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Choi Y, Han S, Kim YJ, Kim JW, Kim CH. Hearing impairment increases the risk of hip fracture-related mortality and recurrent hip fractures: A propensity score matching analysis. Arch Gerontol Geriatr 2024; 127:105548. [PMID: 38964053 DOI: 10.1016/j.archger.2024.105548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Despite the ongoing rise in hip fractures and the adverse effects of hearing impairment (HI) on increased mortality and morbidity, research addressing the influence of HI on mortality risk or complications in patients with hip fractures remains absent. This study aimed to analyze the effects of HI on mortality and treatment outcomes among patients with hip fracture. METHODS We retrospectively collected data from consecutive patients diagnosed with hip fractures between January 2007 and March 2022 who had auditory examination records. From the initially enrolled 265 patients, data for 58 with HI and 58 without HI (control group) were extracted using a 1:1 propensity score matching. The primary outcome included comparison of mortality rates, and the secondary outcome encompassed the comparison of postoperative medical and surgical complications. RESULTS The 1-year cumulative mortality rate was not significantly different between the HI and control groups, but the overall cumulative mortality rate was significantly higher in the HI than in the control group (63.0 % and 48.6, respectively; P = 0.046) in a follow-up period of up to 16 years. The HI group had a significantly higher incidence of "second hip fractures due to falls" than the control group (P = 0.016), although no differences in other medical and surgical complications were revealed. CONCLUSIONS Awareness of the long-term risk of higher mortality when managing patients with hip fracture and HI is important. To reduce the risk of second hip fractures, paying more attention to fall prevention education and taking a more proactive approach, especially for those with HI.
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Affiliation(s)
- Yeonjoo Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sangwon Han
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yun Jae Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Barceló M, Casademont J, Mascaró J, Gich I, Torres OH. Should patients with exceptional longevity be treated for osteoporosis after a hip fracture? Age Ageing 2024; 53:afae118. [PMID: 38899445 DOI: 10.1093/ageing/afae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND There are no studies focusing on treatment for osteoporosis in patients with exceptional longevity after suffering a hip fracture. OBJECTIVE To assess the advisability of initiating treatment for osteoporosis after a hip fracture according to the incidence of new fragility fractures after discharge, risk factors for mortality and long-term survival. DESIGN Retrospective review. SETTING A tertiary university hospital serving a population of ~425 000 inhabitants in Barcelona. SUBJECTS All patients >95 years old admitted with a fragility hip fracture between December 2009 and September 2015 who survived admission were analysed until the present time. METHODS Pre-fracture ambulation ability and new fragility fractures after discharge were recorded. Risk factors for 1-year and all post-discharge mortality were calculated with multivariate Cox regression. Kaplan-Meier survival curve analyses were performed. RESULTS One hundred and seventy-five patients were included. Median survival time was 1.32 years [95% confidence interval (CI) 1.065-1.834], with a maximum of 9.2 years. Male sex [hazard ratio (HR) 2.488, 95% CI 1.420-4.358] and worse previous ability to ambulate (HR 2.291, 95% CI 1.417-3.703) were predictors of mortality. After discharge and up to death or the present time, 10 (5.7%) patients had a new fragility fracture, half of them during the first 6 months. CONCLUSIONS Few new fragility fractures occurred after discharge and half of these took place in the first 6 months. The decision to start treatment of osteoporosis should be individualised, bearing in mind that women and patients with better previous ambulation ability will have a better chance of survival.
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Affiliation(s)
- Montserrat Barceló
- Internal Medicine Department, Geriatric Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Casademont
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Mascaró
- Internal Medicine Department, Geriatric Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ignasi Gich
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Clinical Epidemiology and Public Health, HSCSP Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Olga Herminia Torres
- Internal Medicine Department, Geriatric Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Mohseni V, Fahimfar N, Ansarifar A, Masoumi S, Sanjari M, Khalagi K, Bagherifard A, Larijani B, Janani L, Mansourzadeh MJ, Ostovar A, Solaymani-Dodaran M. Mortality and re-fracture rates in low trauma hip fracture. BMC Geriatr 2024; 24:381. [PMID: 38684943 PMCID: PMC11059755 DOI: 10.1186/s12877-024-04950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES This study aimed to estimate the incidence rate of re-fracture and all-cause mortality rate in patients with hip fractures caused by minor trauma in the first year following the event. MATERIALS AND METHODS This is a retrospective cohort study of patients over 50 years of age conducted in a referral hospital located in Tehran (Shafa-Yahyaian). Using the hospital information system (HIS), all patients hospitalized due to hip fractures caused by minor trauma during 2013-2019 were included in the study. We investigated the occurrence of death and re-fracture in all patients one year after the primary hip fracture. RESULTS A total of 945 patients with hip fractures during a 307,595 person-days of follow-up, were included. The mean age of the participants was 71 years (SD = 11.19), and 533 (59%) of them were women. One hundred forty-nine deaths were identified during the first year after hip fracture, resulting in a one-year mortality rate of 17.69% (95% CI: 15.06-20.77). The one-year mortality rate was 20.06% in men and 15.88% in women. Out of all the participants, 667 answered the phone call, of which 29 cases had experienced a re-fracture in the first year (incidence rate = 5.03%, 95% CI: 3.50-7.24). The incidence rates in women and men were 6.07% and 3.65%, respectively. CONCLUSION Patients with low-trauma hip fractures have shown a high rate of mortality in the first year. Considering the increase in the incidence of hip fractures with age, comprehensive strategies are needed to prevent fractures caused by minor trauma in the elderly population.
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Affiliation(s)
- Vahideh Mohseni
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Ansarifar
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Safdar Masoumi
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Khalagi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Mansourzadeh
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Masoud Solaymani-Dodaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
- Minimally Invasive Surgery Research Center, Hazrat-e-Rasool Hospital, Iran University of Medical Science, Tehran, Iran.
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Murphy EP, Murphy RP, McKenna D, Miller P, Doyle R, Hurson C. Improved adherence to hip fracture standards reduces mortality after hip fractures. Surgeon 2024; 22:25-30. [PMID: 37517981 DOI: 10.1016/j.surge.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/11/2023] [Accepted: 06/25/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Hip fractures are increasing in incidence due to increasing life expectancy. Mortality continues to improve but it is important to explore which factors are responsible for driving improvements. METHODS A cohort of hip fracture patients predating SARS-CoV-2 was examined to determine the predictors of adherence to the six Irish Hip Fracture Standards (IHFS) and the impact of adherence on short (30 day) and long term (1 year) mortality. Our primary aim was assess the impact of a single HFS and cumulative number of HFS on mortality after hip fracture. Our secondary aim was to determine the impact of the HFS which are intrinsically linked to specialist Geriatric care. RESULTS Across 962 patients, over 5 years, the factors which were associated with adherence to HFS were female gender, increasing ASA grade and being nursed on an orthopaedic ward. Patients with increasing ASA were more likely to have met HFS 4-6 (Geriatrician review HFS4, bone health HFS5 & specialist falls assessment HFS6), less likely to have surgery within 48 h are more likely to develop a pressure ulcer. If the patient was not nursed on an orthopaedic ward all HFS were less likely to be met. At 30 days HFS 4-6 were associated with a statistically significant odds ratio (OR) of being alive, while at one year HFS 1 (admitted to an orthopaedic ward within 4 h), 5 and 6 were associated with a statistically significant OR of being alive. As increasing numbers of hip fracture standards were met patients were more likely to be alive at 30 days and one year. CONCLUSION This study has identified that improved adherence to hip fracture standards are associated with improved mortality at 30 days and one year.
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Affiliation(s)
- E P Murphy
- Department of Trauma and Orthopaedics, St Vincents University Hospital Elm Park, Dublin 4, Ireland.
| | - R P Murphy
- Department of Geriatric and Stroke Medicine, Saolta Hospital Group, Galway University Hospital, Newcastle Road, Galway, Ireland.
| | - D McKenna
- Department of Trauma and Orthopaedics, St Vincents University Hospital Elm Park, Dublin 4, Ireland.
| | - P Miller
- Department of Trauma and Orthopaedics, St Vincents University Hospital Elm Park, Dublin 4, Ireland.
| | - R Doyle
- Department of Geriatric Medicine, St. Vincents University Hospital Elm Park, Dublin 4, Ireland.
| | - C Hurson
- Department of Trauma and Orthopaedics, St Vincents University Hospital Elm Park, Dublin 4, Ireland.
