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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abelleyra Lastoria DA, Benny CK, Smith T, Hing CB. Outcomes of hip fracture in centenarians: a systematic review and meta-analysis. Eur Geriatr Med 2023; 14:1223-1239. [PMID: 37792241 PMCID: PMC10754761 DOI: 10.1007/s41999-023-00866-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/11/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Outcomes of hip fractures in centenarians remain underreported owing to the small number of patients reaching 100 years of age. This review aimed to determine outcomes of hip fracture in centenarians and to identify the most common comorbidities among centenarians with hip fracture to better characterise this population. METHODS Published and unpublished literature databases, conference proceedings and the reference lists of included studies were searched to the 25th of January 2023. A random-effects meta-analysis was performed. Included studies were appraised using tools respective of study design. RESULTS Twenty-three studies (6970 centenarians) were included (retrospective period: 1990-2020). The evidence was largely moderate to low in quality. One-year mortality following a hip fracture was 53.8% (95% CI 47.2 to 60.3%). Pooled complication rate following a hip fracture in centenarians was 50.5% (95% CI 25.3 to 75.6%). Dementia (26.2%, 95% CI 15.7 to 38.2%), hypertension (15.6%, 95% CI 3.4 to 33.1%), and diabetes (5.5%, 95% CI 1.9 to 10.7%) were the most common comorbidities among centenarians with hip fracture. CONCLUSION Hip fractures in centenarians typically involve complex patient presentations with diverse comorbidities. However, the current evidence-base is moderate to low in quality. Effective cross-discipline communication and intervention is suggested to promote treatment outcomes.
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Affiliation(s)
| | | | - Toby Smith
- University of Warwick, Coventry, CV4 7HL, UK
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Gao F, Liu G, Ge Y, Tan Z, Chen Y, Peng W, Zhang J, Zhang X, He J, Wen L, Wang X, Shi Z, Hu S, Sun F, Gong Z, Sun M, Tian M, Zhu S, Yang M, Wu X. Orthogeriatric co-managements lower early mortality in long-lived elderly hip fracture: a post-hoc analysis of a prospective study. BMC Geriatr 2023; 23:571. [PMID: 37723423 PMCID: PMC10506232 DOI: 10.1186/s12877-023-04289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 09/06/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE To evaluate the clinical effectiveness of orthogeriatric co-management care in long-lived elderly hip fracture patients (age ≥ 90). METHODS Secondary analysis was conducted in long-lived hip fracture patients between 2018 to 2019 in 6 hospitals in Beijing, China. Patients were divided into the orthogeriatric co-management group (CM group) and traditional consultation mode group (TC group) depending on the management mode. With 30-day mortality as the primary outcome, multivariate regression analyses were performed after adjusting for potential covariates. 30-day mobility and quality of life were compared between groups. RESULTS A total of 233 patients were included, 223 of whom completed follow-up (125 in CM group, 98 in TC group). The average age was 92.4 ± 2.5 years old (range 90-102). The 30-day mortality in CM group was significantly lower than that in TC group after adjustments for (2.4% vs. 10.2%; OR = 0.231; 95% CI 0.059 ~ 0.896; P = 0.034). The proportion of patients undergoing surgery and surgery performed within 48 h also favored the CM group (97.6% vs. 85.7%, P = 0.002; 74.4% vs. 24.5%, P < 0.001; respectively). In addition, much more patients in CM group could walk with or without aids in postoperative 30 days than in the TC group (87.7% vs. 60.2%, P < 0.05), although differences were not found after 1-year follow-up. And there was no significant difference in total cost between the two groups (P > 0.05). CONCLUSIONS For long-lived elderly hip fracture patients, orthogeriatric co-management care lowered early mortality, improved early mobility and compared with the traditional consultation mode.
