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Mostafa OE, Al-Allaf O, Tahir M, Hossain F, Blackwell J. Do Hypoalbuminaemia Increase the Risk of Surgical Site Infection in Neck of Femur Fracture Patients: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e61372. [PMID: 38817798 PMCID: PMC11139050 DOI: 10.7759/cureus.61372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/01/2024] Open
Abstract
Serum albumin plays an important role in physiological and inflammatory haemostasis, and low serum levels are linked with an increased incidence of surgical site infections (SSI). Although this has been demonstrated in the spine and elective arthroplasty settings, there is a paucity of evidence with regard to the effect of low serum albumin on rates of SSI following surgery for adult patients suffering from traumatic and acute hip fractures. A systematic review was conducted using the PRISMA guidelines. Four databases were searched for randomised controlled trials (RCTs), cohort studies, and case-controlled studies. The risk of bias was assessed using the Newcastle-Ottawa Score (NOS). Data was collected and pooled using RevMan Web software. Results were reported as odds ratios (OR) with 95% confidence intervals (CI) and statistical significance of p <0.05. An inverse variance model was used in the meta-analysis. Six retrospective studies (five cohorts and one case-control) with a total of 43,059 patients were included. 45.3% (n=19 496) had low serum albumin (<3.5 g/dL). Hypoalbuminemia was associated with a significantly higher risk of any form of SSI (OR 1.25, p=0.008) and deep SSI (OR 1.76, p=0.05). There was no statistical significance between hypoalbuminemia and the incidence of superficial SSI (OR 1.06, p=0.77). Organ-space SSI was associated with hypoalbuminemia, although one study reported this with poor statistical significance (OR 8.74, p<0.054). Hypoalbuminemia increases the risk of most forms of surgical site infections, both superficial and deep. There is a weak conclusion to draw between the incidence of deep-space organ infections and low serum albumin.
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Affiliation(s)
- Omar E Mostafa
- General Surgery, Dudley Group National Health Service (NHS) Foundation Trust, Dudley, GBR
| | - Omar Al-Allaf
- Trauma and Orthopaedics, Walsall Healthcare National Health Service (NHS) Foundation Trust, Birmingham, GBR
| | - Muaaz Tahir
- Trauma and Orthopaedics, Royal Orthopaedic Hospital, Birmingham, GBR
| | - Fahad Hossain
- Trauma and Orthopaedics, Walsall Healthcare National Health Service (NHS) Foundation Trust, Birmingham, GBR
| | - John Blackwell
- Trauma and Orthopaedics, Walsall Healthcare National Health Service (NHS) Foundation Trust, Birmingham, GBR
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Pedrianes Martín P, Arnás León C, Sánchez Sánchez G, Santana Ojeda B, García Puente I, Comi Díaz C, Calleja Fernández A, de Pablos Velasco PL. [Trends in the characteristics of patients treated with nutritional supplements in the Northern Area of Gran Canaria in the period 2016 -2021]. NUTR HOSP 2024. [PMID: 38450493 DOI: 10.20960/nh.04940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
AIM assess the prescription of oral nutritional supplements (ONS) in the Northern Area of Gran Canaria in the period 2016-2021. MATERIALS AND METHODS based on electronic prescription data, the first ONS prescription during 2016-2021 was analyzed considering age, gender, nutritional requirements (NR), body mass index (BMI), percentage of weight loss (%WL), albumin and number of prescribed ONS per patient. RESULTS 10,595 prescriptions were identified corresponding to 6661 patients with the following characteristics: 46.3 % men, mean age 72.84 ± 15.93 years, BMI 20.60 ± 3.98 kg/m2, %WL 11.89 ± 8.32 %; albumin 3.08 ± 0.63 g/dl. The most frequent etiologies of DRE were: neoplasms 42.6 %; degenerative processes of the CNS 28.9 %; stroke 3.9 %; short intestine 6.9 %, and inflammatory bowel disease (IBD) 5.5 %. The percentages of NR covered by the prescribed ONS were: 100 % in 8.9 % of cases, 50 % in 36.9 %, and 25 % in 54.2 %; 40.4 % of patients received 1 unit of ONS daily, 36.3 % took 2 units of ONS, and 23 % received > 3 units of ONS per day. Greater NR were associated with a greater number of ONS (p < 0.001), but 40.8 % of patients who needed to cover > 50 % of NR received only one unit of ONS. CONCLUSION a significant percentage of patients with DRM do not receive a number of ONS according to their NR.
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Affiliation(s)
- Pablo Pedrianes Martín
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Gran Canaria Doctor Negrín
| | - Claudia Arnás León
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Gran Canaria Doctor Negrín
| | | | - Borja Santana Ojeda
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Gran Canaria Doctor Negrín
| | - Ignacio García Puente
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Gran Canaria Doctor Negrín
| | - Cristina Comi Díaz
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Gran Canaria Doctor Negrín
| | | | - Pedro L de Pablos Velasco
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Gran Canaria Doctor Negrín. Universidad de Las Palmas de Gran Canaria
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Chen B, Zhang JH, Duckworth AD, Clement ND. Effect of oral nutritional supplementation on outcomes in older adults with hip fractures and factors influencing compliance. Bone Joint J 2023; 105-B:1149-1158. [PMID: 37907073 DOI: 10.1302/0301-620x.105b11.bjj-2023-0139.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims Hip fractures are a major cause of morbidity and mortality, and malnutrition is a crucial determinant of these outcomes. This meta-analysis aims to determine whether oral nutritional supplementation (ONS) improves postoperative outcomes in older patients with a hip fracture. Methods A systematic literature search was conducted in August 2022. ONS was defined as high protein-based diet strategies containing (or not containing) carbohydrates, fat, vitamins, and minerals. Randomized trials documenting ONS in older patients with hip fracture (aged ≥ 50 years) were included. Two reviewers evaluated study eligibility, conducted data extraction, and assessed study quality. Results There were 812 studies identified, of which 18 studies involving 1,522 patients met the inclusion criteria. The overall meta-analysis demonstrated that ONS was associated with significantly elevated albumin levels (weighted mean difference (WMD) 1.24 (95% confidence interval (CI) 0.95 to 1.53)), as well as a significant risk reduction in infective complications (odds ratio (OR) 0.54 (95% CI 0.39 to 0.76)), pressure ulcers (OR 0.54 (95% CI 0.33 to 0.88)), and total complications (OR 0.57 (95% CI 0.42 to 0.79)). Length of hospital stay (LOS) was also significantly reduced (WMD -2.36 (95% CI -4.14 to -0.58)), particularly in rehabilitation LOS (WMD -4.17 (95% CI -7.08 to -1.26)). There was a tendency towards a lower mortality risk (OR 0.93 (95% CI 0.62 to 1.4)) and readmission (OR 0.52 (95% CI 0.16 to 1.73)), although statistical significance was not achieved (p = 0.741 and p = 0.285, respectively). The overall compliance with ONS ranged from 64.7% to 100%, but no factors influencing compliance were identified. Conclusion This meta-analysis is the first to quantitatively demonstrate that ONS could nearly halve the risk of infective complications, pressure ulcers, total complications, as well as improve serum albumin and reduce LOS. ONS should be a regular and integrated part of the perioperative care of these patients, especially given that the compliance with ONS is acceptable.
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Affiliation(s)
- Bin Chen
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, China
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jia H Zhang
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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Martín-Fuentes M, Varas de Dios B, Valverde Villar AM, Sánchez Almaraz R, Pérez Torres A, Iglesias Domínguez L, Muñoz García N, Guindal Pérez Y, Aragonés Maza P, Reche Sainz CM, Espina Flores I, Neira Borrajo I, Romero Estarlich V. [Nutritional, bone and body composition assessment of patients with knee and hip arthroplasty]. NUTR HOSP 2023. [PMID: 37073743 DOI: 10.20960/nh.04341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
INTRODUCTION malnutrition, both due to deficiency and excess of nutrients, is related to the morbidity of the surgical patient. OBJECTIVES to analyze the nutritional status, body composition and bone health of patients undergoing elective knee and hip arthroplasty. METHODS an observational cross-sectional study was carried out evaluating patients undergoing hip and knee replacement surgery from February to September 2019. The Malnutrition Universal Screening Tool (MUST), anthropometry, hand-grip dynamometry, bone densitometry, lumbar spine X-ray and bioimpedance analysis were performed. RESULTS eighty-six patients (61.6 % women) were evaluated, with a mean age of 69.5 ± 9.5 years. The mean body mass index (BMI) was 31.3 ± 4.5. According to MUST, 21.3 % were at risk of malnutrition; 16.9 % had decreased triceps skinfold with respect to p50 and 20 % had a pathological hand-grip dynamometry. In 91.4 %, vitamin D was < 30 pg/ml. In the bioimpedanciometry, the women presented significantly decreased muscle mass values. Age was correlated with a lower presence of fat-free mass, total and appendicular muscle mass. In those over 65 years of age, 52.6 % of men vs 14.3 % of women had a decreased muscle mass index; 58.5 % had low bone mineral density. We observed vertebral bone collapses in 13.9 %. CONCLUSION there is a high prevalence of obesity in patients who are candidates for arthroplasty and this does not exclude the existence of a risk of malnutrition. They may also have decreased muscle mass and strength. Nutritional education and physical exercise recommendations are essential in order to optimize nutritional status for surgery.
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Affiliation(s)
| | | | | | | | | | | | - Nuria Muñoz García
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Santa Cristina
| | - Yolanda Guindal Pérez
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Santa Cristina
| | - Paloma Aragonés Maza
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Santa Cristina
| | | | - Irene Espina Flores
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Santa Cristina
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Oberstar JS, Bakker CJ, Sorich M, McCarthy T. What Postoperative Nutritional Interventions Lead to Better Outcomes in Fragility Hip Fractures? A Systematic Review. Geriatr Orthop Surg Rehabil 2023; 14:21514593231155828. [PMID: 36817328 PMCID: PMC9936399 DOI: 10.1177/21514593231155828] [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: 07/15/2022] [Accepted: 01/22/2023] [Indexed: 02/24/2023] Open
Abstract
Background Fragility hip fracture patients are often malnourished. Nutrition supplementation may help, but it is unclear if supplementation is impactful when considering outcomes. A systematic review of literature examining perioperative nutrition status for older adults experiencing a hip fracture was performed. Methods We searched Medline, CAB Abstracts and Embase (Ovid); Cochrane Library (Wiley); PubMed; Scopus; Global Index Medicus; Web of Science Core Collection; SPORTDiscus (EBSCO); and clinical trial registries ClinicalTrials.gov and WHO ICTRP from inception to April 2021, incorporating terminology related to nutritional interventions, fragility fractures, and postoperative outcomes. Two investigators reviewed citations for inclusion, extracted nutrition intervention criteria, and categorized hip fragility outcomes. Results Of 1792 citations, 90 articles underwent full-text screening, and 14 articles were included in the final sample. We identified nutritional interventions and 4 outcomes of interest. 8 studies (n = 649) demonstrated a mean difference of .78 days (CI .34-1.21) in length of stay (LOS) between the nutritional intervention and control groups. Rehabilitation ward stays were discussed in 2 studies demonstrating a non-statistically significant difference. 7 studies (n = 341) reported mortality rates; when pooled there was no statistically significant difference. 5 studies showed data for postoperative infections and 4 studies reported on postoperative urinary tract infections. Pooling of data found a statistically significant result (Relative Risk: .49 [.32, .75], P = .001) with low heterogeneity (I2 = 27%). 4 studies reported urinary tract infections (n = 140) in the intervention group and (n = 121) in the control group with a non-statistically significant result. Grip strength was only reported in two studies but pooling of the data was non-statistically significant. Conclusions This systematic review highlighted the lack of consensus regarding the type of nutrition interventions available and impact on outcomes of interest including mortality, length of stay, infections, and grip strength for fragility hip fractures in older adults.