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Loh B, Jiang L, Timing L, Kong N, Ganesan G, Tan KB, Bee S, Koh JSB, Howe TS, Huei NY. Predictors of 10-year Mortality After Hip Fracture Surgery in a Pre-Pandemic Cohort. Geriatr Orthop Surg Rehabil 2023; 14:21514593231216558. [PMID: 38023062 PMCID: PMC10655639 DOI: 10.1177/21514593231216558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Though hip fractures are associated with significant mortality and morbidity, increasing life expectancy in developed countries necessitates an analysis of mortality trends and factors predicting long term survival. The aim of this study is to identify the predictors of 10-year mortality as well as assess the correlation of Age-adjusted Charlson comorbidity index (ACCI) with 10-year mortality in a surgically treated Asian geriatric hip fracture population. Materials and Methods From January 1, 2007 to December 31, 2009, 766 patients who underwent surgery for hip fracture with a minimum follow up of 10-years were recruited to the study (92% follow-up rate). A review of the patient's electronic hospital records was performed to glean the following data: patient demographics, pre-existing comorbidities, operation duration, length of stay, fracture configuration, as well as mortality data up to 10 years. CCI scores and individual co-morbidities were correlated with inpatient, 30-day, 1-year, 5-year and beyond 10-year mortality. Results Of the 766 patients, the mortality rate for 30-day, 1-year, 5-year and 10-years was 2.9%, 12.0%, 38.9% and 61.6% respectively. The average ACCI was 5.31. The 10-year mortality for patients with ACCI ≤ 3, ACCI 4-5 and ACCI ≥ 6 are 29.4%, 57.4% and 77.5% respectively. End-Stage-Renal Failure (ESRF), liver failure and COPD were dominant predictors of mortality at 10 years, whereas cancer was the predominant predictor at 1 year. Discussion ACCI significantly correlates with the 10-year mortality after surgically treated hip fractures with a shift of the dominant predictors from cancer to ESRF and COPD. This could inform future health policy and resource planning. This data also represents recently available pre-pandemic survival trends after hip fracture surgery and serves as a baseline for post-pandemic outcome surveillance of interventions for fragility fractures. Conclusion This study demonstrates that ACCI correlated with 10-year mortality after surgical treatment of hip fractures.
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Affiliation(s)
- Bryan Loh
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
| | - Lei Jiang
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
| | - Liu Timing
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
| | - Naomi Kong
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
| | | | | | - Suang Bee
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
- Ministry of Health, Singapore
| | | | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
| | - Ng Yeong Huei
- Department of Orthopaedic Surgery, Singapore General Hosptial, Singapore
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George J, Sharma V, Farooque K, Trikha V, Mittal S, Malhotra R. Excess mortality in elderly hip fracture patients: An Indian experience. Chin J Traumatol 2023; 26:363-368. [PMID: 37598017 PMCID: PMC10755790 DOI: 10.1016/j.cjtee.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/03/2023] [Accepted: 05/15/2023] [Indexed: 08/21/2023] Open
Abstract
PURPOSE Hip fractures in elderly have a high mortality. However, there is limited literature on the excess mortality seen in hip fractures compared to the normal population. The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population. METHODS There are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study. Patients were followed up for 1 year and the follow-up record was available for 279 patients. Mortality was assessed during the follow-up from chart review and/or by telephonic interview. One-year mortality of Indian population was obtained from public databases. Standardized mortality ratio (SMR) (observed mortality divided by expected mortality) was calculated. Kaplan-Meir analysis was used. RESULTS The overall 1-year mortality was 19.0% (53/279). Mortality increased with age (p < 0.001) and the highest mortality was seen in those above 80 years (aged 50 - 59 years: 5.0%, aged 60 - 69 years: 19.7%, aged 70 - 79 years: 15.8%, and aged over 80 years: 33.3%). Expected mortality of Indian population of similar age and gender profile was 3.7%, giving a SMR of 5.5. SMR for different age quintiles were: 3.9 (aged 50 - 59 years), 6.6 (aged 60 - 69 years), 2.2 (aged 70 - 79 years); and 2.0 (aged over 80 years). SMR in males and females were 5.7 and 5.3, respectively. CONCLUSIONS Indian patients sustaining hip fractures were about 5 times more likely to die than the general population. Although mortality rates increased with age, the highest excess mortality was seen in relatively younger patients. Hip fracture mortality was even higher than that of myocardial infarction, breast cancer, and cervical cancer.
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Affiliation(s)
- Jaiben George
- Department of Orthopedic Surgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Vijay Sharma
- Department of Orthopedic Surgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Kamran Farooque
- Department of Orthopedic Surgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Trikha
- Department of Orthopedic Surgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Samarth Mittal
- Department of Orthopedic Surgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopedic Surgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Guo S, Liu H. Admission on weekends does not increase mortality after hip fracture: a meta-analysis of 1.4 million patients. Scott Med J 2023; 68:149-158. [PMID: 37427423 DOI: 10.1177/00369330231186433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND The "weekend" effect resulting in increased complication rates in patients admitted on weekends has been noted in many diseases. OBJECTIVE This systematic review and meta-analysis aimed to collate adjusted data from published studies to assess if admission on weekends as compared to weekdays increases mortality rates in hip fracture patients. METHODS Databases of PubMed, CENTRAL, Scopus, Web of Science, and Embase were searched up to 31st December 2022 for studies comparing mortality between weekend versus weekday admission of hip fracture patients. Adjusted hazard ratios (HR) were pooled. RESULTS Fourteen studies including 1,487,986 patients were analyzed. Most studies were from Europe and North America. Results showed no difference in mortality rates of hip fracture patients admitted on weekends versus weekdays (HR: 1.00 95% 0.96, 1.04 I2 = 75%). There was no publication bias and results did not change on the leave-one-out analysis. Subgroup analysis based on sample size and treatment did not change outcomes. CONCLUSION This meta-analysis has shown no apparent weekend effect in cases of hip fractures. Patients admitted on weekends had similar mortality rates as compared to those admitted on weekdays. Current data has high heterogeneity and is mostly from developed countries.
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Affiliation(s)
- Siyuan Guo
- Department of Physical Education, Taiyuan Institute of Technology, Taiyuan, Shanxi, China
| | - Hao Liu
- Department of Physical Education, Taiyuan Institute of Technology, Taiyuan, Shanxi, China
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Ge Y, Chen Y, Liu G, Zhu S, Li B, Tian M, Zhang J, Wu X, Yang M. Association Between Hip Bone Mineral Density and Mortality Risk After Hip Fracture: A Prospective Cohort Study. Calcif Tissue Int 2023; 113:295-303. [PMID: 37347299 PMCID: PMC10449952 DOI: 10.1007/s00223-023-01109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
Factors related to mortality after osteoporotic hip fracture (HF) have been investigated intensively, except for proximal femoral bone mineral density (BMD), which is also the primary cause of osteoporosis. In this study, we aimed to investigate the association of hip BMD with mortality risk after HF. Four hundred and eleven elderly patients with HF in Beijing, China, were included and prospectively followed up with a median time of 3 years. At baseline, quantitative CT technique (QCT) was used to measure areal BMD (aBMD) of the unaffected hip. Areal BMDs of the total hip (TH), femoral neck (FN), trochanter (TR), and intertrochanter were analyzed with postoperative mortality as the primary outcome. A total of 394 patients (78.59 ± 7.59 years, 75.4% female) were included in our final analysis, with 86 (82.23 ± 7.00 years, 81.4% female) dead. All hip bone densities demonstrated a significant association with mortality risks in the unadjusted model, but only TR aBMD remained significantly correlated after adjusting for all covariates. Compared to the lower TR aBMD group, the higher TR aBMD group yielded significantly lower death risks (HR 0.21 95% CI 0.05-0.9, P = 0.036). Higher survival probabilities were observed for higher TH and TR aBMD in survival analysis (P < 0.001). Hip BMD, especially TR BMD assessed by QCT, is an independent risk factor for postoperative mortality following HF. QCT may present a promising avenue for opportunistic analysis in immobilized patients, providing valuable information for early detection and personalized interventions to enhance patient outcomes.
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Affiliation(s)
- Yufeng Ge
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Yimin Chen
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Gang Liu
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Shiwen Zhu
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Bo Li
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Maoyi Tian
- The George Institute for Global Health at Peking University Health Science Centre, Beijing, China
| | - Jing Zhang
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China.
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Hua Y, Li Y, Zhou J, Fan L, Huang F, Wu Z, Xue H, Yang B, Chen P, Rui Y, Tian Y, Moayyeri A, Libanati C, Du W. Mortality following fragility hip fracture in China: a record linkage study. Arch Osteoporos 2023; 18:105. [PMID: 37498371 DOI: 10.1007/s11657-023-01304-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023]
Abstract
Mortality risk declined over time. Patients with fragility hip fracture experienced an approximate ninefold excess mortality, peaking shortly after fracture, in comparison with that of the general population. Continuous efforts in lowering the occurrence of hip fracture have the potential to improve the survival of the elderly population in China. PURPOSE Hip fractures in older adults often lead to an elevated risk of death. However, few studies investigated mortality risk following hip fracture in mainland China. This retrospective cohort study aimed to evaluate the crude mortality and excess mortality after fragility hip fractures in Lishui residents aged 50 years and older. METHODS Patients having a fragility hip fracture between October 2013 and August 2019 were identified from the Lishui District Inpatient Data Collection and followed up until August 2020. Death information was ascertained from the linked death registry records. We calculated the follow-up mortality rate and corresponding 95% confidence intervals (CIs) as well as the standard mortality ratios (SMRs) in comparison with the mortality rates of Lishui residents. RESULTS During the study period, a total of 808 patients (63.4% females) with an average age of 75 years were admitted for fragility hip fractures. The 1st, 2nd, and 3rd year follow-up mortality rates were 16.51, 6.06, and 5.03 per 100 person-year, respectively. The SMRs were 8.46 (6.94, 9.97), 5.74 (4.86, 6.63), and 4.63 (3.98, 5.27) for the 1st, 2nd, and 3rd year following fragility hip fracture. CONCLUSION Although mortality risk declined over time, patients with fragility hip fracture experienced an approximate ninefold excess mortality, peaking shortly after fracture, in comparison with that of the general population. Continuous efforts in lowering the occurrence of hip fracture have the potential to improve the survival of the elderly population in China.
