1
|
Romero Pisonero E, Mora-Fernández J, Queipo Matas R, González Montalvo JI, Neira Álvarez M, Ojeda Thies C, Sáez López P, Malafarina V. Demographic, functional and clinical characteristics in hip fracture patients according to mental status of the Spanish National Hip Fracture Registry. Rev Esp Geriatr Gerontol 2024; 59:101450. [PMID: 38159499 DOI: 10.1016/j.regg.2023.101450] [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: 09/27/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To describe the differences according to mental status at admission on the care process and 30-day outcomes in hip fracture patients, mainly regarding the use of rehabilitation resources and anti-osteoporotic medication, by analysing data from the Spanish National Hip Fracture Registry (RNFC, "Registro Nacional de Fracturas de Cadera" in Spanish). METHODS We analysed prospectively collected data from a cohort of patients admitted participating in the Spanish National Hip Fracture Registry (RNFC) in 76 Spanish hospitals between 2017 and 2019. We classified participants using Short Portable Mental Status Questionnaire (SPMSQ), defining two groups: patients with ≤2 SPMSQ score and patients with >2 SPMSQ score. RESULTS Of 21,254 patients was recorded SPMSQ in 17,242 patients, 9052 were >2 SPMSQ score (52.6%). These were older (87.7 vs. 85.3 years; p<0.001), had worse mobility (no-independent walking ability 26.0% vs. 4.5%; p<0.001) and were more likely to be living in nursing homes (35.3% vs. 9.6%; p<0.001). They were more likely to be treated nonoperatively (3.8% vs. 1.5%; p>0.001), less early mobilisation (57.5% vs. 68.9%; p<0.001) and suffered higher in-hospital mortality (5.2% vs. 2.7%; p<0.001). At discharge, they received less anti-osteoporotic medication (37.9% vs. 48.9%; p<0.001) and returned home less often (29.8%% vs. 51.2%; p<0.001). One month after fracture, patients with >2 SPMSQ score had poorer mobility (no-independent walking ability 44.4% vs. 24.9%; p<0.001) and were newly institutionalised in a nursing home more (12.6% vs. 12.0%; p<0.001) and were more likely to die by one-month post-fracture (9.5% vs. 4.6%; p<0.001). CONCLUSION RNFC patients with >2 SPMSQ score were more vulnerable and had poorer outcomes than patients with ≤2 SPMSQ score, suggesting that they need specialised care in-hospital and in the recovery phase.
Collapse
Affiliation(s)
| | - Jesús Mora-Fernández
- Department of Geriatrics, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University, Madrid, Spain
| | - Rocío Queipo Matas
- Europea University, Madrid, Spain; La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Juan Ignacio González Montalvo
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain; Department of Geriatrics, La Paz University Hospital, Madrid, Spain; Department of Medicine, Faculty of Medicine, Autonoma University, Madrid, Spain
| | | | - Cristina Ojeda Thies
- Department of Traumatology and Orthopaedic Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Pilar Sáez López
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain; Geriatrics Unit, Fundación Alcorcón University Hospital, Alcorcón, Madrid, Spain
| | | |
Collapse
|
2
|
Lee A, Weintraub S, Xi IL, Ahn J, Bernstein J. Predicting life expectancy after geriatric hip fracture: A systematic review. PLoS One 2021; 16:e0261279. [PMID: 34910791 PMCID: PMC8673659 DOI: 10.1371/journal.pone.0261279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/25/2021] [Indexed: 11/19/2022] Open
Abstract
Background Displaced femoral neck fractures in geriatric patients are typically treated with either hemiarthroplasty or total hip arthroplasty. The choice between hemiarthroplasty and total hip arthroplasty requires a good estimate of the patient’s life expectancy, as the recent HEALTH trial suggests that the benefits of the two operations do not diverge, if at all, until the second year post-operatively. A systematic review was this performed to determine if there sufficient information in the medical literature to estimate a patient’s life expectancy beyond two years and to identify those patient variables affecting survival of that duration. Methods Pubmed, Embase, and Cochrane databases were queried for articles reporting survival data for at least two years post-operatively for at least 100 patients, age 65 or greater, treated surgically for an isolated hip fracture. A final set of 43 papers was created. The methods section of all selected papers was then reviewed to determine which variables were collected in the studies and the results section was reviewed to note whether an effect was reported for all collected variables. Results There were 43 eligible studies with 25 unique variables identified. Only age, gender, comorbidities, the presence of dementia and fracture type were collected in a majority of studies, and within that, only age and gender were reported in a majority of the results. Most (15/ 25) variables were reported in 5 or fewer of the studies. Discussion There are important deficiencies in the literature precluding the evidence-based estimation of 2 year life expectancy. Because the ostensible advantages of total hip arthroplasty are reaped only by those who survive two years or more, there is a need for additional data collection, analysis and reporting regarding survival after geriatric hip fracture.
