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Trejo G, Zia A, Caronia C, Arrillaga A, Cuellar J, Pujol TA, Reens H, LeFevre F, Drucker T, Eckardt S, Jawa RS, Eckardt PA. Retrospective Analysis of Risk Factors in Geriatric Hip Fracture Patients Predictive of Surgical Intensive Care Unit Admission. Cureus 2024; 16:e60993. [PMID: 38800776 PMCID: PMC11121594 DOI: 10.7759/cureus.60993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Although numerous risk factors and prediction models affecting morbidity and mortality in geriatric hip fracture patients have been previously identified, there are scant published data on predictors for perioperative Surgical Intensive Care Unit (SICU) admission in this patient population. Determining if a patient will need an SICU admission would not only allow for the appropriate allocation of resources and personnel but also permit targeted clinical management of these patients with the goal of improving morbidity and mortality outcomes. The purpose of this study was to identify specific risk factors predictive of SICU admission in a population of geriatric hip fracture patients. Unlike previous studies which have investigated predominantly demographic, comorbidity, and laboratory data, the present study also considered a frailty index and length of time from injury to presentation in the Emergency Department (ED). METHODS A total of 501 geriatric hip fracture patients admitted to a Level 1 trauma center were included in this retrospective, single-center, quantitative study from January 1, 2019, to December 31, 2022. Using a logistical regression analysis, more than 25 different variables were included in the regression model to identify values predictive of SICU admission. Predictive models of planned versus unplanned SICU admissions were also estimated. The discriminative ability of variables in the final models to predict SICU admission was assessed with receiver operating characteristic curves' area under the curve estimates. RESULTS Frailty, serum lactate > 2, and presentation to the ED > 12 hours after injury were significant predictors of SICU admission overall (P = 0.03, 0.038, and 0.05 respectively). Additionally, the predictive model for planned SICU admission had no common significant predictors with unplanned SICU admission. Planned SICU admission significant predictors included an Injury Severity Score (ISS) of 15 and greater, a higher total serum protein, serum sodium <135, systolic blood pressure (BP) under 100, increased heart rate on admission to ED, thrombocytopenia (<120), and higher Anesthesia Society Association physical status classification (ASA) score (P = 0.007, 0.04, 0.05, 0.002, 0.041, 0.05, and 0.005 respectively). Each SICU prediction model (overall, planned, and unplanned) demonstrated sufficient discriminative ability with the area under the curve (AUC) values of 0.869, 0.601, and 0.866 respectively. Finally, mean hospital Length of Stay (LOS) and mortality were increased in SICU admissions when compared to non-SICU admissions. CONCLUSION Of the three risk factors predictive of SICU admission identified in this study, two have not been extensively studied previously in this patient population. Frailty has been associated with increased mortality and postoperative complications in hip fracture patients, but this is the first study to date to use a novel frailty index specifically designed and validated for use in hip fracture patients. The other risk factor, time from injury to presentation to the ED serves as an indicator for time a hip fracture patient spent without receiving medical attention. This risk factor has not been investigated heavily in the past as a predictor of SICU admissions in this patient population.
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Affiliation(s)
- Gerardo Trejo
- Family Medicine, Good Samaritan University Hospital, West Islip, USA
| | - Aiza Zia
- Trauma, Good Samaritan University Hospital, West Islip, USA
| | | | - Abenamar Arrillaga
- Trauma/Surgical Critical Care, Good Samaritan University Hospital, West Islip, USA
| | - John Cuellar
- Orthopedic Surgery, Good Samaritan University Hospital, West Islip, USA
| | | | | | - Florence LeFevre
- Clinical Professional Development, North Shore University Hospital, Manhasset, USA
| | | | - Sarah Eckardt
- Performance Improvement, Huntington Hospital, Northwell Health, Huntington, USA
| | - Randeep S Jawa
- Division of Trauma Surgery, Stony Brook Medicine, Stony Brook, USA
| | - Patricia A Eckardt
- Nursing, Good Samaritan University Hospital, West Islip, USA
- Nursing, Molloy University, Rockville Centre, USA
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Bui M, Nijmeijer WS, Hegeman JH, Witteveen A, Groothuis-Oudshoorn CGM. Systematic review and meta-analysis of preoperative predictors for early mortality following hip fracture surgery. Osteoporos Int 2024; 35:561-574. [PMID: 37996546 PMCID: PMC10957669 DOI: 10.1007/s00198-023-06942-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/04/2023] [Indexed: 11/25/2023]
Abstract
Hip fractures are a global health problem with a high postoperative mortality rate. Preoperative predictors for early mortality could be used to optimise and personalise healthcare strategies. This study aimed to identify predictors for early mortality following hip fracture surgery. Cohort studies examining independent preoperative predictors for mortality following hip fracture surgery were identified through a systematic search on Scopus and PubMed. Predictors for 30-day mortality were the primary outcome, and predictors for mortality within 1 year were secondary outcomes. Primary outcomes were analysed with random-effects meta-analyses. Confidence in the cumulative evidence was assessed using the GRADE criteria. Secondary outcomes were synthesised narratively. Thirty-three cohort studies involving 462,699 patients were meta-analysed. Five high-quality evidence predictors for 30-day mortality were identified: age per year (OR: 1.06, 95% CI: 1.04-1.07), ASA score ≥ 3 (OR: 2.69, 95% CI: 2.12-3.42), male gender (OR: 2.00, 95% CI: 1.85-2.18), institutional residence (OR: 1.81, 95% CI: 1.31-2.49), and metastatic cancer (OR: 2.83, 95% CI: 2.58-3.10). Additionally, six moderate-quality evidence predictors were identified: chronic renal failure, dementia, diabetes, low haemoglobin, heart failures, and a history of any malignancy. Weak evidence was found for non-metastatic cancer. This review found relevant preoperative predictors which could be used to identify patients who are at high risk of 30-day mortality following hip fracture surgery. For some predictors, the prognostic value could be increased by further subcategorising the conditions by severity.
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Affiliation(s)
- Michael Bui
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands.
| | - Wieke S Nijmeijer
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609, PP, Almelo, The Netherlands
| | - Johannes H Hegeman
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609, PP, Almelo, The Netherlands
| | - Annemieke Witteveen
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
| | - Catharina G M Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
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Ng MK, Pasternack JB, Mastrokostas PG, Voyvodic L, Kang KK. The real time to surgery: Limited delay after medical optimization does not impact hip fracture surgery outcomes. Injury 2024; 55:111421. [PMID: 38359712 DOI: 10.1016/j.injury.2024.111421] [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: 12/11/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Current U.S./Canadian guidelines recommend hip fracture surgery within 48 h of injury to decrease morbidity/mortality. Multiple studies have identified medical optimization as the key component of time to surgery, but have inherent bias as patients with multiple co-morbidities often take longer to optimize. This study aimed to evaluate time from medical optimization to surgery (TMOS) to determine if "real surgical delay" is associated with: 1) mortality and 2) complications for geriatric hip fracture patients. METHODS A retrospective chart review of geriatric hip fractures treated from 2015-2018 at a single, level-1 trauma center was conducted. Univariate logistic regression was performed to identify association between TMOS and post-operative complication rates. For mortality, the Wilcoxon test was used to compare TMOS for patients discharged following surgery to those who were not. RESULTS A total of 884 hip fractures were treated operatively, with median TMOS 16.2 h (5.0-22.5, 1st-3rd quartiles). Univariate logistic regression models did not identify an association between TMOS and complication rates. For patients successfully discharged, median TMOS was 16.2 h (5.0-22.3, 1st-3rd quartiles). For the cohort of patients not successfully discharged, median TMOS was 19.1 h (10.1-25.9, 1st-3rd quartiles, p = 0.16). CONCLUSION "Real surgical delay", or TMOS is not associated with increased complications or with inpatient mortality for geriatric hip fracture patients. With few exceptions, our institution adhered to the 48-hour time window from injury to hip surgery. We maintain the belief timely surgery following optimization plays a crucial role in the geriatric hip fracture patient outcomes.
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Affiliation(s)
- Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, United States.
| | - Jordan B Pasternack
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, United States
| | - Paul G Mastrokostas
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, United States
| | - Lucas Voyvodic
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, United States
| | - Kevin K Kang
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, United States
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Schroeder H, Israeli A, Liebergall M, Or O, Abu Ahmad W, Paltiel O, Justo D, Zimlichman E. Utilising patient-reported outcomes for goal-directed therapy of hip fracture patients: a sequential controlled trial. BMJ Open Qual 2023; 12:e002402. [PMID: 38154820 PMCID: PMC10759100 DOI: 10.1136/bmjoq-2023-002402] [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: 05/03/2023] [Accepted: 12/02/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Hip fracture patients (HFPs) frequently have multiple underlying conditions, necessitating that agreed-upon goals take these complications into consideration. Communication regarding goals between medical-personnel and patients is not always effective. Patient-reported outcomes (PROs) can outline personal goals and help promote quality health care in HFPs. Few studies have been published on this topic. The study's aim was to outline the process of using PROs for goal-directed therapy among HFPs. METHODS This sequential controlled trial was conducted among HFPs from two medical centres. The control and the intervention group received integrative rehabilitation. PROs were measured in both groups using the SF36 questionnaire three times postsurgery: 24-48 hours, 2 weeks and 3 months. During the first round of questioning, only the intervention group was asked 'what matters most to you?' during the rehabilitative process. Accordingly, agreed-upon goals that were determined by the SF36's eight topics and were incorporated into the HFP's rehabilitative process. A Likert scale of 1-5, '1' indicating no-achievement and '5' full-achievement, was used to assess the goal achievement 4-6 months post-fracture. RESULTS 84 HFPs participated in the study: 40 and 44 in the intervention and control group, respectively. In both groups, PROs declined after the HF, then improved somewhat 3 months later, but did not return to prefracture scores. Among the intervention group, 39% reached their specific goals (Likert level 5). Patients who achieved their goals had better PROs in comparison to others. The intervention group indicated PROs helped them articulate their desires and introduced them to new areas of care. CONCLUSIONS Shifting from asking 'what's the matter?' to 'what matters most to you?' can improve the understanding of HFPs' own priorities, promote quality outcomes and enhance patient-centred care. Using PROs as a guide for goal-directed therapy can create a more inclusive process that includes the patients' most important health determinants and needs.
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Affiliation(s)
- Hanna Schroeder
- School of Nursing in the Faculty of Medicine, Henrietta Szold Hadassah, Hebrew University of Jerusalem, Jerusalem, Israel
- Strategic and Economic Planning Administration, Israel Ministry of Health, Jerusalem, Israel
| | - Avi Israeli
- Dr. Julien Rozan Professor of Healthcare, Hebrew University - Hadassah Medical School, Jerusalem, Israel
- Office of the Chief Scientist, Israel Ministry of Health, Jerusalem, Israel
- Hadassah University Medical Center, Jerusalem, Israel
| | - Meir Liebergall
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Omer Or
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wiessam Abu Ahmad
- Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Justo
- Geriatrics Division, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eyal Zimlichman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
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Green J, Watson JT, Shaheen P, Kuldjanov D. Geriatric Intertrochanteric Fractures: What Is the Optimal Follow-Up Period? J Orthop Trauma 2023; 37:557-561. [PMID: 37491707 DOI: 10.1097/bot.0000000000002664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Evaluate patients with intertrochanteric fractures who were treated operatively to determine optimal follow-up to ensure complete fracture healing and recognize complications. DESIGN Retrospective review. SETTING Academic Level 1 trauma center. PATIENTS/PARTICIPANTS Inclusion criteria included isolated intertroch fractures (not pathologic) and complete radiographic and clinical data, with at least 1-year follow-up. Four hundred ninety-seven patients were identified. Two hundred forty-nine patients met inclusion criteria with 194 patients studied. INTERVENTION Operative fixation with either CMN or SHS. MAIN OUTCOME MEASUREMENTS Radiographic parameters included time to union, neck-shaft angle, tip apex distance, and femoral neck screw telescoping (shortening) for both CMS and SHS combined. Postoperative complications were recorded. RESULTS Union was achieved at a mean of 64.8 ± 30.7 days. Mortality (n = 12), infection (n = 4), and implant failure (n = 5) occurred within 3 months. Neck-shaft angle was changed before 3 months. Significant neck shortening for both CMN and SHS occurred within 6 weeks ( P =<0.001). Major complications occurred early, within 3 months. CONCLUSIONS Most fractures healed by 3 months and the remainder by 6 months. Routine follow-up for 6 months is more than sufficient for most of these fractures. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- John Green
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, Saint Louis, MI
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Jeong SH, Lee HJ, Kim SH, Park EC, Jang SY. Effect of dementia on all-cause mortality in hip fracture surgery: a retrospective study on a nationwide Korean cohort. BMJ Open 2023; 13:e069579. [PMID: 37173102 DOI: 10.1136/bmjopen-2022-069579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES We aimed to evaluate the effect of dementia on the 1-year all-cause mortality in elderly patients who underwent hip fracture surgery, using a nationwide cohort in Korea. DESIGN, SETTING, AND PARTICIPANTS This was a nationwide, retrospective study. Elderly patients (≥60 years) with and without dementia who underwent hip fracture surgery between January 2005 and December 2012 were distinguished using the data from the Korean National Health Insurance Service-Senior cohort. INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOME MEASURES The mortality rates with 95% CIs and the impact of dementia on all-cause mortality were calculated using a generalised linear model with Poisson distribution and a multivariable-adjusted Cox proportional hazards model, respectively. RESULTS Among the 10 833 patients who underwent hip fracture surgery, 13.4% were diagnosed with dementia. During the 1-year follow-up period, 1586 patients with hip fracture without dementia died in 8356.5 person-years (incidence rate (IR)=189.2 per 1000 person-years, 95% CI 179.91 to 198.99), while 340 deaths were confirmed in patients with hip fracture with dementia in 1240.8 person-years (IR, 273.1 per 1000 person-years, 95% CI 244.94 to 304.58). Patients with hip fracture and dementia were 1.23 times more likely to die than those in the control group in the same period (HR=1.23, 95% CI 1.09 to 1.39). CONCLUSION Dementia is a risk factor for 1-year all-cause mortality after hip fracture surgery. To improve the postoperative outcomes of patients with dementia who have undergone hip fracture surgery, effective treatment models such as multidisciplinary diagnosis and strategic rehabilitation should be established.