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Affiliation(s)
- Yiwen Hua
- School of Public Health, Southeast University, Gulou District, 87 Dingjiaqiao, Nanjing, 210000, Jiangsu, China
| | - Ying Li
- School of Public Health, Southeast University, Gulou District, 87 Dingjiaqiao, Nanjing, 210000, Jiangsu, China
| | | | - Lijun Fan
- School of Public Health, Southeast University, Gulou District, 87 Dingjiaqiao, Nanjing, 210000, Jiangsu, China
| | - Feng Huang
- School of Public Health, Southeast University, Gulou District, 87 Dingjiaqiao, Nanjing, 210000, Jiangsu, China
| | - Zhanpo Wu
- Department of Trauma Orthopedics, Lishui Renmin Hospital & Zhongda Hospital, Nanjing, China
| | - Hui Xue
- School of Public Health, Southeast University, Gulou District, 87 Dingjiaqiao, Nanjing, 210000, Jiangsu, China
| | - Bingquan Yang
- Department of Trauma Orthopedics, Lishui Renmin Hospital & Zhongda Hospital, Nanjing, China
| | - Ping Chen
- Lishui Smart City Operating Command Center, Nanjing, China
| | - Yunfeng Rui
- Department of Trauma Orthopedics, Lishui Renmin Hospital & Zhongda Hospital, Nanjing, China
| | - Yong Tian
- School of Public Health, Southeast University, Gulou District, 87 Dingjiaqiao, Nanjing, 210000, Jiangsu, China
| | | | | | - Wei Du
- School of Public Health, Southeast University, Gulou District, 87 Dingjiaqiao, Nanjing, 210000, Jiangsu, China.
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10
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Nishimura Y, Inagaki Y, Noda T, Nishioka Y, Myojin T, Ogawa M, Kido A, Imamura T, Tanaka Y. Risk factors for mortality after hip fracture surgery in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Arch Osteoporos 2023; 18:91. [PMID: 37418095 PMCID: PMC10329059 DOI: 10.1007/s11657-023-01293-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023]
Abstract
We investigated the risk factors for mortality of hip fracture in the elderly using the National Database of Health Insurance Claims in Japan, and survival was significantly related to sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism. PURPOSE Hip fracture is the most common fracture in the elderly and is known to have a high mortality rate. In Japan, to the best of our knowledge, no studies have reported on mortality risk factors for hip fracture using nationwide registry databases. This study aimed to determine the number of occurrences of hip fracture and factors that increase mortality using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. METHODS This study included extracted data from patients who were hospitalized and underwent surgical treatment for hip fracture between 2013 and 2021, using a nationwide health insurance claims database in Japan. Patient characteristics, such as sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism, were tabulated to obtain 1-year and in-hospital mortality rates. RESULTS Both 1-year and in-patient survival were significantly lower in men, older patients, patients who underwent surgery after 3 days of admission, and patients with trochanteric and subtrochanteric fractures, internal fixation, more preoperative comorbidities, blood transfusions, and pulmonary embolism. CONCLUSIONS Survival was significantly related to sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism. As the number of male patients with hip fracture will increase with the aging of society, medical staff must provide sufficient information before surgery to avoid postoperative mortality.
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Affiliation(s)
- Yuki Nishimura
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
| | - Yusuke Inagaki
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan.
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan.
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Munehiro Ogawa
- Department of Sports Medicine, Nara Medical University, Kashihara, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
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11
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Chulsomlee K, Prukviwat S, Tuntiyatorn P, Vasaruchapong S, Kulachote N, Sirisreetreerux N, Tanphiriyakun T, Chanplakorn P, Sa-Ngasoongsong P. Correlation between shape-closed femoral stem design and bone cement implantation syndrome in osteoporotic elderly femoral neck fracture undergoing cemented hip arthroplasty: A retrospective case-control study in 128 patients. Orthop Traumatol Surg Res 2023; 109:103450. [PMID: 36273503 DOI: 10.1016/j.otsr.2022.103450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bone cement implantation syndrome (BCIS) is a serious and potentially fatal complication especially in patients with osteoporotic femoral neck fracture (OFNF) undergoing cemented hip arthroplasty (CHA). Recent studies showed that the shape-closed femoral stem profile could lead to a significant increase of the intramedullary pressure during cementation and prosthesis insertion. This study aimed to (1) correlate the use of shaped-closed femoral stem and other perioperative risk factors with severe grade of BCIS grade 2 or 3: BCIS gr2/3, and (2) identify the prevalence of BCIS in the elderly patients with OFNF and treated with CHA. HYPOTHESIS Large wedge-shaped (or "shape-closed") femoral stem design would significantly associate with BCIS gr2/3 in the elderly patients who sustained OFNF and underwent CHA. PATIENTS AND METHODS A total of 128 OFNF patients, who aged over 75years and underwent CHA were retrospectively reviewed and then allocated into 2 groups: SC Group (use shape-closed femoral stem, n=40) and FC Group (use force-closed femoral stem, n=88). BCIS was grading in all patients according to Donaldson classification. Perioperative data between the patients with BCIS-gr2/3 and those with BCIS grade 0 or 1 (BCIS-gr0/1) were compared. Multiple logistic regression analysis was used to identify predictive factors for BCIS-gr2/3. RESULTS The prevalence of overall BCIS and BCIS-gr2/3 was 32.8% (n=42) and 6.2% (n=8), respectively. The total in-hospital and 1-year mortality rates were 2.3% and 4.7%, respectively. The major perioperative complication in patients with BCIS-gr2/3 was significantly higher compared to those in patients with BCIS-gr0/1 (62.5% vs. 10.0%, p=0.001). Multivariate analysis showed that age>90years (OR=9.4, 95% CI: 1.4-62.9, p=0.02), preinjury Parker mobility score<4 (OR=48.8; 95% CI: 2.7-897.2, p=0.008) and shape-closed femoral stem used (OR=19.1; 95% CI: 1.8-204.5, p=0.01) were the significant independent predictors for BCIS-gr2/3 in these patients. CONCLUSION BCIS in OFNF patients undergoing CHA is common and associates with a high major perioperative complication rate. Our initial hypothesis is validated as the patients at risk for BCIS-gr2/3 are those whose CHA procedures use a shape-closed femoral stem design and with extreme age, and having poor preinjury ambulatory status. Therefore, we recommended using cementless stem as the first option in OFNF. However, if CHA is needed, strict guideline for cement insertion should be followed with force-closed stem application to avoid the risk of BCIS-gr2/3. LEVEL OF EVIDENCE III; retrospective case-control study.
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Affiliation(s)
- Kulapat Chulsomlee
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasichol Prukviwat
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panithan Tuntiyatorn
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Satetha Vasaruchapong
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Noratep Kulachote
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Norachart Sirisreetreerux
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thiraphat Tanphiriyakun
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pongsthorn Chanplakorn
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paphon Sa-Ngasoongsong
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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12
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Hoit G, Whelan DB, Atrey A, Ravi B, Ryan G, Bogoch E, Davis AM, Khoshbin A. Association of age, sex and race with prescription of anti-osteoporosis medications following low-energy hip fracture in a retrospective registry cohort. PLoS One 2022; 17:e0278368. [PMID: 36454910 PMCID: PMC9714945 DOI: 10.1371/journal.pone.0278368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Initiation of anti-osteoporosis medications after hip fracture lowers the risk of subsequent fragility fractures. Historical biases of targeting secondary fracture prevention towards certain groups may result in treatment disparities. We examined associations of patient age, sex and race with anti-osteoporosis medication prescription following hip fracture. METHODS A cohort of patients with a hip fracture between 2016-2018 was assembled from the American College of Surgeons National Surgical Quality Improvement Program registry. Patients on anti-osteoporosis medications prior to admission were excluded. Multivariable logistic regression was used to determine adjusted associations between patient age, sex and race and their interactions with prescription of anti-osteoporosis medications within 30 days of surgery. RESULTS In total, 12,249 patients with a hip fracture were identified with a median age of 82 years (IQR: 73-87), and 67% were female (n = 8,218). Thirty days postoperatively, 26% (n = 3146) of patients had been prescribed anti-osteoporosis medication. A significant interaction between age and sex with medication prescription was observed (p = 0.04). Male patients in their 50s (OR:0.75, 95%CI:0.60-0.92), 60s (OR:0.81, 95%CI:0.70-0.94) and 70s (OR:0.89, 95%CI:0.81-0.97) were less likely to be prescribed anti-osteoporosis medication compared to female patients of the same age. Patients who belonged to minority racial groups were not less likely to receive anti-osteoporosis medications than patients of white race. INTERPRETATION Only 26% of patients were prescribed anti-osteoporosis medications following hip fracture, despite consensus guidelines urging early initiation of secondary prevention treatments. Given that prescription varied by age and sex, strategies to prevent disparities in secondary fracture prevention are warranted.