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Affiliation(s)
- Jennifer S. Oberstar
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA,Jennifer S. Oberstar; Department of Family Medicine and Community Health, University of Minnesota 516 Delaware St SE, MMC381, Minneapolis, MN 55455, MN, USA.
| | - Caitlin J. Bakker
- Dr. John Archer Library & Archives, University of Regina, Regina, SK, Canada
| | - Megan Sorich
- Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Teresa McCarthy
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA
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Thomson K, Rice S, Arisa O, Johnson E, Tanner L, Marshall C, Sotire T, Richmond C, O'Keefe H, Mohammed W, Gosney M, Raffle A, Hanratty B, McEvoy CT, Craig D, Ramsay SE. Oral nutritional interventions in frail older people who are malnourished or at risk of malnutrition: a systematic review. Health Technol Assess 2022; 26:1-112. [PMID: 36541454 PMCID: PMC9791461 DOI: 10.3310/ccqf1608] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Malnutrition worsens the health of frail older adults. Current treatments for malnutrition may include prescribed oral nutritional supplements, which are multinutrient products containing macronutrients and micronutrients. OBJECTIVE To assess the effectiveness and cost-effectiveness of oral nutritional supplements (with or without other dietary interventions) in frail older people who are malnourished or at risk of malnutrition. DATA SOURCES MEDLINE, EMBASE, Cochrane Library, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and grey literature were searched from inception to 13 September 2021. REVIEW METHODS A systematic review and meta-analysis was conducted to evaluate the effectiveness and cost-effectiveness of oral nutritional supplements in frail older people (aged ≥ 65 years) who are malnourished or at risk of malnutrition (defined as undernutrition as per National Institute for Health and Care Excellence guidelines). Meta-analysis and network meta-analysis were undertaken, where feasible, along with a narrative synthesis. A cost-effectiveness review was reported narratively. A de novo model was developed using effectiveness evidence identified in the systematic review to estimate the cost-effectiveness of oral nutritional supplements. RESULTS Eleven studies (n = 822 participants) were included in the effectiveness review, six of which were fully or partly funded by industry. Meta-analyses suggested positive effects of oral nutritional supplements compared with standard care for energy intake (kcal) (standardised mean difference 1.02, 95% confidence interval 0.15 to 1.88; very low quality evidence) and poor mobility (mean difference 0.03, p < 0.00001, 95% confidence interval 0.02 to 0.04; very low quality evidence) but no evidence of an effect for body weight (mean difference 1.31, 95% confidence interval -0.05 to 2.66; very low quality evidence) and body mass index (mean difference 0.54, 95% confidence interval -0.03 to 1.11; very low quality evidence). Pooled results for other outcomes were statistically non-significant. There was mixed narrative evidence regarding the effect of oral nutritional supplements on quality of life. Network meta-analysis could be conducted only for body weight and grip strength; there was evidence of an effect for oral nutritional supplements compared with standard care for body weight only. Study quality was mixed; the randomisation method was typically poorly reported. One economic evaluation, in a care home setting, was included. This was a well-conducted study showing that oral nutritional supplements could be cost-effective. Cost-effectiveness analysis suggested that oral nutritional supplements may only be cost-effective for people with lower body mass index (< 21 kg/m2) using cheaper oral nutritional supplements products that require minimal staff time to administer. LIMITATIONS The review scope was narrow in focus as few primary studies used frailty measures (or our proxy criteria). This resulted in only 11 included studies. The small evidence base and varied quality of evidence meant that it was not possible to determine accurate estimates of the effectiveness or cost-effectiveness of oral nutritional supplements. Furthermore, only English-language publications were considered. CONCLUSIONS Overall, the review found little evidence of oral nutritional supplements having significant effects on reducing malnutrition or its adverse outcomes in frail older adults. FUTURE WORK Future research should focus on independent, high-quality, adequately powered studies to investigate oral nutritional supplements alongside other nutritional interventions, with longer-term follow-up and detailed analysis of determinants, intervention components and cost-effectiveness. STUDY REGISTRATION This study is registered as PROSPERO CRD42020170906. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 51. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katie Thomson
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Oluwatomi Arisa
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eugenie Johnson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Tanner
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Marshall
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tumi Sotire
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hannah O'Keefe
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Wael Mohammed
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Anne Raffle
- Elders Council of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Institute for Global Food Security, Queen's University Belfast, Belfast, UK
| | - Dawn Craig
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Lv C, Chen S, Shi T, Jia M. Risk Factors Associated With Postoperative Pulmonary Infection in Elderly Patients With Hip Fracture: A Longitudinal Study. Clin Nurs Res 2022; 31:1454-1461. [PMID: 36082422 DOI: 10.1177/10547738221114713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study aimed to conduct a longitudinal study to explore the influencing factors of pulmonary infection in elderly patients with hip fracture after surgery, to provide evidence and reference for the early identification and nursing care of patients at high risk of postoperative pulmonary infection.A secondary analysis was conducted of electronic medical record data from elderly patients with hip fractures treated in a tertiary hospital from January 1, 2020 to June 30, 2021.A total of 526 patients were included. Age ≥70 years (odd ratio [OR] 2.042, 95% confidence interval [CI] [1.516-4.022]), history of smoking (OR 2.755, 95% CI [2.009-3.175]), time from fracture to operation ≥5 days (OR 3.117, 95% CI [1.925-3.911]), American Society of Anesthesiologists grade ≥II (OR 1.254, 95% CI [1.053-1.921]), chronic obstructive pulmonary disease (OR 2.832, 95% CI [1.775-3.808]), hypoproteinemia (OR 1.395, 95% CI [1.022-1.841]), red blood cell distribution width >15% (OR 3.142, 95% CI [2.104-4.172]), intensive care unit stay (OR 2.174, 95% CI [1.083-3.718]) and duration of mechanical ventilation ≥180 minutes (OR 3.117, 95% CI [2.199-4.807]) were the independent risk factors (all p < .05).Early nursing care should be taken for patients with risk factors to reduce the pulmonary infection.
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Affiliation(s)
- Chang Lv
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shaomin Chen
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Man Jia
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Fairhall NJ, Dyer SM, Mak JC, Diong J, Kwok WS, Sherrington C. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev 2022; 9:CD001704. [PMID: 36070134 PMCID: PMC9451000 DOI: 10.1002/14651858.cd001704.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Improving mobility outcomes after hip fracture is key to recovery. Possible strategies include gait training, exercise and muscle stimulation. This is an update of a Cochrane Review last published in 2011. OBJECTIVES To evaluate the effects (benefits and harms) of interventions aimed at improving mobility and physical functioning after hip fracture surgery in adults. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, trial registers and reference lists, to March 2021. SELECTION CRITERIA All randomised or quasi-randomised trials assessing mobility strategies after hip fracture surgery. Eligible strategies aimed to improve mobility and included care programmes, exercise (gait, balance and functional training, resistance/strength training, endurance, flexibility, three-dimensional (3D) exercise and general physical activity) or muscle stimulation. Intervention was compared with usual care (in-hospital) or with usual care, no intervention, sham exercise or social visit (post-hospital). DATA COLLECTION AND ANALYSIS Members of the review author team independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We used the assessment time point closest to four months for in-hospital studies, and the time point closest to the end of the intervention for post-hospital studies. Critical outcomes were mobility, walking speed, functioning, health-related quality of life, mortality, adverse effects and return to living at pre-fracture residence. MAIN RESULTS We included 40 randomised controlled trials (RCTs) with 4059 participants from 17 countries. On average, participants were 80 years old and 80% were women. The median number of study participants was 81 and all trials had unclear or high risk of bias for one or more domains. Most trials excluded people with cognitive impairment (70%), immobility and/or medical conditions affecting mobility (72%). In-hospital setting, mobility strategy versus control Eighteen trials (1433 participants) compared mobility strategies with control (usual care) in hospitals. Overall, such strategies may lead to a moderate, clinically-meaningful increase in mobility (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.10 to 0.96; 7 studies, 507 participants; low-certainty evidence) and a small, clinically meaningful improvement in walking speed (CI crosses zero so does not rule out a lack of effect (SMD 0.16, 95% CI -0.05 to 0.37; 6 studies, 360 participants; moderate-certainty evidence). Mobility strategies may make little or no difference to short-term (risk ratio (RR) 1.06, 95% CI 0.48 to 2.30; 6 studies, 489 participants; low-certainty evidence) or long-term mortality (RR 1.22, 95% CI 0.48 to 3.12; 2 studies, 133 participants; low-certainty evidence), adverse events measured by hospital re-admission (RR 0.70, 95% CI 0.44 to 1.11; 4 studies, 322 participants; low-certainty evidence), or return to pre-fracture residence (RR 1.07, 95% CI 0.73 to 1.56; 2 studies, 240 participants; low-certainty evidence). We are uncertain whether mobility strategies improve functioning or health-related quality of life as the certainty of evidence was very low. Gait, balance and functional training probably causes a moderate improvement in mobility (SMD 0.57, 95% CI 0.07 to 1.06; 6 studies, 463 participants; moderate-certainty evidence). There was little or no difference in effects on mobility for resistance training. No studies of other types of exercise or electrical stimulation reported mobility outcomes. Post-hospital setting, mobility strategy versus control Twenty-two trials (2626 participants) compared mobility strategies with control (usual care, no intervention, sham exercise or social visit) in the post-hospital setting. Mobility strategies lead to a small, clinically meaningful increase in mobility (SMD 0.32, 95% CI 0.11 to 0.54; 7 studies, 761 participants; high-certainty evidence) and a small, clinically meaningful improvement in walking speed compared to control (SMD 0.16, 95% CI 0.04 to 0.29; 14 studies, 1067 participants; high-certainty evidence). Mobility strategies lead to a small, non-clinically meaningful increase in functioning (SMD 0.23, 95% CI 0.10 to 0.36; 9 studies, 936 participants; high-certainty evidence), and probably lead to a slight increase in quality of life that may not be clinically meaningful (SMD 0.14, 95% CI -0.00 to 0.29; 10 studies, 785 participants; moderate-certainty evidence). Mobility strategies probably make little or no difference to short-term mortality (RR 1.01, 95% CI 0.49 to 2.06; 8 studies, 737 participants; moderate-certainty evidence). Mobility strategies may make little or no difference to long-term mortality (RR 0.73, 95% CI 0.39 to 1.37; 4 studies, 588 participants; low-certainty evidence) or adverse events measured by hospital re-admission (95% CI includes a large reduction and large increase, RR 0.86, 95% CI 0.52 to 1.42; 2 studies, 206 participants; low-certainty evidence). Training involving gait, balance and functional exercise leads to a small, clinically meaningful increase in mobility (SMD 0.20, 95% CI 0.05 to 0.36; 5 studies, 621 participants; high-certainty evidence), while training classified as being primarily resistance or strength exercise may lead to a clinically meaningful increase in mobility measured using distance walked in six minutes (mean difference (MD) 55.65, 95% CI 28.58 to 82.72; 3 studies, 198 participants; low-certainty evidence). Training involving multiple intervention components probably leads to a substantial, clinically meaningful increase in mobility (SMD 0.94, 95% CI 0.53 to 1.34; 2 studies, 104 participants; moderate-certainty evidence). We are uncertain of the effect of aerobic training on mobility (very low-certainty evidence). No studies of other types of exercise or electrical stimulation reported mobility outcomes. AUTHORS' CONCLUSIONS Interventions targeting improvement in mobility after hip fracture may cause clinically meaningful improvement in mobility and walking speed in hospital and post-hospital settings, compared with conventional care. Interventions that include training of gait, balance and functional tasks are particularly effective. There was little or no between-group difference in the number of adverse events reported. Future trials should include long-term follow-up and economic outcomes, determine the relative impact of different types of exercise and establish effectiveness in emerging economies.
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Affiliation(s)
- Nicola J Fairhall
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Suzanne M Dyer
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Jenson Cs Mak
- Healthy Ageing, Mind & Body Institute, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, Australia
| | - Joanna Diong
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Wing S Kwok
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Feng L, Chen W, Ping P, Ma T, Li Y, Xu L, Feng Z, Zhao Y, Fu S. Preoperative malnutrition as an independent risk factor for the postoperative mortality in elderly Chinese individuals undergoing hip surgery: a single-center observational study. Ther Adv Chronic Dis 2022; 13:20406223221102739. [PMID: 35782344 PMCID: PMC9243382 DOI: 10.1177/20406223221102739] [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: 02/19/2022] [Accepted: 04/28/2022] [Indexed: 11/15/2022] Open
Abstract
Objective: Malnutrition is prevalent in elderly with hip fracture and higher than in community-dwelling older adults. Scarce studies have examined the association between preoperative malnutrition and postoperative mortality in elderly Chinese individuals with hip fracture. This study was designed to explore the effect of preoperative malnutrition on the postoperative long-term mortality in elderly Chinese individuals undergoing hip surgery. Methods: As a single-center observational study, this study included 263 consecutive patients above 70 years old with hip fracture and elective surgery. Preoperative nutritional status was evaluated by prognostic nutritional index (PNI). Patients were divided into one group with malnutrition (26 patients with PNI ⩽ 38) and the other group without malnutrition (169 patients with PNI > 38), respectively. Results: The overall malnutrition rate was 13.3% (26 patients). The postoperative long-term mortality rates of patients with and without malnutrition had statistically significant difference [10 patients (38.5%) and 32 patients (18.9%), p < 0.05]. Cox regression analysis showed that malnutrition (hazard ratio: 0.269, 95% confidence interval: 0.085–0.859, p < 0.05) and partial pressure of carbon dioxide (hazard ratio: 0.873, 95% confidence interval: 0.790–0.964, p < 0.05) were independent risk factors for the postoperative long-term mortality. Conclusion: This study demonstrated that preoperative malnutrition was an independent risk factor for the postoperative long-term mortality and resulted in a more than 2.5-fold increase of the postoperative long-term mortality in elderly Chinese individuals undergoing hip surgery.