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Affiliation(s)
- Feng Gao
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Gang Liu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Yufeng Ge
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Zhelun Tan
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Yimin Chen
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Weidong Peng
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Jing Zhang
- School of Population Health, University of New South Wales, Sydney, NSW Australia
| | - Xinyi Zhang
- The George Institute for Global Health at Peking University Health Science Centre, Beijing, China
| | - Jiusheng He
- Department of Orthopaedics, Beijing Shunyi District Hospital, Beijing, China
| | - Liangyuan Wen
- Department of Orthopaedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xianhai Wang
- Department of Orthopaedics, Beijing Changping District Hospital, Beijing, China
| | - Zongxin Shi
- Department of Orthopaedics, Beijing Liangxiang Hospital, Beijing, China
| | - Sanbao Hu
- Department of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fengpo Sun
- Department of Orthopaedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zishun Gong
- Department of Orthopaedics, Beijing Liangxiang Hospital, Beijing, China
| | - Mingyao Sun
- Department of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, Harbin, China
| | - Shiwen Zhu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
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Ogawa T, Onuma R, Kristensen MT, Yoshii T, Fujiwara T, Fushimi K, Okawa A, Jinno T. Association between additional weekend rehabilitation and in-hospital mortality in patients with hip fractures. Bone Joint J 2023; 105-B:872-879. [PMID: 37525626 DOI: 10.1302/0301-620x.105b8.bjj-2022-0890.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Aims The aim of this study was to investigate the association between additional rehabilitation at the weekend, and in-hospital mortality and complications in patients with hip fracture who underwent surgery. Methods A retrospective cohort study was conducted in Japan using a nationwide multicentre database from April 2010 to March 2018, including 572,181 patients who had received hip fracture surgery. Propensity score matching was performed to compare patients who received additional weekend rehabilitation at the weekend in addition to rehabilitation on weekdays after the surgery (plus-weekends group), as well as those who did not receive additional rehabilitation at the weekend but did receive weekday rehabilitation (weekdays-only group). After the propensity score matching of 259,168 cases, in-hospital mortality as the primary outcome and systemic and surgical complications as the secondary outcomes were compared between the two groups. Results The plus-weekends group was significantly associated with lower in-hospital mortality rates compared with the weekdays-only group (hazard ratio 0.86; 95% confidence interval 0.8 to 0.92; p < 0.001). Systemic complications such as acute coronary syndrome, heart failure, renal failure, and sepsis were significantly lower in the plus-weekends group, whereas urinary tract infection (UTI) and surgical complications such as surgical site infection and haematoma were significantly higher in the plus-weekends group. Conclusion Additional weekend rehabilitation was significantly associated with lower in-hospital mortality, as well as acute coronary syndrome, heart failure, renal failure, and sepsis, but was also significantly associated with a higher risk of UTI and surgical complications. This result can facilitate the effective use of the limited rehabilitation resources at the weekend and improve the clinical awareness of specific complications. To establish more robust causal associations between additional rehabilitation over the weekend and clinical outcomes, further prospective studies or randomized controlled trials with larger sample sizes are warranted.
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Affiliation(s)
- Takahisa Ogawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Ryo Onuma
- Department of Rehabilitation, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Morten T Kristensen
- Department of Physical and Occupational Therapy, Department of Clinical Medicine, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takeo Fujiwara
- Global Health Promotion, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Tokyo, Japan
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Ludski J, Carp B, Makar T, Yii M, Lee DK, Weinberg L. Outcomes and complications of nonagenarians undergoing cardiac surgery: a scoping review protocol. BMJ Open 2023; 13:e072293. [PMID: 37463807 PMCID: PMC10357299 DOI: 10.1136/bmjopen-2023-072293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Continually rising life expectancy and a shift towards an ageing population are resulting in an increasing population of nonagenarians. By 2030, the global population of nonagenarians is expected to exceed 30 million. The incidence of symptomatic cardiac disease is reported to occur in 25% of those aged over 75 years. Therefore, the number of nonagenarians undergoing cardiac surgery is also expected to increase. A linear relationship between advanced age and surgical risk has previously been demonstrated; however, it is not yet known whether this knowledge extends to the perioperative course and mortality of nonagenarians undergoing cardiac surgery. This scoping review aims to review the literature, assess whether a deficiency exists in the published literature and potentially identify knowledge gaps to guide future efforts to improve the understanding of nonagenarians undergoing cardiac surgery. METHODS AND ANALYSIS Following the relevant aspects of the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review guidelines, electronic databases of MEDLINE, EMBASE and the Cochrane Library will be systematically searched, with additional reference tracking of eligible studies. Studies reporting the outcomes of nonagenarians undergoing open cardiac surgery or minimally invasive cardiac surgery requiring cardiopulmonary bypass will be included. Screening and data extraction will be performed by two reviewers independently. The data will be analysed and summarised descriptively with a narrative approach. Qualitative data that capture quality-of-life outcomes will be subjected to thematic analysis where feasible. Additionally, reporting results will highlight similarities and differences in nonagenarian selection for surgery. ETHICS AND DISSEMINATION Ethics approval was not required. The findings will be disseminated through professional networks, conference presentations and publications in scientific journals.