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Affiliation(s)
- Graeme Hoit
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Daniel B. Whelan
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Unity Health – St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Amit Atrey
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Unity Health – St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gareth Ryan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Earl Bogoch
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Unity Health – St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Aileen M. Davis
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Amir Khoshbin
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Unity Health – St. Michael’s Hospital, Toronto, Ontario, Canada
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13
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Wu PY, Chen SC, Lin YC, Chen PC, Chung WS, Huang YC, Wu PH, Tsai YC, Huang JC, Chiu YW, Chang JM. Role of Fracture Risk Assessment Tool and Bone Turnover Markers in Predicting All-Cause and Cardiovascular Mortality in Hemodialysis Patients. Front Med (Lausanne) 2022; 9:891363. [PMID: 35463031 PMCID: PMC9021425 DOI: 10.3389/fmed.2022.891363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Fracture Risk Assessment Tool (FRAX) and bone turnover markers (BTMs) predict fractures in the general population. However, the role of FRAX and BTMs in predicting mortality remains uncertain in hemodialysis (HD) patients. Methods One hundred and sixty-four HD patients stratified by low or high risk of 10-year fracture probability using FRAX. High risk of fracture was defined as 10-year probability of hip fracture ≥3% or major osteoporotic fracture ≥20%. The association of high risk of fracture and BTMs with all-cause mortality and cardiovascular (CV) mortality were evaluated using multivariate-adjusted Cox regression analysis. Results Eighty-five (51.8%) patients were classified as high risk of fracture based on FRAX among 164 HD patients. During a mean follow-up period of 3.5 ± 1.0 years, there were 39 all-cause deaths and 23 CV deaths. In multivariate-adjusted Cox regression, high risk of fracture based on FRAX was independently associated with all-cause mortality [hazard ratio (HR): 2.493, 95% confidence interval (CI): 1.026–6.056, p = 0.044) but not with CV mortality (HR: 2.129, 95% CI: 0.677–6.700, p = 0.196). There were no associations between BTMs and mortality risk. Furthermore, lower geriatric nutritional risk index (GNRI) was significantly associated with increased CV mortality (HR: 0.888, 95% CI: 0.802–0.983, p = 0.022) after adjusting by confounding variables. Conclusion High risk of fracture using FRAX was an independent predictor of all-cause mortality in patients undergoing HD. FRAX, rather than BTMs, has an important role of prognostic significance in HD patients.
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Affiliation(s)
- Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ching Lin
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Doctoral Degree Program of Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chih Chen
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Shiuan Chung
- Department of Radiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Radiology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Chin Huang
- Department of Preventive Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Occupational & Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Hsun Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chun Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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14
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Wantonoro W, Shyu YIL, Chen ML, Tsai HH, Chen MC, Wu CC. Functional Status in Older Persons After Hip Fracture Surgery: A Longitudinal Study of Indonesian Patients. J Nurs Res 2022; 30:e211. [PMID: 34690333 DOI: 10.1097/jnr.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hip fractures are one of the most serious injuries affecting older adults. Evidence-based knowledge regarding the functional status of older persons after hip fracture can provide information critical for developing effective continuous-care and rehabilitation programs. PURPOSE This study was developed to examine the post-hospital-discharge outcome measures and predictors of functional status in older adults in Indonesia after hip fracture surgery. METHODS The functional status of 109 patients discharged from an orthopedic hospital in Indonesia after hip fracture surgery was evaluated in this prospective cohort study. Functional status was evaluated using measures of physical and independent activities of daily living (PADL and IADL, respectively) at 1, 3, and 6 months postdischarge. Predictors of changes in functional status, including age, length of hospital stay, comorbidity, prefracture walking ability, type of surgery, status of depression and nutrition, type of insurance, and residential status (urban vs. rural), were also examined. Data were analyzed using generalized estimating equations. RESULTS Significant improvements in PADL were found at 3 and 6 months, and significant improvements in IADL were found at 6 months. Predictors of poor outcomes found in this study included age, a dependent prefracture walking ability, depression, and having public health insurance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The findings of this study support the effectiveness of using presurgery assessments to identify individuals at a higher postdischarge risk of having poor PADL and IADL outcomes. Home nursing or subacute rehabilitation is recommended to improve and maintain functional status in older persons after hip fracture surgery. In addition, interventions and rehabilitation should take into consideration different recovery periods for PADL and IADL after hospital discharge after hip fracture surgery.
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Affiliation(s)
- Wantonoro Wantonoro
- PhD, CNS, RN, Lecturer, Faculty of Health Science, Department of Nursing, Universitas 'Aisyiyah, Yogyakarta, Indonesia
| | - Yea-Ing Lotus Shyu
- PhD, RN, FAAN, Distinguished Professor, School of Nursing, College of Medicine, and Healthy Aging Research Center, Chang Gung University; Research Fellow, Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital; and Adjunct Professor, Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taiwan, ROC
| | - Mei-Ling Chen
- PhD, RN, Professor, School of Nursing, College of Medicine, Chang Gung University, Taiwan, ROC
| | - Hsiu-Hsin Tsai
- PhD, RN, Professor, School of Nursing, College of Medicine, Chang Gung University, Taiwan, ROC
| | - Min-Chi Chen
- PhD, Professor, Department of Public Health & Biostatistics Consulting Center, Chang Gung University, Taiwan, ROC
| | - Chi-Chuan Wu
- MD, Professor and Attending Physician, Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taiwan, ROC
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15
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Kobayashi S, Tanaka S, Yoshino Y, Tobita H, Kuwagaki K, Fujioka R, Totsuka H, Ichiba Y, Ishimine S, Sakamoto K, Ohama H, Kubo T. Impact of osteoporosis liaison services on the expected lifetime osteoporosis-related medical expenses of patients with fragility fracture in a private hospital in Japan. Arch Osteoporos 2022; 17:64. [PMID: 35416539 DOI: 10.1007/s11657-022-01101-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/18/2022] [Indexed: 02/03/2023]
Abstract
We report the efficacy of a Japanese fracture liaison service (FLS), the osteoporosis liaison service (OLS), in suppressing osteoporosis-related expenses from the public insurance by preventing secondary fracture in spite of higher medication costs during expected life spans. OLS could reduce medical expenses for osteoporosis in all age groups. PURPOSE Osteoporosis liaison services (OLS), which are based on fracture liaison services (FLS), are used in Japan to prevent both primary and secondary fractures in older people. We aimed to clarify the effects of OLS on the medical expenses. PATIENTS AND METHODS We compared patients with fragile fractures hospitalized to Saitama Jikei Hospital before and after implementing OLS. These were labeled a non-OLS group and an OLS group, and they were further organized by age (< 75, 75-84, and ≥ 85 years). The expected osteoporosis-related medical expenses during life were calculated by the occurrence, fracture site, medication, and life expectancy and compared between the non-OLS and OLS groups by the age group. RESULTS The non-OLS group included 400 people (100 males and 300 females, mean age 81.7 ± 9.7 years), comprising 154 with vertebral fractures and 246 with hip fractures. The OLS group included 406 patients (101 males and 305 females, mean age 82.4 ± 9.3 years), of whom 161 had vertebral fractures and 245 had hip fractures. The suppressive secondary fracture effects of OLS were previously reported. The expected expense of osteoporosis treatment in the OLS group was found to be greater than that in the non-OLS group for all age groups. In contrast, expected expenses for treating secondary fractures were shown to increase more in the non-OLS group. However, total expenses were lower in the OLS group across all age groups. CONCLUSION The implementation of OLS can reduce overall healthcare costs despite the increased expenses required to provide medical therapy and periodic examinations.
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Affiliation(s)
- Saori Kobayashi
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
| | - Shinya Tanaka
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan.
- Department of Orthopaedic Surgery, Saitama Northern Medical Center, Japan Community Health Organization, 851, Miyahara 1 chome, Kita-ku, Saitama-city, Saitama, 331-8625, Japan.
- Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan.
