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Méndez Medina RJ, Hernández Arenas ÁR, Barrera Orozco JV, Rodríguez Villanueva DO. Potential predictors for surgical delay in patients with intertrochanteric fractures and their impact on hospitalization length, in a Latin American trauma center. Injury 2023; 54 Suppl 6:110807. [PMID: 38143132 DOI: 10.1016/j.injury.2023.05.038] [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: 03/05/2023] [Revised: 04/30/2023] [Accepted: 05/11/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION The incidence of intertrochanteric fractures is increasing, and health institutions must know the profile of their patients. This paper describes the relationship between clinical characteristics and attention process with surgical delay and prolonged hospitalization length in patients with intertrochanteric fractures admitted to a Latin-American trauma center. MATERIALS AND METHODS Retrospective, comparative, cross-sectional study. The medical records of patients admitted for intertrochanteric fracture between August 1st 2019 and May 31st 2021 were reviewed to extract data regarding clinical characteristics, causes of surgery delay, and hospitalization length. Regression models were used to distinguish potential predictor variables on surgical delay and hospitalization length. RESULTS 362 cases with intertrochanteric fractures were surgically treated during the study period. The mean time from admission to surgery was 4.2 ± 3.8 days. in 33,1% of the cases the surgery was performed within the first 48 h. A history of coronary heart disease (CHD) and chronic kidney disease were potential predictors of surgery delay (p<0.005). Only CHD was independently associated with surgery delay (OR 5.267 [95%CI 1.201-23.100); p = 0.028). Hospitalization was extended in cases where surgery was performed after 48 h (10,1 ± 6,2 days vs 5,9 ± 3,0 days; p<0.001). The regression model showed that for each day passed from fracture to admission and each day from admission to surgery, the hospitalization duration increased by 3,7 and 4,4 days, respectively. DISCUSSION Patients with intertrochanteric fractures have comorbidities that potentially delay their surgical treatment and prolong hospitalization duration. The efficient use of hospital resources and the proper early evaluation of cardiac pathologies conducted during admission, could positively impact the achievement of surgical treatment within the first 48 h after the fracture, reducing hospitalization duration.
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Öztürk B, Johnsen SP, Röck ND, Pedersen L, Pedersen AB. Impact of comorbidity on the association between surgery delay and mortality in hip fracture patients: A Danish nationwide cohort study. Injury 2019; 50:424-431. [PMID: 30616809 DOI: 10.1016/j.injury.2018.12.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the association between surgery delay and mortality in hip fracture patients with and without known comorbidity. METHODS We identified all patients with a first time hip fracture diagnose operated between January 1, 2010 and December 31, 2015 (n = 36,552). As a measure of comorbidity we used Charlson Comorbidity Index stratified in categories: none (no registered comorbidities prior fracture), medium (1-2 points) and high (≥3 points). RESULTS No association between surgery delay, regardless of the threshold, and 30-days mortality was observed among patients with high level of comorbidity. Surgery delay of >24h vs. ≤24 h was associated with higher 0-30-days mortality in patients with medium level of comorbidity (adjusted HR: 1.12 (95% CI: 1.01 ; 1.24)). In addition, surgery delay was associated with up to 45% increased mortality in patients with none comorbidity prior surgery, although the confidence intervals were wide. Furthermore, surgery delay of >24 h (vs. <24 h) and >48 h (vs. ≤48 h) was associated with higher 31-90-days mortality among all patients (adjusted HR: 1.19 (95% CI: 1.10 ; 1.29) and 1.35 (95% CI: 1.16 ; 1.56), respectively), but in particular among patients with none (adjusted HR: 1.26 (95% CI: 1.08 ; 1.47) and 1.65 (95% CI: 1.26 ; 2.17), respectively) and medium (adjusted HR: 1.21 (95% CI: 1.07 ; 1.36) and 1.25 (95% CI: 1.00 ; 1.57), respectively) level of comorbidity at the time of surgery. CONCLUSIONS There was an association between surgery delay and 30-days mortality in hip fracture surgery patients with none and medium level of comorbidity, whereas no such association was observed among hip fracture patients with a high comorbidity level. Surgery delay was associated with one year increased risk of dying in both patients with and without comorbidity prior surgery.