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Affiliation(s)
- Sung Hoon Jeong
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon Ji Lee
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Seung Hoon Kim
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
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Ahn TR, Yoon YC, Kim HS, Kim K, Lee JH. Association Between Pelvic Bone Computed Tomography-Derived Body Composition and Patient Outcomes in Older Adults With Proximal Femur Fracture. Korean J Radiol 2023; 24:434-443. [PMID: 37133212 PMCID: PMC10157326 DOI: 10.3348/kjr.2022.0835] [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: 10/30/2022] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE To investigate the association between pelvic bone computed tomography (CT)-derived body composition and patient outcomes in older adult patients who underwent surgery for proximal femur fractures. MATERIALS AND METHODS We retrospectively identified consecutive patients aged ≥ 65 years who underwent pelvic bone CT and subsequent surgery for proximal femur fractures between July 2018 and September 2021. Eight CT metrics were calculated from the cross-sectional area and attenuation of the subcutaneous fat and muscle, including the thigh subcutaneous fat (TSF) index, TSF attenuation, thigh muscle (TM) index, TM attenuation, gluteus maximus (GM) index, GM attenuation, gluteus medius and minimus (Gmm) index, and Gmm attenuation. The patients were dichotomized using the median value of each metric. Multivariable Cox regression and logistic regression models were used to determine the association between CT metrics with overall survival (OS) and postsurgical intensive care unit (ICU) admission, respectively. RESULTS A total of 372 patients (median age, 80.5 years; interquartile range, 76.0-85.0 years; 285 females) were included. TSF attenuation above the median (adjusted hazard ratio [HR], 2.39; 95% confidence interval [CI], 1.41-4.05), GM index below the median (adjusted HR, 2.63; 95% CI, 1.33-5.26), and Gmm index below the median (adjusted HR, 2.33; 95% CI, 1.12-4.55) were independently associated with shorter OS. TSF index (adjusted odds ratio [OR], 6.67; 95% CI, 3.13-14.29), GM index (adjusted OR, 3.45; 95% CI, 1.49-7.69), GM attenuation (adjusted OR, 2.33; 95% CI, 1.02-5.56), Gmm index (adjusted OR, 2.70; 95% CI, 1.22-5.88), and Gmm attenuation (adjusted OR, 2.22; 95% CI, 1.01-5.00) below the median were independently associated with ICU admission. CONCLUSION In older adult patients who underwent surgery for proximal femur fracture, low muscle indices of the GM and gluteus medius/minimus obtained from their cross-sectional areas on preoperative pelvic bone CT were significant prognostic markers for predicting high mortality and postsurgical ICU admission.
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Affiliation(s)
- Tae Ran Ahn
- Department of Radiology, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyunga Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Mortality following hip fracture: Trends and geographical variations over the last SIXTY years. Injury 2023; 54:620-629. [PMID: 36549980 DOI: 10.1016/j.injury.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The management of hip fractures has advanced on all aspects from prevention pre-operatively, specialised hip fracture units, early operative intervention and rehabilitation. This is in line with the appropriate recognition over the past years of an important presentation with significant mortality and socioeconomic consequences of ever increasing incidence in an aging population. It is therefore imperative to continue to gather data on the incidence and trends of hip fractures to guide future management planning of this important presentation. METHODS A review of all articles published on the outcome after hip fracture over a twenty year period (1999-2018) was undertaken to determine any changes that had occurred in the demographics and mortality over this period. This article complements and expands upon the findings of a previous article by the authors assessing a four decade period (1959 - 1998) and attempts to present trends and geographical variations over sixty years. RESULTS The mean age of patients sustaining hip fractures continues to be steadily increasing at approximately just over 1 year of age for every 5-year time period. The mean age of patients sustaining hip fractures increased from 73 years (1960s) to 81 years (2000s) to 82 years (2010s). Over the six decade period one-year mortality has reduced from an overall mean of 27% (1960s) to 20% (2010s). The proportion of female hip fractures has decreased from 84% (1960s) to 70% (2010s). There is a decreasing trend in the proportion of intracapsular fractures from 54% (1970s) to 49% (2000s) and 48% (2010s). CONCLUSION Our study indicates that significant progress has been made with preventative planning, medical management, specialised orthogeriatric units and surgical urgency all playing a role in the improvements in mean age of hip fracture incidence and reduction in mortality rates. While geographical variations do still exist there has been an increase in the study of hip fractures globally with results now being published from more widespread institutions indicating appropriate increased attention and commitment to an ever-increasing presentation.
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Celik B, Kose A, Milcan A, Yarkac A, Babus SB, Erdogan S. RELATION OF FEMUR FRACTURES LOCATION WITH CLINICAL OUTCOMES IN ELDERLY PATIENTS. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e239997. [PMID: 37082157 PMCID: PMC10112354 DOI: 10.1590/1413-785220233101e239997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/06/2020] [Indexed: 04/22/2023]
Abstract
Objectives This study was designed to investigate the possible relationship between the anatomical location of the PFF (head-neck fractures) and the demographic features, comorbidities, and risk factors of elderly patients. Methods 233 patients aged 65 years and over, who were admitted to the emergency department with a diagnosis of proximal femur fracture were included in this study. Results Most patients (59.6%) had a trochanteric fracture. The incidence of trochanteric fractures had a statistically significant positive correlation with age. Falls at ground level were found to be highly associated with trochanteric fractures (92,8%). At least one complication was observed in 57 (41,0%) cases and 31 (22,3%) died in one year, of the patients with trochanteric fractures. Comorbidity was not related to fracture location statistically. Fall ground level (p = 0.013), complication rate (73.7%; p <0.001), and Charlesen comorbidity index (p = 0.019) were statistically significantly associated with death. The logistic regression analysis of variables determined that only the quantity of comorbidities may be related to femoral neck fractures (p = 0.047). Conclusion Female patients with trochanteric fractures were found to be older than male patients. Fall ground level, mortality, and complications were more frequently seen in patients with trochanteric fractures. Level of Evidence II, Retrospective study.
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Affiliation(s)
- Burak Celik
- Sanlıurfa Suruc State Hospital, Emergency Service, Sanlıurfa, Turkey
| | - Ataman Kose
- Mersin University, Faculty of Medicine, Department of Emergency Medicine, Mersin, Turkey
| | - Abtullah Milcan
- Mersin University, Faculty of Medicine, Department of Orthopedics and Traumatology, Mersin, Turkey
| | - Akif Yarkac
- Mersin University, Faculty of Medicine, Department of Emergency Medicine, Mersin, Turkey
| | - Seyran Bozkurt Babus
- Mersin University, Faculty of Medicine, Department of Emergency Medicine, Mersin, Turkey
| | - Semra Erdogan
- Mersin University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Mersin, Turkey
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Chen Y, Liang S, Wu H, Deng S, Wang F, Lunzhu C, Li J. Postoperative delirium in geriatric patients with hip fractures. Front Aging Neurosci 2022; 14:1068278. [PMID: 36620772 PMCID: PMC9813601 DOI: 10.3389/fnagi.2022.1068278] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Postoperative delirium (POD) is a frequent complication in geriatric patients with hip fractures, which is linked to poorer functional recovery, longer hospital stays, and higher short-and long-term mortality. Patients with increased age, preoperative cognitive impairment, comorbidities, perioperative polypharmacy, and delayed surgery are more prone to develop POD after hip fracture surgery. In this narrative review, we outlined the latest findings on postoperative delirium in geriatric patients with hip fractures, focusing on its pathophysiology, diagnosis, prevention, and treatment. Perioperative risk prediction, avoidance of certain medications, and orthogeriatric comprehensive care are all examples of effective interventions. Choices of anesthesia technique may not be associated with a significant difference in the incidence of postoperative delirium in geriatric patients with hip fractures. There are few pharmaceutical measures available for POD treatment. Dexmedetomidine and multimodal analgesia may be effective for managing postoperative delirium, and adverse complications should be considered when using antipsychotics. In conclusion, perioperative risk intervention based on orthogeriatric comprehensive care is the most effective strategy for preventing postoperative delirium in geriatric patients with hip fractures.
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Affiliation(s)
- Yang Chen
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shuai Liang
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Huiwen Wu
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shihao Deng
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Fangyuan Wang
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Ciren Lunzhu
- Department of Orthopedics, Shannan City People’s Hospital, Shannan, China
| | - Jun Li
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China,*Correspondence: Jun Li,
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11
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Chen M, Du Y, Tang W, Yu W, Li H, Zheng S, Cheng Q. Risk factors of mortality and second fracture after elderly hip fracture surgery in Shanghai, China. J Bone Miner Metab 2022; 40:951-959. [PMID: 35939235 DOI: 10.1007/s00774-022-01358-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/01/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Hip fracture is one of the leading causes of death and disability in the elderly. We analyzed the risk factors of mortality and second fracture within 2 years after hip fracture surgery in elderly Chinese patients. MATERIALS AND METHODS A total of 613 elderly patients after hip fracture surgery were selected, including 181 males and 432 females, and the patients were followed for at least 24 months. Information about patients and surgery was collected from medical records. Information on death, secondary fracture, and postoperative activities of daily living (ADL) was obtained by telephone follow-up. Cox regression was performed to identify risk factors associated with mortality and second fracture, measured by hazard ratio (HR). RESULTS The 1-year and 2-year mortality rates after hip fracture were 13.4% and 20.7%, respectively. The second fracture rate within 2 years was 9.5%. Male gender (HR 1.51, P = 0.035), increased age (HR 1.07, P < 0.001), preoperative hypoalbuminemia (HR 1.79, P = 0.004), preoperative pneumonia (HR 2.60, P = 0.005) and poor ADL (P = 0.048) were independent risk factors for 2-year mortality, while high preoperative hemoglobin (HR 0.98, P = 0.002), high preoperative eGFR (HR 0.99, P = 0.031), high preoperative LVEF (HR 0.92, P = 0.048) were protective factors for 2-year mortality. Poor ADL (P = 0.002) was the independent risk factor for second fracture within 2 years. CONCLUSIONS The 2-year mortality rate and second fracture rate after hip fracture in elderly remained high, which was related to old age and complications exists. Postoperative rehabilitation and improving ADL were very important to reduce mortality and second fracture.
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Affiliation(s)
- Minmin Chen
- Research Section of Geriatric Metabolic Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, 221 West Yan An Road, Shanghai, 200040, China
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Yanping Du
- Research Section of Geriatric Metabolic Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, 221 West Yan An Road, Shanghai, 200040, China
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Wenjing Tang
- Research Section of Geriatric Metabolic Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, 221 West Yan An Road, Shanghai, 200040, China
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Weijia Yu
- Research Section of Geriatric Metabolic Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, 221 West Yan An Road, Shanghai, 200040, China
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Huilin Li
- Research Section of Geriatric Metabolic Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, 221 West Yan An Road, Shanghai, 200040, China
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Songbai Zheng
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Qun Cheng
- Research Section of Geriatric Metabolic Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, 221 West Yan An Road, Shanghai, 200040, China.
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China.
