhu S, Liang Y, Feng X, Wang X, Wu S. Engineered probiotics biofilm enhances osseointegration via immunoregulation and anti-infection. SCIENCE ADVANCES 2020; 6:eaba5723. [PMID: 33188012 PMCID: PMC10763977 DOI: 10.1126/sciadv.aba5723] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
Preventing multidrug-resistant bacteria-related infection and simultaneously improving osseointegration are in great demand for orthopedic implants. However, current strategies are still limited to a combination of non-U.S. Food and Drug Administration-approved antibacterial and osteogenic agents. Here, we develop a food-grade probiotic-modified implant to prevent methicillin-resistant Staphylococcus aureus (MRSA) infection and accelerate bone integration. Lactobacillus casei is cultured on the surface of alkali heat-treated titanium (Ti) substrates and inactivated by ultraviolet irradiation to avoid sepsis induced by viable bacteria. This inactivated L. casei biofilm shows excellent 99.98% antibacterial effectiveness against MRSA due to the production of lactic acid and bacteriocin. In addition, the polysaccharides in the L. casei biofilm stimulate macrophages to secrete abundant osteogenic cytokines such as oncostatin M and improve osseointegration of the Ti implant. Inactivated probiotics modification can be a promising strategy to endow implants with both excellent self-antibacterial activity and osteointegration ability.
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Affiliation(s)
- Lei Tan
- Ministry of Education Key Laboratory for the Green Preparation and Application of Functional Materials, Hubei Key Laboratory of Polymer Materials, School of Materials Science and Engineering, Hubei University, Wuhan 430062, China
| | - Jieni Fu
- School of Materials Science and Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Tianjin 300072, China
| | - Fan Feng
- Ministry of Education Key Laboratory for the Green Preparation and Application of Functional Materials, Hubei Key Laboratory of Polymer Materials, School of Materials Science and Engineering, Hubei University, Wuhan 430062, China
| | - Xiangmei Liu
- Ministry of Education Key Laboratory for the Green Preparation and Application of Functional Materials, Hubei Key Laboratory of Polymer Materials, School of Materials Science and Engineering, Hubei University, Wuhan 430062, China.
| | - Zhenduo Cui
- School of Materials Science and Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Tianjin 300072, China
| | - Bo Li
- State Key Laboratory for Mechanical Behavior of Materials, School of Materials Science and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Yong Han
- State Key Laboratory for Mechanical Behavior of Materials, School of Materials Science and Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Yufeng Zheng
- State Key Laboratory for Turbulence and Complex System and Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Kelvin Wai Kwok Yeung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Zhaoyang Li
- School of Materials Science and Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Tianjin 300072, China
| | - Shengli Zhu
- School of Materials Science and Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Tianjin 300072, China
| | - Yanqin Liang
- School of Materials Science and Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Tianjin 300072, China
| | - Xiaobo Feng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xianbao Wang
- Ministry of Education Key Laboratory for the Green Preparation and Application of Functional Materials, Hubei Key Laboratory of Polymer Materials, School of Materials Science and Engineering, Hubei University, Wuhan 430062, China
| | - Shuilin Wu
- School of Materials Science and Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Tianjin 300072, China.
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Smit M, Coetzee A, Lochner A. The Pathophysiology of Myocardial Ischemia and Perioperative Myocardial Infarction. J Cardiothorac Vasc Anesth 2020; 34:2501-2512. [DOI: 10.1053/j.jvca.2019.10.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/10/2019] [Accepted: 10/02/2019] [Indexed: 12/28/2022]
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Takotsubo Syndrome: Is this a Common Occurrence in Elderly Females after Hip Fracture? J Crit Care Med (Targu Mures) 2020; 6:146-151. [PMID: 32864459 PMCID: PMC7430354 DOI: 10.2478/jccm-2020-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/31/2020] [Indexed: 01/24/2023] Open
Abstract
Background The prevalence of Takotsubo syndrome in hip fracture is not known. Methods Hip fracture patients were evaluated in a multidisciplinary unit. Patients with ECG abnormalities and increased troponin I values at the time of hospital admission were included in the study Follow-up was clinical at 30 days and by telephonic interview at one year. Results Between October 1st 2011 to September 30th 2016, 51 of 1506 patients had preoperative evidence of myocardial damage. Eight, all females, fulfilled the Mayo criteria for Takotsubo syndrome, six had no coronary lesions. Hip surgery was uneventful, and all eight were alive at thirty days, and seven of these were still alive after one year. Forty-three patients had myocardial infarction: mortality at thirty days and one year were 11% and 44% (p<0.0001, Student's t-test; log-rank test). Conclusion At least 15% of patients with hip fracture and preoperative myocardial damage had Takotsubo syndrome. They were all elderly females. Contrary to myocardial infarction, Takotsubo syndrome has a favourable long term prognosis.