Collapse
Affiliation(s)
- Alexander Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sara Weintraub
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ianto Lin Xi
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Joseph Bernstein
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| |
Collapse
|
3
|
Alarcon T, Ojeda-Thies C, Sáez-López P, Gomez-Campelo P, Navarro-Castellanos L, Otero-Puime A, González-Montalvo JI. Usefulness of a national hip fracture registry to evaluate the profile of patients in whom antiosteoporotic treatment is prescribed following hospital discharge. Osteoporos Int 2020; 31:1369-1375. [PMID: 32080755 DOI: 10.1007/s00198-020-05341-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 02/07/2020] [Indexed: 11/30/2022]
Abstract
UNLABELLED This study was carried out to describe the profile of prescription of antiosteoporotic treatment at discharge after a hip fracture in the Spanish National Hip Fracture Registry. Prescription rates among hospitals ranged from 0 to 94% of patients discharged. The prescription rate was higher among patients with better cognitive and functional baseline status. PURPOSE National hip fracture registries are useful for assessing current care processes. The goals of this study were as follows: first, to know the rate of antiosteoporotic prescription at discharge among hip fracture patients in hospitals participating in the Spanish National Hip Fracture Registry (RNFC); second, to compare the differences between treated and non-treated patients; third, to analyze patients' characteristics associated with antiosteoporotic prescription at discharge; and fourth, to evaluate whether there were differences in the profile of patients discharged from hospitals with high and low prescription rates. METHOD Patients discharged after a fragility hip fracture in 2017 and participating in the RNFC were included. Demographic variables, cognitive and functional status, prefracture osteoporosis treatment, fracture type, anesthetic risk, hospital volume, and antiosteoporotic prescription at discharge were analyzed. Given that patients were clustered within hospitals, intraclass correlation was calculated and generalized estimating equations were fitted. RESULTS A total of 6701 patients from 54 hospitals were included. Antiosteoporotic prescription at discharge was prescribed to 36.5% (CI95% 35.8-37.2%), with a wide inter-hospital variability (range 0-94%). The intraclass correlation due of clustering of patients within hospitals was 47.9%. Antiosteoporotic prescription was more likely in patients who were younger, lived at home, previously treated for osteoporosis, had better baseline functional and cognitive status, lower anesthetic risk, and were discharged from high-volume hospitals, all with p < 0.001. The general profile of patients discharged from hospitals with high and low rate of prescription was similar. CONCLUSIONS There is a wide variability between hospitals regarding antiosteoporotic prescription after hip fracture. This is more likely to be initiated in patients with better clinical, functional, and mental status and in those discharged from hospitals with larger volumes of patients. These results offer insights regarding the selection of patients receiving secondary prevention and raises questions on who and how many should be treated.
Collapse
Affiliation(s)
- T Alarcon
- Hospital Universitario La Paz, Madrid, Spain.