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12
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Chung HJ, Kim DS, Lee JW, Hong SI. Analyzing the Risk Factors of Mortality after Osteoporotic Hip Fractures Using the National Health Insurance Service Sample Cohort 2.0 Database. Hip Pelvis 2022; 34:150-160. [PMID: 36299469 PMCID: PMC9577307 DOI: 10.5371/hp.2022.34.3.150] [Citation(s) in RCA: 6] [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: 02/14/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 11/04/2022] Open
Abstract
Purpose The purpose of this study is to determine risk factors that affect mortality following osteoporotic hip fracture in patients 50 years or older using the National Health Insurance Service (NHIS) sample cohort 2.0 database. Materials and Methods Data from 2,533 patients who satisfied the inclusion criteria for the NHIS sample cohort 2.0 database were used in this study. Data from patients who suffered osteoporotic hip fractures between 2002-2015 were used. An analysis of correlations between the incidence of osteoporotic hip fractures and various factors (sex, age, underlying diseases, etc.) was performed. Analysis of the associations between the mortality of osteoporotic hip fracture and the various factors with hazard ratio (HR) was performed using Cox regression models. Results Patient observation continued for an average of 38.12±32.09 months. During the observation period, a higher incidence of hip fracture was observed in women; however, higher mortality following the fracture was observed in men (HR=0.728; 95% confidence interval [CI], 0.635-0.836). The incidence and mortality of fractures increased when there were increasing age, more than three underlying diseases (HR=1.945; 95% CI, 1.284-2.945), cerebrovascular diseases (HR=1.429; 95% CI, 1.232-1.657), and renal diseases (HR=1.248; 95% CI, 1.040-1.497). Also, higher mortality was observed in patients who were underweight (HR=1.342; 95% CI, 1.079-1.669), current smokers (HR=1.338; 95% CI, 1.104-1.621), and inactivity (HR=1.379; 95% CI, 1.189-1.601). Conclusion Male gender, the presence of cerebrovascular or kidney disease, a more than three underlying diseases, underweight, a current smoker, and inactivity were risk factors that increased mortality.
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Affiliation(s)
- Hoe Jeong Chung
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Doo Sup Kim
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok In Hong
- Internship of Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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13
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Mandell JC, Khurana B. Musculoskeletal Trauma and Infection. Magn Reson Imaging Clin N Am 2022; 30:441-454. [PMID: 35995472 DOI: 10.1016/j.mric.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
MR is often the most definitive imaging for assessment of musculoskeletal trauma and infection. Although it is not possible to address all the intricacies of these complex topics in a single article, this review will attempt to provide a useful toolbox of skills by discussing several common clinical scenarios faced by emergency radiologists in interpretation of adult trauma and infection. These scenarios include MR assessment of hip and pelvic fracture, traumatic soft tissue injuries, septic arthritis, soft tissue infection, and osteomyelitis.
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Affiliation(s)
- Jacob C Mandell
- Musculoskeletal Imaging and Intervention, Division of Musculoskeletal Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Bharti Khurana
- Division of Emergency Radiology, Brigham and Women's Hospital, Trauma Imaging Research and Innovation Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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14
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Albanese AM, Ramazani N, Greene N, Bruse L. Review of Postoperative Delirium in Geriatric Patients After Hip Fracture Treatment. Geriatr Orthop Surg Rehabil 2022; 13:21514593211058947. [PMID: 35282299 PMCID: PMC8915233 DOI: 10.1177/21514593211058947] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction Postoperative delirium (POD) is a serious complication occurring in 4–53.3%
of geriatric patients undergoing surgeries for hip fracture. Incidence of
hip fractures is projected to grow 11.9% from 258,000 in 2010 to 289,000 in
2030 based on 1990 to 2010 data. As prevalence of hip fractures is projected
to increase, POD is also anticipated to increase. Signficance Postoperative delirium remains the most common complication of emergency hip
fracture surgery leading to high morbidity and mortality rates despite
significant research conducted regarding this topic. This study reviews
literature from 1990 to 2021 regarding POD in geriatric hip fracture
management. Results Potentially modifiable and non-modifiable risk factors for developing POD
include, but are not limited to, male gender, older age, multiple
comorbidities, specific comorbidities (dementia, cognitive impairment,
diabetes, vision impairment, and abnormal blood pressure), low BMI,
preoperative malnutrition, low albumin, low hematocrit, blunted preoperative
cytokines, emergency surgery, time to admission and surgery, preoperative
medical treatment, polypharmacy, delirium-inducing medications, fever,
anesthesia time, and sedation depth and type. Although the pathophysiology
remains unclear, the leading theories suggest neurotransmitter imbalance,
inflammation, and electrolyte or metabolic derangements as the underlying
cause of POD. POD is associated with increased length of hospital stay,
cost, morbidity, and mortality. Prevention and early recognition are key
factors in managing POD. Methods to reduce POD include utilizing
interdisciplinary teams, educational programs for healthcare professionals,
reducing narcotic use, avoiding delirium-inducing medications, and
multimodal pain control. Conclusion While POD is a known complication after hip fracture surgery, further
exploration in prevention is needed. Early identification of risk factors is
imperative to prevent POD in geriatric patients. Early prevention will
enhance delivery of health care both pre- and post-operatively leading to
the best possible surgical outcome and better quality of life after hip
fracture treatment.
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Affiliation(s)
- Anita M Albanese
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Noyan Ramazani
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Natasha Greene
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Laura Bruse
- Adjunct Clinical Assistant Professor Community Faculty, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
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15
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Gannon NP, Kampa J, Westberg JR, Baer MR, Pietrini N, Schmidt AH, Kyle RF. Does Inpatient Mobilization Predict 1-Year Mortality After Femoral Neck Fracture Treated With Hemiarthroplasty? J Orthop Trauma 2022; 36:98-103. [PMID: 35061652 DOI: 10.1097/bot.0000000000002196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether inpatient mobilization (defined as ambulation before hospital discharge) is associated with 1-year mortality and 90-day hospital readmission in patients treated with a hip hemiarthroplasty for a femoral neck fracture. DESIGN Retrospective case-control. SETTING Academic Level 1 trauma center. PATIENTS/PARTICIPANTS Two hundred twelve consecutive femoral neck fractures were treated with hip hemiarthroplasties with a minimum of 1 year of follow-up. INTERVENTION All study patients were treated with a hip hemiarthroplasty and weight-bearing as tolerated postoperative day 1. Patients were prescribed daily physical therapy with the goal of mobilization before discharge from hospital. MAIN OUTCOME MEASURES Mortality at 1 year; hospital readmission within 90 days. RESULTS Two hundred twelve patients were included in the study. One-year mortality was 29%. One hundred thirty-two (62%) patients were able to ambulate before hospital discharge. Ambulation with physical therapy before discharge from hospital was a significant predictor of 1-year mortality when compared with patients who were unable to ambulate (hazard ratio 0.57; 95% confidence interval, 0.34-0.94; P = 0.03), which equates to 43% reduction in risk of mortality. There was no difference in the 90-day readmission rates for ambulatory versus nonambulatory patients. CONCLUSIONS Ambulation with physical therapy before discharge reduced the risk of 1-year mortality by 43%, without an effect on 90-day readmission. Sixty-two percentage of our cohort was able to ambulate before discharge. Future investigations are warranted to further identify those patients at heightened risk of mortality and readmission and the role of early rehabilitation in recovery. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nicholas P Gannon
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - John Kampa
- Department of Orthopaedic Surgery, Welia Health, Mora, MN
| | - Jerald R Westberg
- Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN; and
| | - Michael R Baer
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Nicholas Pietrini
- Department of Internal Medicine, Vanderbilt University, Nashville, TN
| | - Andrew H Schmidt
- Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN; and
| | - Richard F Kyle
- Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN; and
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16
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Turgut N, Ünal AM. Standard and Newly Defined Prognostic Factors Affecting Early Mortality After Hip Fractures. Cureus 2022; 14:e21464. [PMID: 35223248 PMCID: PMC8860722 DOI: 10.7759/cureus.21464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose: Early mortality rate in geriatric patients after hip fractures remains very high. Determining the prognostic factors is crucial for decreasing early mortality. This study aimed to evaluate the prognostic risk factors affecting early mortality after hip fracture in the elderly. Methods: Medical records of 335 patients with age 70 years or older who sustained hip fractures which were treated by hemiarthroplasty or proximal femoral nailing between May 2017 and May 2019 were reviewed. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were investigated for validity as the new prognostic markers. The other variables included age, gender, type of surgery, type of implant, type of anesthesia, American Society of Anesthesiologists (ASA) score, presence of comorbidities, delirium, length of hospital stay, time delay to surgery, number of erythrocyte transfusions, and laboratory data were assessed for 30-day, 90-day, and one-year mortality. Univariate analysis and logistic regression analysis were used to determine the associated mortality. Results: Thirty-day mortality rate was 10.4% and was associated with being aged ≥90 years (p-value: 0.013, odds ratio {OR}: 0.13) and ASA score of 4 (p-value: 0.019, OR: 0.22). Ninety-day mortality rate was 21.5% and was associated with age (p-value: 0.002), being aged 80-89 years (p-value: 0.032, OR: 0.43), being aged ≥90 years (p-value: 0.001, OR: 0.13), general anesthesia (p-value: 0.016, OR: 0.41), preoperative high NLR level (p-value: 0.028, OR: 1.05), high blood urea nitrogen (BUN) level (p-value: 0.049, OR:1.02). One year mortality rate was 33.7% and independent significant prognostic risk factors were determined as being aged ≥90 years (p-value: 0.003, OR: 0.23), length of hospital stay (p-value: 0.003, OR: 1.04), and preoperative serum albumin level (p-value: 0.037, OR: 0.6). The other evaluated risk factors were not independently found to be associated with all early mortality time. Conclusion: Patients at or over 90 years old were at risk for all early mortality time points. NLR which is a new and cheap biomarker can be used as a prognostic risk factor for 90-day mortality. The variable of PLR was not found valuable for early mortality.
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17
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Burm SW, Hong N, Lee SH, Yu M, Kim JH, Park KK, Rhee Y. Fall Patterns Predict Mortality After Hip Fracture in Older Adults, Independent of Age, Sex, and Comorbidities. Calcif Tissue Int 2021; 109:372-382. [PMID: 33830276 DOI: 10.1007/s00223-021-00846-z] [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: 02/03/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
Falls are the most frequent cause of hip fracture. We aimed to investigate whether specific fall patterns have predictive value for mortality after hip fracture. In this cohort study, data of individuals presented to the Severance Hospital, Seoul, Korea, between 2005 and 2019 due to fragility hip fracture (n = 1986) were analyzed. Fall patterns were defined as causes, activities leading to falls, and a combination of both, based on electronic medical records using pre-specified classification from a prior study on video-captured falls. Mean age of study subjects were 77 years (71% women) and 211 patients (10.6%) died during follow-up (median 544 days). Indoor falls at home had a higher mortality than outdoor falls (11.9 vs. 8.0%, p = 0.009). Among 16 fall patterns, incorrect weight shift while sitting down (adjusted hazard ratio [aHR] 4.03) or getting up (aHR 2.01), collapse during low-risk activity (aHR 2.39), and slipping while walking (aHR 2.90, p < 0.01 for all) were associated with increased mortality compared to outdoor falls, after adjustment for age, sex, and Charlson comorbidity index (CCI), constituting a high-risk pattern. High-risk fall patterns were associated with a higher risk of mortality (aHR 2.56, p < 0.001) than low-risk patterns (aHR 1.37, p = 0.080) and outdoor falls (referent; log rank p < 0.001), which improved mortality prediction when added to a base model including age, sex, and CCI (integrative area under receiver-operating characteristics curve 0.675 to 0.698, p < 0.001). Specific fall patterns were associated with higher mortality in older adults with hip fracture, independent of age, sex, and comorbidities.