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Affiliation(s)
- Long Feng
- Department of Anesthesiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Wenji Chen
- Department of Rheumatology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Ping Ping
- Main Station of Drug Instrument Supervision and Inspection, Joint Logistic Support Force of Chinese People's Liberation Army, Beijing, China
| | - Tao Ma
- Department of Anesthesiology, Chinese People's Liberation Army Rocket Force Characteristic Medical Center, Beijing, China
| | - Yang Li
- Department of Anesthesiology and Operation Center, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Longhe Xu
- Department of Anesthesiology and Operation Center, The Third Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zeguo Feng
- Department of Anesthesiology and Operation Center, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Shihui Fu
- Department of Cardiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
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10
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Johansen A, Ojeda-Thies C, Poacher AT, Hall AJ, Brent L, Ahern EC, Costa ML. Developing a minimum common dataset for hip fracture audit to help countries set up national audits that can support international comparisons. Bone Joint J 2022; 104-B:721-728. [PMID: 35638208 PMCID: PMC9948447 DOI: 10.1302/0301-620x.104b6.bjj-2022-0080.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIMS The aim of this study was to explore current use of the Global Fragility Fracture Network (FFN) Minimum Common Dataset (MCD) within established national hip fracture registries, and to propose a revised MCD to enable international benchmarking for hip fracture care. METHODS We compared all ten established national hip fracture registries: England, Wales, and Northern Ireland; Scotland; Australia and New Zealand; Republic of Ireland; Germany; the Netherlands; Sweden; Norway; Denmark; and Spain. We tabulated all questions included in each registry, and cross-referenced them against the 32 questions of the MCD dataset. Having identified those questions consistently used in the majority of national audits, and which additional fields were used less commonly, we then used consensus methods to establish a revised MCD. RESULTS A total of 215 unique questions were used across the ten registries. Only 72 (34%) were used in more than one national audit, and only 32 (15%) by more than half of audits. Only one registry used all 32 questions from the 2014 MCD, and five questions were only collected by a single registry. Only 21 of the 32 questions in the MCD were used in the majority of national audits. Only three fields (anaesthetic grade, operation, and date/time of surgery) were used by all ten established audits. We presented these findings at the Asia-Pacific FFN meeting, and used an online questionnaire to capture feedback from expert clinicians from different countries. A draft revision of the MCD was then presented to all 95 nations represented at the Global FFN conference in September 2021, with online feedback again used to finalize the revised MCD. CONCLUSION The revised MCD will help aspirant nations establish new registry programmes, facilitate the integration of novel analytic techniques and greater multinational collaboration, and serve as an internationally-accepted standard for monitoring and improving hip fracture services. Cite this article: Bone Joint J 2022;104-B(6):721-728.
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Affiliation(s)
- Antony Johansen
- University Hospital of Wales and School of Medicine, Cardiff University, Cardiff, UK,National Hip Fracture Database, Royal College of Physicians, London, UK
| | | | | | | | - Louise Brent
- National Office of Clinical Audit, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Matt L. Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK,Correspondence should be sent to Matt L. Costa. E-mail:
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11
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Ashkenazi I, Rotman D, Amzalleg N, Graif N, Amal Khoury, Ben-Tov T, Steinberg E. Efficacy of Oral Nutritional Supplements in Patients Undergoing Surgical Intervention for Hip Fracture. Geriatr Orthop Surg Rehabil 2022; 13:21514593221102252. [PMID: 35615598 PMCID: PMC9125056 DOI: 10.1177/21514593221102252] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/29/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Malnutrition is considered a risk factor among geriatric individuals with hip fracture, affecting functional healing and recovery, increasing healthcare spending, and associated with high mortality. In this study, we sought to evaluate the clinical efficacy of oral nutritional supplements in geriatric patients undergoing surgery for hip fracture. Material and Methods: We retrospectively analyzed data of 1625 consecutive patients who underwent fixation or arthroplasty for hip fracture in a tertiary medical center between 2017 and 2020. Patients who had no available albumin or body mass index levels were excluded. The study group is of patients who received an advanced formula in the form of an oral nutritional supplement (ONS), and the control group of patients that received no ONS. Peri- and postoperative complications, readmissions, short-term mortality, and albumin levels were compared between the 2 groups. Results: The final cohort included 1123 patients, 298 in the study group and 825 controls, with a follow-up of at least 1-year. Provision of the advanced enriched formula was not associated with 30-day, 90-day, or 1-year mortality (P = .62, P = .52, and P = .72, respectively) or any perioperative complications, such as 30-day or 90-day readmission (P = .37 and P = .1, respectively), revision surgery of any cause (P = .35), and postoperative infection rates (P = .73). Albumin levels on admission and the minimum albumin levels during hospitalization were similar between the groups, but they were significantly higher in the study group before discharge (33.42 g/L vs. 32.79 g/L, P = .01). Discussion: The use of an ONS was not associated with reduced perioperative complications or mortality, although it did affect nutritional status, as indicated by increased albumin levels, a known marker of nutritional status. Conclusions. While current findings do not support ONS use to minimize major postoperative complication after hip fracture surgery, further long-term study is warranted to evaluate subjective and functional outcomes associated with improved nutritional status.
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Affiliation(s)
- Itay Ashkenazi
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dani Rotman
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nissan Amzalleg
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nadav Graif
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Ben-Tov
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ely Steinberg
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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12
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González-Marcos E, González-García E, Rodríguez-Fernández P, Sánchez-González E, González-Bernal JJ, González-Santos J. Determinants of Higher Mortality at Six Months in Patients with Hip Fracture: A Retrospective Study. J Clin Med 2022; 11:jcm11092514. [PMID: 35566638 PMCID: PMC9099846 DOI: 10.3390/jcm11092514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/16/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: Hip fracture is a pathology with high mortality, but the lack of a universal adaptation of the factors associated with death makes it difficult to predict risk and implement prevention in this group. This study aimed to identify the factors that determine a higher mortality at six months following hip fracture. (2) Methods: A retrospective longitudinal study, whose study population consisted of patients over 65 years of age. The main variable was mortality at 6 months of fracture. Relevant data related to sociodemographic and clinical variables for subsequent bivariate (χ2) and multivariate analysis were obtained. (3) Results: In all, 665 people participated in the study, 128 of whom died within 6 months of the fracture. The multivariate adjusted analysis demonstrated significant relationships between the main variable and aspects such as institutionalization at discharge (Odds Ratio (OR) = 2.501), a worse overall functional capacity (OR = 2.453) and cognitive capacity (OR = 3.040) at admission, and complications such as heart failure (OR = 5.767) or respiratory infection (OR = 5.308), in addition to the taking of certain drugs and the presence of a greater number of comorbidities. (4) Conclusions: There are certain factors related to higher mortality at six months in patients with hip fracture who are aged 65 years or older.
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Affiliation(s)
| | - Enrique González-García
- Traumatology and Orthopedic Surgery Service, Burgos University Hospital, 09006 Burgos, Spain;
| | - Paula Rodríguez-Fernández
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain;
- Correspondence: (P.R.-F.); (J.J.G.-B.)
| | | | - Jerónimo J. González-Bernal
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain;
- Correspondence: (P.R.-F.); (J.J.G.-B.)
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13
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Becker N, Hafner T, Pishnamaz M, Hildebrand F, Kobbe P. Patient-specific risk factors for adverse outcomes following geriatric proximal femur fractures. Eur J Trauma Emerg Surg 2022; 48:753-761. [PMID: 35325262 PMCID: PMC9001566 DOI: 10.1007/s00068-022-01953-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Proximal femur fractures (PFFs) occur frequently among geriatric patients due to diverse risk factors, such as a lower bone mineral density and the increased risk of falls. METHODS In this review, we focus on recent literature of patient-specific risk factors and their impact on common complications and outcome parameters in patients with PFF. RESULTS Patient- and treatment related factors have a significant impact on outcome and are associated with an increased risk of mortality, impairments in functional rehabilitation and complicative courses. CONCLUSION Geriatric patients at high risk for complications are nursing home inhabitants suffering from severe osteoporosis, dementia and sarcopenia. The early and ongoing assessment for these individual risk factors is crucial. Strategies including interdisciplinary approaches, addressing comorbidities and facilitating an optimal risk factor evaluation result in a beneficial outcome. The ongoing ambulant assessment and therapy of complicating factors (e.g., malnutrition, sarcopenia, frailty or osteoporosis) have to be improved.
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Affiliation(s)
- Nils Becker
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Tobias Hafner
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Miguel Pishnamaz
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Philipp Kobbe
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
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14
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Pinto D, Alshahrani M, Chapurlat R, Chevalley T, Dennison E, Camargos BM, Papaioannou A, Silverman S, Kaux JF, Lane NE, Morales Torres J, Paccou J, Rizzoli R, Bruyere O. The global approach to rehabilitation following an osteoporotic fragility fracture: A review of the rehabilitation working group of the International Osteoporosis Foundation (IOF) committee of scientific advisors. Osteoporos Int 2022; 33:527-540. [PMID: 35048200 DOI: 10.1007/s00198-021-06240-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/11/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To conduct a review of the current state of the evidence for rehabilitation strategies post-fragility fracture. METHODS Narrative review conducted by the Rehabilitation Working Group of the International Osteoporosis Foundation Committee of Scientific Advisors characterizing the range of rehabilitation modalities instrumental for the management of fragility fractures. RESULTS Multi-modal exercise post-fragility fracture to the spine and hip is strongly recommended to reduce pain, improve physical function, and improve quality of life. Outpatient physiotherapy post-hip fracture has a stronger evidence base than outpatient physiotherapy post-vertebral fracture. Appropriate nutritional care after fragility fracture provides a large range of improvement in morbidity and mortality. Education increases understanding of osteoporosis which in turn increases utilization of other rehabilitation services. Education may improve other health outcomes such as pain and increase a patient's ability for self-advocacy. CONCLUSION Rehabilitation interventions are inter-reliant, and research investigating the interaction of exercise, nutrition, and other multi-modal therapies may increase the relevance of rehabilitation research to clinical care.
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Affiliation(s)
- D Pinto
- Department of Physical Therapy, Marquette University, P.O. Box 1881, Wisconsin, 53201, Milwaukee, USA.
- Department of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, 4000, Liège, Belgium.
| | - M Alshahrani
- Department of Physical Therapy, Marquette University, P.O. Box 1881, Wisconsin, 53201, Milwaukee, USA
- Department of Medical Rehabilitation Science, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - T Chevalley
- Division of Bone Diseases, Department of Medicine, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - E Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - B M Camargos
- Densitometry Diagnostic Unit - Rede Materdei de Saúde, Belo Horizonte, Mina Gerais, Brazil
| | - A Papaioannou
- Department of Medicine, Division of Geriatrics, McMaster University, Hamilton, Canada
| | - S Silverman
- Cedars-Sinai Medical Center and University of California, Los Angeles, CA, USA
| | - J-F Kaux
- Department of Physical and Rehabilitation Medicine, University Hospital of Liège, University of Liège, Liège, Belgium
| | - N E Lane
- Department of Medicine and Rheumatology, Davis School of Medicine, University of California, Sacramento, CA, USA
| | - J Morales Torres
- University of Guanajuato at León, Osteoporosis Unit, Hospital Aranda de La Parra, León, Mexico
| | - J Paccou
- Département Universitaire de Rhumatologie, Centre Hospitalier Et Universitaire, Hôpital Roger Salengro, Lille, France
| | - R Rizzoli
- Division of Bone Diseases, Department of Medicine, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - O Bruyere
- Department of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, 4000, Liège, Belgium
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15
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Tseng MY, Liang J, Wu CC, Cheng HS, Chen CY, Lin YE, Weng CJ, Yu YH, Shyu YIL. Influence of Nutritional Status on a Family-Centered Care Intervention for Older Adults with Cognitive Impairment following Hip-Fracture Surgery: Secondary Data Analysis of a Randomized Controlled Trial. J Nutr Health Aging 2022; 26:1047-1053. [PMID: 36519767 DOI: 10.1007/s12603-022-1864-y] [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: 11/16/2022]
Abstract
OBJECTIVES In Taiwan, older adults with cognitive impairment who undergo hip-fracture surgery are routinely cared for by family members. This study aimed to determine if nutritional status influenced the effects of a family-centered intervention for older adults with cognitive impairment recovering from hip-fracture surgery. DESIGN Secondary data analysis of data from a randomized controlled trial was conducted to examine the influences of nutritional status 1 month after hospital discharge on the effects of a family-centered care intervention model, which was designed for older adults with hip fracture and cognitive impairment. Outcomes were compared among participants according to nutrition status (well-nourished/poorly-nourished) and treatment approach (control/intervention). SETTING The original study was conducted at a 3000-bed medical center from July 2015 to October 2019. PARTICIPANTS Participants were older adults with cognitive impairment who had undergone hip-fracture surgery. Participants were assessed as poorly-nourished or well-nourished with the Mini-Nutritional Assessment (MNA) 1-month post-discharge and were then randomly assigned to either the intervention group or control group. INTERVENTION A family-centered intervention model for family caregivers of older adults with cognitive impairment recovering from hip-fracture surgery was implemented. The intervention was delivered by geriatric nurses, which included instructions for family caregivers in overseeing exercises for strengthening the hip, understanding dietary requirements, and managing behavioral problems associated with cognitive impairment. MEASUREMENTS Outcome measures included activities of daily living (ADLs), instrumental ADLs, hip range of motion, hip muscle strength, depression, measured with the Geriatric Depressive Scale, and physical and mental health related quality of life, measured with the Short Form Survey (SF-36), Taiwanese version. Participants were assessed at 1-, 3-, 6-, and 12-months post-discharge. RESULTS Most of the 134 participants were assessed as poorly nourished (n = 122); 57 were the control group and 65 received the intervention. For the well-nourished participants (n = 12), four were in the intervention group and eight were controls. There were no significant differences in any outcome variables for poorly nourished participants who received the intervention compared with controls. For the sample of well-nourished participants, those who received the intervention performed significantly better in outcomes of IADLs (b = 1.74, p < .05), hip muscle strength (b = 9.64, p < .01), and physical health related quality of life (b = 10.47, p < .01). CONCLUSION The family-centered care intervention was only effective for older adults with cognitive impairment recovering from hip-fracture surgery who were well-nourished at 1 month following hospital discharge, but not for those at risk of malnutrition. Interventions should focus on enhancing nutritional status following hip surgery which could allow the family-centered in-home intervention to be beneficial for more older adults with cognitive impairment recovering from hip-fracture surgery.