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Lowe MJ, Lightfoot NJ. The prognostic implication of perioperative cardiac enzyme elevation in patients with fractured neck of femur: A systematic review and meta-analysis. Injury 2020; 51:164-173. [PMID: 31879176 DOI: 10.1016/j.injury.2019.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/11/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Neck of Femur (NOF) fractures are a common injury in comorbid elderly patients which are associated with increased rates of morbidity and mortality following fracture. Because of their injury, patients can experience reductions in quality of life and independent living leading to transfer to nursing home or dependent levels of care. Numerous factors are associated with either complications or reductions in survival following fractured NOF. From the VISION cohort there is evidence that troponin elevation in the post-operative period following a diverse range of non-cardiac surgical procedures may lead to an increased risk of mortality in the absence of classical ischaemic or cardiac symptoms. The aim of this systematic review and meta-analysis is to validate the utility of perioperative troponin elevation as a prognostic indicator for mortality and cardiac morbidity in those with fractured NOF. METHODS The PRISMA guidelines for the conduct of meta-analyses were followed. An electronic search was conducted of the EMBASE, MEDLINE (Ovid) and Biosis databases. Studies were included for analysis if they stratified outcomes by perioperative troponin elevation in surgically managed fractured NOF and reported sufficient data on troponin elevation and mortality following surgery. Primary and secondary outcomes assessed were all-cause post-operative mortality and a composite measure of cardiac complications (myocardial infarction, cardiac failure and arrhythmia) respectively. RESULTS Eleven studies met inclusion criteria giving a total of 1363 patients. Overall, 497 patients (36.5%) experienced an elevation in troponin levels following surgery. Perioperative troponin elevation was significantly associated with all-cause mortality (OR 2.6; 95% CI 1.5 - 4.6; p <0.001) and cardiac complications (OR 7.4; 95% CI 3.5 - 15.8; p <0.001). Patient factors significantly associated with troponin elevation included pre-existing coronary artery disease, cardiac failure, hypertension, previous stroke and previous myocardial infarction. CONCLUSION Perioperative troponin elevation is significantly associated with increased mortality and post-operative cardiac complications following fractured NOF and may be a useful prognostic indicator in these patients. Future research should further stratify patients by the magnitude of troponin elevation and further refine the risk factors.
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Affiliation(s)
- Matthew J Lowe
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.
| | - Nicholas J Lightfoot
- Department of Anaesthesia and Pain Medicine, Middlemore Hospital, Auckland, New Zealand
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Rui Y, Lu P, Li Y, Dai G, Ma B, Zou J, Chen H, Wang C. [Risk factors analysis for postoperative mortality of elder patients with intertrochanteric fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1538-1542. [PMID: 31823554 DOI: 10.7507/1002-1892.201906079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To analyze the risk factors for postoperative mortality of elder patients with intertrochanteric fractures. Methods Patients with intertrochanteric fractures who underwent proximal femoral interlocking intramedullary nail fixation between January 2014 and December 2015 were enrolled in the study. Among them, 135 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin, albumin, and total lymphocyte count (TLC), and nutritional status. Univariate analysis and Cox proportional hazards regression model were used to screen the risk factors for postoperative mortality. Results Twenty-seven patients (20.0%) died within 2 years after surgery, and 16 (11.9%) died within 1 year after surgery. Univariate analysis showed that age, coronary atherosclerotic heart disease, number of comorbidities, preoperative hemoglobin and albumin levels were the influencing factors of postoperative mortality in elder patients with intertrochanteric fractures treated with proximal femoral interlocking intramedullary nail fixation (P<0.05). Multivariate analysis showed that age (≥80 years), combined more than 2 medical diseases, and preoperative albumin (<35 g/L) were the independent risk factors for postoperative mortality (P<0.05). Conclusion To improve the clinical outcomes, perioperative risk should be comprehensively evaluated and perioperative management strengthened in the elder patients with intertrochanteric fractures, especially those with advanced age, more combined diseases, and low albumin, for the high postoperative mortality.