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Affiliation(s)
- Seung Won Burm
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Seung Hyun Lee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Minheui Yu
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Ji Hoon Kim
- Department of Emergency Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kwan Kyu Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
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18
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Debate Update: Surgery After 48 Hours of Admission for Geriatric Hip Fracture Patients Is Associated With Increase in Mortality and Complication Rate: A Study of 27,058 Patients Using the National Trauma Data Bank. J Orthop Trauma 2021; 35:535-541. [PMID: 33993177 DOI: 10.1097/bot.0000000000002075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the association between surgical timing and short-term morbidity and mortality in elderly patients who sustain hip fractures using a national trauma database (OTA/AO 31A1-3, 31B1-3). DESIGN Retrospective cohort study. SETTING Level I-IV trauma centers in the United States. PATIENTS/PARTICIPANTS All patients ≥65 years of age who underwent surgery for hip fracture from 2011 to 2013. INTERVENTION Time to surgery of <24, 24-48, and >48 hours from admission. MAIN OUTCOME MEASUREMENTS Primary outcome was mortality by hospital discharge. Secondary outcomes were complications of myocardial infarction, cardiac arrest, acute respiratory distress syndrome (ARDS), unplanned reintubation, pneumonia, stroke, severe sepsis, and intensive care unit length of stay. RESULTS Twenty-seven thousand fifty-eight patients were included in the study. Relative to the <24 hours cohort, patients in the >48 hours cohort were at increased risk for mortality (OR 1.89, 95% CI 1.52-2.33, P < 0.001), ARDS (OR 2.57, 95% CI 1.94-3.39, P < 0.001 for ARDS), myocardial infarction (OR 2.19, 95% CI 1.64-2.94, P < 0.0001), pneumonia (OR 2.04, 95% CI 1.71-2.44, P < 0.001), severe sepsis (OR 2.34, 95% CI 1.52-3.58, P = 0.003), and intensive care unit stay (OR 2.48, 95% CI 2.25-2.74, P < 0.0001). A subgroup analysis showed that healthier patients (modified Charlson Comorbidity Index less than 5) who had surgery >48 hours were not at increased risk of mortality. CONCLUSIONS For elderly patients with hip fractures, delaying surgery for more than 48 hours may be associated with increased short-term morbidity and mortality. This association may be pronounced for patients with more medical comorbidities. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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19
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Christiano AV, Elsevier HC, Sarker S, Agriantonis G, Joseph D, Hasija R. Improving outcomes after hip fracture at a safety net hospital with a standardised hip fracture protocol. Hip Int 2021; 31:696-699. [PMID: 32323588 DOI: 10.1177/1120700020919332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION standardised protocols for the care of geriatric hip fractures demonstrate improved patient outcomes with decreased cost. The purpose of this study is to evaluate outcomes of a standardised hip fracture protocol at an urban safety-net hospital. METHODS All trauma patients presenting to our urban safety-net hospital are included in a trauma database and inpatient outcomes recorded. A hip fracture protocol was introduced at our institution in 2015, which depended on admission to a monitored setting due to the absence of a geriatric co-management service. The database was queried to identify patients surgically treated for a geriatric hip fracture in the 3 years prior to protocol implementation (2012-2014) and patients treated in the 3 years following protocol implementation (2016-2018). Demographics, time to surgery, inpatient complications, and length of stay were compared between groups. RESULTS A total of 633 patients treated operatively for isolated hip fractures were identified, 262 patients in the 2012-2014 pre-protocol cohort, and 371 patients in the 2016-2018 protocol cohort. Following implementation of a hip fracture protocol the number of patients admitted to a surgical service increased from 198 (76%) to 348 (94%, p < 0.005) with the number of patients being admitted to a monitored setting increasing from 40 (15%) to 83 (22%, p = 0.026). The time to surgery was reduced to 2.75 days (p = 0.054). The complication rate fell from 23% to 4% (p < 0.0005). Length of stay was significantly reduced from 13.2 days to 12 days (p = 0.045). CONCLUSIONS A hip fracture protocol including admission to a monitored setting can be effectively implemented at an urban safety-net hospital where geriatric co-management is not available. This resulted in a decrease in complications and length of stay. Additional interventions are required to decrease average time to surgery below 36 hours.
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Affiliation(s)
- Anthony V Christiano
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah C Elsevier
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Salman Sarker
- Department of Orthopaedic Surgery, Elmhurst Hospital Center, Queens, NY, USA
| | - George Agriantonis
- Department of General Surgery, Elmhurst Hospital Center, Queens, NY, USA
| | - David Joseph
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Orthopaedic Surgery, Elmhurst Hospital Center, Queens, NY, USA
| | - Rohit Hasija
- Department of Orthopaedic Surgery, Elmhurst Hospital Center, Queens, NY, USA
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20
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Raichandani K, Agarwal S, Jain H, Bharwani N. Mortality profile after 2 years of hip fractures in elderly patients treated with early surgery. J Clin Orthop Trauma 2021; 18:1-5. [PMID: 33936949 PMCID: PMC8079428 DOI: 10.1016/j.jcot.2021.04.009] [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: 02/21/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND In geriatric age group, hip fractures tend to become a major public health hazard. Due to this high occurrence, there is a need to develop standardized, effective, and multidisciplinary management for treatment. These elderly patients have excessive mortality that can extend ahead of the time of recovery. Early surgery after hip fractures has lead to a notable reduction in mortality rates. Still, it is considerably high as compared to other fractures. METHODS 266 patients of >65 years who were operated within 72 h hours in a tertiary level health care centre for hip fractures were included. They were evaluated with X-rays and grade of Singh's index was noted. Mortality rates and the factors associated with it such as age, sex, co morbidities (using Charlson's co morbidity Index/CCI) were evaluated after 2 year follow up. RESULTS The overall 2-year mortality reported in our study population was 11.2%. It was broadly lower as compared to most of the other studies. It was 6.3% in females as compared to 18.1% in males. While it was reported to be only 6% in 65-74 years of age, it was 25% in patients who were 85 years and above. 76.6% of the patients had Singh's index of ≤ grade 3 showing osteoporosis. The patients with Low Charlson's score showed only 4.2% mortality while those with high Charlson's score showed 25.5% mortality. CONCLUSION It was concluded that Mortality among elderly patients after early surgery after osteoporotic hip fractures is quite significant. The factors for improvement in long term survival post-hip fracture may include changing treatment patterns, increasing life expectancy and early surgery. Increase in age, female sex, and high CCI Scores were major risk factors of mortality after hip fractures in a 2-year follow-up period.
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Affiliation(s)
| | - Shubham Agarwal
- Department of Orthopaedics, Dr SN Medical College, Jodhpur, India
| | - Hemant Jain
- Department of Orthopaedics, Dr SN Medical College, Jodhpur, India
| | - Nandlal Bharwani
- Department of Orthopaedics, Dr SN Medical College, Jodhpur, India
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21
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Abdelnasser MK, Khalifa AA, Amir KG, Hassan MA, Eisa AA, El-Adly WY, Ibrahim AK, Farouk OA, Abubeih HA. Mortality incidence and its determinants after fragility hip fractures: a prospective cohort study from an Egyptian level one trauma center. Afr Health Sci 2021; 21:806-816. [PMID: 34795739 PMCID: PMC8568210 DOI: 10.4314/ahs.v21i2.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Fragility hip fracture is a common condition with serious consequences. Most outcomes data come from Western and Asian populations. There are few data from African and Middle Eastern countries. Objective The primary objective was to describe mortality rates after fragility hip fracture in a Level-1 trauma centre in Egypt. The secondary objective was to study the causes of re-admissions, complications, and mortality. Methods A prospective cohort study of 301 patients, aged > 65 years, with fragility hip fractures. Data collected included sociodemographic, co-morbidities, timing of admission, and intraoperative,ostoperative, and post-discharge data as mortality, complications, hospital stay, reoperation, and re-admission. Cox regression analysis was conducted to investigate factors associated with 1-year mortality. Results In-hospital mortality was 8.3% (25 patients) which increased to 52.8% (159 patients) after one year; 58.5% of the deaths occurred in the first 3-months. One-year mortality was independently associated with increasing age, ASA 3–4, cardiac or hepatic co-morbidities, trochanteric fractures, total hospital stay, and postoperative ifection and metal failure. Conclusion Our in-hospital mortality rate resembles developed countries reports, reflecting good initial geriatric healthcare. However, our 3- and 12-months mortality rates are unexpectedly high. The implementation of orthogeriatric care after discharge is mandatory to decrease mortality rates.
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Affiliation(s)
| | - Ahmed A Khalifa
- Orthopedic Department, Qena faculty of medicine and its University Hospital, South valley university, Qena, Egypt
| | - Khaled G Amir
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | | | - Amr A Eisa
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Wael Y El-Adly
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed K Ibrahim
- Public Health and Community Medicine Department, faculty of medicine, Assiut University, Assiut, Egypt
| | - Osama A Farouk
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Hossam A Abubeih
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
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22
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Sahin A, Agar A, Gulabi D, Erturk C. The Surgical Outcomes of Unstable Ankle Fractures in Patients Aged >65 Years. Geriatr Orthop Surg Rehabil 2021; 12:2151459321997765. [PMID: 33796343 PMCID: PMC7968019 DOI: 10.1177/2151459321997765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 01/02/2023] Open
Abstract
AIM To evaluate the surgical outcomes and complications of patients over 65 years of age, with unstable ankle fractures. MATERIAL AND METHOD The study included 111 patients (73F/38 M) operated on between January 2015 and February 2019 and followed up for a mean of 21.2 months (range, 6-62 months).Demographic characteristics, comorbidities, fracture type, and mechanisms of injury were evaluated. Relationships between postoperative complications and comorbidities were examined. In the postoperative functional evaluations, the AOFAS score was used and pre and postoperative mobilization (eg, use of assistive devices) was assessed. RESULTS The mean age of the patients was 70.5 ± 6.1 years (range, 65-90 years). The mechanism of trauma was low-energy trauma in 90.1% of the fractures and high-energy trauma in 9.9%. The fractures were formed with a SER injury (supination external rotation) in 83.7% of cases and bimalleolar fractures were seen most frequently (85/111, 76%).Complications developed in 16 (14.4%) patients and a second operation was performed in 11 (9.9%) patients with complications. Plate was removed and debridement was performed in 5 of 6 patients due to wound problems. Nonunion was developed in the medial malleolus in 4 patients. Revision surgery was performed because of implant irritation in 2 patients and early fixation loss in the medial malleolus fracture in one patient. Calcaneotibial arthrodesis was performed in 3 patients because of implant failure and ankle luxation associated with non-union. A correlation was determined between ASA score and DM and complications, but not with osteoporosis. The mean follow-up AOFAS score was 86.7 ± 12.5 (range, 36-100).A total of 94 (84.7%) patients could walk without assistance postoperatively and 92 (82.9%) were able to regain the preoperative level of mobilization. CONCLUSION Although surgery can be considered an appropriate treatment option for ankle fractures in patients aged >65 years, care must be taken to prevent potential complications and the necessary precautions must be taken against correctable comorbidities.
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Affiliation(s)
- Adem Sahin
- Orthopaedic and Traumatology Department, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Kucukcekmece/Istanbul, Turkey
| | - Anıl Agar
- Orthopaedic and Traumatology Department, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Kucukcekmece/Istanbul, Turkey
| | - Deniz Gulabi
- Orthopaedic and Traumatology Department, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Kucukcekmece/Istanbul, Turkey
| | - Cemil Erturk
- Orthopaedic and Traumatology Department, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Kucukcekmece/Istanbul, Turkey
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23
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Palliative care and aggressive interventions after falling: A Nationwide Inpatient Sample analysis. Palliat Support Care 2021; 20:101-106. [PMID: 33663643 DOI: 10.1017/s1478951521000158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this study is to identify whether there is an opportunity for improvement to provide palliative care services after a serious fall. We hypothesized that (1) palliative care services would be utilized in less than 10% of patients over the age of 65 who fall and (2) more than 20% of patients would receive aggressive life-sustaining treatments (LSTs) prior to death. METHODS Using the 2017 Nationwide Inpatient Sample, we identified patients who were admitted to the hospital with a fall (ICD-10 W00-W19) and were hospitalized at least two days with valid discharge data. Palliative care services (Z51.5) or LSTs (cardiopulmonary resuscitation, ventilation, reintubation, tracheostomy, feeding tube placement, vasopressors, transfusion, total parenteral nutrition, and hemodialysis) were identified with ICD-10 codes. We examined the use of palliative care or LSTs by discharge destination (home, facility, and death). Logistic regression was used to identify factors associated with palliative care. RESULTS In total, 155,241 patients were identified (median 82 years old, interquartile range 74-88); 2.5% died in hospital, and 69.4% were transferred to a facility. Palliative care occurred in 4.5% of patients, and LST occurred in 15.1%. Patients who died were significantly more likely to have had palliative care (50.1% vs. 3.4% of home or facility discharges) and were more likely to have an LST [53.0% vs. 9.8% (home) vs. 15.9% (facility)]. Palliative care was associated with both death [adjusted odds ratio (AOR) 19.84, 95% confidence interval (CI) 18.39-21.41, p < 0.001] and LST (AOR 1.36, 95% CI 1.27-1.46, p < 0.001). SIGNIFICANCE OF RESULTS Palliative care is associated with both death and LST, suggesting that physicians use palliative care as a last resort after aggressive measures have been exhausted. Patients who fall would likely benefit from the early use of palliative care to align future goals of care.