- Instituto de Investigación del Hospital La Paz (IdiPAZ), Madrid, Spain.
| | | | - P Sáez-López
- Instituto de Investigación del Hospital La Paz (IdiPAZ), Madrid, Spain
- Hospital Universitario Fundación Alcorcón, Madrid, Spain
- Head Coordinator of the Spanish National Hip Fracture Registry, Madrid, Spain
| | - P Gomez-Campelo
- Instituto de Investigación del Hospital La Paz (IdiPAZ), Madrid, Spain
| | | | - A Otero-Puime
- Instituto de Investigación del Hospital La Paz (IdiPAZ), Madrid, Spain
| | - J I González-Montalvo
- Hospital Universitario La Paz, Madrid, Spain
- Instituto de Investigación del Hospital La Paz (IdiPAZ), Madrid, Spain
| | | |
Collapse
|
4
|
Zamora-Navas P, Esteban-Peña M. Seasonality in incidence and mortality of hip fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
5
|
Zamora-Navas P, Esteban-Peña M. Seasonality in incidence and mortality of hip fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:132-137. [PMID: 30683522 DOI: 10.1016/j.recot.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/22/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES To determine whether there is a seasonal relationship in the incidence and in-hospital mortality of patients with hip fracture. PATIENTS AND METHODS Longitudinal descriptive study of cases that included 1104 patients older than 64years admitted for fracture of the proximal extremity of the femur in the Hospital HCU Virgen de la Victoria during a period of 30months The epidemiological characteristics of the patients were recorded and the monthly incidence of fractures was related with the month of the year in which it occurred, as well as with the meteorological conditions, temperature and rainfall. RESULTS The study population comprised a total of 1104 patients, with a greater proportion of women (75.1%). The average age was 82.3years. A tendency towards an increased incidence of these fractures was found. The in-hospital annual mortality rate was 2.97%, higher for men and in the age group over 84years. Seasonality was found in terms of the incidence of fractures above the average in the month of October and below this in the month of February. On the other hand, mortality was lower than the average in the month of March and higher in August. In both, a low correlation with temperature and rainfall was found. CONCLUSIONS The seasonal distribution of hip fractures presented an increase over the average in the month of October and a decrease in February. Mortality increased over the average in the month of August and decreased in March.
Collapse
Affiliation(s)
| | - M Esteban-Peña
- Facultad de Medicina, Universidad de Málaga, Málaga, España
| |
Collapse
|
6
|
[Multidisciplinary geriatric rehabilitation in the patient with hip fracture and dementia]. Rev Esp Geriatr Gerontol 2018; 54:220-229. [PMID: 30606498 DOI: 10.1016/j.regg.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 12/14/2022]
Abstract
Hip fracture and dementia rates increase with age, and both groups of patients suffer increased morbidity and mortality and functional impairment. The management of these patients is a challenge for the orthogeriatric and rehabilitation team process, as despite the evidence on the benefit, the results analysed are still worse than in patients without cognitive impairment. For this reason, and due to the limitation in health resources, many of them have problems in accessibility to them, or are limited to a less intense rehabilitation. There are insufficient studies on the best rehabilitation interventions in this group of patients, but it is suggested: 1) to use a multidisciplinary rehabilitation model adapted to the patient with dementia, and 2) to redefine results of the rehabilitation of these patients not only in terms of functional improvement, without highlighting other concepts, such as quality of life, decrease in complications or improved social support.
Collapse
|
7
|
Molina Hernández MJ, González de Villaumbrosia C, Martín de Francisco de Murga E, Alarcón Alarcón T, Montero-Fernández N, Illán J, Bielza R, Mora-Fernández J. [Multi-centre register study of hip fractures in Orthogeriatric Units in the Community of Madrid (Spain)]. Rev Esp Geriatr Gerontol 2018; 54:5-11. [PMID: 30131189 DOI: 10.1016/j.regg.2018.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/12/2018] [Accepted: 07/25/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe the characteristics of patients with hip fractures admitted over a period of two years (from January 2015 to December 2016) in eight Orthogeriatric Units in public hospitals of the Community of Madrid. MATERIAL AND METHOD This is a descriptive, prospective and multi-centre study. In 2014, all hospitals in Madrid providing joint Geriatric and Traumatology assistance were invited to a recently created orthogeriatric work group. Geriatricians in charge of the Orthogeriatric Unit from eight hospitals took part in this study. The participants established a database including all variables that influenced health outcomes (socio-demographic and clinical variables). RESULTS The study includes 3,995 patients, with a mean age of 85.3years (range: 58-108years old). Two-thirds of them were ASA (American Society Physical Status Classification System) III-IV. Almost all (96.7%) of the patients underwent a surgical operation, and 35.9% of them were operated during the first 48hours. The delay was mainly due to logistic problems (43.5%). The mean hospital stay was 11.2days. Just over half (53.1%) of the patients required a blood transfusion. In-hospital mortality was 5.3%. DISCUSSION Hip fracture registries are essential tools to monitor the healthcare process of these patients, as well as to improve the quality of care. Our results are similar to other records. It would be necessary to improve pre-operative time, which must be less than 48hours in patients without clinical instability. We also need more resources for functional recovery and more uniformity.