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Affiliation(s)
- M-Y Tseng
- Yea-Ing L. Shyu, School of Nursing, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan, E-mail: Phone: +886-3-2118800 Ext. 5275; Fax: +886-3-2118400, ORCID code 0000-0002-9697-535X
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16
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Malnutrition, poor function and comorbidities predict mortality up to one year after hip fracture: a cohort study of 2800 patients. Eur Geriatr Med 2021; 13:433-443. [PMID: 34854063 DOI: 10.1007/s41999-021-00598-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Despite extensive research, a complete understanding of factors influencing mortality risk after hip fractures is lacking. Previous research has focused on static risk factors; however, to improve outcomes, attention should be directed towards risk factors that may be optimised. The present study aimed to investigate the association of 19 risk factors with mortality among patients with hip fracture treated according to a well-defined guideline. METHODS The study was a retrospective analysis of a large prospective patient cohort with all consecutive patients surgically treated for a hip fracture from January 2011 to December 2017 included (n = 2800). Variables were obtained from patient records and the Holstebro Hip Fracture Database comprising prospectively registered data on demographics, comorbidity, malnutrition (low Body Mass Index (BMI) or albumin) and hospital stay (including fracture and surgical data, biochemistry, mobilisation and discharge). Outcomes were 30-day and one-year mortality. RESULTS Patients were predominantly female (66%); median age 81.6 years. Overall mortality was 9% at 30 days and 24% at one year. Age ≥ 75 years, male gender, nursing home residence, cognitive impairment, American Society of Anesthesiologists (ASA) score ≥ 3, BMI < 20 kg/m2, albumin < 35 g/l, creatinine ≥ 100 µmol/l, a low New Mobility Score and no mobilisation were all associated with increased mortality at 30 days and one year. CONCLUSION In addition to non-modifiable risk factors, comorbidities (expressed as high ASA score and creatinine), malnutrition, and failure to achieve early post-operative mobilisation were associated with increased short and long-term mortality among patients with hip fracture: these are potentially modifiable. The effect of optimisation interventions warrants further research.
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17
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Fu M, Guo J, Zhang Y, Zhao Y, Zhang Y, Wang Z, Hou Z. Effect of Wearing Medical Masks on Perioperative Respiratory Complications in Older Adults with Hip Fracture: A Retrospective Cohort Study. Clin Interv Aging 2021; 16:1967-1974. [PMID: 34824528 PMCID: PMC8610772 DOI: 10.2147/cia.s333238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Respiratory complication is one of the major challenges in the treatment of older adults with hip fractures. However, no study so far has investigated the effect of wearing medical masks on the prevention of perioperative respiratory complications in these patients. Patients and Methods In this retrospective cohort study, 1016 consecutive patients aged ≥65 years with hip fractures were included and assigned to two groups: the control group and the observation group. The two groups received the same perioperative management modalities. In addition, patients in the observation group were asked to wear medical masks for protection. Data of patients’ demographics, fracture type, surgical methods, comorbidities, the incidence of perioperative respiratory and other complications, and hospital outcomes were collected and compared between the two groups. Subgroup analyses were also performed stratified by fracture types. Results A total of 1016 patients (292 females and 724 males) with a mean age of 79.4±7.3 years were analyzed in the study, including 533 in the control group and 483 in the observation group. The overall incidence of perioperative respiratory complication, and the incidence of pulmonary infection, respiratory failure and arrhythmia in the observation group were significantly lower than the control group, especially in winter and spring. There was no difference in other complications, hospital length of stay, and total hospital costs. Further subgroup analyses showed that the incidence of heart failure and arrhythmia in the observation group was lower than that in the control group for patients with femoral neck fractures, which was different from patients with intertrochanteric fractures. Conclusion The incidence of perioperative respiratory complications, including pulmonary infection and respiratory failure, could be reduced in older adults with hip fractures by strengthening personal protection, including wearing medical masks, especially in winter and spring. Wearing medical masks could also effectively reduce the incidence of perioperative heart failure and arrhythmia in femoral neck fracture patients and do not increase the incidence of other complications and the burden of hospitalization.
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Affiliation(s)
- Mingming Fu
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yaqian Zhang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yuqi Zhao
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China.,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
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18
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Lai WY, Chiu YC, Lu KC, Huang IT, Tsai PS, Huang CJ. Beneficial effects of preoperative oral nutrition supplements on postoperative outcomes in geriatric hip fracture patients: A PRISMA-compliant systematic review and meta-analysis of randomized controlled studies. Medicine (Baltimore) 2021; 100:e27755. [PMID: 34964732 PMCID: PMC8615416 DOI: 10.1097/md.0000000000027755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 10/27/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Geriatric hip fracture patients often present malnutrition during admission, which leads to higher morbidity and mortality. Protein-based oral nutrition supplements may improve nutritional status. We conducted this systematic review and meta-analysis of randomized controlled trials (RCTs) according to the PRISMA guidelines to elucidate whether preoperative nutrition supplements can improve postoperative outcomes in geriatric hip fracture patients. METHODS Only RCTs conducted to compare postoperative outcomes between geriatric hip fracture patients (>60 years old) receiving preoperative oral protein-based nutrition supplement (ONS group) and those who receiving regular diet (Control group) were included. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception until August, 2021. Postoperative outcomes, including complications, length of hospital stay, and in-hospital mortality, were assessed. RESULTS A total of 5 RCTs with 654 geriatric hip fracture patients (ONS group: 320 subjects; Control group 334 subjects) were included. Our data revealed that postoperative complications risk in the ONS group was significantly lower than in the Control group (odd's ratio: 0.48, 95% confidence intervals [CI]: 0.26-0.89, P = .02, I2 = 64%). However, no significant differences in the length of hospital stay (standardized mean difference: -0.35 days, 95% CI: -1.68 to 0.98 days, P = .61, I2 = 0%) and the risk of having postoperative in-hospital mortality (odd's ratio: 1.07, 95% CI: 0.43-2.63, P = .89, I2 = 54%) between these 2 groups were observed. Quality assessment revealed high risk of bias and significant data heterogeneity (I2>50%) in most included RCTs. CONCLUSION Preoperative protein-based oral nutrition supplements exert beneficial, but limited, effects on postoperative outcomes in geriatric patients with hip fracture undergoing surgery.
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Affiliation(s)
- Wen-Yi Lai
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chi Chiu
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Ching Lu
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - I-Tao Huang
- Emergency Department, Redcliffe Hospital, QLD, Australia
- School of Public Health, Faculty of Medicine, University of Queensland, QLD, Australia
| | - Pei-Shan Tsai
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chun-Jen Huang
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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19
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Han CY, Crotty M, Thomas S, Cameron ID, Whitehead C, Kurrle S, Mackintosh S, Miller M. Effect of Individual Nutrition Therapy and Exercise Regime on Gait Speed, Physical Function, Strength and Balance, Body Composition, Energy and Protein, in Injured, Vulnerable Elderly: A Multisite Randomized Controlled Trial (INTERACTIVE). Nutrients 2021; 13:nu13093182. [PMID: 34579060 PMCID: PMC8468965 DOI: 10.3390/nu13093182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
It is imperative that the surgical treatment of hip fractures is followed up with rehabilitation to enhance recovery and quality of life. This randomized controlled trial aimed to determine if an individualised, combined exercise–nutrition intervention significantly improved health outcomes in older adults, after proximal femoral fracture. We commenced the community extended therapy while in hospital, within two weeks post-surgery. The primary outcome was gait speed and secondary outcomes included physical function, strength and balance, body composition, energy and protein intake. Eighty-six and 89 participants were randomized into six months individualised exercise and nutrition intervention and attention-control groups, respectively. There were no statistically significant differences in gait speed between the groups at six and 12 months. There were no major differences between groups with respect to the secondary outcomes, except estimated energy and protein intake. This may be explained by the sample size achieved. Participants in the intervention group had greater increment in energy (235 kcal; 95% CI, 95 to 375; p = 0.01) and protein intake (9.1 g; 95% CI, 1.5 to 16.8; p = 0.02), compared with those in the control group at six months but not significant at 12 months. This study has demonstrated that providing early, combined exercise and nutrition therapy can improve dietary energy and protein intake in older adults with hip fractures.
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Affiliation(s)
- Chad Yixian Han
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Maria Crotty
- Rehabilitation and Ageing Studies Unit, Flinders University, Adelaide, SA 5042, Australia; (M.C.); (S.T.); (C.W.)
| | - Susie Thomas
- Rehabilitation and Ageing Studies Unit, Flinders University, Adelaide, SA 5042, Australia; (M.C.); (S.T.); (C.W.)
| | - Ian D. Cameron
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2065, Australia;
| | - Craig Whitehead
- Rehabilitation and Ageing Studies Unit, Flinders University, Adelaide, SA 5042, Australia; (M.C.); (S.T.); (C.W.)
| | - Susan Kurrle
- Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
| | - Shylie Mackintosh
- Allied Health and Human Performance, University of South Australia, Adelaide, SA 5042, Australia;
| | - Michelle Miller
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
- Correspondence: ; Tel.: +61-8-82012421
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20
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De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Galluzzo L, Iolascon G, Maggi S, Martini E, Momoli A, Onder G, Paoletta M, Pietrogrande L, Roselli M, Ruggeri M, Ruggiero C, Santacaterina F, Tritapepe L, Zurlo A, Antonelli Incalzi R. Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2021; 33:2405-2443. [PMID: 34287785 DOI: 10.1007/s40520-021-01898-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIM To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. METHODS A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). CONCLUSION These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.
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21
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Liu J, Qu Q, Xuekelati S, Bai X, Wang L, Xiang H, Wang H. Geographic and Age Variations in Low Body Mass Index Among Community-Dwelling Older People in Xinjiang: A Cross-Sectional Study. Front Med (Lausanne) 2021; 8:675931. [PMID: 34336883 PMCID: PMC8319472 DOI: 10.3389/fmed.2021.675931] [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: 03/04/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Studies have shown an association between undernutrition and increased adverse outcome, as well as substantial geographic and age variations in undernutrition. Body mass index (BMI), a core indicator of undernutrition, is easy to measure and reflects the nutritional and health status of the human body. It is a simple and suitable tool for epidemiological investigations in large sample populations. Herein, we provide the first description of geographic and age variations in the prevalence of low BMI among community-dwelling older people in Xinjiang. Methods: From January 2019 to December 2019, using a multi-stage random sampling method, we conducted a cross-sectional epidemiological survey of the community-dwelling older people in Xinjiang at different latitudes. Of the 87,000 participants, the statistical analyses included 86,514 participants with complete data. Results: In Xinjiang, the prevalence of low BMI was 7.7% in the community-dwelling older people. The BMI gradually decreased with increasing age and gradually increased with latitude. The prevalence of low BMI in northern Xinjiang was 5.3%, which was significantly lower than that in eastern (7.7%) and southern (9.3%) Xinjiang. In the 60–69-, 70–79-, 80–89-, and ≥90-year age groups, the prevalence rates of low BMI were 5.8, 7.9, 10.0, and 13.9%, respectively. After adjusting for confounding factors (sex, ethnic group, hypertension, diabetes, hyperlipemia, smoking, and drinking), multivariate logistic regression analysis showed that the odds ratios (95% CI) for low BMI in eastern and southern Xinjiang were 1.165 (1.056–1.285) and 1.400 (1.274–1.538), respectively, compared to northern Xinjiang. The adjusted odds ratios (95% CI) for low BMI in the 70–79-, 80–89-, and ≥90-year age groups were 1.511 (1.39–1.635), 2.233 (2.030–2.456), and 3.003 (2.439–3.696), respectively, compared to the 60–69-year age group. Conclusion: The results of this study revealed geographic and age variations in the prevalence of low BMI in the community-dwelling older people in Xinjiang. The prevalence of low BMI gradually increased as the latitude decreased and as age increased.