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24
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Development and Internal Validation of a Prediction Model for In-Hospital Mortality in Geriatric Patients With a Hip Fracture. J Orthop Trauma 2020; 34:656-661. [PMID: 32502058 DOI: 10.1097/bot.0000000000001851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop and validate a prediction model for in-hospital mortality in patients with hip fracture 85 years of age or older undergoing surgery. DESIGN A multicenter prospective cohort study. SETTING Six Dutch trauma centers, level 2 and 3. PARTICIPANTS Patients with hip fracture 85 years of age or older undergoing surgery. INTERVENTION Hip fracture surgery. MAIN OUTCOME MEASUREMENTS In-hospital mortality. RESULTS The development cohort consisted of 1014 patients. In-hospital mortality was 4%. Age, male sex, American Society of Anesthesiologists classification, and hemoglobin levels at presentation were independent predictors of in-hospital mortality. The bootstrap adjusted performance showed good discrimination with a c-statistic of 0.77. CONCLUSION Age, male sex, higher American Society of Anesthesiologists classification, and lower hemoglobin levels at presentation are robust independent predictors of in-hospital mortality in patients with geriatric hip fracture and were incorporated in a simple prediction model with good accuracy and no lack of fit. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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25
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Pasternack JB, Ciminero ML, Silver M, Chang J, Simon RJ, Kang KK. Effect of weekend admission on geriatric hip fractures. World J Orthop 2020; 11:391-399. [PMID: 32999859 PMCID: PMC7507075 DOI: 10.5312/wjo.v11.i9.391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/02/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The care discrepancy for patients presenting to a hospital on the weekend relative to the work week is well documented. With respect to hip fractures, however, there is no consensus about the presence of a so-called “weekend effect”. This study sought to determine the effects, if any, of weekend admission on care of geriatric hip fractures admitted to a large tertiary care hospital. It was hypothesized that geriatric hip fracture patients admitted on a weekend would have longer times to medical optimization and surgery and increased complication and mortality rates relative to those admitted on a weekday.
AIM To determine if weekend admission of geriatric hip fractures is associated with poor outcome measures and surgical delay.
METHODS A retrospective chart review of operative geriatric hip fractures treated from 2015-2017 at a large tertiary care hospital was conducted. Two cohorts were compared: patients who arrived at the emergency department on a weekend, and those that arrived at the emergency department on a weekday. Primary outcome measures included mortality rate, complication rate, transfusion rate, and length of stay. Secondary outcome measures included time from emergency department arrival to surgery, time from emergency department arrival to medical optimization, and time from medical optimization to surgery.
RESULTS There were no statistically significant differences in length of stay (P = 0.2734), transfusion rate (P = 0.9325), or mortality rate (P = 0.3460) between the weekend and weekday cohorts. Complication rate was higher in patients who presented on a weekend compared to patients who presented on a weekday (13.3% vs 8.3%; P = 0.044). Time from emergency department arrival to medical optimization (22.7 h vs 20.0 h; P = 0.0015), time from medical optimization to surgery (13.9 h vs 10.8 h; P = 0.0172), and time from emergency department arrival to surgery (42.7 h vs 32.5 h; P < 0.0001) were all significantly longer in patients who presented to the hospital on a weekend compared to patients who presented to the hospital on a weekday.
CONCLUSION This study provided insight into the “weekend effect” for geriatric hip fractures and found that day of presentation has a clinically significant impact on delivered care.
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Affiliation(s)
- Jordan B Pasternack
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, United States
| | - Matthew L Ciminero
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, United States
| | - Michael Silver
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, United States
| | - Joseph Chang
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, United States
| | - Ronald J Simon
- Department of Trauma Surgery, Maimonides Medical Center, Brooklyn, NY 11219, United States
| | - Kevin K Kang
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, United States
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26
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Internal fixation of intracapsular femoral neck fractures in elderly patients: mortality and reoperation rate. Aging Clin Exp Res 2020; 32:1173-1178. [PMID: 31175608 DOI: 10.1007/s40520-019-01237-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND A significant increase in the prevalence of intracapsular femoral neck fractures in the elderly population was reported but the best treatment is still debated. AIM To evaluate the mortality rate and the reoperation rate of stable neck fractures treated with cannulated screw fixation in elderly patients. METHODS This was a retrospective study of patients older than 60 years with a Garden I or II femoral neck fractures treated with cannulated screw fixation without capsulotomy. A total of 244 patients (246 hips) who underwent surgery between 2008 and 2018 were included. The average age at the time of surgery was 80 years (range 60-99 years). The mean ASA score was 2.64 (range 1-4). Mortality rate, complications, reoperation rate, the time elapsed between surgeries were recorded. RESULTS The mortality rate was 50.0%. There were 16 mortalities (6.6%) in the first-month follow-up. We observed higher mortality rates in ASA 4 (80.8%). In 22 patients (8.9%), complications after surgery were observed, and in 11 patients (4.5%) underwent conversion surgery to hemiarthroplasty at a mean of 14.6 months (range 2-48 months) after the femoral screw fixation. Two patients were treated with hardware removal and Gamma Nail for a peri-implant subtrochanteric femur fracture. INTERPRETATION Cannulated screw fixation should be considered a valid option in intraarticular femoral Garden I-II fractures in elderly patients. LEVEL OF EVIDENCE Level IV, therapeutic study.
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27
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Kılınç S, Pazarcı Ö. Investigating the risk factors that affect mortality after cemented hemiarthroplasty in advanced age patients. J Orthop 2020; 21:249-252. [PMID: 32280162 DOI: 10.1016/j.jor.2020.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/03/2020] [Accepted: 03/22/2020] [Indexed: 11/15/2022] Open
Abstract
Background & aims The number of hip fracture surgeries exhibit an increasing trend due to the aging of the world's population and it is expected to become a serious public health problem in the future. This study aimed to investigate the relationship between mortality and morbidity in patients aged 65 years or older who underwent partial hip prosthesis due to hip fracture. Methods Four-hundred and forty-three patients aged 65 and above who underwent partial hip prosthesis for fractured hips between 2007 and 2014 were retrospectively investigated. The age before surgery, gender, type of fracture, additional diseases, ASA scores of the patients and time to mortality were investigated in addition to the factors that affect mortality. Results Of the 443 patients in the study, 167 were males and 276 were females, with an average age of 80.5 ± 7.2 and 81.1 ± 7.0 years, respectively. One hundred and sixty-two (36.57%) of these patients died within the first year. When the patients were investigated according to age groups, there was a significant relationship between mortality after surgery and patients aged 80 years and above. No statistically significant relationship was found between the time to surgery and mortality. When compared in terms of ASA scores, it was concluded mortality in ASA 3 and 4 groups was significantly higher than ASA 1 and 2 groups (p < 0.001). When hospital stay and one-year mortality rates were compared, it was seen that the length of hospital stay of the patients who died in the first year was significantly higher. Conclusions In patients who underwent partial hip replacement after hip fracture, there was a significant relationship between mortality, long hospital stay, patients with an ASA score of 3-4, and patients aged 80 years and above, whereas no relationship was detected with time to surgery.
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Affiliation(s)
- Seyran Kılınç
- Department of Orthopedics and Traumatology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Özhan Pazarcı
- Department of Orthopedics and Traumatology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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28
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Kramer IF, Blokhuis TJ, Verdijk LB, van Loon LJC, Poeze M. Perioperative nutritional supplementation and skeletal muscle mass in older hip-fracture patients. Nutr Rev 2020; 77:254-266. [PMID: 30624706 DOI: 10.1093/nutrit/nuy055] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Older people with hip fractures are often malnourished at the time of fracture, which can have substantial influence on mortality and clinical outcomes, as well as functional outcome and quality of life. A close relationship between protein intake and muscle maintenance has been demonstrated. Skeletal muscle weakness is an independent risk factor for falls and fall-related injuries in the elderly and is an independent marker of prognosis. However, the effect of perioperative nutritional interventions on outcomes in elderly hip-fracture patients remains controversial. In this narrative review, an overview is presented of the existing literature on nutritional status and sarcopenia in elderly hip-fracture patients, clinical outcomes, and the effects of nutritional intervention on outcome and rehabilitation in this patient group.
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Affiliation(s)
- Irene Fleur Kramer
- Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Human Biology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Taco J Blokhuis
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lex B Verdijk
- Department of Human Biology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Luc J C van Loon
- Department of Human Biology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martijn Poeze
- Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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29
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Davey MS, Flynn SO, Hayes J, Feeley I, Grant Freemantle MC, Burke N. Two-hole versus four-hole plate dynamic hip screw: a systematic review of current evidence. Ir J Med Sci 2020; 189:1317-1322. [PMID: 32067189 DOI: 10.1007/s11845-020-02184-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The dynamic hip screw (DHS) is a common device used in the fixation of hip fractures. Traditionally, this involves the use of a four-hole side plate. Reducing the length of the side plate would theoretically reduce the amount of surgical exposure required, decrease surgery duration, and decrease perioperative morbidity and mortality. Our study aims to review the current evidence regarding the use of two-hole side plates, their use and potential complications. METHODS Using PRISMA guidelines, two independent reviewers performed a search to collate the available literature from medical databases PubMed, EMBASE, Web of Science, and the Cochrane library. Only clinical and biochemical studies were included. The reference lists of articles included for full text review were searched for any additional primary or review publications. RESULTS Four online libraries were searched, with a combined total of 5344 titles reviewed. Following title, abstract, and full text review, 8 articles were considered suitable for inclusion in qualitative analysis. There was a trend towards equal efficiency between two- and four-hole plates when used in stable fractures in terms of blood loss, failure/revision rates, operative and hospital stay durations, collapse loading testing, maximum stress, and fragment migration. CONCLUSION The results of this study show that DHS constructs with two- or four-hole side plates have comparable outcomes when used in patients with stable fracture patterns. However, the majority of the clinical data regarding the use of two-hole DHS plates come from retrospective case series; further prospective, randomised control trials would be of significant benefit. LEVEL OF EVIDENCE Level II; systematic review of all levels of evidence.
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Affiliation(s)
- Martin S Davey
- Department of Trauma & Orthopaedics, Beaumont Hospital, Dublin 9, Ireland. .,Royal College of Surgeons in Ireland, Dublin 2, Ireland.
| | - Sean O Flynn
- Department of Trauma & Orthopaedics, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Joshua Hayes
- Department of Trauma & Orthopaedics, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Iain Feeley
- Department of Trauma & Orthopaedics, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Marc C Grant Freemantle
- Department of Trauma & Orthopaedics, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Neil Burke
- Department of Trauma & Orthopaedics, Beaumont Hospital, Dublin 9, Ireland
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30
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Schultz KA, Westcott BA, Barber KR, Sandrock TA. Elevated 1-Year Mortality Rate in Males Sustaining Low-Energy Proximal Femur Fractures and Subgroup Analysis Utilizing Age-Adjusted Charlson Comorbidity Index. Geriatr Orthop Surg Rehabil 2020; 11:2151459319898644. [PMID: 32010476 PMCID: PMC6971960 DOI: 10.1177/2151459319898644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/02/2019] [Accepted: 12/08/2019] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Low-energy proximal femur fractures are common in the aging population and the ability to identify patients at increased mortality risk provides surgeons information to improve informed decision-making with patients and families. We evaluated for gender differences in 1-year mortality after sustaining low-energy proximal femur fractures with subgroup analysis to identify the impact of fracture location, age, and comorbidities on mortality. MATERIALS AND METHODS Patients ≥40 years of age sustaining a low-energy proximal femur fracture identified at our institution between January 1, 2014, and December 31, 2017. International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes were used to identify comorbidities for calculation of the age-adjusted Charlson comorbidity index (ACCI). The county clerk database was searched to identify mortality within 1 year of injury. One-year mortality rates were calculated and multiple comparisons were made between genders controlling for age, fracture location, and/or ACCI. RESULTS Women presented with low-energy proximal femur fractures at a rate of almost 3:1 to men at our institution (P = .001). Men demonstrated a significantly increased ACCI at presentation (5.35 ± 2.55 vs 4.86 ± 1.77, P = .03). Men had an increased 1-year mortality rate for all (31.3% vs 21.5%, P = .004) and intertrochanteric (IT) fractures (36.2% vs 22.9%, P = .008). Controlling for ACCI, gender, and fracture location, men demonstrated increased mortality rate with IT fractures (P = .002) and trended toward but did not reach significance with femoral neck fractures (P = .07). DISCUSSION Men presenting with low-energy femur fractures are at an increased mortality risk compared to women. On average, men present with an overall worse health status as identified by ACCI, which could predispose these patients not only to fractures themselves but also impair their ability to recover from injury. CONCLUSION Men are at an increased 1-year mortality risk after sustaining proximal femur fractures.