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Affiliation(s)
- Yunfeng Rui
- Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China;School of Medicine, Southeast University, Nanjing Jiangsu, 210009,
| | - Panpan Lu
- Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China;School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Yingjuan Li
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Department of Geriatrics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Guangchun Dai
- Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China;School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Binbin Ma
- Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Jihong Zou
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Department of Geriatrics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Hui Chen
- Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China;School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Chen Wang
- Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China;School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
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Rostagno C, Peris A, Polidori GL, Ranalli C, Cartei A, Civinini R, Boccaccini A, Prisco D, Innocenti M, Di Mario C. Perioperative myocardial infarction in elderly patients with hip fracture. Is there a role for early coronary angiography? Int J Cardiol 2019; 284:1-5. [DOI: 10.1016/j.ijcard.2018.10.095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 10/28/2022]
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Sheikh HQ, Hossain FS, Aqil A, Akinbamijo B, Mushtaq V, Kapoor H. A Comprehensive Analysis of the Causes and Predictors of 30-Day Mortality Following Hip Fracture Surgery. Clin Orthop Surg 2017; 9:10-18. [PMID: 28261422 PMCID: PMC5334018 DOI: 10.4055/cios.2017.9.1.10] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/08/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A fracture neck of femur is the leading cause of injury-related mortality in the elderly population. The 30-day mortality figure is a well utilised marker of clinical outcome following a fracture neck of femur. Current studies fail to analyse all patient demographic, biochemical and comorbid parameters associated with increased 30-day mortality. We aimed to assess medical risk factors for mortality, which are easily identifiable on admission for patients presenting with a fractured neck of femur. METHODS A retrospective review of a prospectively populated database was undertaken to identify all consecutive patients with a fracture neck of femur between October 2008 and March 2011. All factors related to the patient, injury and surgery were identified. The primary outcome of interest was 30-day mortality. Univariate and subsequent multivariate analyses using a backward stepwise likelihood ratio Cox regression model were performed in order to establish all parameters that significantly increased the risk of death. RESULTS A total of 1,356 patients were included in the study. The 30-day mortality was 8.7%. The most common causes of death included pneumonia, sepsis and acute myocardial infarction. Multiple regression analysis revealed male gender, increasing age, admission source other than the patient's own home, admission haemoglobin of less than 10 g/dL, a history of myocardial infarction, concomitant chest infection during admission, increasing Charlson comorbidity score and liver disease to be significant predictors of mortality. CONCLUSIONS This study has elucidated risk factors for mortality using clinical and biochemical information which are easily gathered at the point of hospitalization. These results allow for identification of vulnerable patients who may benefit from a prioritisation of resources.
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Affiliation(s)
| | | | - Adeel Aqil
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds, UK
| | | | - Vhaid Mushtaq
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds, UK
| | - Harish Kapoor
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds, UK
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Xue FS, Li RP, Liu GP. Assessing Association Among Anemia, Bleeding, and Transfusion with Long-Term Mortality. Am J Med 2016; 129:e209. [PMID: 27554962 DOI: 10.1016/j.amjmed.2015.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/05/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Fu Shan Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Rui Ping Li
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Gao Pu Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Sheehan KJ, Sobolev B, Chudyk A, Stephens T, Guy P. Patient and system factors of mortality after hip fracture: a scoping review. BMC Musculoskelet Disord 2016; 17:166. [PMID: 27079195 PMCID: PMC4832537 DOI: 10.1186/s12891-016-1018-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 04/07/2016] [Indexed: 12/03/2022] Open
Abstract
Background Several patient and health system factors were associated with the risk of death among patients with hip fracture. However, without knowledge of underlying mechanisms interventions to improve survival post hip fracture can only be designed on the basis of the found statistical associations. Methods We used the framework developed by Arksey and O’Malley and Levac et al. for synthesis of factors and mechanisms of mortality post low energy hip fracture in adults over the age of 50 years, published in English, between September 1, 2009 and October 1, 2014 and indexed in MEDLINE. Proposed mechanisms for reported associations were extracted from the discussion sections. Results We synthesized the evidence from 56 articles that reported on 35 patient and 9 system factors of mortality post hip fracture. For 21 factors we found proposed biological mechanisms for their association with mortality which included complications, comorbidity, cardiorespiratory function, immune function, bone remodeling and glycemic control. Conclusions The majority of patient and system factors of mortality post hip fracture were reported by only one or two articles and with no proposed mechanisms for their effects on mortality. Where reported, underlying mechanisms are often based on a single article and should be confirmed with further study. Therefore, one cannot be certain whether intervening on such factors may produce expected results.