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Affiliation(s)
- Jinling Liu
- Second Department of the Cadre Health Care Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Qun Qu
- The Health Center for the Cadre of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Saiyare Xuekelati
- Second Department of the Cadre Health Care Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Xue Bai
- Second Department of the Cadre Health Care Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Li Wang
- Second Department of the Cadre Health Care Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Hong Xiang
- Second Department of the Cadre Health Care Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Hongmei Wang
- Second Department of the Cadre Health Care Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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22
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Min K, Beom J, Kim BR, Lee SY, Lee GJ, Lee JH, Lee SY, Won SJ, Ahn S, Bang HJ, Cha Y, Chang MC, Choi JY, Do JG, Do KH, Han JY, Jang IY, Jin Y, Kim DH, Kim DH, Kim IJ, Kim MC, Kim W, Lee YJ, Lee IS, Lee IS, Lee J, Lee CH, Lim SH, Park D, Park JH, Park M, Park Y, Ryu JS, Song YJ, Yang S, Yang HS, Yoo JS, Yoo JI, Yoo SD, Choi KH, Lim JY. Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures. Ann Rehabil Med 2021; 45:225-259. [PMID: 34233406 PMCID: PMC8273721 DOI: 10.5535/arm.21110] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/10/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. METHODS Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. RESULTS A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. CONCLUSION This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.
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Affiliation(s)
- Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | | | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sun Jae Won
- Department of Rehabilitation Medicine, Yeouido Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sangwoo Ahn
- Physical Therapy, Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Hee Do
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Jae-Young Han
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youri Jin
- Department of Food and Nutrition Services, Hanyang University Hospital, Seoul, Korea
| | - Dong Hwan Kim
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Jong Kim
- Howareyou Rehabilitation Clinic, Seoul, Korea
| | - Myung Chul Kim
- Department of Physical Therapy, Eulji University, Seongnam, Korea
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Jung Lee
- Department of Physical Medicine and Rehabilitation, Myongji Hospital, Goyang, Korea
| | - In Seok Lee
- Nutrition Team, Kyung Hee University Medical Center, Seoul, Korea
| | - In-Sik Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - JungSoo Lee
- Department of Rehabilitation Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Chang-Hyung Lee
- Department of Physical Medicine and Rehabilitation, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jung Hyun Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Myungsook Park
- Department of Nursing, Konkuk University, Chungju, Korea
| | - Yongsoon Park
- Department of Food and Nutrition, Hanyang University, Seoul, Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Jin Song
- Occupational Therapy, Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea
| | - Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Woman’s University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Seung Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Ji Sung Yoo
- Department of Rehabilitation Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jun-il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Peng LN, Yu PC, Lee HF, Lin MH, Chen LK. Protein-enriched diet improved muscle endurance and marginally reduced intramuscular adiposity: Results from a randomized controlled trial among middle-aged and older adults. Arch Gerontol Geriatr 2021; 96:104436. [PMID: 34098214 DOI: 10.1016/j.archger.2021.104436] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Maintaining sufficient dietary protein intake is important for nutritional status, muscle mass, and healthy aging, but the clinical effects of high protein diet remained controversial.. METHODS This 12-week randomized controlled trial enrolled community-dwelling middle-aged and older adults to evaluate clinical effects of daily diet with different protein density.. All participants received 10 frozen meals per week for 12 weeks containing either 15% daily calorie of protein (regular-protein group, RPG), or 25% daily calorie of protein (high-protein group, HPG). Bioimpedance analysis was used to assess body composition, and the magnetic resonance imaging on both mid-thighs was performed to measure muscle mass and the intramuscular adiposity. RESULTS This trial enrolled 70 participants, and data of 52 participants (mean age: 53.7 ± 8.3 years, 53.8% male; 25 in RPG and 27 in HPG) were available for analysis. Baseline demographic characteristics, functional assessment, body composition and muscle parameters, and laboratory data were similar between groups. During the study period, participants of both groups significantly reduced body weight, body mass index, total body fat percentage, and handgrip strength, but not in the relative appendicular muscle mass). Compared to participants of RPG, HPG participants showed significant improvement in 6-minute walking distance, increased high-sensitivity C-reactive protein and marginal reduction in intramuscular adiposity than RPG participants. CONCLUSIONS Higher dietary protein intake significantly improved physical endurance and marginally reduced intramuscular adiposity, but increased the inflammatory biomarker among middle-aged and older adults. Further study is needed to explore long-term effects of high-protein diet among middle-aged and older adults..
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Affiliation(s)
- Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Chin Yu
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Institute of Neuroscience, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huei-Fang Lee
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - Ming-Hsien Lin
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Institute of Neuroscience, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Municipal Gab-Dau Hospital, Taipei, Taiwan
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24
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Hulsbæk S, Bandholm T, Ban I, Foss NB, Jensen JEB, Kehlet H, Kristensen MT. Feasibility and preliminary effect of anabolic steroids in addition to strength training and nutritional supplement in rehabilitation of patients with hip fracture: a randomized controlled pilot trial (HIP-SAP1 trial). BMC Geriatr 2021; 21:323. [PMID: 34016037 PMCID: PMC8136760 DOI: 10.1186/s12877-021-02273-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/05/2021] [Indexed: 12/14/2022] Open
Abstract
Background Anabolic steroid has been suggested as a supplement during hip fracture rehabilitation and a Cochrane Review recommended further trials. The aim was to determine feasibility and preliminary effect of a 12-week intervention consisting of anabolic steroid in addition to physiotherapy and nutritional supplement on knee-extension strength and function after hip fracture surgery. Methods Patients were randomized (1:1) during acute care to: 1. Anabolic steroid (Nandrolone Decanoate) or 2. Placebo (Saline). Both groups received identical physiotherapy (with strength training) and a nutritional supplement. Primary outcome was change in maximal isometric knee-extension strength from the week after surgery to 14weeks. Secondary outcomes were physical performance, patient reported outcomes and body composition. Results Seven hundred seventeen patients were screened, and 23 randomised (mean age 73.4years, 78% women). Target sample size was 48. Main limitations for inclusion were not home-dwelling (18%) and cognitive dysfunction (16%). Among eligible patients, the main reason for declining participation was Overwhelmed and stressed by situation (37%). Adherence to interventions was: Anabolic steroid 87%, exercise 91% and nutrition 61%. Addition of anabolic steroid showed a non-significant between-group difference in knee-extension strength in the fractured leg of 0.11 (95%CI -0.25;0.48) Nm/kg in favor of the anabolic group. Correspondingly, a non-significant between-group difference of 0.16 (95%CI -0.05;0.36) Nm/Kg was seen for the non-fractured leg. No significant between-group differences were identified for the secondary outcomes. Eighteen adverse reactions were identified (anabolic=10, control=8). Conclusions Early inclusion after hip fracture surgery to this trial seemed non-feasible, primarily due to slow recruitment. Although inconclusive, positive tendencies were seen for the addition of anabolic steroid. Trial registration Clinicaltrials.gov NCT03545347. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02273-z.
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Affiliation(s)
- Signe Hulsbæk
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark.
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ilija Ban
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Bang Foss
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Anesthesiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jens-Erik Beck Jensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology 7621, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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25
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Lin C, Rosen S, Breda K, Tashman N, T Black J, Lee J, Chiang A, Rosen B. Implementing a Geriatric Fracture Program in a Mixed Practice Environment Reduces Total Cost and Length of Stay. Geriatr Orthop Surg Rehabil 2021; 12:2151459320987701. [PMID: 33747608 PMCID: PMC7905728 DOI: 10.1177/2151459320987701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/27/2020] [Accepted: 12/22/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction: Geriatric-orthopaedic co-management models can improve patient outcomes. However, prior reports have been at large academic centers with “closed” systems and an inpatient geriatric service. Here we describe a Geriatric Fracture Program (GFP) in a mixed practice “pluralistic” environment that includes employed academic faculty, private practice physicians, and multiple private hospitalist groups. We hypothesized GFP enrollment would reduce length of stay (LOS), time to surgery (TTS), and total hospital costs compared to non-GFP patients. Materials and Methods: A multidisciplinary team was created around a geriatric Nurse Practitioner (NP) and consulting geriatrician. Standardized geriatric focused training programs and electronic tools were developed based on best practice guidelines. Fracture patients >65 years old were prospectively enrolled from July 2018 – June 2019. A trained biostatistician performed all statistical analyses. A p < 0.05 was considered significant. Results: 564 operative and nonoperative fractures in patients over 65 were prospectively followed with 153 (27%) enrolled in the GFP and 411 (73%) admitted to other hospitalists or their primary care provider (non-GFP). Patients enrolled in the GFP had a significantly shorter median LOS of 4 days, compared to 5 days in non-GFP patients (P < 0.001). There was a strong trend towards a shorter median TTS in the GFP group (21.5 hours v 25 hours, p = 0.066). Mean total costs were significantly lower in the GFP group ($25,323 v $29085, p = 0.022) Discussion: Our data shows that a geriatric-orthopaedic co-management model can be successfully implemented without an inpatient geriatric service, utilizing the pre-existing resources in a complex environment. The program can be expanded to include additional groups to improve care for entire geriatric fracture population with significant anticipated cost savings. Conclusions: With close multidisciplinary team work, a successful geriatric-orthopaedic comanagement model for geriatric fractures can be implemented in even a mixed practice environment without an inpatient geriatrics service.
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Affiliation(s)
- Carol Lin
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sonja Rosen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | | | - Jae Lee
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aaron Chiang
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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26
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Barrimore S, Davey M, Pulle RC, Crouch A, Bell JJ. Why Don't We Tube Feed Hip Fracture Patients? Findings from the Implementation of an Enteral Tube Feeding Decision Support Tool. Geriatrics (Basel) 2021; 6:geriatrics6010012. [PMID: 33540618 PMCID: PMC7930976 DOI: 10.3390/geriatrics6010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background: This study aimed to report (i) the prevalence of enteral tube feeding (ETF), (ii) investigate whether implementing a decision support tool influenced ETF rates, and (iii) understand reasons influencing decisions to offer ETF. Methods: A pre/post evaluation included consecutive patients admitted to a hip fracture unit. Following baseline data collection, a published ETF Decision Support Tool was implemented by the multidisciplinary team to determine the necessity and influencing reasons for offering ETF. Results: Pre-post groups (n = 90,86) were well matched for age (83 vs. 84.5 years; p = 0.304) and gender (females 57 vs. 57; p = 0.683). ETF rates remained low across groups (pre/post n = 4,2; p = 0.683) despite high malnutrition prevalence (41.6% vs. 50.6%; p = 0.238). Diverse and conflicting reasons were identified regarding decisions to offer ETF. Conclusion: A complex interplay of factors influences the team decision-making process to offer ETF to nutritionally vulnerable patients. These demands are individualised, rather than algorithmic, involving shared decision-making and informed consent processes.
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Affiliation(s)
- Sally Barrimore
- The Prince Charles Hospital, Chermside, QLD 4032, Australia; (S.B.); (R.C.P.); (A.C.)
| | - Madeleine Davey
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia;
| | | | - Alisa Crouch
- The Prince Charles Hospital, Chermside, QLD 4032, Australia; (S.B.); (R.C.P.); (A.C.)
| | - Jack J. Bell
- The Prince Charles Hospital, Chermside, QLD 4032, Australia; (S.B.); (R.C.P.); (A.C.)
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD 4067, Australia
- Correspondence: ; Tel.: +61-7-3139-6172; Fax: +61-7-3139-6147
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Inoue T, Maeda K, Nagano A, Shimizu A, Ueshima J, Murotani K, Sato K, Tsubaki A. Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes. Nutrients 2020; 12:nu12123743. [PMID: 33291800 PMCID: PMC7762043 DOI: 10.3390/nu12123743] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022] Open
Abstract
Geriatric patients with hip fractures often experience overlap in problems related to nutrition, including undernutrition, sarcopenia, and frailty. Such problems are powerful predictors of adverse responses, although few healthcare professionals are aware of them and therefore do not implement effective interventions. This review aimed to summarize the impact of undernutrition, sarcopenia, and frailty on clinical outcomes in elderly individuals with hip fractures and identify successful strategies that integrate nutrition and rehabilitation. We searched PubMed (MEDLINE) and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant literature published over the last 10 years and found that advanced interventions targeting the aforementioned conditions helped to significantly improve postoperative outcomes among these patients. Going forward, protocols from advanced interventions for detecting, diagnosing, and treating nutrition problems in geriatric patients with hip fractures should become standard practice in healthcare settings.
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Affiliation(s)
- Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Shimami-cho 950-3198, Japan; (T.I.); (A.T.)