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Affiliation(s)
- Kyle A. Schultz
- Department of Orthopedics, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | | | - Kimberly R. Barber
- Department of Clinical & Academic Research, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Todd A. Sandrock
- Department of Orthopedics, Ascension Genesys Hospital, Grand Blanc, MI, USA
- Greater Michigan Orthopedics, Grand Blanc, MI, USA
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Boissonneault A, Mener A, Schwartz A, Wilson J, Staley C, Schenker M. Impact of Frailty on 30-Day Morbidity and Mortality of Patients With Intertrochanteric Femur Fractures. Orthopedics 2019; 42:344-348. [PMID: 31587075 DOI: 10.3928/01477447-20191001-05] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 11/16/2018] [Indexed: 02/03/2023]
Abstract
The aim of this study was to evaluate the association between frailty and 30-day morbidity and mortality in patients with intertrochanteric femur fractures. Furthermore, the authors sought to identify a specific frailty index score that would help identify high-risk patients. This retrospective study evaluated 229 consecutive patients 50 years or older who presented to a single level I trauma center for surgical fixation of an intertrochanteric femur fracture. Frailty was determined using a previously validated 11-point modified frailty index (mFI) scale. Primary outcome variables included 30-day morbidity and mortality. Of the 229 patients included in this study, 82 (36%) had a postoperative complication and there were 10 (4%) mortalities. The most common complications were delirium (n=40; 17%) and acute kidney injury (n=25; 11%). Mean mFI score for those who developed a postoperative complication was 0.24 compared with 0.14 for those who did not (P<.001). The mortality rate increased from 0% for mFI of 0 to 11% for mFI of 0.27 or more. Patients with an mFI of 0.27 or more were more than 9 times as likely to have a mortality compared with patients with an mFI of less than 0.27 (P=.006). This study demonstrates that the mFI is associated with 30-day morbidity and mortality in patients aged 50 years or older with intertrochanteric femur fractures. The authors identified an mFI score of 0.27 or more as the most robust predictor of increased 30-day morbidity and mortality following surgical fixation of intertrochanteric femur fractures. [Orthopedics. 2019; 42(6):344-348.].
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Ghassibi M, Boyalakuntla DS, Gentile J. Low-Energy Pelvic Ring Fractures in the Elderly Population: Expected Outcomes and Associated Mortality Rates. J Clin Med Res 2019; 11:725-728. [PMID: 31803314 PMCID: PMC6879025 DOI: 10.14740/jocmr3891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/26/2019] [Indexed: 11/11/2022] Open
Abstract
Background The aim of the study was to uncover mortality risk utilizing a retrospective review at a level I trauma center in addition to demographic factors. Methods Patients aged 65 and older with low-energy closed pelvic ring fractures treated non-operatively from 2007 to 2017 were queried from the level I trauma center database. Mortality rate and associated risks were calculated. Results The average age of all the patients included in this study who sustained a low-energy pelvic fracture was 83.1 years (± 7.5; 66 - 97). The mean length of stay was 4.6 days (± 4.4; 0 - 37). The mean number of comorbidities was 2.2. The 1-year mortality rate was 23%. The relative risk (RR) of 1-year mortality for low-energy pelvic fractures for ages 65+ did not statistically differ compared to the US population in 2016 (6.6%) (RR: 1.0; 95% CI). The 2+ comorbidities showed a statistical significance in the pelvic fracture population with a P value of 0.037. Race, sex, discharge disposition and length of stay did not reach statistical significance (P > 0.05). Conclusion Low-energy pelvic injuries do not appear to increase rate of mortality compared to the US population. Fracture pattern, race, sex, discharge disposition and length of stay do not seem to have an effect on mortality. Elderly patients with an average age of 84.5 years and more than two comorbidities had higher rates of mortality; however, these patients were likely to sustain earlier mortality regardless of low-energy pelvic fracture.
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Affiliation(s)
- Michael Ghassibi
- Orthopedic Surgery, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH 44501, USA
| | | | - John Gentile
- Orthopedic Surgery, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH 44501, USA
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Hwang KT, Moon JK, Kim YH. Do we really need a surgery for hip fractures in elderly patients? Mortality rate and influencing factors. ARTHROPLASTY 2019; 1:7. [PMID: 35240759 PMCID: PMC8796628 DOI: 10.1186/s42836-019-0009-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/19/2019] [Indexed: 01/27/2023] Open
Abstract
Background Hip fractures are associated with notable mortality rates in elderly patients. The purpose of the study was to evaluate the mortality rate and influencing factors associated with mortality in the elderly patients with hip fractures. Methods Between October 2000 and December 2009, 807 elderly patients with hip fractures were enrolled in this study. There were 197 men and 610 women. The mean age at injuries were 78 years (range, 65–99 years). The fractures consisted of 390 femoral neck fractures and 417 intertrochanteric fractures. The mortality rate was evaluated between patients who underwent surgical and nonsurgical treatments. The influencing factors associated with mortality rate were evaluated statistically. Results Overall, 691 (85.6%) patients treated surgically and 116 (14.4%) patients treated nonsurgically were included. The overall mortality rates one and two years after injuries were 16.6 and 39.4%, respectively. In surgical treatment group, the mortality rate one and two years after injuries were 12.0 and 35.7%, respectively. In nonsurgical treatment group, the mortality rates were 44.0 and 61.2%, respectively (p < 0.05). No significant difference was noted between the types of fractures and the time from injury to surgery. Regardless of surgical methods, a significantly higher mortality rate was observed in patients with heart disease, chronic renal disease, dementia, and cancer, or in patients with 3 or more comorbidities. Conclusions In elderly patients with hip fractures, surgical treatments can decrease the mortality rate as compared with nonsurgical treatments. In addition, patients who had three or more comorbidities (heart disease, chronic renal failure, dementia, and history of cancer) are associated with a higher risk of mortality. Trial registration Retrospectively registered.
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Kim JW, Kim DH, Jang EC, Lee YK, Koo KH, Ha YC. Mortality and its risk factors in nonagenarians after hip fractures. J Orthop Sci 2019; 24:850-854. [PMID: 30904205 DOI: 10.1016/j.jos.2019.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/29/2019] [Accepted: 02/04/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The purpose of this study was to assess mortality with a minimum of 2-year follow-up, related risk factors for mortality, and functional outcomes after surgical interventions in nonagenarian patients with hip fractures at the latest follow up. METHODS Between June 2003 and November 2015, 260 nonagenarians (271 hips) with femoral neck and intertrochanteric fractures were included in this retrospective study. Cumulative mortality using the Kaplan-Meier method and risk factors for mortality using Cox proportional-hazards regression model were estimated. As functional outcome, ambulatory ability was assessed before injury and at the latest follow-up. RESULTS Six-teen patients (16 hips) were lost to follow-up. The mean age at the time of surgery was 92.2 years (range 90-108 years). Mortality rates were 23.4% (57 of 244 patients) at 1 year and 40.6% (99 of 244 patients) at 2 years. Both genders had elevated standardized mortality ratio at 2-year post-fracture compared to that a 1-year post fracture. Multivariate analysis showed that American Society of Anesthesiologists (OR, 1.371; 95% CI, 1.021-1.843; P = 0.036) and time interval from trauma to operation (OR, 1.043; 95% CI, 1.002-1.086; P = 0.039) were significantly associated with risk of mortality. Of 58 patients alive, 13 patients (22.4%) had the same ambulatory ability before and after injury. CONCLUSIONS This study demonstrates that mortality is higher in nonagenarians with hip fracture. Risk factors for mortality in nonagenarians with hip fracture are American Society of Anesthesiologists and time interval from trauma to operation. And, nonagenarians with hip fractures have lower rate of maintaining pre-injury ambulatory ability.
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Affiliation(s)
- Jin-Woo Kim
- Department of Orthopaedic Surgery, Eulji Medical Center, Eulji University College of Medicine, Seoul, South Korea
| | - Dong-Hyun Kim
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Eui-Chan Jang
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea.
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TURHAN Y, ARICAN M. Kalça Kırığı Nedeniyle Cerrahi Tedavi Uygulanan 65 Yaş Üstü Hastaların Bir Yıllık Mortalite Oranları. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2019. [DOI: 10.33631/duzcesbed.528982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lahtinen A, Leppilahti J, Vähänikkilä H, Kujala S, Ristiniemi J, Jalovaara P. No Major Differences in Recovery After Hip Fracture Between Home-Dwelling Female and Male Patients. Scand J Surg 2019; 109:250-264. [PMID: 31088335 DOI: 10.1177/1457496919847932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Studies comparing recovery of men and women after hip fracture have reported conflicting results, some reporting worse recovery in male patients, while others found no differences between genders. METHODS Recovery was compared in 105 male and 433 female patients with hip fractures and in age-matched groups of patients 50 years or older, who were home-dwelling and received similar rehabilitation. Residential status, walking ability, hip pain and activities of daily living function were recorded at admission and 4 and 12 months postoperatively, along with mortality and re-operations. RESULTS No differences were observed between men and women 4 and 12 months postoperatively regarding residential status (p = 0.181 vs p = 0.883), mortality rates (p = 0.232 vs p = 0.880) or total activities of daily living scores (p = 0.546 vs p = 0.435). Walking ability was better among male patients prefracture (p < 0.001) and 4 and 12 months after fracture (p < 0.001, p = 0.031, respectively). In age-matched pair analysis, no differences were found regarding mortality, residential status, walking ability, or ADL score. Cox regression analysis identified mortality risk factors as being age, prefracture ADL score, American Society of Anesthesiologists score 4-5 and place of rehabilitation. Sex was not mortality risk factor. INTERPRETATION Home-dwelling male and female patients had similar courses of recovery from hip fracture, although there were singular differences in specific activities of daily living functions and postoperative pain. There were no differences in mortality, even when prefracture characteristics were considered. Mortality was higher among older patients and who had high American Society of Anesthesiologists scores and low prefracture activities of daily living scores.
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Affiliation(s)
- A Lahtinen
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - J Leppilahti
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - H Vähänikkilä
- Institute of Dentistry, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - S Kujala
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - J Ristiniemi
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - P Jalovaara
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Oulu, Oulu, Finland
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Blood TD, Deren ME, Goodman AD, Hayda RA, Trafton PG. Assessment of a Geriatric Hip Fracture Program: Analysis of Harmful Adverse Events Using the Global Trigger Tool. J Bone Joint Surg Am 2019; 101:704-709. [PMID: 30994588 DOI: 10.2106/jbjs.18.00376] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to assess the impact of adding a geriatric comanagement program to the care of geriatric patients with a hip fracture at our hospital. The Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT) was used to follow the frequency and severity of adverse events occurring in hospitalized patients and to examine the effectiveness of a comanagement program (the Geriatric Hip Fracture Program [GHFP]). METHODS Data were collected for patients treated for a hip fracture from 2010 to 2014, which was 1 year prior to (October 2010 to September 2011) and 2 years after the implementation of the GHFP, and were grouped into 3-month intervals for analysis. The patients treated prior to the implementation of the GHFP were compared with those treated following the implementation of the program. The frequency and severity of adverse events were collected using the GTT. RESULTS There were 75.9 patients with an adverse event and 160.7 adverse events per 100 admissions. After the institution of the GHFP, there was a significant decrease in the number of patients with adverse events and the number of adverse events per 100 admissions over time. The rate of adverse events decreased by 12% per year when acute blood loss anemia was excluded. Similarly, the number of adverse events (excluding blood loss anemia) decreased significantly over time, from 128.7 per 100 admissions before the GHFP to 34.2 in the last quarter. Multivariable analysis (excluding acute blood loss anemia) demonstrated a trend toward a decreased likelihood of a patient experiencing an adverse event after the institution of the GHFP as well as a trend toward a decrease in the number of adverse events per patient. The length of the hospital stay was significantly shorter after the implementation of the GHFP. CONCLUSIONS The implementation of the GHFP reduced the number of adverse events over time. Increasing age and the Carlson Comorbidity Index (CCI) were predictors of adverse events, while only age was a predictor of readmissions and CCI was a predictor of death in our study. The implementation of the GHFP has played an important role at our institution in quantifying the decrease in adverse events over a 2-year period, and we believe that it is essential for improving care of geriatric patients with a hip fracture. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Travis D Blood
- Department of Orthopedics, Brown University, Providence, Rhode Island
| | - Matthew E Deren
- Department of Orthopedics, Brown University, Providence, Rhode Island
| | - Avi D Goodman
- Department of Orthopedics, Brown University, Providence, Rhode Island
| | - Roman A Hayda
- Department of Orthopedics, Brown University, Providence, Rhode Island
| | - Peter G Trafton
- Department of Orthopedics, Brown University, Providence, Rhode Island
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Finlayson G, Tucker A, Black ND, McDonald S, Molloy M, Wilson D. Outcomes and predictors of mortality following periprosthethic proximal femoral fractures. Injury 2019; 50:438-443. [PMID: 30482411 DOI: 10.1016/j.injury.2018.10.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/30/2018] [Accepted: 10/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Periprosthetic fractures are a well-documented, serious complication of joint arthroplasty, occurring in up to 11% of hip replacements. We examined periprosthetic femoral fractures over an 8 year period to determine the demographics, fracture pattern and management options and associated outcomes. Furthermore, we sought to determine which comorbidities resulted in increased risk of 12 month mortality after periprosthetic fractures about hip replacements Methods: A retrospective review of a prospective fracture database was conducted for the years 2007-2015. The Fracture Outcomes Research Database (FORD) was interrogated for patients aged >60 years, admitted with periprosthetic hip fracture. Radiographic and Electronic Clinical Record review was performed to classify fractures, record treatments, comorbidies and 12 month mortality. A multivariate analysis was performed to determine comorbidities that significantly increased the risk of 12 month mortality. RESULTS A total of 189 patients were identified. The majority were Vancouver B1 fractures (61.9%); the operations were primarily cable plating (75.1%), with a smaller number of revision arthroplasties (21.2%) and only three proximal femoral replacement (1.6%). Four patients (2.1%) died before surgery. Only 27.3% returned to their usual residence post-discharge. Overall 30-day mortality was 2.1%, and one-year mortality was 11.6%. Patients who died tended to be older. In the multivariate analysis, ASA grade III/IV and active neoplasia were significant contributors to 12 month mortality. CONCLUSION(S) Our 12 month mortality (11.6%) is at the lower end of existing reported literature, and serves as a benchmark for UK practice. In the multivariate analysis, only ASA grade III/IV and an active neoplastic process were significantly associated with increased risk of mortality. Whilst large, multicenter trials, utilizing standardized treatment techniques are required to fully assess risk factors for 12-month mortality, it appears that those at significant risk are elderly, frail individuals with an active malignancy.
