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Essa S, Venter S, Jordaan JD. The effect of a post-anaesthesia high-care unit (PAHCU) admission on mobilization, length of stay and in-hospital mortality post-surgery in low energy neck of femur fracture patients. Eur J Orthop Surg Traumatol 2024; 34:1389-1396. [PMID: 38194124 PMCID: PMC10980606 DOI: 10.1007/s00590-023-03799-1] [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] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/25/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE/AIM With an ageing population and an increase in fragility fractures of the hip (FFH), the role of an anaesthetist is evolving to include more peri-operative care. A post-anaesthesia high-care unit (PAHCU) should enhance care in post-operative patients. To our knowledge, there are no studies that have investigated the effect of a PAHCU admission on post-operative outcomes after FFH. This study aimed to compare post-operative outcomes of FFH patients admitted to PAHCU versus a standard post-operative orthopaedic ward (POOW). METHODOLOGY A retrospective cohort study was conducted on adult patients with FFH who underwent surgery between January 2019 and December 2020 at our institution. Data were sourced from electronic medical records. SPSS version 28 was used to analyse data. RESULTS A total of 231 patients were included. The PAHCU group (n = 35) displayed a higher burden of chronic illness and higher peri-operative risk scores as compared to the POOW group (n = 196). Median time to mobilize (TTM) in PAHCU was 84 h vs. 45 h in POOW group (p = 0.013). Median length of stay (LOS) in PAHCU was 133 h vs. 94 h in POOW (p = 0.001). The in-hospital mortality was 2.9% (n = 1) for PAHCU and 3.6% (n = 7) for POOW (p = 1). The 30-day mortality was 11.8% (n = 4) for PAHCU and 10.1% (n = 19) in POOW. CONCLUSION PAHCU admission resulted in delayed time to surgery and TTM, together with prolonged LOS, compared to those managed in POOW. However, these mortality rates remained comparable in both groups. This study contributes valuable insights into post-operative care of FFH patients in a resource-poor setting.
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Affiliation(s)
- S Essa
- Department of Anaesthesia and Critical Care, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - S Venter
- Department of Anaesthesia and Critical Care, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J D Jordaan
- Department of Orthopaedic Surgery, Faculty Health Sciences, Stellenbosch University, Cape Town, South Africa
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Johansson H, Dela SS, Cassim B, Paruk F, Brown SL, Conradie M, Harvey NC, Jordaan JD, Kalla AA, Liu E, Lorentzon M, Lukhele M, McCloskey EV, Mohamed O, Chutterpaul P, Vandenput L, Kanis JA. FRAX-based fracture probabilities in South Africa. Arch Osteoporos 2021; 16:51. [PMID: 33649966 PMCID: PMC7921059 DOI: 10.1007/s11657-021-00905-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/01/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED The hip fracture rates in South Africa were used to create ethnic-specific FRAX® models to facilitate fracture risk assessment. INTRODUCTION The aim of this study was to develop FRAX models to compute the 10-year probability of hip fracture and major osteoporotic fracture and assess their potential clinical application. METHODS Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for the White, Black African, Coloured and Indian population of South Africa. Age-specific 10-year probabilities of a major osteoporotic fracture were calculated in women to determine fracture probabilities at a femoral neck T score of -2.5 SD, or those equivalent to a woman with a prior fragility fracture. Fracture probabilities were compared with those from selected countries. RESULTS Probabilities were consistently higher in Indian than in Coloured men and women, in turn, higher than in Black South Africans. For White South Africans, probabilities were lower than in Indians at young ages up to the age of about 80 years. When a BMD T score of -2.5 SD was used as an intervention threshold, FRAX probabilities in women age 50 years were approximately 2-fold higher than in women of the same age but with an average BMD and no risk factors. The increment in risk associated with the BMD threshold decreased progressively with age such that, at the age of 80 years or more, a T score of -2.5 SD was no longer a risk factor. Probabilities equivalent to women with a previous fracture rose with age and identified women at increased risk at all ages. CONCLUSIONS These FRAX models should enhance accuracy of determining fracture probability amongst the South African population and help guide decisions about treatment.