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Affiliation(s)
- Jarryd Ludski
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Bradly Carp
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Tim Makar
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Michael Yii
- Department of Cardiac Surgery, Epworth Eastern Hospital, Box Hill, Victoria, Australia
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea (the Republic of)
| | - Laurence Weinberg
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
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Bermejo Boixareu C, Ojeda-Thies C, Guijarro Valtueña A, Cedeño Veloz BA, Gonzalo Lázaro M, Navarro Castellanos L, Queipo Matas R, Gómez Campelo P, Royuela Vicente A, González-Montalvo JI, Sáez-López P. Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures. Clin Interv Aging 2023; 18:441-451. [PMID: 36987460 PMCID: PMC10040167 DOI: 10.2147/cia.s386563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/19/2023] [Indexed: 03/30/2023] Open
Abstract
Objective The primary objective was to describe the clinical characteristics, management, and outcomes of centenarians with fragility hip fracture and compare them to other age groups. The secondary objective was to determine the variables associated with length of stay, in-hospital mortality and 30-day mortality. Materials and Methods This is a secondary analysis of the Spanish National Hip Fracture Registry. We included patients ≥75 years admitted for fragility hip fractures in 86 Spanish hospitals between 2017 and 2019, dividing the sample into four age groups. The variables studied were baseline characteristics, type of fracture, management, length of stay, in-hospital mortality and 30-day mortality. Results We included 25,938 patients (2888 were 75-79 years old; 14,762 octogenarians; 8,035 nonagenarians and 253 centenarians). Of the centenarians, 83% were women, 33% had severe dementia, 9% had severe dependency and 36% lived in residential care homes. Six out of ten had intertrochanteric fracture. Length of hospital stay was 8.6 days; in-hospital mortality was 10.3% and 30-day mortality 20.9%. Older age groups had more women, severe functional dependency, severe dementia, intertrochanteric fracture, living in care facilities and being discharged to nursing care. They had less frequent early mobilization, osteoporosis treatment and discharge to rehabilitation units. In-hospital and 30-day mortality were higher with increasing age. In centenarians, time to surgery >48 hours was independently associated with length of stay (correlation coefficient 3.99 [95% CI: 2.35-5.64; p<0.001]) and anaesthetic risk, based on an ASA score of V, was related to 30-day mortality (ASA score II [OR 0.25, 95% CI: 0.09-0.70; p=0.009] and ASA score III [OR 0.43, 95% CI: 0.19-0.96; p=0.039]). Conclusion Centenarians had different clinical characteristics, management and outcomes. Although centenarians had worse outcomes, nearly 4 out of 5 centenarians were alive one month after surgery.
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Affiliation(s)
- Cristina Bermejo Boixareu
- Geriatrics Department, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
- Correspondence: Cristina Bermejo Boixareu, Geriatrics Department, Puerta de Hierro University Hospital, Madrid, Spain, Email
| | - Cristina Ojeda-Thies
- Orthopaedic Surgery and Traumatology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Ainhoa Guijarro Valtueña
- Orthopaedic Surgery and Traumatology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | | | | | - Laura Navarro Castellanos
- La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
| | - Rocío Queipo Matas
- La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
- European University of Madrid, Madrid, Spain
| | - Paloma Gómez Campelo
- La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Royuela Vicente
- Biostatistics Unit, Puerta de Hierro Majadahonda University Hospital, IDIPHISA, CIBERESP, Madrid, Spain
| | - Juan Ignacio González-Montalvo
- La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
- Geriatrics Department, La Paz University Hospital, Madrid, Spain
| | - Pilar Sáez-López
- La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
- Geriatrics Department, Fundación Alcorcón University Hospital, Madrid, Spain
- Spanish National Hip Fracture Registry, Madrid, Spain
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Langenhan R, Müller F, Füchtmeier B, Probst A, Schütz L, Reimers N. Surgical treatment of proximal femoral fractures in centenarians: prevalence and outcomes based on a German multicenter study. Eur J Trauma Emerg Surg 2022; 49:1407-1416. [DOI: 10.1007/s00068-022-02184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