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Affiliation(s)
- K J Sheehan
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - B Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - A Chudyk
- Centre for Hip Health and Mobility, Vancouver, Canada
| | - T Stephens
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - P Guy
- Centre for Hip Health and Mobility, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
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Rostagno C, Cammilli A, Di Cristo A, Polidori GL, Ranalli C, Cartei A, Buzzi R, Prisco D. Acute coronary syndromes with significant troponin increase in patients with hip fracture prior to surgical repair: differential diagnosis and clinical implications. Intern Emerg Med 2016; 11:219-24. [PMID: 26563767 DOI: 10.1007/s11739-015-1348-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/28/2015] [Indexed: 11/27/2022]
Abstract
Myocardial infarction after hip fracture but before surgical repair is associated with a 30-day mortality as high as 30 % at 1 month. In Florence, since 2011, hip fractures are referred to a multidisciplinary hip fracture team including internal medicine specialists, anesthesiologists, and orthopaedic surgeons. The aim of the present investigation was to evaluate the clinical characteristics of patients with hip fracture who had at hospital admission a significant increase of troponin (>10 times reference levels), the diagnostic and therapeutic strategies adopted, and overall 1-year survival. Protocol at admission included careful clinical evaluation (including bedside echocardiography) in order to stratify surgical risk and schedule surgery and anaesthesiology strategy. 21/1025 patients had preoperative significant troponin increase. In sixteen patients, a diagnosis of NSTEMI was made, five presented with ST elevation. In five patients with NSTEMI considered at very high surgical risk (ASA ≥ 3, severe cognitive and functional impairment), surgery was not performed. None survived at 1 year. Hip surgery was performed in the other 11. Four underwent coronary revascularization after hip surgery. In this group, 1-year survival was 80 %. Four of five ST elevation patients fulfilled criteria for stress cardiomyopathy confirmed by angiography. Hip surgery was performed, and the patients are alive at 1-year follow-up. Close to 2 % of patients with hip fracture are found to have a significant troponin increase before surgery. Three out of four have an NSTEMI diagnosis. In patients undergoing hip surgery, survival at 1 year is close to 80 %. In patients with ST elevation at admission, stress cardiomyopathy should be considered in the differential diagnosis. This clinical condition is associated with a favourable prognosis after hip surgery.
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Affiliation(s)
- Carlo Rostagno
- Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Viale Morgagni 85, 50134, Florence, Italy.
- SOD Medicina Interna e Post Chirurgica AOU Careggi, Florence, Italy.
| | | | | | | | - Claudia Ranalli
- SOD Medicina Interna e Post Chirurgica AOU Careggi, Florence, Italy
| | | | - Roberto Buzzi
- SOD Traumatologia ed Ortopedia AOU Careggi, Florence, Italy
| | - Domenico Prisco
- Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Viale Morgagni 85, 50134, Florence, Italy
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Errando CL, Peiró CM, Gimeno A, Soriano JL. Single shot spinal anesthesia with very low hyperbaric bupivacaine dose (3.75 mg) for hip fracture repair surgery in the elderly. A randomized, double blinded study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2014; 61:481-488. [PMID: 25060950 DOI: 10.1016/j.redar.2014.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/11/2014] [Accepted: 02/14/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE Single shot spinal anesthesia is used worldwide for hip fracture repair surgery in the elderly. Arterial hypotension is a frequent adverse effect. We hypothesized that lowering local anesthetics dose could decrease the incidence of arterial hypotension, while maintaining quality of surgical anesthesia. METHODS In a randomized double blinded study, 66 patients over the age of 65 years, with hip fracture needing surgical repair, were assigned to B0.5 group 7.5mg hyperbaric bupivacaine 5mg/ml (control group), and B0.25 group 3.75mg hyperbaric bupivacaine 2.5mg/ml (study group). Sensory and motor block level, and hemodynamic parameters including blood presure, heart rate and vasopressor dose administration were registered, along with rescue anesthesia needs, the feasibility of surgery, its duration, and regression time of sensory anesthesia to T12. RESULTS After exclusions, 61 patients were included in the final analysis. Arterial hypotension incidence was lower in the B0.25 group (at the 5, 10, and 15min determinations), and a lower amount of vasopressor drugs was needed (mean accumulated ephedrine dose 1.6mg vs. 8.7mg in the B0.5 group, p<0.002). Sensory block regression time to T12 was shorter in the B0.25 group, mean 78.6±23.6 (95% CI 51.7-110.2)min vs. 125.5±37.9 (95% CI 101.7-169.4)min in the B0.5 group, p=0.033. All but one patient in the B0.25 group were operated on under the anesthetic procedure first intended. No rescue anesthesia was needed. CONCLUSION Lowering bupivacaine dose for single shot spinal anesthesia for hip fracture repair surgery in elderly patients was effective in decreasing the occurrence of arterial hypotension and vasopressor use, while intraoperative quality remained.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - C M Peiró