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute 480-1195, Japan
- Correspondence: ; Tel.: +81-561-62-3311; Fax: +81-561-78-6364
| | - Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya 663-8211, Japan;
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8127, Japan;
| | - Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Tokyo 141-8625, Japan;
| | - Kenta Murotani
- Biostatistics Center, Kurume University, Kurume 830-0011, Japan;
| | - Keisuke Sato
- Okinawa Chuzan Hospital Clinical Research Center, Chuzan Hospital, Matsumoto 904-2151, Japan;
| | - Atsuhiro Tsubaki
- Department of Physical Therapy, Niigata University of Health and Welfare, Shimami-cho 950-3198, Japan; (T.I.); (A.T.)
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Eminovic S, Vincze G, Eglseer D, Riedl R, Sadoghi P, Leithner A, Bernhardt GA. Malnutrition as predictor of poor outcome after total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2020; 45:51-56. [PMID: 33244636 PMCID: PMC7801298 DOI: 10.1007/s00264-020-04892-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 12/28/2022]
Abstract
Introduction The aim of this study was to assess the prevalence of protein energy malnutrition (PEM) and correlation with poor post-operative outcome in the elderly undergoing primary total hip arthroplasty (THA). Hypothesis Patients with PEM would have inferior post-operative outcome after THA. Materials and method We retrospectively evaluated the nutritional status of 220 hospitalized patients undergoing THA, 65 years and older. PEM was assessed using serum albumin and total lymphocyte count (TLC). Studied outcome parameters were length of pre-operative and post-operative stay, complications up to six months after surgery and 12-month mortality. Clinical and demographic data were retrieved from medical records from the hospital database. Results The prevalence of PEM among patients undergoing THA was 12.3% (27/220). Patients with PEM were significantly older (mean age 81.3 ± 7.0, p < 0.001), had a lower BMI (24.7 ± 4.1 kg/m 2, p = 0.022), and showed more comorbid conditions (mean CCI 2.8 ± 2.0, p = 0.002) compared with well-nourished patients (age 75.6 ± 6.2, BMI 26.8 ± 4.3 kg/m 2, CCI: 1.7 ± 1.7). Length of pre-operative stay differed significantly (p < 0.001) between PEM (median 7, range 1–36 days) and non PEM (median 1, range 1–22 days). In the PEM group, 12 (44.4%) patients had post-operative complications within six months after OP and 15 (7.8%) patients in the non PEM group (HR = 6.3, 95% CI 1.7–23.1). Conclusion We observed a higher post-operative complication rate for malnourished patients undergoing elective THA. These results underline the importance of pre-operative nutritional assessment in the elderly. Therefore, serum albumin and TLC are valuable clinical markers of PEM and the post-operative outcome.
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Affiliation(s)
- Sandra Eminovic
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Gabor Vincze
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, 8010, Graz, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Gerwin A Bernhardt
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
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He Z, Zhou K, Tang K, Quan Z, Liu S, Su B. Perioperative hypoalbuminemia is a risk factor for wound complications following posterior lumbar interbody fusion. J Orthop Surg Res 2020; 15:538. [PMID: 33203417 PMCID: PMC7672919 DOI: 10.1186/s13018-020-02051-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023] Open
Abstract
Background Although serum albumin levels are increasingly used as an indicator of nutritional status in the clinic, the relationship between perioperative hypoalbuminemia and wound complications after posterior lumbar interbody fusion in the treatment of lumbar degenerative disease remains ambiguous. The aim of this study was to evaluate perioperative serum albumin in relation to postoperative wound complications after posterior lumbar interbody fusion in the treatment of single-segment lumbar degenerative disease. Material and methods We reviewed patients who underwent single-segment posterior lumbar interbody fusion surgery from December 2014 to April 2017 in the Department of Orthopedics at the First Affiliated Hospital of Chongqing Medical University. Perioperative (preoperative and early postoperative) serum albumin levels were assessed in all patients and were used to quantify nutritional status. We divided the patients into a surgical wound dehiscence (SWD) group and a normal wound healing group and into a surgical site infection (SSI) group and a non-SSI group. To evaluate the relationship between perioperative serum albumin level and postoperative wound complications, we conducted univariate and multiple logistic regression analyses. Results A total of 554 patients were enrolled in the study. The univariate and multiple logistic regression analysis of these differences showed that preoperative serum albumin < 3.5 g/dl (P = 0.001) and postoperative serum albumin < 3.0 g/dl (P = 0.001) were significantly correlated to SWD. There were also significant differences between the SSI groups in terms of preoperative serum albumin < 3.5 g/dl (P = 0.001) and chronic steroid use (P = 0.003). Additionally, the increased hospitalization costs (P < 0.001) and length of hospitalization (P < 0.001) were statistically significant for patients with perioperative hypoalbuminemia. Conclusions For patients who underwent single-segment posterior lumbar interbody fusion surgery, we need to pay more attention to perioperative hypoalbuminemia and chronic steroid use, which are more likely to be associated with increased wound complications, hospitalization costs, and length of hospitalization after surgery. Adequate assessment and management of these risk factors will help reduce wound complications and hospital stays for surgical patients and will save medical costs.
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Affiliation(s)
- Zhongyuan He
- Department of Orthopedics, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangming District, Shenzhen, 518000, China
| | - Kai Zhou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Ke Tang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Zhengxue Quan
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Shaoyu Liu
- Department of Orthopedics, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangming District, Shenzhen, 518000, China
| | - Bao Su
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, 400016, China.
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Baldwin C, Smith R, Gibbs M, Weekes CE, Emery PW. Quality of the Evidence Supporting the Role of Oral Nutritional Supplements in the Management of Malnutrition: An Overview of Systematic Reviews and Meta-Analyses. Adv Nutr 2020; 12:503-522. [PMID: 32945835 PMCID: PMC8009750 DOI: 10.1093/advances/nmaa108] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/13/2020] [Indexed: 01/08/2023] Open
Abstract
There is considerable heterogeneity across the findings of systematic reviews of oral nutritional supplement (ONS) interventions, presenting difficulties for healthcare decision-makers and patients alike. It is not known whether heterogeneity arises from differences in patient populations or relates to methodological rigor. This overview aimed to collate and compare findings from systematic reviews of ONSs compared with routine care in adult patients who were malnourished or at risk of malnutrition with any clinical condition and to examine their methodological quality. Three electronic databases were searched to July 2019, supplemented with hand-searching. Data on all outcomes were extracted and review methodological quality assessed using A MeaSurement Tool for Assessment of systematic Reviews (AMSTAR). Twenty-two reviews were included, 11 in groups from mixed clinical backgrounds and 11 in specific clinical conditions. Ninety-one meta-analyses were identified for 12 different outcomes but there was discordance between results. Significant benefits of ONSs were reported in 4 of 4 analyses of energy intake, 7 of 11 analyses of body weight, 7 of 22 analyses of mortality, 10 of 17 analyses of complications (total and infectious), 1 of 3 analyses of muscle strength, 4 of 9 analyses of body composition/nutritional status, 2 of 14 analyses of length of stay, and 2 of 5 analyses of hospital readmissions. Ten reviews were high quality (AMSTAR scores 8-11), 9 moderate (AMSTAR scores 3-8), and 3 poor (AMSTAR scores 0-3). Methodological deficiencies were limitations to searches, poor reporting of heterogeneity, and failure to incorporate quality of evidence into any recommendations. Discordance between reviews was not markedly reduced when only high-quality reviews were considered. Evidence for the effects of ONS in malnourished patients or those who are at risk of malnutrition is uncertain, and discordance in results can arise from differences in clinical background of patients or the etiological basis of malnutrition.
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Affiliation(s)
| | - Rosemary Smith
- Department of Nutritional Sciences, King's College London, London, United Kingdom
| | - Michelle Gibbs
- Department of Nutritional Sciences, King's College London, London, United Kingdom
| | - C Elizabeth Weekes
- Department of Nutritional Sciences, King's College London, London, United Kingdom,Department of Nutrition and Dietetics, Guy's and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Peter W Emery
- Department of Nutritional Sciences, King's College London, London, United Kingdom
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Chen R, Li L, Xiang Z, Li H, Hou XL. Association of iron supplementation with risk of transfusion, hospital length of stay, and mortality in geriatric patients undergoing hip fracture surgeries: a meta-analysis. Eur Geriatr Med 2020; 12:5-15. [PMID: 32691389 DOI: 10.1007/s41999-020-00366-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/13/2020] [Indexed: 02/08/2023]
Abstract
AIMS To assess the efficacy and safety of iron supplementation for perioperative anemia in geriatric patients with hip fracture. METHODS A systematic search was conducted for studies published using PubMed, EMBASE and Cochrane Library Databases that compared iron supplementation with placebo in patients undergoing hip fracture surgery. The outcomes were blood transfusion rate and volume, length of stay, infection and mortality (last follow-up). Sub-group and sensitivity analyses were performed in cases of substantial heterogeneity. RESULTS The meta-analysis (6 studies: 1201 patients) indicated that iron supplements were not associated with reducing blood transfusion rate (OR 0.92, 95% CI 0.60-1.41; P = 0.69), but high heterogeneity (I2 = 61%) was detected and a significant association was found in sensitivity analysis of four studies (n = 637; OR 0.68, 95% CI 0.49-0.95; P = 0.02). A significant reduction was detected in transfusion volume (two studies: n = 234; MD - 0.45 units/patient, 95% CI - 0.74 to - 0.16; P = 0.002), hospital stay (five studies: n = 998; MD - 1.42, 95% CI - 2.18 to - 0.67; P = 0.0002) and caused no increased risk of mortality (five studies: n = 937; OR 0.94, 95% CI 0.65-1.36; P = 0.76) and infection (four studies: n = 701; OR 0.58, 95% CI 0.38-0.90; P = 0.01). Sub-group analyses of four studies showed that the preoperative intravenous use of iron at 200-300 mg (two studies) may be the beneficial option for hip fractures patients. CONCLUSIONS Iron supplementation, especially preoperative intravenous use of 200-300 mg iron, is safe and associated with reducing transfusion requirement and hospital stay. Unfortunately, data were too limited to draw a definite conclusion. Further evaluation is required before recommending iron supplementation for older patients with hip fracture surgeries.
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Affiliation(s)
- Ran Chen
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610000, China.,Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Lang Li
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610000, China.,Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, 610041, Sichuan, China
| | - Zhou Xiang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610000, China
| | - Hong Li
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Xiao-Ling Hou
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610000, China.
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Reyes BJ, Mendelson DA, Mujahid N, Mears SC, Gleason L, Mangione KK, Nana A, Mijares M, Ouslander JG. Postacute Management of Older Adults Suffering an Osteoporotic Hip Fracture: A Consensus Statement From the International Geriatric Fracture Society. Geriatr Orthop Surg Rehabil 2020; 11:2151459320935100. [PMID: 32728485 PMCID: PMC7366407 DOI: 10.1177/2151459320935100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The majority of patients require postacute care (PAC) after a hip fracture. Despite its importance, there is no established consensus regarding the standards of care provided to hip fracture patients in PAC facilities. METHODOLOGY A writing group was created by professionals from the International Geriatric Fracture Society (IGFS) with representation from other organizations. The focus of the statements included in this article is toward PAC providers located in nursing facilities. Contributions were integrated in a single document that underwent several reviews by each author and then underwent a final review by the lead and senior authors. After this process was completed, the document was appraised by reviewers from IGFS. RESULTS/CONCLUSION A total of 15 statements were crafted. These statements summarize the best available evidence and is intended to help PAC facilities managing older adults with hip fractures more efficiently, aiming toward overall better outcomes in the areas of function, quality of life, and with less complications that could interfere with their optimal recovery.
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Affiliation(s)
- Bernardo J. Reyes
- Charles E Schmidt College of Medicine, Florida Atlantic University,
FL, USA
| | | | - Nadia Mujahid
- Warren Alpert School of Brown University, Rhode Island, USA
| | | | - Lauren Gleason
- The University of Chicago Medical and Biological Science, IL,
USA
| | | | - Arvind Nana
- Charles E Schmidt College of Medicine, Florida Atlantic University,
FL, USA
| | - Maria Mijares
- Charles E Schmidt College of Medicine, Florida Atlantic University,
FL, USA
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Sim DS, Zainul-Abidin S, Sim EY, Seng CS, Tan SEE, Tan MH, Howe TS, Koh JSB. Serum albumin level predicts survival after surgical treatment of metastatic femur fractures: a retrospective study. J Orthop Surg Res 2020; 15:128. [PMID: 32245389 PMCID: PMC7118955 DOI: 10.1186/s13018-020-01632-7] [Citation(s) in RCA: 4] [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: 12/07/2019] [Accepted: 03/12/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Surgical treatment for metastatic pathological femur fractures is associated with high mortality. Correct estimation of prognosis helps in determining the palliative value of surgical treatment and informs surgical decision. This study evaluates the risk factors for mortality in these patients who were surgically treated. METHODS This is a retrospective study of 112 patients with surgical treatment of metastatic pathological femur fractures. Risk factors evaluated included age, ASA status, Charlson comorbidity index, preoperative serum albumin and haemoglobin, primary tumour site, presence of visceral metastases, presence of spinal metastases, time from diagnosis of cancer to occurrence of pathological fracture, type of surgical procedure performed, lesion and whether treatment was received for an actual or impending fracture. A Cox regression model was used to determine if these factors were independent significant factors for survival. RESULTS Mortality at 2 years after surgical treatment of metastatic femoral fractures was 86%. Cox regression analysis of risk factors revealed that preoperative serum albumin and type primary tumour were independent risk factors for mortality. Presence of visceral metastases was strongly correlated to serum albumin levels. CONCLUSION Preoperative serum albumin level and primary tumour site are independent risk factors of survival in patients treated for pathological femur fractures. Serum albumin level may be used as a prognostic tool to guide treatment in this cohort of patients with high mortality rates.