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Schermann H, Ashkenazi I, Graif N, Ogawa T, Morgan S, Ben Tov T, Khoury A, Warschawski Y. Would giving priority in surgery timing to the oldest patients result in lower mortality? Int Orthop 2022; 46:1701-1706. [PMID: 35678841 DOI: 10.1007/s00264-022-05466-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Early hip fracture surgery in elderly patients is recognized as a positive prognostic factor. When applied as an intervention, it does not always reduce overall patient mortality. A plausible explanation for this is that not all patients equally benefit from early surgery. The purpose of the study is to investigate the effect of early surgery on mortality in patients ages 80 and older. METHODS This is a retrospective cohort of 3463 patients with hip fractures, operated upon within seven days of admission in a tertiary medical center between 2010 and 2018. Patients were divided into five groups: ages 80-84, 85-89, 90-94, 95-99, and 100 or above. Baseline characteristics were compared between groups. Mortality at one year post-operatively as a function of surgery delay was visualized for each group, using restricted spline curve analysis. RESULTS Patients with increasing age were operated on earlier, had increased co-morbidities with a higher ASA score and experienced higher mortality. Spline curve analysis in younger patients, ages 80 to 94, demonstrated an inflection point at 48 hours after admission, prior to which mortality was rising rapidly and after which it continued rising slowly. In the two oldest age cohorts, there was no increased mortality with an increasing surgical delay. CONCLUSIONS In patients ages 80-94 surgery on day one may be preferable to surgery on day two. In patients ages 95 and older, surgery time did not influence mortality. Pursuit of better patient outcomes may include prioritizing early surgery in younger patients.
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Affiliation(s)
- Haggai Schermann
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel.
| | - Itay Ashkenazi
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Nadav Graif
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Takahisa Ogawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Tomer Ben Tov
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
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Ng JPH, Tan TL, Pillai A, Ho SWL. Outcomes of ultra-old vs old patients after hip fracture surgery: a matched cohort analysis of 1524 patients. Arch Orthop Trauma Surg 2022; 143:3145-3154. [PMID: 35864337 DOI: 10.1007/s00402-022-04550-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/08/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Surgical management of geriatric hip fractures yields improved functional outcomes with decreased morbidity and mortality. Cohort studies have suggested that the older patients within the geriatric age group have worse outcomes with surgery, However, these studies inherently report inflated risks due to poor handling of confounders and have inadequately age-stratified their geriatric population. AIM This study aims to investigate the effect of age alone on the 1-year mortality and functional status of geriatric patients after hip fracture surgery. METHODS This is a retrospective single institution cohort study based on the prospectively-maintained registry of hip fracture patients. 2603 patients aged 60 years and above were treated surgically under a geriatric-orthopaedic hip fracture pathway from January 2014 to December 2018. Patients were split into two age groups: ultra-old (≥ 85 years) vs old (< 85 years). Baseline demographics and the ASA (American Society of Anaesthesiologists) status and the Modified Barthel's Index (MBI) were obtained at admission and 1 year after the fracture. Adverse outcomes from the fracture and surgery were recorded during a follow-up period of minimally 2 years. A 2:1 matching process based on the gender, fracture type, ASA status, CCI and MBI categories was conducted. RESULTS There were 1009 and 515 patients in the old and ultra-old age groups, respectively. 1-year mortality was similar for both age groups (4.0% ultra-old vs 3.6% old, p = 0.703). 30-day morbidity was similar except for higher rates of postoperative pneumonia in the ultra-old (14.0 vs 6.3%, p < 0.001). MBI scores at 1-year were lower in the ultra-old (severe dependence: 16.4 vs 10.0%; p = 0.001). Ultra-old patients were less likely to be community ambulant at 12 months (21.2 vs 36.0%) with the deterioration in ambulatory status significant after correction for baseline status (p < 0.001). CONCLUSION The 1-year mortality of surgically-managed geriatric hip fracture patients older than 85 years of age is not determined by age alone. Patients aged 85 years and above are at higher risk for pneumonia postoperatively. Ultra-old hip fracture patients with an intertrochanteric fracture are more likely to have poorer function at 1 year after hip fracture surgery.