- Department of Orthopedic Surgery, Saitama Jikei Hospital, Saitama, Japan.
| | - Yasumasa Yoshino
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Department of Orthopedic Surgery, Saitama Jikei Hospital, Saitama, Japan
| | - Hideki Tobita
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Department of Rehabilitation, Saitama Jikei Hospital, Saitama, Japan
| | - Kanae Kuwagaki
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Department of Rehabilitation, Saitama Jikei Hospital, Saitama, Japan
| | - Rie Fujioka
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Nutrition of Saitama Jikei Hospital, Saitama, Japan
| | - Hiroaki Totsuka
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Pharmacy of Saitama Jikei Hospital, Saitama, Japan
| | - Yuka Ichiba
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Nursing Department of Saitama Jikei Hospital, Saitama, Japan
| | - Sachiko Ishimine
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Nursing Department of Saitama Jikei Hospital, Saitama, Japan
| | - Kazumi Sakamoto
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Department of Radiology, Saitama Jikei Hospital, Saitama, Japan
| | - Hikaru Ohama
- Osteoporosis Liaison Service, Saitama Jikei Hospital, Saitama, Japan
- Department of Orthopedic Surgery, Saitama Jikei Hospital, Saitama, Japan
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16
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Manosroi W, Atthakomol P, Isaradech N, Phinyo P, Vaseenon T. Preoperative Correction of Low Hemoglobin Levels Can Reduce 1-Year All-Cause Mortality in Osteoporotic Hip Fracture Patients: A Retrospective Observational Study. Clin Interv Aging 2022; 17:165-173. [PMID: 35210763 PMCID: PMC8860348 DOI: 10.2147/cia.s354519] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/04/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose Osteoporotic hip fracture surgery is associated with a risk of morbidity and mortality. Admission hemoglobin levels <10 g/dL have been documented as a strong predictor of mortality risk. This study aimed to investigate the mortality outcome between osteoporotic hip fracture patients who had preoperative hemoglobin levels raised to ≥10 g/dL and those with hemoglobin levels were <10 g/dL. Patients and Methods This 5-year retrospective observational study included 226 participants with osteoporotic hip fractures that required surgery and who had admission hemoglobin levels <10 g/dL. Patients were categorized into two groups: those with corrected preoperative hemoglobin ≥10 g/dL and those with either corrected or uncorrected preoperative hemoglobin <10 g/dL. Outcomes were analyzed using Cox proportional hazard regression adjusted for confounders. Results are presented as hazard ratio (HR) and 95% confidence interval (95% CI). Results Among 226 the patients, the overall mortality rate was 17.25% (n=39/226) of the 226 patients, 93 (41.15%) had their hemoglobin levels raised to ≥10 g/dL by red blood cell transfusion. Multivariable analysis after adjustment for confounders showed a 50% lower incidence of mortality among patients with preoperative hemoglobin levels ≥10 g/dL than among those with hemoglobin levels <10 g/dL (HR 0.50, 95% CI (0.25–0.99), p=0.048). Conclusion In osteoporotic hip fracture patients with admission hemoglobin <10g/dL, raising preoperative hemoglobin levels to ≥10 g/dL can significantly reduce the risk of mortality. Testing for and correction of low preoperative hemoglobin levels is of value in hip surgery patients.
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Affiliation(s)
- Worapaka Manosroi
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pichitchai Atthakomol
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Correspondence: Pichitchai Atthakomol, Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Muang Chiang Mai, Thailand, Tel +66 53 936453 Email
| | - Natthanaphop Isaradech
- Biomedical Informatics Center, Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanawat Vaseenon
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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17
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Fu TS, Huang TS, Sun CC, Shyu YC, Chen FP. Impact of bisphosphonates and comorbidities on initial hip fracture prognosis. Bone 2022; 154:116239. [PMID: 34688941 DOI: 10.1016/j.bone.2021.116239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/28/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study is to investigate the impact of bisphosphonate treatment on the prognosis of patients with initial hip fracture. Patients aged fifty years and older with initial hip fracture were identified from the Taiwan National Health Insurance Research Database between 2002 and 2011. A multi-state model was established to evaluate the transition between "first to second hip fracture", "first hip fracture to death", and "second hip fracture to death". Transition probability and cumulative hazards were used to compare the prognosis of initial hip fracture in a bisphosphonate treated cohort versus non-treated cohort. In addition, Deyo-Charlson comorbidities, both vertebral and non-vertebral fractures, and cataracts were also included for analysis. After 10-year follow-up, there is decreased cumulative transition probability for both second hip fracture and mortality after both first and second hip fracture in the bisphosphonate treated cohort. Multivariable, transition-specific time-dependent Cox model revealed that bisphosphonate treatment significantly reduced risk for second hip fracture in the first 5 years of the treatment (HR 0.88; 95% CI 0.79-0.99; P: 0.034), first hip fracture mortality (HR 0.88; 95% CI 0.83-0.93; P < 0.001), and second hip fracture mortality in the first 2 years of the treatment (HR 0.78; 95% CI 0.65-0.95; P = 0.011). Female sex, both vertebral and non-vertebral fractures, cataracts, dementia in the first 2 years, and DM with complication were all significantly associated with risk of a second hip fracture. Cerebrovascular disease and hemiplegia comorbidities had less risk of a second hip fracture. The risk of mortality after both first and second hip fracture was significantly associated with congestive heart failure, renal disease, myocardial infarction, and moderate to severe liver disease. Our study demonstrated that bisphosphonate treatment and strict management of comorbidities after the initial hip fracture significantly decrease the risk for a second hip fracture and mortality.
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Affiliation(s)
- Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 259, Taiwan; Osteoporosis Prevention and Treatment Center, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Ting-Shuo Huang
- Osteoporosis Prevention and Treatment Center, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; Department of Chinese Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 259, Taiwan; Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Chi-Chin Sun
- Osteoporosis Prevention and Treatment Center, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; Department of Chinese Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 259, Taiwan; Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; Institute of Molecular Biology, Academia Sinica, Nankang, 115 Taipei, Taiwan
| | - Fang-Ping Chen
- Department of Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 259, Taiwan; Osteoporosis Prevention and Treatment Center, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan.
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18
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Liow MHL, Ganesan G, Chen JDY, Koh JSB, Howe TS, Yong EL, Kramer MS, Tan KB. Excess mortality after hip fracture: fracture or pre-fall comorbidity? Osteoporos Int 2021; 32:2485-2492. [PMID: 34129060 DOI: 10.1007/s00198-021-06023-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED Comorbidity and hip fracture independently increased mortality risk for 9 years in both sexes, with a significant additive interaction in the first year among women and through 6 years among men. INTRODUCTION Hip fracture is associated with a persistently elevated mortality risk, but it is unknown whether the elevated risk is due to the fracture or to pre-fracture comorbidity. METHODS In a population-based study in Singapore with 9 years of follow-up, patients age > 50 with first hip fracture from 2008 to 2017 were pair-matched to a cohort without hip fracture by age, sex, ethnicity, and pre-fracture Charlson Comorbidity Index (CCI). We investigated additive interaction using the relative excess risk due to interaction (RERI) and multiplicative interaction using the ratio of relative risks. RESULTS Twenty-two thousand five hundred ninety of 22,826 patients with a first hip fracture in 2008-2017 were successfully matched. Hip fracture and comorbidity independently increased mortality risk for 9 years in both sexes. After adjustment for comorbidity, excess mortality risk continued to persist for 9 years post-fracture in both men and women. Women with a hip fracture and pre-fracture CCI > 4 had a higher relative risk (RR) of mortality at 9 years of 3.29 [95% confidence interval (CI) 3.01, 3.59] than those without comorbidity (RR 1.51, 95%CI 1.36, 1.68) compared to the referent without hip fracture or comorbidity. An additive interaction between hip fracture and pre-fracture CCI > 4 was observed in the first post-fracture year` [relative excess risk due to interaction (RERI) 1.99, 95%CI 0.97, 3.01]. For men with CCI ≥ 4, the positive additive interaction was observed through 6 years. CONCLUSIONS Excess mortality risks post-fracture are attributable to both the fracture and pre-fracture comorbidity. Early interventions in hip fracture patients with high comorbidity could reduce their excess mortality.
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Affiliation(s)
- M H L Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - G Ganesan
- Division of Policy, Research and Evaluation, Ministry of Health, Singapore, Singapore
| | - J D Y Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - J S B Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - T S Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - E-L Yong
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, Singapore
| | - M S Kramer
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, Singapore
- Departments of Epidemiology, Biostatistics and Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Quebec, Montreal, H3G 1Y6, Canada
| | - K B Tan
- Division of Policy, Research and Evaluation, Ministry of Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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19
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Halalau A, Imam Z, Karabon P, Mankuzhy N, Shaheen A, Tu J, Carpenter C. External validation of a clinical risk score to predict hospital admission and in-hospital mortality in COVID-19 patients. Ann Med 2021; 53:78-86. [PMID: 32997542 PMCID: PMC7877986 DOI: 10.1080/07853890.2020.1828616] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/20/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Identification of patients with novel coronavirus disease 2019 (COVID-19) requiring hospital admission or at high-risk of in-hospital mortality is essential to guide patient triage and to provide timely treatment for higher risk hospitalized patients. METHODS A retrospective multi-centre (8 hospital) cohort at Beaumont Health, Michigan, USA, reporting on COVID-19 patients diagnosed between 1 March and 1 April 2020 was used for score validation. The COVID-19 Risk of Complications Score was automatically computed by the EHR. Multivariate logistic regression models were built to predict hospital admission and in-hospital mortality using individual variables constituting the score. Validation was performed using both discrimination and calibration. RESULTS Compared to Green scores, Yellow Scores (OR: 5.72) and Red Scores (OR: 19.1) had significantly higher odds of admission (both p < .0001). Similarly, Yellow Scores (OR: 4.73) and Red Scores (OR: 13.3) had significantly higher odds of in-hospital mortality than Green Scores (both p < .0001). The cross-validated C-Statistics for the external validation cohort showed good discrimination for both hospital admission (C = 0.79 (95% CI: 0.77-0.81)) and in-hospital mortality (C = 0.75 (95% CI: 0.71-0.78)). CONCLUSIONS The COVID-19 Risk of Complications Score predicts the need for hospital admission and in-hospital mortality patients with COVID-19. Key points: Can an electronic health record generated risk score predict the risk of hospital admission and in-hospital mortality in patients diagnosed with coronavirus disease 2019 (COVID-19)? In both validation cohorts of 2,025 and 1,290 COVID-19, the cross-validated C-Statistics showed good discrimination for both hospital admission (C = 0.79 (95% CI: 0.77-0.81)) and in-hospital mortality (C = 0.75 (95% CI: 0.71-0.78)), respectively. The COVID-19 Risk of Complications Score may help predict the need for hospital admission if a patient contracts SARS-CoV-2 infection and in-hospital mortality for a hospitalized patient with COVID-19.