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Affiliation(s)
- Helena Johansson
- grid.411958.00000 0001 2194 1270Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia ,grid.11835.3e0000 0004 1936 9262Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, S10 2RX, Sheffield, UK
| | - Sapna S. Dela
- grid.16463.360000 0001 0723 4123Department of Internal Medicine, Edendale Hospital, School of Clinical Medicine (SCM), University of KwaZulu-Natal, Durban, South Africa
| | - Bilkish Cassim
- grid.16463.360000 0001 0723 4123Department of Geriatrics, School of Clinical Medicine (SCM), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Farhanah Paruk
- grid.16463.360000 0001 0723 4123Division of Internal Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Susan L. Brown
- Department of Medicine, Mahathma Gandhi Memorial Hospital, Durban, South Africa
| | - Magda Conradie
- grid.11956.3a0000 0001 2214 904XDivision of Endocrinology, University of Stellenbosch, Stellenbosch, South Africa
| | - Nicholas C. Harvey
- grid.5491.90000 0004 1936 9297MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Johannes D. Jordaan
- grid.11956.3a0000 0001 2214 904XDivision of Orthopaedics, University of Stellenbosch, Stellenbosch, South Africa
| | - Asgar A. Kalla
- grid.7836.a0000 0004 1937 1151Division of Rheumatology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Enwu Liu
- grid.411958.00000 0001 2194 1270Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Mattias Lorentzon
- grid.411958.00000 0001 2194 1270Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia ,grid.8761.80000 0000 9919 9582Geriatric Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mkhululi Lukhele
- grid.11951.3d0000 0004 1937 1135Department of Orthopaedics, University of Witwatersrand, Witwatersrand, South Africa
| | - Eugene V. McCloskey
- grid.11835.3e0000 0004 1936 9262Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, S10 2RX, Sheffield, UK ,grid.11835.3e0000 0004 1936 9262Mellanby Centre for bone research, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Ozayr Mohamed
- grid.16463.360000 0001 0723 4123Discipline of Public Health Medicine, SCM, College of Health Sciences, UKZN, Durban, South Africa
| | - Pariva Chutterpaul
- grid.16463.360000 0001 0723 4123Division of Internal Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Liesbeth Vandenput
- grid.411958.00000 0001 2194 1270Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia ,grid.8761.80000 0000 9919 9582Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John A. Kanis
- grid.411958.00000 0001 2194 1270Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia ,grid.11835.3e0000 0004 1936 9262Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, S10 2RX, Sheffield, UK
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Dela SS, Paruk F, Brown SL, Lukhele M, Kalla AA, Jordaan JD, Conradie M, Mohamed O, Chutterpaul P, Cassim B. Corrigendum to "Ethnic and gender-specific incidence rates for hip fractures in South Africa: A multi-centre study" [Bone 133C (2020) 115253]. Bone 2020; 137:115435. [PMID: 32485632 DOI: 10.1016/j.bone.2020.115435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- S S Dela
- Department of Internal Medicine, Edendale Hospital, School of Clinical Medicine (SCM), University of KwaZulu-Natal (UKZN), South Africa.
| | - F Paruk
- Division of Internal Medicine, SCM, College of Health Sciences, UKZN, South Africa
| | - S L Brown
- Mahatma Gandhi Memorial Hospital, Durban, South Africa
| | - M Lukhele
- Department of Orthopaedics, University of Witwatersrand, South Africa
| | - A A Kalla
- Division of Rheumatology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - J D Jordaan
- Division of Orthopaedics, Stellenbosch University, South Africa
| | - M Conradie
- Division of Endocrinology, Stellenbosch University, South Africa
| | - O Mohamed
- Discipline of Public Health Medicine, SCM, College of Health Sciences, UKZN, South Africa
| | - P Chutterpaul
- Division of Internal Medicine, SCM, College of Health Sciences, UKZN, South Africa
| | - B Cassim
- Department of Geriatrics, SCM, College of Health Sciences, UKZN, South Africa
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Dela SS, Paruk F, Brown SL, Lukhele M, Kalla AA, Jordaan JD, Conradie M, Mohamed O, Chutterpaul P, Cassim B. Ethnic and gender-specific incidence rates for hip fractures in South Africa: A multi-centre study. Bone 2020; 133:115253. [PMID: 31987987 DOI: 10.1016/j.bone.2020.115253] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 09/06/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data exist on the incidence of hip fractures in South Africa (SA). We report gender and ethnic specific incidence rates of hip fractures in SA. METHODS In a multicentre prospective study, conducted in geographically defined municipalities of three provinces in SA, a structured questionnaire was administered to all subjects aged 40 years and over, presenting with a new atraumatic hip fracture, from 1 April 2017 to 31 March 2018. Gender and ethnic specific incidence rates (IR) of hip fractures were calculated using population statistics from Statistics SA. FINDINGS Of the 2767 subjects enrolled, 1914 (69·2%) were women and 853 (30·8%) were men. The majority