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Affiliation(s)
- Graham Finlayson
- C/O Fracture Clinic, Level 2, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, United Kingdom.
| | - Adam Tucker
- C/O Fracture Clinic, Level 2, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, United Kingdom.
| | - Nicholas D Black
- C/O Anaesthetic Department, Level 3, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, United Kingdom.
| | - Sinead McDonald
- C/O Fracture Outcomes Research Dept., Level 4, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, United Kingdom.
| | - Mary Molloy
- C/O Anaesthetic Department, Level 3, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, United Kingdom.
| | - Darrin Wilson
- C/O Fracture Clinic, Level 2, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, United Kingdom.
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Palmer A, Taitsman LA, Reed MJ, Nair BG, Bentov I. Utility of Geriatric Assessment in the Projection of Early Mortality Following Hip Fracture in the Elderly Patients. Geriatr Orthop Surg Rehabil 2018; 9:2151459318813976. [PMID: 30546923 PMCID: PMC6287303 DOI: 10.1177/2151459318813976] [Citation(s) in RCA: 6] [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: 05/11/2018] [Revised: 09/16/2018] [Accepted: 09/22/2018] [Indexed: 01/10/2023] Open
Abstract
Hip fractures result in significant morbidity and mortality in elders. Indicators of frailty are associated with poor outcomes. Commonly used frailty tools rely on motor skills that cannot be performed by this population. We determined the association between the Charlson Comorbidity Score (CCS), intraoperative hypotension (IOH), and a geriatric medicine consult index (GCI) with short-term mortality in hip fracture patients. A retrospective cohort study was conducted at a single institution over a 2-year period. Patients aged 65 years and older who sustained a hip fracture following a low-energy mechanism were identified using billing records and our orthopedic fracture registry. Medical records were reviewed to collect demographic data, fracture classification and operative records, calculation of CCS, intraoperative details including hypotension, and assessments recorded in the geriatric consult notes. The GCI was calculated using 30 dichotomous variables contained within the geriatric consult note. The index, ranging from 0 to 1, included markers for physical and cognitive function, as well as medications. A higher GCI score indicated more markers for frailty. One hundred eight patients met inclusion criteria. Sixty-four (59%) were females and the average age was 77.3 years. Thirty-five (32%) patients sustained femoral neck fractures, and 73 (68%) patients sustained inter-/pertrochanteric hip fractures. The 30-day mortality was 6%; the 90-day mortality was 13%. The mean GCI was 0.30 in the 30-day survivor group as compared to 0.52 in those who died. The mean GCI was 0.28 in patients who were alive at 90 days as compared to 0.46 in those who died. In contrast, the CCS and IOH were not associated with 30- or 90-day mortality. In our older hip fracture patients, an index calculated from information routinely obtained in the geriatric consult evaluation was associated with 30- and 90-day mortality, whereas the CCS and measures of IOH were not.
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Affiliation(s)
| | | | - May J Reed
- Harborview Medical Center, Seattle, WA, USA
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Abstract
Purpose of review Healthcare systems are embarking on innovative, technologically savvy approaches to caring for our most rapidly growing population worldwide- the elderly. As healthcare systems respond, adapt and strategically plan for this rapidly growing population, it is paramount that we develop new paradigms of care for older patients. This review highlights some of the approaches academic medical centers are taking to improve the musculoskeletal and orthopaedic health of older adults. Recent Findings Academic health centers are posed to set and lead the standard of care for the next generation of orthopaedic care for older adults by leveraging innovative informatics platforms, quality improvement methodologies, game-changing research initiatives, education to the next generation of providers and helping change policies to help patients receive the best quality of life possible across the aging spectrum. Summary Academic geriatric orthopaedics can help society embrace a new paradigm in care for older adults by leveraging rapidly developing technologically and innovative approaches to care, advanced research, and education.
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Chiu HC, Chen CM, Su TY, Chen CH, Hsieh HM, Hsieh CP, Shen DL. Dementia predicted one-year mortality for patients with first hip fracture: a population-based study. Bone Joint J 2018; 100-B:1220-1226. [PMID: 30168771 DOI: 10.1302/0301-620x.100b9.bjj-2017-1342.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims We aimed to determine the effect of dementia and Parkinson's disease on one, three and 12-month mortality following surgery for fracture of the hip in elderly patients from an Asian population. Patients and Methods Using a random sample of patients taken from the Taiwan National Health Insurance Research Database, this retrospective cohort study analyzed the data on 6626 elderly patients who sustained a fracture of the hip between 1997 and 2012 who had ICD-9 codes within the general range of hip fracture (820.xx). We used Cox regression to estimate the risk of death associated with dementia, Parkinson's disease or both, adjusting for demographic, clinical, treatment, and provider factors. Results Among 6626 hip fracture patients, 10.20% had dementia alone, 5.60% had Parkinson's disease alone, and 2.67% had both. Corresponding one-year mortality rates were 15.53%, 11.59%, and 15.82%, compared with 9.22% for those without neurological illness. Adjusted hazard ratio for one-year mortality was 1.45 (95% confidence intervals (CI) 1.17 to 1.79) for those with dementia, and 1.57 (95% CI 1.07 to 2.30) with both dementia and Parkinson's disease versus patients with neither. There was no significant association with death for Parkinson's disease alone. Age, male gender and comorbidities were also associated with a higher risk of mortality. Conclusion Dementia, with or without Parkinson's disease, is an independent predictor of mortality following surgery for fractures of the hip. Age, male gender and comorbidities also increase the risk of death. Parkinson's disease alone has no significant effect. Cite this article: Bone Joint J 2018;100-B:1220-6.
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Affiliation(s)
- H-C Chiu
- Research Education and Epidemiology Centre, Changhua Christian Hospital, Changhua, Taiwan, Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan, Institute of Hospital Management, Tsinghua University, China, and Department of Health Policy and Management, Bloomberg School of Public Health, John Hopkins University, USA
| | - C-M Chen
- Research Education and Epidemiology Centre, Changhua Christian Hospital, Changhua, Taiwan
| | - T-Y Su
- Center of Cancer Program Development, E-DA Cancer Hospital, Kaohsiung, Taiwan
| | - C-H Chen
- Orthopedic Research Centre, Kaohsiung Medical University; Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - H-M Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - C-P Hsieh
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - D-L Shen
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
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Cho HM, Seo JW, Lee HJ. One-year Survival Rates and Functional Recovery in Veterans Who Suffer from Hip Fractures: Evaluation of Commissioned Hospitals' System through Comparison between Veterans Hospitals and Commissioned Hospitals. Hip Pelvis 2018; 30:101-108. [PMID: 29896459 PMCID: PMC5990528 DOI: 10.5371/hp.2018.30.2.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/02/2018] [Accepted: 03/03/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose This study was performed to compare the: i) 1-year survival rate of patients with hip fractures, ii) factors affecting mortality in patients with hip fractures, and iii) results of functional recovery at commissioned hospitals (CH) and veterans hospitals (VH) to characterize the quality of care provided in the Korean commissioned hospital system. Materials and Methods The study population consisted of 183 veteran patients (84 and 99 treated at a single VH and 39 CH, respectively) who underwent hip fracture surgery between January 2010 and February 2015. This study compared baseline characteristics (i.e., age, comorbidities, fracture types and surgical treatment approaches) of the two groups vs. clinical outcomes, and evaluated the waiting time, length of hospital stay, total medical expenses, mortality rate within one year, and functional recovery at last follow up. Results There were no significant differences in age, fracture types, comorbidities, ambulatory status before fracture, waiting time, or length of hospital stay between the two groups, however, the total medical cost was higher in the CH group (P=0.009). There was no significant difference in mortality within one year after hip fracture (P=0.224) or functional recovery at last follow-up (P=0.463) between the two groups. Conclusion The results of this study confirm that the Korean commissioned hospitals system is operating in accordance with its purpose. However, further studies are needed to better characterize the medical expenses of CHs vs. veterans hospitals.
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Affiliation(s)
- Hong Man Cho
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea
| | - Jae Woong Seo
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea
| | - Hyun Ju Lee
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea
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Blay-Domínguez E, Lajara-Marco F, Bernáldez-Silvetti PF, Veracruz-Gálvez EM, Muela-Pérez B, Palazón-Banegas MÁ, Salinas-Gilabert JE, Lozano-Requena JA. O-POSSUM score predicts morbidity and mortality in patients undergoing hip fracture surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Incidence, Risk Factors, and Clinical Implications of Pneumonia After Surgery for Geriatric Hip Fracture. J Arthroplasty 2018; 33:1552-1556.e1. [PMID: 29289445 DOI: 10.1016/j.arth.2017.11.068] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 11/25/2017] [Accepted: 11/29/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Little is known regarding the occurrence of pneumonia after hip fracture surgery. The purpose of this study is to determine the incidence, risk factors, and clinical implications of pneumonia after surgery for geriatric hip fracture. METHODS The American College of Surgeons National Surgical Quality Improvement Program was used to retrospectively study geriatric patients undergoing surgery for hip fracture during 2006-2014. Independent risk factors for developing pneumonia within 30 days of surgery were identified using multivariate regression. RESULTS Of the 29,377 patients meeting inclusion criteria, 13,736 (46.8%) underwent hemiarthroplasty, 9468 (32.2%) intramedullary fixation, 4294 (14.6%) plate and/or screw fixation, 1299 (4.4%) total joint arthroplasty, and 580 (2.0%) percutaneous fixation. In total 1191 patients developed pneumonia, an incidence of 4.1%. The strongest risk factors for pneumonia were male sex, older age (especially ≥90 years), low body mass index, and chronic obstructive pulmonary disease. Patients who developed pneumonia had a higher readmission rate (79.1% vs 8.2%, P < .001), a higher rate of sepsis (16.6% vs 1.7%, P < .001), and a higher mortality rate (29.2% vs 5.7%, P < .001). Among 1602 total mortalities, 348 (17.9%) occurred in patients with pneumonia. CONCLUSION Pneumonia is a serious complication after geriatric hip fracture surgery, which increases the readmission and mortality risks. Evidence-based pneumonia prevention programs should be implemented among high-risk patients-males, patients ≥90 years, body mass index <18.5 kg/m2, and/or patients with chronic obstructive pulmonary disease-to decrease morbidity and mortality.