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Affiliation(s)
- Alexandra Halalau
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Zaid Imam
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
| | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Nikhil Mankuzhy
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Aciel Shaheen
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
| | - John Tu
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Clinical Informatics, Beaumont Health, Southfield, MI, USA
| | - Christopher Carpenter
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Section of Infectious Disease, Beaumont Health, Royal Oak, MI, USA
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20
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Cher EWL, Carson JA, Sim EY, Abdullah HR, Howe TS, Koh Suang Bee J. Developing a Simpler Prognosticating Tool: Comparing the Combined Assessment of Risk Encountered in Surgery Score with Deyo-Charlson Comorbidity Index and The American Society of Anesthesiologists Physical Status Score in Predicting 2 years Mortality after Hip Fracture Surgery. Geriatr Orthop Surg Rehabil 2021; 12:21514593211036235. [PMID: 34595044 PMCID: PMC8477708 DOI: 10.1177/21514593211036235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: The use of risk stratification tools in identifying high-risk hip fracture patients plays an important role during treatment. The aim of this study was to compare our locally derived Combined Assessment of Risk Encountered in Surgery (CARES) score with the the American Society of Anesthesiologists physical status (ASA-PS) score and the Deyo–Charlson Comorbidity Index (D-CCI) in predicting 2-year mortality after hip fracture surgery. Methods and Material: A retrospective study was conducted on surgically treated hip fracture patients in a large tertiary hospital from Jan 2013 through Dec 2015. Age, gender, time to surgery, ASA-PS score, D-CCI, and CARES score were obtained. Univariate and multivariable logistic regression analyses were used to assess statistical significance of scores and risk factors, and area under the receiver operating characteristic (ROC) curve (AUC) was used to compare ASA-PS, D-CCI, and CARES as predictors of mortality at 2 years. Results: 763 surgically treated hip fracture patients were included in this study. The 2-year mortality rate was 13.1% (n = 100), and the mean ± SD CARES score of surviving and demised patients was 21.2 ± 5.98 and 25.9 ± 5.59, respectively. Using AUC, CARES was shown to be a better predictor of 2-year mortality than ASA-PS, but we found no statistical difference between CARES and D-CCI. A CARES score of 23, attributable primarily to pre-surgical morbidities and poor health of the patient, was identified as the statistical threshold for “high” risk of 2-year mortality. Conclusion: The CARES score is a viable risk predictor for 2-year mortality following hip fracture surgery and is comparable to the D-CCI in predictive capability. Our results support the use of a simpler yet clinically relevant CARES in prognosticating mortality following hip fracture surgery, particularly when information on the pre-existing comorbidities of the patient is not immediately available.
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Affiliation(s)
- Eric Wei Liang Cher
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - John Allen Carson
- Centre of Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Eileen Yilin Sim
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
| | | | - Tet Sen Howe
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Joyce Koh Suang Bee
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
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21
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Yong EL, Cheong WF, Huang Z, Thu WPP, Cazenave-Gassiot A, Seng KY, Logan S. Randomized, double-blind, placebo-controlled trial to examine the safety, pharmacokinetics and effects of Epimedium prenylflavonoids, on bone specific alkaline phosphatase and the osteoclast adaptor protein TRAF6 in post-menopausal women. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 91:153680. [PMID: 34352588 DOI: 10.1016/j.phymed.2021.153680] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/04/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Fragility fractures due to menopausal osteoporosis are a major cause of morbidity and mortality. Osteoporotic medications have substantial side effects that limit long term use. HYPOTHESES Ingestion of a purified extract of Epimedium spp. (EP) is safe, can increase serum levels of prenylflavonoid metabolites, exert positive changes in bone specific alkaline phosphatase (BSAP), suppress of tumor necrosis factor receptor associated factor 6 (TRAF6) protein in osteoclast-precursor monocytes in peripheral blood and therefore have the potential to reduce post-menopausal bone loss. STUDY DESIGN & METHODS Healthy postmenopausal women were randomized in a double-blind fashion to consume either EP prenylflavonoid extract (740 mg daily) or placebo daily for 6 weeks. The main outcome measures were safety and pharmacokinetics of EP flavonoids. Fasting blood was collected at 3- and 6-weeks, and two weeks after stopping medication for safety evaluations and measurement of BSAP. Peripheral blood monocytes were harvested for measurement of TRAF6 levels. Serum levels of the EP metabolites icariin, icariside I & II, icaritin and desmethylicaritin were measured using tandem mass spectrometry, and non-compartmental pharmacokinetic analyses performed using WinNonlin software. RESULTS Between October 2018 and Jun 2020, 58 postmenopausal women, aged 57.9 ± 8.9 years, were randomized and completed the study. Consumption of EP prenylflavonoids was not associated with any significant adverse symptoms, with no changes in hepatic, hematological, and renal parameters observed. The main metabolites detected in sera after ingestion of EP prenylflavonoid capsules were desmethylicaritin, icaritin and icariside II. Icariin and icariside I were below detection levels. Ingestion of EP prenylflavonoids induced a median Cmax and AUC0→∞ for desmethylicaritin of 60.9 nM, and 157.9 nM ×day, respectively; and were associated with higher levels of BSAP (p < 0.05) and a trend (p = 0.068) towards lower levels of TRAF6 in peripheral blood monocytes eight weeks after commencing prenylflavonoid ingestion. Prenylflavonoid metabolites were not detected in the sera of placebo participants. CONCLUSIONS Despite the widespread consumption of EP extracts, the safety, mechanisms of action of their bioactive compounds, and therapeutic indications in humans are unknown. Daily consumption of EP prenylflavonoids for six weeks was safe. The predominant metabolite in sera was desmethylicaritin. Rise in prenylflavonoid metabolites was associated with higher levels of the bone anabolic marker BSAP, suggesting potential therapeutic value for post-menopausal osteoporosis.
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Affiliation(s)
- Eu-Leong Yong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore.
| | - Wei Fun Cheong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore
| | - Zhongwei Huang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Institute of Molecular and Cell Biology, Agency of Science, Technology and Research, 138673 Singapore
| | - Win Pa Pa Thu
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore
| | - Amaury Cazenave-Gassiot
- Singapore Lipidomics Incubator, Life Sciences Institute, National University of Singapore, 117456 Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 117596 Singapore
| | - Kok Yong Seng
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, 117600 Singapore
| | - Susan Logan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore
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22
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Gatot C, Shern-En Tan E, Liow MHL, Yongqiang Chen J, Png MA, Tan MH, Howe TS, Bee Koh JS. Higher Charlson Comorbidity Index Increases 90-Day Readmission Rate with Poorer Functional Outcomes in Surgically Treated Hip Fracture Patients. Geriatr Orthop Surg Rehabil 2021; 12:21514593211036252. [PMID: 34422439 PMCID: PMC8371729 DOI: 10.1177/21514593211036252] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/04/2021] [Accepted: 12/07/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction The associated mortality and morbidity in hip fracture patients pose a major
healthcare burden for ageing populations worldwide. We aim to analyse how an
individual’s comorbidity profile based on age-adjusted Charlson Comorbidity
Index (CCI) may impact on functional outcomes and 90-day readmission rates
after hip fracture surgery. Materials and Methods Surgically treated hip fracture patients between 2013 and 2016 were followed
up for 1-year and assessed using Parker Mobility Score (PMS), EuroQol-5D
(EQ-5D) and Physical and Mental Component Scores (PCS and MCS, respectively)
of Short Form-36 (SF-36). Statistical analysis was done by categorising 444
patients into three groups based on their CCI: (1) CCI 0–3, (2) CCI 4–5 and
(3) CCI ≥ 6. Results PMS, EQ-5D and SF-36 PCS were significantly different amongst the CCI groups
pre-operatively and post-operatively at 3, 6 and 12 months (all
P < 0.05), with CCI ≥ 6 predicting for poorer
outcomes. In terms of 90-day readmission rates, patients who have been
readmitted have poorer outcome scores. Multivariate analysis showed that
high CCI scores and 90-day readmission rate both remained independent
predictors of worse outcomes for SF-36 PCS, PMS and EQ-5D. Discussion CCI scores ≥6 predict for higher 90-day readmission rates, poorer quality of
life and show poor potential for functional recovery 1-year post-operation
in hip fracture patients. 90-day readmission rates are also independently
associated with poorer functional outcomes. Peri-operatively, surgical teams
should liaise with medical specialists to optimise patients’ comorbidities
and ensure their comorbidities remain well managed beyond hospital discharge
to reduce readmission rates. With earlier identification of patient groups
at risk of poorer functional outcomes, more planning can be directed towards
appropriate management and subsequent rehabilitation. Conclusion Further research should focus on development of a stratified, peri-operative
multidisciplinary, hip-fracture care pathway treatment regime based on CCI
scores to determine its effectiveness in improving functional outcomes.