of subjects were from the White population (40·9%) followed by those from the African (26·4%), Coloured (18·7%) and Indian (13·9%) populations. Men with hip fractures were significantly younger than women in the total group (69 [IQR 59-79] versus 77 years [IQR 68-84], p < 0·001) and in each ethnic group. White subjects were significantly older (p < 0·0001) and Africans significantly younger (p < 0·0001) than the other ethnic groups. In women, the highest IR was noted in the White population (176·0 per 100,000), followed by that in the Indian (147·7 per 100,000), Coloured (73·2 per 100,000) and African populations (43·6 per 100,000). A similar pattern was seen in men albeit at lower rates, with the highest rate in White men at 76·5 per 100,000. In the total study population and the African population, the IR was higher in men compared to women in subjects under 60 years. In the White population, the IR was higher in men compared to women in the 40-44 years age group. While in the Coloured and Indian populations the IR was higher in men compared to women in the 40-49 years and 45-54 years age groups, respectively. There was an increase in the relative risk ratios with age in the total study population, and in all ethnic groups in both women and men. INTERPRETATION Hip fractures occur in all ethnic groups in South Africa with higher IRs in the White and Indian populations compared to the Coloured and African populations. Consistent with the published literature, the overall hip fracture IR was higher in women than in men, except in the younger age groups, and increased with age. FUNDING South African Medical Research Council and the University of KwaZulu-Natal Competitive Research Grant.
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Affiliation(s)
- S S Dela
- Department of Internal Medicine, Edendale Hospital, School of Clinical Medicine (SCM), University of KwaZulu-Natal (UKZN), South Africa.
| | - F Paruk
- Division of Internal Medicine, SCM, College of Health Sciences, UKZN, South Africa
| | - S L Brown
- Mahatma Gandhi Memorial Hospital, Durban, South Africa
| | - M Lukhele
- Department of Orthopaedics, University of Witwatersrand, South Africa
| | - A A Kalla
- Division of Rheumatology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - J D Jordaan
- Division of Orthopaedics, Stellenbosch University, South Africa
| | - M Conradie
- Division of Endocrinology, Stellenbosch University, South Africa
| | - O Mohamed
- Discipline of Public Health Medicine, SCM, College of Health Sciences, UKZN, South Africa
| | - P Chutterpaul
- Division of Internal Medicine, SCM, College of Health Sciences, UKZN, South Africa
| | - B Cassim
- Department of Geriatrics, SCM, College of Health Sciences, UKZN, South Africa
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Wiese KR, Kock FW, Blake CA, Franken T, Jordaan JD. The accuracy of pre-operative digital templating in total hip arthroplasty performed in a low-volume, resource-constrained orthopaedic unit. SA orthop j 2020. [DOI: 10.17159/2309-8309/2020/v19n1a4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Plenge U, Nortje MB, Marais LC, Jordaan JD, Parker R, van der Westhuizen N, van der Merwe JF, Marais J, September WV, Davies GL, Pretorius T, Solomon C, Ryan P, Torborg AM, Farina Z, Smit R, Cairns C, Shanahan H, Sombili S, Mazibuko A, Hobbs HR, Porrill OS, Timothy NE, Siebritz RE, van der Westhuizen C, Troskie AJ, Blake CA, Gray LA, Munting TW, Steinhaus HKS, Rowe P, van der Walt JG, Isaacs Noordien R, Theron A, Biccard BM. Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study. BMC Musculoskelet Disord 2018; 19:140. [PMID: 29743063 PMCID: PMC5944094 DOI: 10.1186/s12891-018-2062-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/26/2018] [Indexed: 12/30/2022] Open
Abstract
Background A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs. Methods Applying a Delphi method, 33 stakeholders (13 arthroplasty surgeons, 12 anaesthetists and 8 physiotherapists) from 10 state hospitals representing 4 South African provinces identified and prioritised i) risk factors associated with poor outcomes, ii) perioperative interventions to improve outcomes and iii) patient and clinical outcomes necessary to benchmark practice for patients scheduled for primary elective unilateral total hip and knee arthroplasty. Results Thirty of the thirty-three stakeholders completed the 3 months Delphi study. The first round yielded i) 36 suggestions to preoperative risk factors, ii) 14 (preoperative), 18 (intraoperative) and 23 (postoperative) suggestions to best practices for perioperative interventions to improve outcomes and iii) 25 suggestions to important postsurgical outcomes. These items were prioritised by the group in the consecutive rounds and consensus was reached for the top ten priorities for each category. Conclusion The consensus derived risk factors, perioperative interventions and important outcomes will inform the development of a structured, perioperative multidisciplinary enhanced patient care protocol for total hip and knee arthroplasty. It is anticipated that this study will provide the construct necessary for developing pragmatic enhanced care pathways aimed at improving patient outcomes after arthroplasty in LMICs.