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Affiliation(s)
- David Shaoen Sim
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore. .,, Singapore, Singapore.
| | | | - Eileen Yilin Sim
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Chu Sheng Seng
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | | | - Mann Hong Tan
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Tet Sen Howe
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
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Rynecki ND, Congiusta DV, Fields M, Patel R, Vosbikian MM, Ahmed IH. Increased risk of complications in patients with hypoalbuminemia undergoing revision total hip arthroplasty. J Orthop 2020; 21:253-257. [PMID: 32280163 DOI: 10.1016/j.jor.2020.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/23/2020] [Indexed: 12/19/2022] Open
Abstract
Objective The relationship between hypoalbuminemia and complications after revision total hip arthroplasty (THA) has not been established. We hypothesize that hypoalbuminemia is associated with complications in patients undergoing revision THA. Methods The ACS-NSQIP database was queried for patients undergoing revision THA. Chi square and regression analyses were used to assess the relationship between hypoalbuminemia, demographics, other comorbidities, and complications. Results Hypoalbuminemia is associated with an increased risk of reoperation, bleeding complications, surgical site infections, non-routine discharge, medical complications, and surgical complications. Conclusions Albumin levels should be considered in the preoperative planning of patients undergoing revision THA for possible nutritional optimization.
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Affiliation(s)
- Nicole D Rynecki
- Rutgers New Jersey Medical School, Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, USA
| | - Dominick V Congiusta
- Rutgers New Jersey Medical School, Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, USA
| | - Michael Fields
- Rutgers New Jersey Medical School, Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, USA
| | - Rushi Patel
- Rutgers New Jersey Medical School, Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, USA
| | - Michael M Vosbikian
- Rutgers New Jersey Medical School, Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, USA
| | - Irfan H Ahmed
- Rutgers New Jersey Medical School, Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, USA
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Pratt KJ, Hernandez B, Blancato R, Blankenship J, Mitchell K. Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital. BMJ Open Qual 2020; 9:e000735. [PMID: 32213547 PMCID: PMC7170540 DOI: 10.1136/bmjoq-2019-000735] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 02/14/2020] [Accepted: 03/01/2020] [Indexed: 01/21/2023] Open
Abstract
As many as 50% of hospitalised patients are estimated to be malnourished or at risk of malnutrition on hospital admission, but this condition often goes unrecognised, undiagnosed and untreated. Malnutrition is associated with an elevated need for continued medical interventions, higher costs of care and increased patient safety risks. Tampa General Hospital (TGH), a large teaching hospital in the southeastern USA, initiated a project to improve the quality of patient care at its institution. They did this first by focusing on improving the care quality for their malnourished patients (or patients who were at risk of malnourishment) and by using elements of the national Malnutrition Quality Improvement Initiative (MQii) Toolkit as a mechanism to measure and improve quality. The aim of this study was to evaluate the impact of quality improvement interventions on patient length of stay (LOS), infection rates and readmissions, particularly for malnourished patients. The structure of the MQii and the use of the MQii Toolkit helped staff members identify problems and systematically engage in quality improvement processes. Using the MQii Toolkit, TGH implemented a multipronged approach to improving the treatment of malnourished patients that involved creating interdisciplinary teams of staff and identifying gaps in care that could be improved through a series of changes to hospital-wide clinical workflows. They enhanced interdisciplinary coordination through increased dietitian engagement, the use of electronic health record alerts and new surgical protocols. These interventions lasted 8 months in 2016 and data reported here were collected from 985 patients before the interventions (2015) and 1046 patients after the interventions (2017). The study examines how these process changes affected LOS, infection rates and readmissions at TGH. Following implementation of these quality improvement processes, patients who were malnourished or at risk of malnutrition had a 25% reduction in LOS (from 8 to 6 days, p<0.01) and a 35.7% reduction in infection rates (from 14% to 9%, p<0.01). No statistically significant changes in readmission rates were observed. This study adds to a growing body of literature on quality improvement processes hospitals can undertake to better identify and treat malnourished patients. Hospitals and health systems can benefit from adopting similar institution-wide, quality improvement projects, while policy-makers' support for such programmes can spur more rapid uptake of nutrition-focused initiatives across care delivery settings.
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Affiliation(s)
- Kelsey Jones Pratt
- Center for Healthcare Transformation, Avalere Health, Washington, DC, USA
| | - Beverly Hernandez
- Clinical Nutrition Services, Tampa General Hospital, Tampa, Florida, USA
| | | | - Jeanne Blankenship
- Policy Initiatives and Advocacy, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Kristi Mitchell
- Center for Healthcare Transformation, Avalere Health, Washington, DC, USA
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Föger-Samwald U, Dovjak P, Azizi-Semrad U, Kerschan-Schindl K, Pietschmann P. Osteoporosis: Pathophysiology and therapeutic options. EXCLI JOURNAL 2020; 19:1017-1037. [PMID: 32788914 PMCID: PMC7415937 DOI: 10.17179/excli2020-2591] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
Osteoporosis is a metabolic bone disease that, on a cellular level, results from osteoclastic bone resorption not compensated by osteoblastic bone formation. This causes bones to become weak and fragile, thus increasing the risk of fractures. Traditional pathophysiological concepts of osteoporosis focused on endocrine mechanisms such as estrogen or vitamin D deficiency as well as secondary hyperparathyroidism. However, research over the last decades provided exiting new insights into mechanisms contributing to the onset of osteoporosis, which go far beyond this. Selected mechanisms such as interactions between bone and the immune system, the gut microbiome, and cellular senescence are reviewed in this article. Furthermore, an overview on currently available osteoporosis medications including antiresorptive and bone forming drugs is provided and an outlook on potential future treatment options is given.
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Affiliation(s)
- Ursula Föger-Samwald
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- *To whom correspondence should be addressed: Ursula Föger-Samwald, Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Tel: +43 (1) 40400-56940 or 51270, Fax: +43 (1) 40400-51300, E-mail:
| | - Peter Dovjak
- Department of Acute Geriatrics, Salzkammergut Klinikum Gmunden, Gmunden, Austria
| | - Ursula Azizi-Semrad
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Katharina Kerschan-Schindl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Pietschmann
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
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Hulsbæk S, Ban I, Aasvang TK, Jensen JEB, Kehlet H, Foss NB, Bandholm T, Kristensen MT. Preliminary effect and feasibility of physiotherapy with strength training and protein-rich nutritional supplement in combination with anabolic steroids in cross-continuum rehabilitation of patients with hip fracture: protocol for a blinded randomized controlled pilot trial (HIP-SAP1 trial). Trials 2019; 20:763. [PMID: 31870451 PMCID: PMC6929304 DOI: 10.1186/s13063-019-3845-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/24/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND A 2014 Cochrane review evaluating the effect of anabolic steroids after hip fracture concluded that the quality of the studies was insufficient to draw conclusions on the effects and recommended further high-quality trials in the field. Therefore, the aim of this pilot trial is to determine the preliminary effect and feasibility of a 12-week multimodal intervention consisting of physiotherapy (with strength training), protein-rich nutritional supplement and anabolic steroid on knee-extension muscle strength and function 14 weeks after hip fracture surgery. METHODS We plan to conduct a randomized, placebo-controlled pilot trial with 48 patients operated for acute hip fracture. The patients are randomized (1:1) to either (1) physiotherapy with protein-rich nutritional supplement plus anabolic steroid or (2) physiotherapy with protein-rich nutritional supplement plus placebo. Outcome assessments will be carried out blinded at baseline (3-10 days after surgery) and at 14 weeks after entering the trial. Primary outcome is the change from baseline to follow-up in maximal isometric knee-extension muscle strength in the fractured limb. Secondary outcomes are physical performance test, patient-reported outcomes, and measures of body composition. DISCUSSION If the trial is found feasible and the results show an indication of anabolic steroid being a relevant addition to further enhance the recovery of muscle strength and function in an enhanced recovery after surgery program, this trial will constitute the basis of a larger confirmatory trial. TRIAL REGISTRATION ClinicalTrials.gov, NCT03545347. Preregistered on 4 June 2018.
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Affiliation(s)
- Signe Hulsbæk
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Ilija Ban
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Tobias Kvanner Aasvang
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Jens-Erik Beck Jensen
- Department of Endocrinology, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology 721, Copenhagen University Hospital, Rigshospitalet Ole Maaløes vej 26, 2100 Copenhagen Ø, Denmark
| | - Nicolai Bang Foss
- Department of Anesthesiology, Copenhagen University Hospital, Amager-Hvidovre and Institute of Clinical Medicine, University of Copenhagen, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Clinical Research Centre, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
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Mortality in a low energy geriatric polytrauma patient. Trauma Case Rep 2019; 24:100258. [PMID: 31768413 PMCID: PMC6872862 DOI: 10.1016/j.tcr.2019.100258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/12/2019] [Indexed: 11/23/2022] Open
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40
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Lim BG, Lee IO. Anesthetic management of geriatric patients. Korean J Anesthesiol 2019; 73:8-29. [PMID: 31636241 PMCID: PMC7000283 DOI: 10.4097/kja.19391] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/20/2019] [Indexed: 12/15/2022] Open
Abstract
The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.
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Affiliation(s)
- Byung-Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Il-Ok Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Arkley J, Dixon J, Wilson F, Charlton K, Ollivere BJ, Eardley W. Assessment of Nutrition and Supplementation in Patients With Hip Fractures. Geriatr Orthop Surg Rehabil 2019; 10:2151459319879804. [PMID: 31667002 PMCID: PMC6801887 DOI: 10.1177/2151459319879804] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/06/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction: Malnutrition is common in older people, is known to interact with frailty, and is a
risk factor for wound complications and poor functional outcomes postoperatively.
Sustaining a hip fracture is a significant life event, often resulting in a decline in
mobility and functional ability. A poor nutritional state may further impede recovery
and rehabilitation, so strategies to improve perioperative nutrition are of considerable
importance. We provide a review of nutritional supplement practices in this vulnerable
and growing population. Method: Systematic review of preoperative oral nutritional supplementation (ONS) in hip
fracture patients. Results: We identified 12 articles pertaining to this important area of perioperative care. The
findings suggest postoperative ONS can improve postoperative outcomes in hip fracture
patients, especially in terms of increasing total serum protein, improving nutritional
status to near-optimum levels, and decreasing postoperative complications. Discussion: There is an absence of evidence specific to preoperative ONS in patients admitted
following hip fracture. Literature relating to other populations is encouraging but is
yet to be robustly studied. It is unclear whether these results are generalizable to the
frailer hip fracture population. There is a need for studies clearly defining outcome
measurement and complication assessment pertaining to preoperative ONS. The potential
benefit is considerable, and this review will provide a means to inform the construction
of meaningful trials in preoperative ONS of patients sustaining hip fracture. Conclusion: Oral nutritional supplementation in hip fracture patients may decrease postoperative
complications while increasing elderly patient’s nutritional state to a near-optimum
level. This is extrapolated from postoperative literature, however with a clear gap in
research pertaining specifically to preoperative care. The need for well-constructed
studies focused on the impact and assessment of early ONS in this population is
transparent.
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Affiliation(s)
- James Arkley
- Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Ján Dixon
- Newcastle University, Newcastle Upon Tyne, United Kingdom
| | | | - Karl Charlton
- North East Ambulance Service NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | | | - William Eardley
- James Cook University Hospital, Middlesbrough, United Kingdom
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He Y, Xiao J, Shi Z, He J, Li T. Supplementation of enteral nutritional powder decreases surgical site infection, prosthetic joint infection, and readmission after hip arthroplasty in geriatric femoral neck fracture with hypoalbuminemia. J Orthop Surg Res 2019; 14:292. [PMID: 31481078 PMCID: PMC6724262 DOI: 10.1186/s13018-019-1343-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/22/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nearly half of elderly patients with hip fracture were malnourished, indicated with a serum marker of hypoalbuminemia. Malnutrition was a risk factor for poor outcomes in geriatrics after hip replacement. The purpose of this study was to investigate if oral nutritional supplementation after the procedure in geriatrics with hypoalbuminemia was beneficial for outcomes. METHODS A retrospective cohort study of older (≥ 65 years old) patients suffering femoral neck fracture and undergoing hip replacement with hypoalbuminemia was conducted. Outcomes were compared between patients with and without postoperative nutritional supplementation. RESULTS There were 306 geriatric patients met the criteria. Following adjustment for baseline characteristics, patients with nutritional supplementation showed a lower grade of wound effusion with adjusted OR 0.57 (95% confidence interval (CI), 0.36 to 0.91, P < 0.05). And also a lower rate of surgical site infection (5.5% compared with 13.0% [adjusted OR 0.40, 95% CI, 0.17 to 0.91, P < 0.05]), periprosthetic joint infection (2.8% compared with 9.9% [adjusted OR 0.26, 95% CI, 0.08 to 0.79, P < 0.05]), and 30 days readmission (2.1% compared with 8.7% [adjusted OR 0.22, 95% CI, 0.06 to 0.79, P < 0.05]). The average total hospital stay was longer in patients without nutritional supplementation (10.7 ± 2.0 compared with 9.2 ± 1.8 days, P < 0.05). CONCLUSIONS The data suggest that postoperative nutritional supplementation is a protective factor for surgical site infection, periprosthetic joint infection, and 30-days readmission in geriatric with hypoalbuminemia undergoing a hip replacement. Postoperative nutritional supplementation for these patients should be recommended.