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Affiliation(s)
- Cheryl Gatot
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Evan Shern-En Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Meng Ai Png
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Mann Hong Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Joyce Suang Bee Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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23
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Gani L, Anthony N, Dacay L, Tan P, Chong LR, King TF. Incidence of Atypical Femoral Fracture and Its Mortality in a Single Center in Singapore. JBMR Plus 2021; 5:e10515. [PMID: 34368607 PMCID: PMC8328799 DOI: 10.1002/jbm4.10515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 12/29/2022] Open
Abstract
Bisphosphonates (BP) are the most commonly prescribed effective form of osteoporosis treatment with adverse effects associated with prolonged use such as atypical femoral fractures (AFF). Asians have an elevated risk of AFF at 5 to 6 times those of whites and Hispanics. In this study, we characterize factors associated with AFF and its mortality in a single center in Singapore. We conducted a cohort study of subjects older than 50 years admitted to Changi General Hospital (CGH), Singapore, with fragility subtrochanteric femoral fractures from 2009 to 2015. Using the ASBMR 2014 criteria, fractures are classified into atypical and typical subtrochanteric femoral fractures. CGH uses a nationalized electronic health record that allows review of information on patients' demographics, clinical history and previous investigations. Mortality was assessed as of December 31, 2019. Between 2009 and 2015, there were 3097 hip fractures, of which 393 were subtrochanteric femoral fractures and 69 were classified as AFF by ASBMR 2014 criteria. A total of 52.2% of AFF occurred with BP exposure of median duration 56.5 (28 to 66) months. Multivariate regression showed that BP exposure was associated with the highest risk of AFF (odds ratio [OR] = 6.65 [2.35–18.9]). AFF patients had higher 5‐year survival (0.85 versus 0.62, p = 0.001) compared with typical subtrochanteric fracture patients. However, after adjusting for variables, the type of subtrochanteric femoral fractures were no longer significantly associated with progression to death, whereas older age, higher mean Charlson comorbidity score, and Malay ethnicity were the strongest predictors of death. AFF constitutes a small proportion of hip and femoral fractures with prolonged BP use being the highest risk factor for its development. There is no evidence of increased mortality or morbidity in patients with AFF compared with the typical subtrochanteric fracture. The fear of AFF should not impede treatment of typical osteoporotic fractures in this population. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Linsey Gani
- Department of Endocrinology Department of Medicine Changi General Hospital 2 Simei Street 3 529889 Singapore Singapore
| | - Natasha Anthony
- Department of Endocrinology Department of Medicine Changi General Hospital 2 Simei Street 3 529889 Singapore Singapore
| | - Lily Dacay
- Department of Endocrinology Department of Medicine Changi General Hospital 2 Simei Street 3 529889 Singapore Singapore
| | - Pei Tan
- Centre of Trial Research Unit Changi General Hospital Singapore Singapore
| | - Le Roy Chong
- Department of Radiology Changi General Hospital Singapore Singapore
| | - Thomas Fj King
- Department of Endocrinology Department of Medicine Changi General Hospital 2 Simei Street 3 529889 Singapore Singapore
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24
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Yoshino Y, Tanaka S, Ohama H, Kobayashi S, Tobita H, Kuwagaki K, Fujioka R, Totsuka H, Ichiba Y, Ishimine S, Sakamoto K, Kubo T. Effectiveness of a Japanese multi-professional cooperative osteoporosis liaison service at a private hospital for decreasing secondary fractures in osteoporosis patients with fragility fractures. Arch Osteoporos 2021; 16:75. [PMID: 33890181 DOI: 10.1007/s11657-021-00924-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/23/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE A fracture liaison service (FLS) was established in England to support patients with fragility fractures, and it was introduced in Japan as the osteoporosis liaison service (OLS). The study aim was to determine if the Japanese OLS/FLS prevents secondary fractures in patients with fragility fractures and assess the value of the OLS/FLS. Our OLS/FLS evaluated the status of osteoporosis in patients and their life circumstances. Additionally, it introduced osteoporosis therapies during the patients' hospitalization period and then continued periodical examinations and prescription of drug after discharge. PATIENTS AND METHODS This study was conducted in consecutive patients: 400 were assigned to the non-OLS group and 406 to the OLS group. The mean age of the patients was 81.7 ± 9.7 years in the non-OLS group (154 patients with vertebral fractures and 246 with hip fractures; 100 males, 300 females) and 82.4 ± 9.3 years in the OLS group (245 patients with hip fractures and 161 with vertebral fractures; 101 males, 305 females). RESULTS During hospitalization, 74.9% of the OLS group patients started medications and 63.9% of patients continued after discharge, while 35.8% and 53.5% of non-OLS group. The incidence rate of secondary fractures was 89.8/1000 person-years in the non-OLS group, and 55.2/1000 person-years in the OLS group. The multivariate Cox hazards test showed that secondary fractures after vertebral or hip fractures increased with age, and the risk was 0.58-fold in patients in the OLS group. CONCLUSION OLS was effective in reducing secondary fractures in patients with osteoporosis with fragility fractures.
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Affiliation(s)
- Yasumasa Yoshino
- Department of Orthopaedic Surgery, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Shinya Tanaka
- Department of Orthopaedic Surgery, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan. .,Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan. .,Department of Orthopaedic Surgery, Saitama Medical University, Morohongo 38, Moroyama-cho, Iruma-gun, 350-0495, Saitama, Japan.
| | - Hikaru Ohama
- Department of Orthopaedic Surgery, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Saori Kobayashi
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Hideki Tobita
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Department of Rehabilitation, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Kanae Kuwagaki
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Department of Rehabilitation, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Rie Fujioka
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Nutrition of Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Hiroaki Totsuka
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Pharmacy of Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Yuka Ichiba
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Nursing Department, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Sachiko Ishimine
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Nursing Department, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Kazumi Sakamoto
- Osteoporosis Liaison Service, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan.,Department of Radiology, Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
| | - Toshiro Kubo
- Director of Saitama Jikei Hospital, 208, Ishihara 3, Kumagaya, Saitama, 360-0816, Japan
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Lulla D, Teo CW, Shen X, Loi ZBJ, Quek KW, Lis HLA, Koh SA, Chan ET, Lim SWC, Low LL. Assessing the knowledge, attitude and practice of osteoporosis among Singaporean women aged 65 years and above at two SingHealth polyclinics. Singapore Med J 2021; 62:190-194. [PMID: 33948668 DOI: 10.11622/smedj.2021039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Singapore has one of the world's most rapidly ageing populations. Osteoporosis is associated with significant morbidity and mortality from hip fractures in the elderly. This pilot study aims to evaluate the knowledge, attitude and practice of osteoporosis among Singaporean women aged ≥ 65 years, and assess barriers to osteoporosis screening. METHODS We conducted a cross-sectional survey of 99 English-speaking women aged ≥ 65 years at two SingHealth polyclinics by convenience sampling. The validated Osteoporosis Prevention and Awareness Tool was used to assess their knowledge about osteoporosis prevention and awareness and perceived barriers to osteoporosis screening. Osteoporosis health education was provided, and bone mineral density (BMD) screening was offered to all participants. RESULTS The response rate was 91.6%. The majority of the participants (54.5%) had low knowledge of osteoporosis, and only 12.1% had high knowledge scores. Higher education levels were associated with higher knowledge scores (p = 0.018). Although participants with higher knowledge scores were more willing to undergo osteoporosis screening, these findings did not reach statistical significance (p = 0.067). The top reasons for declining BMD testing were misconceptions that lifestyle management is sufficient to prevent osteoporosis, poor awareness and knowledge of the disease, and the perceived high cost of BMD testing. CONCLUSION Interventions should focus on osteoporosis education and, eventually, BMD screening for less-educated patients. Health education should rectify common misconceptions of the disease, increase awareness of osteoporosis and improve screening rates.