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Affiliation(s)
- Julia Poh Hwee Ng
- Department of Orthopedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Tong Leng Tan
- Department of Orthopedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Anand Pillai
- Department of Orthopedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Sean Wei Loong Ho
- Department of Orthopedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
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Weinberg L, Walpole D, Lee DK, D'Silva M, Chan JW, Miles LF, Carp B, Wells A, Ngun TS, Seevanayagam S, Matalanis G, Ansari Z, Bellomo R, Yii M. Modern Cardiac Surgical Outcomes in Nonagenarians: A Multicentre Retrospective Observational Study. Front Cardiovasc Med 2022; 9:865008. [PMID: 35911518 PMCID: PMC9330044 DOI: 10.3389/fcvm.2022.865008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background There have been multiple recent advancements in the selection, optimisation and management of patients undergoing cardiac surgery. However, there is limited data regarding the outcomes in nonagenarians, despite this cohort being increasingly referred for these interventions. The objective of this study was to describe the patient characteristics, management and outcomes of a cohort of nonagenarians undergoing cardiac surgery receiving contemporary peri-operative care. Methods After receiving ethics approval, we conducted a retrospective observational study of nonagenarians who had undergone cardiac surgery requiring a classic median sternotomy. All operative indications were included. We excluded patients who underwent transcatheter aortic valve implantation (TAVI), and surgery on the thoracic aorta via an endovascular approach (TEVAR). Patients undergoing TEVAR often have the procedure done under sedation and regional blocks with local anesthetic solution. There is no open incision and these patients do not require cardiopulmonary bypass. We also excluded patients undergoing minimally invasive mitral valve surgery via a videoscope assisted approach. These patients do not have a median sternotomy, have the procedure done via erector spinae block, and often are extubated on table. Data were collected from four hospitals in Victoria, Australia, over an 8-year period (January 2012–December 2019). The primary objective was to assess 6-month mortality in nonagenarian patients undergoing cardiac surgery and to provide a detailed overview of postoperative complications. We hypothesized that cardiac surgery in nonagenarian patients would be associated with a 6-month postoperative mortality <10%. As a secondary outcome, we hypothesized that significant postoperative complications (i.e., Clavien Dindo Grade IIIb or greater) would occur in > 30% of patients. Results A total of 12,358 adult cardiac surgery patients underwent surgery during the study period, of whom 18 nonagenarians (0.15%) fulfilled inclusion criteria. The median (IQR) [min-max] age was 91.0 years (90.0:91.8) [90–94] and the median body mass index was 25.0 (kg/m2) (22.3:27.0). Comorbidities, polypharmacy, and frailty were common. The median predicted mortality as per EuroSCORE-II was 6.1% (4.1:14.5). There were no cases of intra-operative, in-hospital, or 6-month mortality. One (5.6%) patient experienced two Grade IIIa complications. Three (16.7%) patients experienced Grade IIIb complications. Three (16.7%) patients had an unplanned hospital readmission within 30 days of discharge. The median value for postoperative length of stay was 11.6 days (9.8:17.6). One patient was discharged home and all others were discharged to an inpatient rehabilitation facility. Conclusion In this selected, contemporary cohort of nonagenarian patients undergoing cardiac surgery, postoperative 6-month mortality was zero. These findings support carefully selected nonagenarian patients being offered cardiac surgery (Trials Registry: https://www.anzctr.org.au/ACTRN12622000058774.aspx).