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Affiliation(s)
- Yaoquan He
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jun Xiao
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhanjun Shi
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jinwen He
- Department of Rehabilitation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Tao Li
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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Wyers CE, Reijven PLM, Breedveld-Peters JJL, Denissen KFM, Schotanus MGM, van Dongen MCJM, Eussen SJPM, Heyligers IC, van den Brandt PA, Willems PC, van Helden S, Dagnelie PC. Efficacy of Nutritional Intervention in Elderly After Hip Fracture: A Multicenter Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2019; 73:1429-1437. [PMID: 30204859 PMCID: PMC6132112 DOI: 10.1093/gerona/gly030] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 03/10/2018] [Indexed: 11/29/2022] Open
Abstract
Background Malnutrition after hip fracture is associated with increased rehabilitation time, complications, and mortality. We assessed the effect of intensive 3 month nutritional intervention in elderly after hip fracture on length of stay (LOS). Methods Open-label, randomized controlled trial. Exclusion criteria: age < 55 years, bone disease, life expectancy < 1 year, bedridden, using oral nutritional supplements (ONS) before hospitalization, and cognitive impairment. Intervention: weekly dietetic consultation, energy-protein–enriched diet, and ONS (400 mL per day) for 3 months. Control: usual nutritional care. Primary outcome: total LOS in hospital and rehabilitation clinic, including readmissions over 6 months (Cox regression adjusted for confounders); hazard ratio (HR) < 1.0 reflects longer LOS in the intervention group. Secondary outcomes: nutritional and functional status, cognition, quality of life, postoperative complications (6 months); subsequent fractures and all-cause mortality (1 and 5 years). Effect modification by baseline nutritional status was also tested. Results One hundred fifty-two patients were randomized (73 intervention, 79 control). Median total LOS was 34.0 days (range 4–185 days) in the intervention group versus control 35.5 days (3–183 days; plogrank = .80; adjusted hazard ratio (adjHR): 0.98; 95% CI: 0.68–1.41). Hospital LOS: 12.0 days (4–56 days) versus 11.0 days (3–115 days; p = .19; adjHR: 0.75; 95% CI: 0.53–1.06) and LOS in rehabilitation clinics: 19.5 days (0–174 days) versus 18.5 days (0–168 days; p = .82; adjHR: 1.04; 95% CI: 0.73–1.48). The intervention improved nutritional intake/status at 3, but not at 6 months, and did not affect any other outcome. No difference in intervention effect between malnourished and well-nourished patients was found. Conclusions Intensive nutritional intervention after hip fracture improved nutritional intake and status, but not LOS or clinical outcomes. Paradigms underlying nutritional intervention in elderly after hip fracture may have to be reconsidered.
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Affiliation(s)
- Caroline E Wyers
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Petronella L M Reijven
- Department of Dietetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - José J L Breedveld-Peters
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Karlijn F M Denissen
- Department of Epidemiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Martijn G M Schotanus
- Department of Orthopaedic Surgery, Zuyderland Medical Center Sittard-Geleen, The Netherlands
| | - Martien C J M van Dongen
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Simone J P M Eussen
- Department of Epidemiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Ide C Heyligers
- Department of Orthopaedic Surgery, Zuyderland Medical Center Heerlen, Heerlen, The Netherlands
| | - Piet A van den Brandt
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.,Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Paul C Willems
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Svenhjalmar van Helden
- Department of Trauma surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Trauma surgery, Isala Klinieken, Zwolle, The Netherlands
| | - Pieter C Dagnelie
- Department of Epidemiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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Lizaur-Utrilla A, Gonzalez-Navarro B, Vizcaya-Moreno MF, Lopez-Prats FA. Altered seric levels of albumin, sodium and parathyroid hormone may predict early mortality following hip fracture surgery in elderly. INTERNATIONAL ORTHOPAEDICS 2019; 43:2825-2829. [PMID: 31256198 DOI: 10.1007/s00264-019-04368-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 06/19/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyse a wide set of routine laboratory parameters at admission to predict mortality within 30 post-operative days in elderly patients with hip fracture, as well as calculate the critical values of those biomarkers. METHOD Data of 994 patients older than 65 years with hip fracture were analysed of which 89 (8.2%) died within 30 post-operative days. Variables described in the literature with potential influence on early mortality were collected, including demographics, fracture type, American Society of Anesthesiologists score, Charlson's comorbidity index and pre-operative Hodkinson's mental test and the Katz index for activities of daily living. In addition, an exhaustive collection of biomarkers from routine blood testing at admission was performed. Critical levels of biomarkers were calculated by the method of area under ROC curve. RESULTS At admission, early mortality group had significantly higher Charlson's index (p = 0.001) and lower the Katz index (p = 0.001). The surgical delay also was significantly longer in that group (p = 0.001). In univariate analyses, serum concentration at admission of total protein (p = 0.004), albumin (p = 0.001), sodium (p = 0.001), and parathyroid hormone (PTH) (p = 0.001) were significantly different between both groups. In multivariate analysis, serum albumin < 2.9 g/dL (p = 0.013), sodium < 127 mEq/L (p = 0.035) and PTH > 65 pg/mL (p = 0.005) were predictors of early mortality. The three biomarkers together accounted for 67% of the variability in early mortality. CONCLUSION The association of altered levels at admission of serum concentration of albumin, sodium and PTH was predictor of early mortality following hip fracture surgery in elderly patients.
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Affiliation(s)
- Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Sax s/n, Elda, 03600, Alicante, Spain. .,Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain.
| | - Blanca Gonzalez-Navarro
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Sax s/n, Elda, 03600, Alicante, Spain
| | - Maria F Vizcaya-Moreno
- Clinical Research Group, Faculty of Health Sciences, University of Alicante, Ctra San Vicente Raspeig s/n, San Vicente Raspeig, 03690, Alicante, Spain
| | - Fernando A Lopez-Prats
- Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain
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46
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Voeten SC, Krijnen P, Voeten DM, Hegeman JH, Wouters MWJM, Schipper IB. Quality indicators for hip fracture care, a systematic review. Osteoporos Int 2018; 29:1963-1985. [PMID: 29774404 PMCID: PMC6105160 DOI: 10.1007/s00198-018-4558-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/30/2018] [Indexed: 11/26/2022]
Abstract
Quality indicators are used to measure quality of care and enable benchmarking. An overview of all existing hip fracture quality indicators is lacking. The primary aim was to identify quality indicators for hip fracture care reported in literature, hip fracture audits, and guidelines. The secondary aim was to compose a set of methodologically sound quality indicators for the evaluation of hip fracture care in clinical practice. A literature search according to the PRISMA guidelines and an internet search were performed to identify hip fracture quality indicators. The indicators were subdivided into process, structure, and outcome indicators. The methodological quality of the indicators was judged using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. For structure and process indicators, the construct validity was assessed. Sixteen publications, nine audits and five guidelines were included. In total, 97 unique quality indicators were found: 9 structure, 63 process, and 25 outcome indicators. Since detailed methodological information about the indicators was lacking, the AIRE instrument could not be applied. Seven indicators correlated with an outcome measure. A set of nine quality indicators was extracted from the literature, audits, and guidelines. Many quality indicators are described and used. Not all of them correlate with outcomes of care and have been assessed methodologically. As methodological evidence is lacking, we recommend the extracted set of nine indicators to be used as the starting point for further clinical research. Future research should focus on assessing the clinimetric properties of the existing quality indicators.
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Affiliation(s)
- S C Voeten
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands.
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - P Krijnen
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands
| | - D M Voeten
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - J H Hegeman
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands
| | - M W J M Wouters
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - I B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands
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Siletz A, Childers CP, Faltermeier C, Singer ES, Hu QL, Ko CY, Kates SL, Maggard-Gibbons M, Wick E. Surgical Technical Evidence Review of Hip Fracture Surgery Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery. Geriatr Orthop Surg Rehabil 2018; 9:2151459318769215. [PMID: 29844947 PMCID: PMC5964861 DOI: 10.1177/2151459318769215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/16/2018] [Accepted: 03/07/2018] [Indexed: 01/04/2023] Open
Abstract
Background: Enhanced recovery pathways (ERPs) have been shown to improve patient outcomes in a variety of contexts. This review summarizes the evidence and defines a protocol for perioperative care of patients with hip fracture and was conducted for the Agency for Healthcare Research and Quality safety program for improving surgical care and recovery. Study Design: Perioperative care was divided into components or “bins.” For each bin, a semisystematic review of the literature was conducted using MEDLINE with priority given to systematic reviews, meta-analyses, and randomized controlled trials. Observational studies were included when higher levels of evidence were not available. Existing guidelines for perioperative care were also incorporated. For convenience, the components of care that are under the auspices of anesthesia providers will be reported separately. Recommendations for an evidence-based protocol were synthesized based on review of this evidence. Results: Eleven bins were identified. Preoperative risk factor bins included nutrition, diabetes mellitus, tobacco use, and anemia. Perioperative management bins included thromboprophylaxis, timing of surgery, fluid management, drain placement, early mobilization, early alimentation, and discharge criteria/planning. Conclusions: This review provides the evidence basis for an ERP for perioperative care of patients with hip fracture.
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Affiliation(s)
- Anaar Siletz
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Christopher P Childers
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Claire Faltermeier
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Emily S Singer
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Q Lina Hu
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,American College of Surgeons, Chicago, IL, USA
| | - Clifford Y Ko
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,American College of Surgeons, Chicago, IL, USA
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Elizabeth Wick
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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Childers CP, Siletz AE, Singer ES, Faltermeier C, Hu QL, Ko CY, Golladay GJ, Kates SL, Wick EC, Maggard-Gibbons M. Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery. Geriatr Orthop Surg Rehabil 2018; 9:2151458518754451. [PMID: 29468091 PMCID: PMC5813847 DOI: 10.1177/2151458518754451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/30/2017] [Accepted: 12/28/2017] [Indexed: 12/12/2022] Open
Abstract
Background: Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery—a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA). Study Design: This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format. Results: Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning. Conclusion: This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving Surgical Care and Recovery aims to guide hospitals and surgeons in identifying the best practices to implement in the surgical care of TKA and THA patients.
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Affiliation(s)
| | - Anaar E Siletz
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Emily S Singer
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Q Lina Hu
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,American College of Surgeons, Chicago, IL, USA
| | - Clifford Y Ko
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,American College of Surgeons, Chicago, IL, USA
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Elizabeth C Wick
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD, USA
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49
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Relevant outcomes for nutrition interventions to treat and prevent malnutrition in older people: a collaborative senator-ontop and manuel delphi study. Eur Geriatr Med 2018; 9:243-248. [DOI: 10.1007/s41999-018-0024-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/03/2018] [Indexed: 12/18/2022]
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Kirkland LL, Shaughnessy E. Recognition and Prevention of Nosocomial Malnutrition: A Review and A Call to Action! Am J Med 2017; 130:1345-1350. [PMID: 28843651 DOI: 10.1016/j.amjmed.2017.07.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 12/22/2022]
Abstract
Nosocomial malnutrition in hospitalized adults is a morbid, costly, and potentially preventable and treatable problem. Although recognized as contributing to many serious complications of hospitalization, malnutrition is often missed when present on admission and rarely diagnosed if it occurs during hospital stay. Many routine clinical practices such as holding nutrition for testing or failing to address poor intake, when added to acute inflammatory disease states, cause rapid deterioration in nutritional status in up to 70% of inpatients. Malnutrition during hospitalization is associated with increased mortality for years after discharge. In addition, unrecognized (and under-coded) malnutrition is associated with potential lost revenues for hospital systems. Low-cost interventions of recognizing at-risk patients and providing adequate nutrition have the potential to improve patient outcomes and reduce health care costs. Physicians must champion implementation of these interventions, using guidance from national organizations.
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Affiliation(s)
- Lisa L Kirkland
- Department of Critical Care, Abbott Northwestern Hospital, Minneapolis, Minn; Division of Hospital Medicine, Mayo Clinic, Rochester, Minn.
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