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Gimeno
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J L Soriano
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Errando CL, Soriano-Bru JL, Peiró CM, Ubeda J. Single shot spinal anaesthesia with hypobaric bupivacaine for hip fracture repair surgery in the elderly. Randomized, double blinded comparison of 3.75 mg vs. 7.5 mg. ACTA ACUST UNITED AC 2014; 61:541-8. [PMID: 25236946 DOI: 10.1016/j.redar.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Arterial hypotension is the most frequent adverse effect of subarachnoid anaesthesia in the elderly sustaining a femoral proximal fracture. Decreasing the local anaesthetic dose reduces the incidence of hypotension but shortens sensory block duration that could be insufficient in some surgical procedures. Sensory block duration could be prolonged using hypobaric local anaesthetics. We evaluated whether low hypobaric bupivacaine doses were adequate for this type of surgery while maintaining the haemodynamic stability. METHODS A prospective, randomized, double blinded study was designed. Patients over 65 years old, sustaining traumatic hip fracture, were assigned to one of two groups: B0.5 group, hypobaric bupivacaine 7.5mg 5mg/ml (control group), and B0.25 group, hypobaric bupivacaine 3.75 mg 2.5mg/ml (study group). After subarachnoid injection, sensory level and motor blockade degree were registered, as were blood pressure, and heart rate at basal time and at 2, 5, 10, 15, 20 and 30 min after injection. The doses of vasopressor needed were registered as well. Surgical conditions and the duration of the surgical procedure-whether rescue analgesia or anaesthesia was needed-and sensory level regression to T12, were registered as well. RESULTS Sixty four patients was the calculated sample size. The study was stopped in an interim analysis because an elevated number of patients in the B0.25 group needed iv rescue anaesthesia. In the analyzed cases, blood pressure was significantly lower in the B0.5 group at the 15 and 30 min measurements. Vasopressor drugs needs were similar between groups [ephedrine accumulated mean (SD) doses 11.4 (5.2) mg vs. 9.1 (2.7) mg, p=0.045)]. Sensory block regression to T12 was faster in the B0.25 group, [(mean (SD) 68.2 (29.0) min vs. 112.8 (17.3) min in the B0.5 group, p<0.05]. Five out of 19 patients in the B0.25 group needed intravenous anaesthesia rescue before surgery started. CONCLUSION Lowering hypobaric bupivacaine dose to 3.75 mg in subarachnoid anaesthesia for hip fracture repair surgery in elderly patients decrease intraoperative blood pressure, but in an important number of patients intravenous anaesthesia rescue was needed and preclude recommendation.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - J L Soriano-Bru
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - C M Peiró
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J Ubeda
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Predictors of early mortality after hip fracture surgery. INTERNATIONAL ORTHOPAEDICS 2013; 37:2119-24. [PMID: 23982637 DOI: 10.1007/s00264-013-2068-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/03/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to examine causes and potential risk factors for 30-day mortality after hip fracture surgery (HFS) at a high-volume tertiary-care hospital. METHODS We retrospectively reviewed 467 patients who underwent HFS at our institution. Multivariate analysis was undertaken to identify potential predictors of early mortality. RESULTS The 30-day mortality rate was 7.5% (35/467). The most common causes of death were pneumonia (37.1%, 13/35), acute coronary syndrome (31.4%, 11/35) and sepsis (14.3%, 5/35). Surgery after 48 hours of admission had a significantly higher 30-day mortality rate (11 % versus 4%, p = 0.006). There was a significant difference in age (p = 0.034), admission source (p < 0.001), preoperative haemoglobin (p < 0.001), walking ability (p = 0.004), number of comorbidities (p = 0.004) and pre-existing dementia (p = 0.01), cardiac disease (p < 0.001), chronic obstructive pulmonary disorder (COPD) (p = 0.036) and renal failure (p = 0.007) between the 30-day mortality group and the rest of the cohort. Surgical delay greater than 48 hours, admission source and pre-existing cardiac disease were identified as the strongest predictors of 30-day mortality. CONCLUSION Surgical delay is an important but avoidable determinant of early mortality after HFS. Respiratory and cardiac function needs to be optimised postoperatively with early intervention in patients with signs of cardiovascular compromise or infection.
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