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Affiliation(s)
- Laurence Weinberg
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Laurence Weinberg
| | - Dominic Walpole
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | - Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Michael D'Silva
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | - Jian Wen Chan
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | - Lachlan Fraser Miles
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Bradly Carp
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | - Adam Wells
- Department of Cardiac Surgery, Epworth Eastern Hospital, Melbourne, VIC, Australia
| | - Tuck Seng Ngun
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | | | - George Matalanis
- Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia
| | - Ziauddin Ansari
- Department of Intensive Care, Epworth Eastern Hospital, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - Michael Yii
- Department of Cardiac Surgery, Epworth Eastern Hospital, Melbourne, VIC, Australia
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Seckel T, Mahoney K, Hewitt C, Liu H, Ang D. Outcomes After Definitive Surgery for Nonagenarians with Isolated Hip Fractures within 24 hours of Admission. Am Surg 2022:31348211067994. [PMID: 35282709 DOI: 10.1177/00031348211067994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Isolated hip fractures are a common orthopedic injury in the elderly population. Estimates are that there will be over 21 million hip fractures globally by 2050. Current recommendations are early operative fixation within 48 hours. Despite evidence showing that fixation of hip fractures within 24 hours is beneficial in the elderly population, the effect this has on the nonagenarian population has yet to be examined. METHODS This is a single institution retrospective cohort study examining isolated hip fractures from 2014 to 2020 from an American College of Surgeons verified trauma center. Patients ≥65 years old with IHF were included. A total number of 1150 isolated hip fracture patients 65 years or older were included in this study. Three cohorts were examined: (1) patients ≥90 years old; (2) patients 65-89 years old; and (3) patients stratified by ≥90 vs 65-75 years old and ≥90 vs 75-89 years old. Patients were then sub stratified by timing of surgery whether it was performed ≤24 hours or >24 hours. The primary outcome was inpatient mortality. RESULTS Nonagenarians who had delayed surgery had higher mortality rates compared to nonagenarians with early surgery (15.2% vs 4.2%; P = .02). Patients aged 65-75 had higher complication rates with delayed surgery (12.9% vs 4.1%; P = .01) as did those aged 76-89 (9.0% vs 3.2%, P = .004). DISCUSSION Early surgical intervention of isolated hip fractures in the nonagenarian population within 24 hours is associated with good clinical outcomes as well as a lower inpatient mortality that approaches significance.
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Affiliation(s)
- Tyler Seckel
- General Surgery Program, 124506UCF/HCA College of Medicine, Ocala, FL, USA.,23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Kyle Mahoney
- General Surgery Program, 124506UCF/HCA College of Medicine, Ocala, FL, USA.,23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Cory Hewitt
- General Surgery Program, 124506UCF/HCA College of Medicine, Ocala, FL, USA.,23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Huazhi Liu
- General Surgery Program, 124506UCF/HCA College of Medicine, Ocala, FL, USA.,23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Darwin Ang
- General Surgery Program, 124506UCF/HCA College of Medicine, Ocala, FL, USA.,23703Ocala Regional Medical Center, Ocala, FL, USA
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12
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MacDowall J, Tully P, Guha R, Ferguson M, Tan C, Weinberg L. Characteristics, comorbidity burden and outcomes in centenarians undergoing surgery in a university hospital: A case series. Int J Surg Case Rep 2021; 88:106563. [PMID: 34743060 PMCID: PMC8578033 DOI: 10.1016/j.ijscr.2021.106563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/30/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction As the population ages, so too does the age of those requiring surgery. People over the age of 100, centenarians, often have a greater degree of comorbidity and frailty than their younger counterparts but may also have a greater incidence of events requiring surgical intervention. There is, however, a dearth of literature describing the clinical course and practical considerations for this vulnerable population undergoing surgery. We aimed to describe the demographics of centenarians undergoing surgery, the procedures they receive, their intraoperative anaesthesia management, and their postoperative outcomes. Presentation of cases A retrospective cohort study was completed to understand key perioperative and intraoperative variables linked to improved outcomes. Of the 25 patients included in this study, 22 (88%) were female and the median age was 101 years. Emergency cases predominated (72%) and 44% of surgeries occurred after hours. 60% underwent an intermediate risk surgery, and no centenarians underwent high risk surgery in this study period. Discussion 64% of patients experienced at least one episode of intraoperative hypotension, with a median 3.5 epochs per patient. 68% of patients experienced postoperative complications and 20% of patients had a complication of Clavien-Dindo severity ≥ III. In centenarians, the risk of high severity postoperative complications was independent of the intrinsic procedural risk. Conclusion Centenarian patients have an elevated burden of comorbidity, presenting often in the emergent setting. However, age alone should not preclude surgical intervention as expert multidisciplinary care can have acceptable outcomes. Centenarian patients undergoing surgery are frail Most centenarian patients experience postoperative complications Surgery in centenarians can be feasible and undertaken safely Appropriate patient selection leads to acceptable outcomes Centenarians should not be denied surgery based on age alone
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Affiliation(s)
| | - Patrick Tully
- Department of Anaesthesia, Austin Health, Melbourne, Australia
| | - Ranj Guha
- Department of Anaesthesia, Austin Health, Melbourne, Australia
| | | | - Chong Tan
- Department of Anaesthesia, Austin Health, Melbourne, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Melbourne, Australia; Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Australia; Department of Critical Care, The University of Melbourne, Melbourne, Australia.
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