Age-adjusted Charlson comorbidity index predicts postoperative mortality in elderly patients with hip fracture: A prospective cohort

Elevated albumin: a protective factor against mortality in geriatric hip fracture patients

INTRODUCTION

To evaluate the association between albumin concentration at admission and mortality in elderly patients with hip fractures.

METHODS

Elderly patients with hip fractures were screened between Jan 2015 and Sep 2019. Demographic and clinical characteristics of the patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between albumin concentration at admission and mortality. All analyses were performed using EmpowerStats and the R software.

RESULTS

This retrospective cohort study included 2387 patients who met the study criteria. The mean follow-up was 37.64 months. The albumin concentration was 37.72 ± 4.03 g/L. Multivariate Cox regression showed that albumin concentration was associated with mortality in geriatric patients with hip fracture (Hazard Ratio [HR] = 0.94, 95% confidence intervals [CI]:0.92-0.96, P < 0.0001). Compared to the low albumin group (< 35 g/L), the medium group (≥ 35 g/L and < 40 g/L) decreased mortality risk by 29% (HR = 0.71, 95%CI:0.59-0.86, P = 0.0003), and the high group (≥ 40 g/L) decreased mortality risk by 38% (HR = 0.62, 95%CI:0.49-0.79, P < 0.0001). In addition, the test for a linear trend (P for trend) also showed a linear correlation in the different models. No saturation or threshold effect was observed in the nonlinear association. The sensitivity analysis used propensity score matching, and the results were stable.

CONCLUSION

The albumin concentrations at admission were associated with mortality in geriatric hip fractures, and it could be considered a predictor for the risk of mortality. (ChiCTR2200057323).

Surgical timing and clinical factor predicting in-hospital mortality in older adults with hip fractures: a neuronal network analysis

INTRODUCTION

Hip fractures in older adults are associated with a significant mortality rate, which has been reported to be around 35% within a year. Today, the incidence of these fractures is on the rise, and this trend is expected to increase even more owing to the aging of the population. Treatment timing and perioperative management of these patients are typically challenging owing to the presence of multiple comorbidities that are important risk factors for mortality after surgery. This study aims to evaluate the relationship between surgical timing and in-hospital mortality, analyzing the role of both acute events and chronic preexisting comorbidities in patient outcomes.

MATERIALS AND METHODS

This is a single-center, retrospective observational study (from January 2018 until June 2023). All consecutive patients ≥ 65 years with a diagnosis of proximal femur fracture were enrolled. The primary study endpoint was to evaluate risk factors associated with in-hospital mortality. The secondary endpoint was the assessment of the relationship between surgical timing and in-hospital mortality, including factors such as preexisting comorbidities, the Charlson Comorbidity Index, and the Nottingham Hip Fracture Score. The relative weight of each factor for predicting the mortality rate was also evaluated using neural network analysis, comparing patients treated within 24 h to those treated after a longer surgical delay.

RESULTS

Among the 2320 patients enrolled, 1391 (60%) underwent surgery within 24 h, while 929 patients (40%) were treated after 24 h. For patients who underwent surgery within 24 h, the in-hospital mortality was 2.8%, and for those who underwent surgery after 24 h, it was 5.2% (p = 0.046; odds ratio (OR) 1.58). Age (p = 0.001; OR 1.06) and Nottingham score (p = 0.04; OR 1.32) are factors predicting mortality. Acute infections were related to a high risk of mortality (p = 0.001; OR 5.99), both in patients treated within and after 24 h. Acute events, such as atrial fibrillation and electrolyte imbalance, were related to mortality risk only in patients treated within 24 h (p = 0.001 versus p = 0.51). Neural network analysis revealed that atrial fibrillation (AF), flutter, and electrolyte imbalance had the highest relative weight for mortality in patients treated in the first 24 h; by contrast, renal failure and pneumonia were most present in patients who died that were treated after 24 h.

CONCLUSIONS

Hip fracture is known to be a significant cause of morbidity and mortality in older adults. The impact of the timing of surgical treatment in those patients is crucial for postoperative outcomes. Early surgery is essential to reduce the risk of mortality. Our study has shown that, while in the case of acute and reversible conditions, waiting about 24 h to stabilize the patient with preoperative stabilization protocols, such as managing anticoagulation, optimizing hemodynamics, or addressing acute medical conditions including infection prevention, guarantees better results, in the case of sepsis or acute infection presence, the prolonged waiting to optimize patients before and after surgery does not help improve outcomes.

Association between the age-adjusted Charlson Comorbidity Index and complications after kidney transplantation: a retrospective observational cohort study

BACKGROUND

Complications following kidney transplantation elevate the risks of readmission and mortality. The aim of this study was to assess the association between the age-adjusted Charlson Comorbidity Index (ACCI) and postoperative complications among kidney transplant (KT) recipients.

METHODS

Between January 2015 and March 2021, a study involving 886 kidney transplant recipients at the Third Affiliated Hospital of Sun Yat-sen University was conducted. Postoperative complications were defined by the Clavien-Dindo Classification of Surgical Complications. Target Maximum Likelihood Estimation (TMLE) was employed to assess the association between ACCI and postoperative complications. The odds ratio (OR) was computed to determine the relationship between ACCI and postoperative complications. Subsequent interaction and stratified analyses were performed to assess the robustness of the findings.