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Affiliation(s)
- Dypti Lulla
- SingHealth Polyclinics - Marine Parade, Singapore
| | | | - XiaoYou Shen
- SingHealth Polyclinics - Marine Parade, Singapore
| | | | | | | | | | | | | | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
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Abstract
Screening for osteoporosis in women can be based on age and weight, using the Osteoporosis Screening Tool for Asians and assessment for other risk factors such as early menopause, Chinese ethnicity and other secondary factors. Based on the resulting risk profile, women can be triaged to dual-energy X-ray absorptiometry (DEXA) scanning for definite diagnosis of osteoporosis. Treatment should be considered in women with previous fragility fractures, DEXA-diagnosed osteoporosis and high risk of fracture. Exercise improves muscle function, can help prevent falls and has moderate effects on improvements in bone mass. Women should ensure adequate calcium intake and vitamin D. Menopausal hormone therapy (MHT) effectively prevents osteoporosis and fractures, and should be encouraged in those aged < 50 years. For women aged < 60 years, MHT or tibolone can be considered, especially if they have vasomotor or genitourinary symptoms. Risedronate or bisphosphonates may then be reserved for those aged over 60 years.
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Affiliation(s)
- Eu-Leong Yong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Susan Logan
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Wang ZC, Jiang W, Chen X, Yang L, Wang H, Liu YH. Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study. BMC Geriatr 2021; 21:155. [PMID: 33663402 PMCID: PMC7934427 DOI: 10.1186/s12877-021-02102-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/22/2021] [Indexed: 01/01/2023] Open
Abstract
Background The systemic immune-inflammation index (SII), based on peripheral platelet, neutrophil and lymphocyte counts, has been proven to be a promising prognostic indicator in various diseases. Hip fracture is a common injury among the older adults, and has become a global public health problem with high mortality and disability rates. However, the relationship between SII and the prognosis of hip fracture is not yet well-known. The aim of the this study was to explore the predictive value of SII in older adults with hip fracture undergoing surgery. Methods This was a prospective cohort study performed from January 2014 to December 2018 at a orthopaedic center, China. The SII was calculated as platelet×neutrophil/lymphocyte counts. Univariable and multivariable Cox proportional hazard models were used to assess the association between SII and all-cause mortality. Results A total of 290 older adults with hip fracture were included, and the mean (SD) age was 77.6 (8.6) years, and 189 (65.2%) were female. The median (IQR) SII was 759.4 (519.0–1128.7) × 109/L. After a median follow-up time of 33.4 months, 13 (4.5%), 26 (9.0%) and 54 (18.6%) patients died within the 30-day, 1-year and last follow-up, respectively. Multivariable Cox analysis revealed that each increase of 100 units of SII was associated with a 8% increased hazard of death at 1-year follow-up (HR = 1.08, 95% CI: 1.01–1.17, p = 0.033), and 9% increased hazard of death at last follow-up (HR = 1.09, 95% CI: 1.03–1.15, p = 0.003). Conclusions SII is associated with poor all-cause mortality in older adults with hip fracture undergoing surgery, and deserves further investigation and application in clinical practice.
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Affiliation(s)
- Zhi-Cong Wang
- Orthopaedic Center of Deyang City, Department of Orthopedics, People's Hospital of Deyang City, Deyang City, 618000, Sichuan, China
| | - Wei Jiang
- Orthopaedic Center of Deyang City, Department of Orthopedics, People's Hospital of Deyang City, Deyang City, 618000, Sichuan, China
| | - Xi Chen
- Orthopaedic Center of Deyang City, Department of Orthopedics, People's Hospital of Deyang City, Deyang City, 618000, Sichuan, China
| | - Ling Yang
- Orthopaedic Center of Deyang City, Department of Orthopedics, People's Hospital of Deyang City, Deyang City, 618000, Sichuan, China
| | - Hong Wang
- Orthopaedic Center of Deyang City, Department of Orthopedics, People's Hospital of Deyang City, Deyang City, 618000, Sichuan, China
| | - Yue-Hong Liu
- Orthopaedic Center of Deyang City, Department of Orthopedics, People's Hospital of Deyang City, Deyang City, 618000, Sichuan, China.
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Blanco JF, da Casa C, Pablos-Hernández C, González-Ramírez A, Julián-Enríquez JM, Díaz-Álvarez A. 30-day mortality after hip fracture surgery: Influence of postoperative factors. PLoS One 2021; 16:e0246963. [PMID: 33592047 PMCID: PMC7886122 DOI: 10.1371/journal.pone.0246963] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/28/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose The 30-day mortality rate after hip fracture surgery has been considered as an indirect indicator of the quality of care. The aim of this work is to analyse preoperative and postoperative factors potentially related to early 30-day mortality in patients over 65 undergoing hip fracture surgery. Methods Prospective cohort study including all consecutive primary hip fracture patients over 65 admitted to Trauma and Orthopaedics department from January 1, 2018 to December 31, 2019. Bed-ridden, non- surgically treated patients, and high energy trauma or tumoral aetiology fractures were excluded. A total of 943 patients were eligible (attrition rate: 2.1%). Follow-up included 30-days after discharge. We noted the 30-day mortality after hip fracture surgery, analysing 130 potentially related variables including biodemographic, fracture-related, preoperative, and postoperative clinical factors. Qualitative variables were assessed by χ2, and quantitative variables by non-parametric tests. Odds ratio determined by binary logistic regression. We selected preventable candidate variables for multivariate risk assessment by logistic regression. Results A total of 923 patients were enrolled (mean age 86.22±6.8, 72.9% women). The 30-day mortality rate was 6.0%. We noted significant increased mortality on men (OR = 2.381[1.371–4.136], p = 0.002), ageing patients (ORyear = 1.073[1.025–1.122], p = 0.002), and longer time to surgery (ORday = 1.183[1.039–1146], p<0.001), on other 20 preoperative clinical variables, like lymphopenia (lymphocyte count <103/μl, OR = 1.842[1.063–3.191], p = 0.029), hypoalbuminemia (≤3.5g/dl, OR = 2.474[1.316–4.643], p = 0.005), and oral anticoagulant intake (OR = 2.499[1.415–4.415], p = 0.002), and on 25 postoperative clinical variables, like arrhythmia (OR = 13.937[6.263–31.017], p<0.001), respiratory insufficiency (OR = 7.002[3.947–12.419], p<0.001), hyperkalaemia (OR = 10.378[3.909–27.555], p<0.001), nutritional supply requirement (OR = 3.576[1.894–6.752], p = 0.021), or early arthroplasty dislocation (OR = 6.557[1.206–35.640], p = 0.029). We developed a predictive model for early mortality after hip fracture surgery based on postoperative factors with 96.0% sensitivity and 60.7% specificity (AUC = 0.863). Conclusion We revealed that not only preoperative, but also postoperative factors have a great impact after hip fracture surgery. The influence of post-operative factors on 30-day mortality has a logical basis, albeit so far they have not been identified or quantified before. Our results provide an advantageous picture of the 30-day mortality after hip fracture surgery.
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Affiliation(s)
- Juan F. Blanco
- Trauma and Orthopaedics Department, University Hospital of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Carmen da Casa
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- * E-mail:
| | - Carmen Pablos-Hernández
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Orthogeriatric Unit, University Hospital of Salamanca, Salamanca, Spain
| | - Alfonso González-Ramírez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Orthogeriatric Unit, University Hospital of Salamanca, Salamanca, Spain
| | - José Miguel Julián-Enríquez
- Trauma and Orthopaedics Department, University Hospital of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Agustín Díaz-Álvarez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Anaesthesiology Department, University Hospital of Salamanca, Salamanca, Spain
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Abstract
OBJECTIVES To examine one health system's response to the essential care of its hip fracture population during the COVID-19 pandemic and report on its effect on patient outcomes. DESIGN Prospective cohort study. SETTING Seven musculoskeletal care centers within New York City and Long Island. PATIENTS/PARTICIPANTS One hundred thirty-eight recent and 115 historical hip fracture patients. INTERVENTION Patients with hip fractures occurring between February 1, 2020, and April 15, 2020, or between February 1, 2019, and April 15, 2019, were prospectively enrolled in an orthopaedic trauma registry and chart reviewed for demographic and hospital quality measures. Patients with recent hip fractures were identified as COVID positive (C+), COVID suspected (Cs), or COVID negative (C-). MAIN OUTCOME MEASUREMENTS Hospital quality measures, inpatient complications, and mortality rates. RESULTS Seventeen (12.2%) patients were confirmed C+ by testing, and another 14 (10.1%) were suspected (Cs) of having had the virus but were never tested. The C+ cohort, when compared with Cs and C- cohorts, had an increased mortality rate (35.3% vs. 7.1% vs. 0.9%), increased length of hospital stay, a greater major complication rate, and a greater incidence of ventilator need postoperatively. CONCLUSIONS COVID-19 had a devastating effect on the care of patients with hip fracture during the pandemic. Although practice patterns generally remained unchanged, treating physicians need to understand the increased morbidity and mortality in patients with hip fracture complicated by COVID-19. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of Levels of Evidence.
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