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Affiliation(s)
- U Plenge
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - M B Nortje
- Department of Orthopaedic Surgery, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - L C Marais
- Department of Orthopaedic surgery, School of Clinical Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - J D Jordaan
- Department of Orthopaedic Surgery, Tygerberg Medical School, University of Stellenbosch, Cape Town, South Africa
| | - R Parker
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - N van der Westhuizen
- Department Anaesthesia, University of the Free State, Bloemfontein, South Africa
| | - J F van der Merwe
- Department of Orthopaedic surgery, University of the Free State, Bloemfontein, South Africa
| | - J Marais
- Department of Physiotherapy, Paarl Provincial Hospital, Paarl, South Africa
| | - W V September
- Department of Physiotherapy, Paarl Provincial Hospital, Paarl, South Africa
| | - G L Davies
- Department of Anaesthesia, Paarl Provincial Hospital, Paarl, South Africa
| | - T Pretorius
- Department of Anaesthesia, Paarl Provincial Hospital, Paarl, South Africa
| | - C Solomon
- Department of Orthopaedics, Paarl Provincial Hospital, Paarl, South Africa
| | - P Ryan
- Arthroplasty and Sports Medicine unit, Department of Orthopaedics, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - A M Torborg
- Department of Anaesthesia, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - Z Farina
- Department of Anaesthesia, Critical Care and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
| | - R Smit
- Department of Orthopaedic surgery, Grey's Hospital, Pietermaritzburg, South Africa
| | - C Cairns
- Greys Pain clinic, Department of Anaesthesia, Grey's Hospital, Pietermaritzburg, South Africa
| | - H Shanahan
- Department of Physiotherapy, Grey's Hospital, Pietermaritzburg, South Africa
| | - S Sombili
- Department of Orthopaedic surgery, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - A Mazibuko
- Department of Anaesthesia, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - H R Hobbs
- Department of Orthopaedic Surgery, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - O S Porrill
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - N E Timothy
- Department of Physiotherapy, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - R E Siebritz
- Department of Physiotherapy, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - A J Troskie
- Department of Orthopaedic Surgery, Worcester Hospital, Worcester, South Africa
| | - C A Blake
- Department of Orthopaedic Surgery, Worcester Hospital, Worcester, South Africa
| | - L A Gray
- Department of Physiotherapy, New Somerset Hospital, Cape Town, South Africa
| | - T W Munting
- Department of Orthopaedics, New Somerset Hospital and Christiaan Barnard Memorial Hospital, Cape Town, South Africa
| | - H K S Steinhaus
- Department of Anaesthesia, New Somerset Hospital, Cape Town, South Africa
| | - P Rowe
- Department of Orthopaedic surgery, Victoria Hospital, Cape Town, South Africa
| | - J G van der Walt
- Department of Anaesthesia, Victoria Hospital, Cape Town, South Africa
| | - R Isaacs Noordien
- Department of Physiotherapy, Victoria Hospital, Cape Town, South Africa
| | - A Theron
- Department of Anaesthesiology and Critical Care, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa
| | - B M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Snyders RF, Jordaan JD, Rasool MN, Goga IE. Vitamin D status in patients undergoing arthroplasty. SA orthop j 2016. [DOI: 10.17159/2309-8309/2016/v15n4a6] [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] [Indexed: 11/05/2022] Open
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