Collapse
Affiliation(s)
| | | | | | | | - Nuria Montero-Fernández
- Servicio de Geriatría, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Julia Illán
- Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Rafael Bielza
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Jesús Mora-Fernández
- Servicio de Geriatría, IdISSC, Hospital Universitario Clínico San Carlos, Madrid, España.
| |
Collapse
|
8
|
Alarcón T, González-Montalvo JI, Hoyos R, Diez-Sebastián J, Otero A, Mauleon JL. Parathyroid hormone response to two levels of vitamin D deficiency is associated with high risk of medical problems during hospitalization in patients with hip fracture. J Endocrinol Invest 2015; 38:1129-35. [PMID: 26048596 DOI: 10.1007/s40618-015-0320-9] [Citation(s) in RCA: 10] [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: 02/02/2015] [Accepted: 05/21/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Vitamin D and the parathyroid hormone (PTH) response play an important role in hip fracture patients. This study was carried out to determine the factors associated with the PTH response to different levels of vitamin D deficiency during hospitalization. METHODS This was a cross-sectional study of patients over 64 years of age admitted with an acute fragility hip fracture between March 1st 2009 and November 30th 2012. Demographic, clinical, functional, and cognitive function were evaluated at admission and during hospitalization. Levels of 25-hydroxyvitamin D (25-OHD) and PTH were analyzed. Two 25-OHD cut-off points were considered, <12 ng/ml and 12-20 ng/ml. Multivariate logistic regression analysis was used. RESULTS Mean age of the 607 patients included was 84.7 years (SD 7.10), and 81.9 % were women. The mean 25-OHD level in the total sample was 13.2 (SD 11.1) ng/ml. Levels of 25-OHD <12 ng/ml were present in 347 patients (57.2 %), of whom 158 (45.5 %) had secondary hyperparathyroidism (SHPT) (PTH >65 pg/ml). 25-OHD levels of 12-20 ng/ml were present in 168 (27.7 %) patients, of whom 47 (28 %) had SHPT. Following logistic regression, SHPT was associated in both groups (25-OHD <12 and 12-20 ng/ml) with a greater number of medical problems during hospitalization. In the 25-OHD group <12 ng/ml, SHPT was also associated with poorer glomerular filtration rates. CONCLUSION The PTH response to vitamin D deficiency in hip fracture patients may be a marker for patients with higher risk of developing multiple medical problems, both when considering severe (<12 ng/ml) and moderate (12-20 ng/ml) vitamin D deficiency.
Collapse
Affiliation(s)
- T Alarcón
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPaz, Paseo Castellana 261, 28046, Madrid, Spain.
| | - J I González-Montalvo
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPaz, Paseo Castellana 261, 28046, Madrid, Spain
| | - R Hoyos
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPaz, Paseo Castellana 261, 28046, Madrid, Spain
| | - J Diez-Sebastián
- Servicio de Bioestadística, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - A Otero
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid. IdiPaz, Madrid, Spain
| | - J L Mauleon
- Servicio de Traumatología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| |
Collapse
|
9
|
Romero Pisonero E, Mora Fernández J. [Rehabilitation in hip-fracture patients: a challenge]. Rev Esp Geriatr Gerontol 2012; 47:285-287. [PMID: 23062687 DOI: 10.1016/j.regg.2012.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 06/09/2012] [Indexed: 06/01/2023]
|