RESULTS

Out of 859 KT participants ultimately included in the study, 30.7% were documented to have encountered postoperative complications. Participants with an ACCI value exceeding 3 exhibited a notably increased risk of postoperative complications following multivariable adjustment [aOR = 1.64, 95% CI [1.21,2.21], p = 0.001]. Congestive heart failure (OR = 16.18, 95% CI [1.98-132.17], p < 0.001), peripheral vascular disease (OR = 2.32, 95% CI [1.48-3.78], p < 0.001), and chronic obstructive pulmonary disease (OR = 6.05, 95% CI [2.95-12.39], p < 0.001) emerged as the top three preoperative comorbidities significantly linked to postoperative complications in ACCI.

CONCLUSION

An ACCI value exceeding 3 preoperatively constituted a risk factor for postoperative complications among KT patients.

The association between preoperative serum cholinesterase and all-cause mortality in geriatric patients with hip fractures: a cohort study of 2387 patients

OBJECTIVE

This study is to evaluate the association between preoperative cholinesterase levels and all-cause mortality in geriatric hip fractures.

METHODS

Elderly patients with hip fractures were screened between Jan 2015 and Sep 2019. Demographic and clinical characteristics of patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between preoperative cholinesterase levels and mortality in these patients. Analyses were performed using EmpowerStats and the R software.

RESULTS

Two thousand three hundred eighty-seven patients were included in this study. The mean follow-up period was 37.64 months. Seven hundred eighty-seven (33.0%) patients died due to all-cause mortality. Preoperative cholinesterase levels were 5910 ± 1700 U/L. Linear multivariate Cox regression models showed that preoperative cholinesterase level was associated with mortality (HR = 0.83, 95% CI: 0.78-0.88), P < 0.0001) for every 1000 U/L. However, the linear association was unstable, and nonlinearity was identified. A cholinesterase concentration of 5940 U/L was an inflection point. When preoperative cholinesterase level < 5940 U/L, the mortality decreased by 28% for every 1000 U/L increase in cholinesterase (HR = 0.72, 95%CI: 0.66-0.79, P < 0.0001). When cholinesterase was > 5940 U/L, the mortality was no longer decreased with the rise of cholinesterase (HR = 1.01, 95%CI: 0.91-1.11, P = 0.9157). We found the nonlinear association was very stable in the propensity score-matching sensitive analysis.

CONCLUSIONS

Preoperative cholinesterase levels were nonlinearly associated with mortality in elderly hip fractures, and cholinesterase was a risk indicator of all-cause mortality.

TRIAL REGISTRATION

This study is registered on the website of the Chinese Clinical Trial Registry (ChiCTR: ChiCTR2200057323) (08/03/2022).

Correlation Between Anesthesia Methods and Adverse Short-Term Postoperative Outcomes Depending on Frailty: A Prospective Cohort Study

Purpose

This study aims to investigate how the type of anesthesia used during major orthopedic surgery may impact adverse short-term postoperative outcomes depending on frailty.

Methods

To conduct this investigation, we recruited individuals aged 65 years and older who underwent major orthopedic surgery between March 2022 and April 2023 at a single institution. We utilized the FRAIL scale to evaluate frailty. The primary focus was on occurrences of death or the inability to walk 60 days after the surgery. Secondary measures included death within 60 days; inability to walk without human assistance at 60 days; death or the inability to walk without human assistance at 30 days after surgery, the first time out of bed after surgery, postoperative blood transfusion, length of hospital stay, hospital costs, and the occurrence of surgical complications such as dislocation, periprosthetic fracture, infection, reoperation, wound complications/hematoma.

Results

In a study of 387 old adult patients who had undergone major orthopedic surgery, 41.3% were found to be in a frail state. Among these patients, 262 had general anesthesia and 125 had neuraxial anesthesia. Multifactorial logistic regression analyses showed that anesthesia type was not linked to complications. Instead, frailty (OR 4.04, 95% CI 1.04 to 8.57, P< 0.001), age (OR 1.05, 95% CI 1.00-1.10, P= 0.017), and aCCI scores, age-adjusted Charlson Comorbidity Index, (OR 1.36, 95% CI 1.12 to 1.66, P= 0.002) were identified as independent risk factors for death or new walking disorders in these patients 60 days after surgery. After adjusting for frailty, anesthesia methods was not associated with the development of death or new walking disorders in these patients (P > 0.05).

Conclusion

In different frail populations, neuraxial anesthesia is likely to be comparable to general anesthesia in terms of the incidence of short-term postoperative adverse outcomes.

Mind the Gap: Unraveling the Intricate Dance Between Alzheimer's Disease and Related Dementias and Bone Health

PURPOSE OF REVIEW

This review examines the linked pathophysiology of Alzheimer's disease/related dementia (AD/ADRD) and bone disorders like osteoporosis. The emphasis is on "inflammaging"-a low-level inflammation common to both, and its implications in an aging population.

RECENT FINDINGS

Aging intensifies both ADRD and bone deterioration. Notably, ADRD patients have a heightened fracture risk, impacting morbidity and mortality, though it is uncertain if fractures worsen ADRD. Therapeutically, agents targeting inflammation pathways, especially Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) and TNF-α, appear beneficial for both conditions. Additionally, treatments like Sirtuin 1 (SIRT-1), known for anti-inflammatory and neuroprotective properties, are gaining attention. The interconnectedness of AD/ADRD and bone health necessitates a unified treatment approach. By addressing shared mechanisms, we can potentially transform therapeutic strategies, enriching our understanding and refining care in our aging society. This review article is part of a series of multiple manuscripts designed to determine the utility of using artificial intelligence for writing scientific reviews.