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Affiliation(s)
- Buket Öztürk
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
| | - Søren P Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark
| | - Niels Dieter Röck
- Department of Orthopedic Surgery O, Odense University Hospital, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
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Schermann H, Gurel R, Gold A, Maman E, Dolkart O, Steinberg EL, Chechik O. Safety of urgent hip fracture surgery protocol under influence of direct oral anticoagulation medications. Injury 2019; 50:398-402. [PMID: 30391072 DOI: 10.1016/j.injury.2018.10.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 08/08/2018] [Revised: 10/23/2018] [Accepted: 10/27/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Direct oral anticoagulation agents (DOACs) are increasingly prescribed to older adults. Concerns for perioperative blood loss dictate cessation of anticoagulation treatment and postponement of surgery until the coagulation system returns to normal state. The goal of this study is to compare the estimates of perioperative blood loss and mortality between patients using DOACs and patients receiving no anticoagultaion, in order to challenge the existing policy and question the need for surgery deferral. MATERIALS AND METHODS This is a retrospective cohort of patients (age > 65) with proximal hip fractures treated with either closed reduction internal fixation (CRIF, n = 1143; DOAC use n = 60) or hemiarthroplasty (HA, n = 571; DOAC use n = 29). Baseline patient characteristics included age, gender, ASA score, socioeconomic level, type of surgica#1: In general a l treatment, duration of surgery and time from admission to surgery. The effect of anticoagulant prescription on percentage of hemoglobin change, odds of receiving blood transfusions and one-month and one-year mortality was evaluated separately for CRIF and HA patients. RESULTS Patients receiving DOACs had similar perioperative hemoglobin change, transfusion rates and mortality, compared to subjects without anticoagulants in both CRIF and HA cohorts. DOAC patients undergoing CRIF had a longer delay to surgery (40.2 ± 26.9 vs 31.2 ± 22.2, p = 0.003) and higher mortality rates at one year postoperatively (26.7% vs 16.1%, p = 0.015). CONCLUSIONS DOAC use was not associated with an increased perioperative blood loss or mortality compared to controls. However, they had to wait longer for surgery, which itself was an independent predictor of mortality. It may be safe to shorten waiting time for surgery in patients using anticoagulation, with the goal to minimize surgery delay.
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Affiliation(s)
- Haggai Schermann
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel.
| | - Ron Gurel
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Aviram Gold
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Eran Maman
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Oleg Dolkart
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ely L Steinberg
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ofir Chechik
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel
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Boeri L, Soligo M, Frank I, Boorjian SA, Thompson RH, Tollefson M, Quevedo FJ, Cheville JC, Karnes RJ. Delaying Radical Cystectomy After Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer is Associated with Adverse Survival Outcomes. Eur Urol Oncol 2018; 2:390-396. [PMID: 31277775 DOI: 10.1016/j.euo.2018.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 06/20/2018] [Revised: 09/03/2018] [Accepted: 09/10/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Delaying radical cystectomy (RC) after a diagnosis of muscle-invasive bladder cancer (MIBC) has been associated with adverse survival. However, data are lacking regarding the impact of RC delay in patients receiving neoadjuvant chemotherapy (NAC). OBJECTIVES To assess whether the time from last cycle of NAC to RC (time to cystectomy, TTC) is associated with survival among MIBC patients. DESIGN, SETTING, AND PARTICIPANTS The study cohort comprised 226 patients treated with NAC and RC between 1999 and 2015 for cT2-T4N0M0 bladder cancer. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Descriptive statistics were used to test the association between TTC and clinicopathologic variables. Overall mortality (OM) and cancer-specific mortality (CSM) were analyzed via Kaplan-Meier estimation according to TTC. We assessed factors associated with OM and CSM using multivariable Cox regression analyses. RESULTS AND LIMITATIONS The median TTC was 7.57wk (interquartile range 5.2-10.8). Patients with a Charlson comorbidity index (CCI) ≥1 had a longer TTC than those with a score of <1 (p=0.027). The group with TTC >10wk had significantly lower OM-free (p=0.003) and CSM-free rates (p<0.001) than the group with TTC ≤10wk. TTC was independently associated with higher risk of OM (p=0.027) and CSM (p=0.004) after accounting for age, gender, pathologic extravesical disease, and nodal status. CONCLUSIONS TTC of >10wk after NAC was associated with adverse survival among patients with MIBC. Patients with a higher CCI were more likely to have prolonged TTC. PATIENT SUMMARY The impact of delaying radical cystectomy in patients who have received neoadjuvant chemotherapy (NAC) is unknown. In this study we assessed whether prolonged time to cystectomy (TTC) after NAC affects survival outcomes in patients with muscle-invasive bladder cancer. We found that TTC of >10wk was associated with adverse overall survival and cancer-specific survival, and attempts should be made to shorten TTC after preoperative chemotherapy.
