Management of pertrochanteric fractures in patients over 90 years: In-hospital mortality rate, complications and associated risk factors

Short-term outcomes after laparoscopic colorectal cancer surgery in patients over 90 years old: a Japanese multicenter study

BACKGROUND

The effect of laparoscopic surgery on short-term outcomes in colorectal cancer patients over 90 years old has remained unclear.

METHODS

We reviewed 87 colorectal cancer patients aged over 90 years who underwent surgery between 2016 and 2022. Patients were divided into an open surgery group (n = 22) and a laparoscopic surgery group (n = 65). The aim of this study was to investigate the effect of laparoscopic surgery on postoperative outcome in elderly colorectal cancer patients, as compared to open surgery.

RESULTS

Seventy-eight patients (89.7%) had comorbidities. Frequency of advanced T stage was lower with laparoscopic surgery (p = 0.021). Operation time was longer (open surgery 146 min vs. laparoscopic surgery 203 min; p = 0.002) and blood loss was less (105 mL vs. 20 mL, respectively; p < 0.001) with laparoscopic surgery. Length of hospitalization was longer with open surgery (22 days vs. 18 days, respectively; p = 0.007). Frequency of infectious complications was lower with laparoscopic surgery (18.5%) than with open surgery (45.5%; p = 0.021). Multivariate analysis revealed open surgery (p = 0.026; odds ratio, 3.535; 95% confidence interval, 1.159-10.781) as an independent predictor of postoperative infectious complications.

CONCLUSIONS

Laparoscopic colorectal resection for patients over 90 years old is a useful procedure that reduces postoperative infectious complications.

Prediction of Mortality in Older Hospitalized Patients after Discharge as Determined by Comprehensive Geriatric Assessment

Several dimensional impairments regarding Comprehensive Geriatric Assessment (CGA) have been shown to be associated with the prognosis of older patients. The purpose of this study is to investigate mortality prediction factors based upon clinical characteristics and test in CGA, and then subsequently develop a prediction model to classify both short- and long-term mortality risk in hospitalized older patients after discharge. A total of 1565 older patients with a median age of 81 years (74.0−86.0) were consecutively enrolled. The CGA, which included assessment of clinical, cognitive, functional, nutritional, and social parameters during hospitalization, as well as clinical information on each patient was recorded. Within the one-year follow up period, 110 patients (7.0%) had died. Using simple Cox regression analysis, it was shown that a patient’s Length of Stay (LOS), previous hospitalization history, admission Barthel Index (BI) score, Instrumental Activity of Daily Living (IADL) score, Mini Nutritional Assessment (MNA) score, and Charlson’s Comorbidity Index (CCI) score were all associated with one-year mortality after discharge. When these parameters were dichotomized, we discovered that those who were aged ≥90 years, had a LOS ≥ 12 days, an MNA score < 17, a CCI ≥ 2, and a previous admission history were all independently associated with one-year mortality using multiple cox regression analyses. By applying individual scores to these risk factors, the area under the receiver operating characteristics curve (AUC) was 0.691 with a cut-off value score ≧ 3 for one year mortality, 0.801 for within 30-day mortality, and 0.748 for within 90-day mortality. It is suggested that older hospitalized patients with varying risks of mortality may be stratified by a prediction model, with tailored planning being subsequently implemented.

Periprosthetic fracture rate after short and long hip nails: Analysis of a regional health database

INTRODUCTION

Intertrochanteric hip fractures are a major socio-economic burden, and a significant source of morbidity and mortality. Treatment is generally surgical, with either a dynamic hip screw or a cephalomedullary hip nail. Recently, there has been a trend toward the use of hip nails. The use of short nails over long nails, which span the length of the femur, remains a source of controversy. Historically, short nails were associated with a higher periprosthetic fracture rate compared with long nails, however newer nail designs, appear to have resolved this issue. Small retrospective studies show a refracture rate similar in both long and short nails. Given the small sample size of current studies, it remains unclear if the refracture rate is indeed the same between treatment arms, or if studies are not sufficiently large to identify a difference between the two. A large database review would provide the practical next step to further explore this question.

METHODS

Intertrochanteric hip fracture cases from our Regional Hip Fracture Registry were reviewed. All patients with an intertrochanteric fracture treated with a cephalomedullary nail from June 2009 to December 2017 were included. Patient demographics were compared using the t-test. Fracture rate was compared using the chi square test.

RESULTS

655 short nails and 315 long nails were reviewed. Patients in the short nail (SN) group were older than in the long nail group (LN) (SN: 81, LN 76 p < 0.001). The periprosthetic fracture rate was 2.1% overall with 1.3% in LN group and 2.4% in SN group (p = 0.34). There was no difference identified in the rate of blood transfusions (SN 38% LN 40% p = 0.5), however the procedure time was shorter in the SN group (SN: 81 min LN: 112 min p < 0.001).

DISCUSSION

This study did not find a statistical difference in periprosthetic fracture rate when comparing short and long cephalomedullary nails for the treatment of intertrochanteric fractures. Procedure time was shorter in the SN group. However, no difference in rate of blood transfusion was noted between patient groups. This study supports use of both nail type for hip fracture fixation, on the basis of periprosthetic fracture rate.