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Chang W, Lv H, Feng C, Yuwen P, Wei N, Chen W, Zhang Y. Preventable risk factors of mortality after hip fracture surgery: Systematic review and meta-analysis. Int J Surg 2018. [PMID: 29530826 DOI: 10.1016/j.ijsu.2018.02.061] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Although many studies have reported risk factors of mortality following hip fracture surgery, the preventable risk factors of mortality following hip fracture surgery have not been well-identified. The aim of this study was to identify the preventable risk factors of mortality following hip fracture surgery. METHODS We searched PubMed, Web of Science, Google scholar, and the Chinese National Knowledge Infrastructure (CNKI) databases from January 1997 to March 2017 for studies reporting risk factors of mortality following hip fracture surgery. The primary outcomes assessed in this meta-analysis were time to surgery, residential status, smoking, cardiovascular disease, pulmonary disease, diabetes, and malignancy. All analyses were conducted using Stata/SE version 11.0 software. RESULTS Sixteen studies involving 25 349 patients meeting the inclusion criteria were included. Statistically significant associations between the mortality after hip fracture surgery and the risk factors, including the time to surgery (>2days/<2days) (odds ratio[OR] = 1.91; 95%CI, 1.14-3.18; P = 0.013), residential status (nursing home/home) (OR = 1.97; 95%CI, 1.02-3.78; P = 0.043), cardiovascular disease (OR = 1.14; 95%CI, 1.03-1.26; P = 0.012), pulmonary disease (OR = 1.52; 95%CI, 1.37-1.69; P < 0.001), diabetes (OR = 1.41; 95%CI, 1.19-1.67; P < 0.001), and malignancy (OR = 2.99, 95%CI, 1.14-7.83; P = 0.013) were established. However, the available data failed to demonstrate an association between the mortality, and time to surgery (>1day/<1day) (OR = 1.25; 95%CI, 0.93-1.66; P = 0.136) and smoking (OR = 0.89; 95%CI, 0.69-1.14; P = 0.340). CONCLUSION This meta-analysis explicitly indicated that malignancy, nursing home residence, time to surgery (>2days/<2days), pulmonary disease, diabetes, and cardiovascular disease significantly increased the risk of mortality after hip fracture surgery. These preventable risk factors may be used to create algorithms that are more effective and pertinent to reduce the mortality following hip fracture surgery.
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Affiliation(s)
- Wenli Chang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China.
| | - Hongzhi Lv
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China.
| | - Chen Feng
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China.
| | - Peizhi Yuwen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China.
| | - Ning Wei
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China.
| | - Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China.
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China.
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Bohl DD, Shen MR, Hannon CP, Fillingham YA, Darrith B, Della Valle CJ. Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture. J Bone Joint Surg Am 2017; 99:2110-2118. [PMID: 29257017 DOI: 10.2106/jbjs.16.01620] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Serum albumin level is the most well-established serum marker of malnutrition, with a serum albumin concentration <3.5 g/dL considered to be suggestive of malnutrition. The purpose of this study was to test if serum albumin level is associated with death, specific postoperative complications (e.g., pneumonia), length of hospital stay, and readmission following a surgical procedure for geriatric hip fracture. METHODS A retrospective cohort study of geriatric patients (≥65 years of age) undergoing a hip fracture surgical procedure as part of the American College of Surgeons National Surgical Quality Improvement Program was conducted. Outcomes were compared between patients with and without hypoalbuminemia. All comparisons were adjusted for baseline and procedural differences between populations, and patients with missing serum albumin concentration were included in analyses using a missing data indicator. RESULTS There were 29,377 geriatric patients undergoing a hip fracture surgical procedure who met inclusion criteria; of these patients, 17,651 (60.1%) had serum albumin available for analysis. The prevalence of hypoalbuminemia was 45.9%. Following adjustment for baseline and procedural characteristics, the risk of death was inversely associated with serum albumin concentration as a continuous variable (adjusted relative risk, 0.59 [95% confidence interval (CI), 0.53 to 0.65]; p < 0.001). In comparison with patients with normal albumin concentration, patients with hypoalbuminemia had higher rates of death (9.94% compared with 5.53% [adjusted relative risk, 1.52 (95% CI, 1.37 to 1.70); p < 0.001]), sepsis (1.19% compared with 0.53% [adjusted relative risk, 1.92 (95% CI, 1.36 to 2.72); p < 0.001]), and unplanned intubation (2.64% compared with 1.47% [adjusted relative risk, 1.51 (95% CI, 1.21 to 1.88); p < 0.001]). The mean length of stay (and standard deviation) was longer among patients with hypoalbuminemia at 5.67 ± 4.68 days compared with those without hypoalbuminemia at 4.99 ± 3.95 days; the adjusted difference was 0.50 day (95% CI, 0.38 to 0.63 day; p < 0.001). However, the rate of readmission did not differ (p = 0.054) between patients with hypoalbuminemia (10.91%) and those without hypoalbuminemia (9.03%); the adjusted relative risk was 1.10 (95% CI, 1.00 to 1.21). CONCLUSIONS Hypoalbuminemia is a powerful independent risk factor for mortality following a surgical procedure for geriatric hip fracture. These data suggest that further investigation into postoperative nutritional supplementation is warranted to decrease the risk of complications. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Mary R Shen
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brian Darrith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Blay-Domínguez E, Lajara-Marco F, Bernáldez-Silvetti PF, Veracruz-Gálvez EM, Muela-Pérez B, Palazón-Banegas MÁ, Salinas-Gilabert JE, Lozano-Requena JA. O-POSSUM score predicts morbidity and mortality in patients undergoing hip fracture surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 62:207-215. [PMID: 29191635 DOI: 10.1016/j.recot.2017.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/13/2017] [Accepted: 10/28/2017] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the O-POSSUM score capacity to predict the morbidity and mortality of patients undergoing hip fracture surgery. MATERIAL AND METHODS We retrospectively reviewed the clinical records of patients older than 65years old, operated on for hip fractures between January 2012 and December 2013. Of 229 patients, the mean age was 82.3years and 170 were women. We collected comorbidities, type of surgery, and expected morbidity and mortality O-POSSUM values. RESULTS After a minimum follow up of one year, 38 deaths were reported and 77 patients had complications. The expected mortality according to the O-POSSUM was 35 patients and expected morbidity 132. CONCLUSION By comparing the observed results with those predicted, the O-POSSUM scale is reliable in predicting mortality and overestimates morbidity.
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Affiliation(s)
- Elena Blay-Domínguez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vega Baja, Orihuela, Alicante, España.
| | - Francisco Lajara-Marco
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vega Baja, Orihuela, Alicante, España
| | | | | | - Beatriz Muela-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vega Baja, Orihuela, Alicante, España
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Lystad RP, Cameron CM, Mitchell RJ. Mortality risk among older Australians hospitalised with hip fracture: a population-based matched cohort study. Arch Osteoporos 2017; 12:67. [PMID: 28726112 DOI: 10.1007/s11657-017-0359-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/04/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED With an ageing population, the burden of hip fractures is expected to increase in the coming decades. Older individuals with hip fracture are more than 3.5 times more likely to die within 12 months compared to non-injured individuals. The main priority for reducing mortality should be prevention of hip fracture. PURPOSE The aim of this study is to quantify and describe the 12-month mortality of older persons presenting to hospitals in Australia with a hip fracture. METHODS Population-based matched cohort study using linked hospital and mortality data from four Australian states (New South Wales, Queensland, South Australia, and Tasmania). Individuals aged 65 years and older who had a hospital admission with a primary diagnosis of hip fracture in 2009 (n = 9748) and a matched comparison cohort of non-injured individual were selected from the electoral roll (n = 9748). The comparison group was matched 1:1 on age, sex, and postcode of residence. Adjusted mortality rate ratios (MRR) and attributable risk percent were calculated. Cox proportional hazard regression was used to examine the effect of risk factors on survival. RESULTS The hip fracture cohort experienced significantly worse survival at the 12-month post-fracture hospitalisation (P < 0.0001). Individuals with hip fracture were more than 3.5 times more likely to die within 12 months compared to their non-injured counterparts (MRR 3.62 [95%CI 3.23-4.05]). Hip fracture was likely to be a contributory factor in 72% of mortality within 12 months after the index hospital admission. Excess mortality risk at 12 months was higher in males than that in females and in the 65-74-year age group. CONCLUSIONS With an ageing population in Australia, the burden of hip fractures is expected to increase in the coming decades. Because incident hip fracture is the main predictor of subsequent mortality, the main priority for reducing excess mortality after hip fracture is primary and secondary prevention of hip fracture.
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Affiliation(s)
- Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, 2109, Australia.
| | - Cate M Cameron
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, 2109, Australia
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Luan F, Wang W, Liu N, Zhang Y, Liu J. Digital Assessment of the Implantation Angle of Proximal Femoral Nail Antirotation Helical Blade Using CT Three-dimensional Reconstruction. J INVEST SURG 2017; 32:111-117. [PMID: 29083940 DOI: 10.1080/08941939.2017.1381788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To facilitate simple and safe manipulation during proximal femoral nail antirotation (PFNA) operation, we studied the range of safe implantation angle of the helical blade of the PFNA system by using a digital-based three-dimensional reconstruction model of CT images. METHODS Thirty-five healthy volunteers were recruited. Original multilayer helical CT scan data of the left femur were collected and imported into Mimics software. Anatomic features of the femur, including the safe implantation angle, anterior and posterior angle, were measured. Differences in each angle between male and female subjects were compared using Student's t test, and the determinants of each angle were analyzed by linear regression. RESULTS The mean safe implantation angle was 30.09° ± 4.73°, the mean anterior angle was 15.82° ± 2.07°, and the mean posterior angle was 14.27° ± 3.19°. All the three angles were greater in males than females (P < 0.05). Neck shaft angle and the diameter of the femoral neck and head were linearly correlated with the safe implantation angle, the anterior and posterior angle, respectively. Femoral neck diameter was a significant determinant of the safe implantation angle and posterior angle, respectively. Moreover, femoral neck diameter and femoral head diameter were significant determinants of the anterior angle. CONCLUSIONS The study has introduced and delineated a novel parameter, the safe implantation angle, for FPNA surgery, which may help orthopedic surgeons in deciding a safe range of PFNA operation and improve the accuracy of PFNA helical blade implantation.
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Affiliation(s)
- Feiyu Luan
- a The 3rd Department of orthopedics , First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Wenbo Wang
- a The 3rd Department of orthopedics , First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Ning Liu
- a The 3rd Department of orthopedics , First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Yanan Zhang
- b Department of Computed Tomography , First Affiliated Hospital of Harbin Medical University , Harbin , China
| | - Jinyi Liu
- c Department of Physical diagnostics section, Rehabilitation Branch of Seafarers General Hospital of Heilongjiang province , Harbin , China
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Nkanang B, Parker M, Parker E, Griffiths R. Perioperative mortality for patients with a hip fracture. Injury 2017; 48:2180-2183. [PMID: 28801200 DOI: 10.1016/j.injury.2017.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/10/2017] [Accepted: 07/09/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Studies on mortality following hip fracture surgery have hitherto focused on the 30 day to 1 year period and beyond. This study focuses on the immediate perioperative period. It examines mortality rates, patient characteristics, operative details and post-operative complications. PATIENTS AND METHODS A retrospective study of a hip fracture database in a large District General Hospital in the United Kingdom, from 1986 to 2015. A dataset of 9393 patients was identified, including patients undergoing surgery for curative and palliative purposes, over fifteen years of age and with no upper age limit imposed. It compared patients who survived the first 48h from start of surgery with those who died within this perioperative period. RESULTS 9393 patients were treated surgically and included within this study, with a mean age of 80.13 and consisting of 7130 female and 2263 male patients. The all cause mortality within 48h from start of surgery was 0.8% (72 patients). Increased risk of perioperative mortality was associated with increasing age, ASA grade 3 and above, in-hospital falls, impaired mobility prior to the fall and a reduced mental test score on admission. For the patient with a perioperative death, the most common circumstances identified in this study involved being found dead in bed by attending staff within 48h of surgery. DISCUSSION There has been significant attention paid to the optimization of patient management leading up to hip fracture surgery and its attendant impact on medium and longer term survival. The information from this study may be used to identify patients most at risk of death in the 48h after surgery. The importance of this dataset is that it provides large numbers, which are needed in order to look for associations, given the low 48h mortality rate found. CONCLUSION We are unable to highlight any correctable or alterable factors associated with mortality. Further studies with detailed collection of data on a national scale may be needed to assess the impact of levels of postoperative care for hip fracture patients and perioperative mortality.
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Affiliation(s)
- Bassey Nkanang
- Department of Anaesthetics, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, United Kingdom.
| | - Martyn Parker
- Department of Trauma & Orthopaedics, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, United Kingdom
| | - Emily Parker
- Department of Anaesthetics, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, United Kingdom
| | - Richard Griffiths
- Department of Anaesthetics, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, United Kingdom
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