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Affiliation(s)
- Luca Boeri
- Department of Urology, Mayo Clinic, Rochester, MN, USA; Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Soligo
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Bachand J, Soulos PR, Herrin J, Pollack CE, Xu X, Ma X, Gross CP. Physician peer group characteristics and timeliness of breast cancer surgery. Breast Cancer Res Treat 2018; 170:657-665. [PMID: 29693229 DOI: 10.1007/s10549-018-4789-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/13/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Little is known about how the structure of interdisciplinary groups of physicians affects the timeliness of breast cancer surgery their patients receive. We used social network methods to examine variation in surgical delay across physician peer groups and the association of this delay with group characteristics. METHODS We used linked Surveillance, Epidemiology, and End Results-Medicare data to construct physician peer groups based on shared breast cancer patients. We used hierarchical generalized linear models to examine the association of three group characteristics, patient racial composition, provider density (the ratio of potential vs. actual connections between physicians), and provider transitivity (clustering of providers within groups), with delayed surgery. RESULTS The study sample included 8338 women with breast cancer in 157 physician peer groups. Surgical delay varied widely across physician peer groups (interquartile range 28.2-50.0%). For every 10% increase in the percentage of black patients in a peer group, there was a 41% increase in the odds of delayed surgery for women in that peer group regardless of a patient's own race [odds ratio (OR) 1.41, 95% confidence interval (CI) 1.15-1.73]. Women in physician peer groups with the highest provider density were less likely to receive delayed surgery than those in physician peer groups with the lowest provider density (OR 0.65, 95% CI 0.44-0.98). We did not find an association between provider transitivity and delayed surgery. CONCLUSIONS The likelihood of surgical delay varied substantially across physician peer groups and was associated with provider density and patient racial composition.
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Affiliation(s)
- Jacqueline Bachand
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA.,Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT, 06520, USA
| | - Jeph Herrin
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA.,Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,Health Research & Educational Trust, Chicago, IL, USA
| | - Craig E Pollack
- Johns Hopkins School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiao Xu
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.,Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA
| | - Cary P Gross
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA. .,Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT, 06520, USA.
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Cha YH, Ha YC, Yoo JI, Min YS, Lee YK, Koo KH. Effect of causes of surgical delay on early and late mortality in patients with proximal hip fracture. Arch Orthop Trauma Surg 2017; 137:625-30. [PMID: 28321571 DOI: 10.1007/s00402-017-2674-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate the reasons for delayed surgery in patients with proximal hip fracture and to compare differences in mortality between delayed surgery cases and non-delayed surgery cases. In addition, we evaluated causal factors for delayed surgery that affected differences in mortality. METHODS From 2003 to 2013, 1290 patients (1290 hips) with unilateral femoral neck or intertrochanteric fractures who underwent surgery were categorized into Group Ia (402 patients, early surgery group) and Group Ib (888 patients, delayed surgery group). The delayed surgery group was categorized as Group IIa (270 patients, pre-hospital delay group) and Group IIb (618 patients, post-hospital delay group). Among 618 patients with post-hospital delay, 165 patients in Group IIIa were defined as delayed surgery cases due to patient factors, and 453 patients in Group IIIB were defined as delayed surgery cases due to hospital factors. Early and late mortality was compared between each group. RESULTS Of 1290 patients, 888 patients underwent delayed surgery (mean 7.5 days, range 3-167 days) after hip fracture. The cumulative mortality rate at 30, 60 days, 3, and 12 months was 0.7, 2.0, 3.0, and 9.5% in Group Ia, respectively, and 2.4, 4.5, 5.2, and 14.5% in Group Ib, respectively (p = 0.047, p = 0.027, p = 0.078, and p = 0.012, respectively). Of 618 patients with post-hospital surgery delay, the cumulative mortality rate at 30 days and 12 months was 4.8 and 21.2% in Group IIIa, respectively, and 1.8, and 12.6% in Group IIIb, respectively (p = 0.033 and p = 0.008, respectively). After adjustments, patient factors for delayed surgery (HR 2.780; 95% CI 1.012-7.640, p = 0.047) were significantly associated with death after hip fracture. CONCLUSIONS This study demonstrated that delayed surgery was significantly related to 30-day and 1-year mortality. Surgery delay due to drugs' hold and medical comorbidity was related to 30-day mortality after adjustment.
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