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Chan LL, Ho YY, Taylor ME, Mcveigh C, Jung S, Armstrong E, Close JC, Harvey LA. Incidence of fragility hip fracture across the Asia-pacific region: A systematic review. Arch Gerontol Geriatr 2024; 123:105422. [PMID: 38579379 DOI: 10.1016/j.archger.2024.105422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE This systematic review aimed to update fragility hip fracture incidences in the Asia Pacific, and compare rates between countries/regions. METHOD A systematic search was conducted in four electronic databases. Studies reporting data between 2010 and 2023 on the geographical incidences of hip fractures in individuals aged ≥50 were included. Exclusion criteria were studies reporting solely on high-trauma, atypical, or periprosthetic fractures. We calculated the crude incidence, age- and sex-standardised incidence, and the female-to-male ratio. The systematic review was registered with PROSPERO (CRD42020162518). RESULTS Thirty-eight studies were included across nine countries/regions (out of 41 countries/regions). The crude hip fracture incidence ranged from 89 to 341 per 100,000 people aged ≥50, with the highest observed in Australia, Taiwan, and Japan. Age- and sex-standardised rates ranged between 90 and 318 per 100,000 population and were highest in Korea and Japan. Temporal decreases in standardised rates were observed in Korea, China, and Japan. The female-to-male ratio was highest in Japan and lowest in China. CONCLUSION Fragility hip fracture incidence varied substantially within the Asia-Pacific region. This observation may reflect actual incidence differences or stem from varying research methods and healthcare recording systems. Future research should use consistent measurement approaches to enhance international comparisons and service planning.
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Affiliation(s)
- Lloyd Ly Chan
- Fall, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Y Y Ho
- Fall, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; Tengku Ampuan Afzan Hospital, Jalan Tanah Putih, Kuantan, Pahang 25100, Malaysia
| | - Morag E Taylor
- Fall, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Mcveigh
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sonya Jung
- Fall, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Elizabeth Armstrong
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jacqueline Ct Close
- Fall, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Lara A Harvey
- Fall, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
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Harvey LA, Payne NL, Tan A, Zhang J, Lai YC, Taylor ME, Armstrong E, McVeigh C, Mikolaizak AS, Hairu R, Scott TA, Bishop M, Close J. Variation in mortality following hip fracture across the Asia Pacific region: Systematic review and proportional meta-analysis. Arch Gerontol Geriatr 2024; 126:105519. [PMID: 38941947 DOI: 10.1016/j.archger.2024.105519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/24/2024] [Accepted: 06/02/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE To determine country/region-specific mortality (in-hospital, 30-day and 1-year) following hip fracture across the Asia Pacific region. METHODS Five databases MEDLINE, PUBMED, EMBASE, Web of Science and the Cochrane Library were searched to identify studies that reported mortality following hospitalisation for low-trauma hip fracture in adults aged ≥50 years with data from 2010 to 30 September 2021. There were no restrictions on study design or language. Pooled mortality estimates for countries/regions with ≥2 studies were calculated using random-effects models. RESULTS In total 244 studies were included in the meta-analysis. 123 studies (1,382,810 patients, 13 countries/regions) reported in-hospital mortality which ranged from 1.4 % in Japan [95 %CI 1.2-1.7], Singapore [95 %CI 1.0-1.6], China [95 %CI 0.8-2.3] and Hong Kong SAR [95 %CI 0.8-2.6] to 5.5 % [95 %CI 4.1-7.2] in New Zealand. 92 studies (628,450 patients, 13 countries/regions) reported 30-day mortality which ranged from 1.2 % in Japan [95 %CI 0.9-1.5] and Thailand [95 %CI 0.7-2.0] to 7.4 % [95 %CI 7.0-7.8] in Australia. 142 studies (1,139,752 patients, 14 countries/regions) reported 1-year mortality which ranged from 10.8 % [95 %CI 9.6-12.1] in Singapore to 23.3 % [95 %CI 22.3-24.5] in Australia and 23.8 % in New Zealand. CONCLUSION There is substantial variation in mortality across the Asia Pacific region. Short-term mortality rates in Asian countries, notably Japan and Singapore, are up to four-fold lower than for Australia and New Zealand. This difference, although less marked, is sustained at 1-year with a two-fold lower mortality rate in Asia. This meta-analysis is the first to delineate these differences, further studies are required to understand the reasons for this variation.
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Affiliation(s)
- L A Harvey
- Neuroscience Research Australia, Sydney, Australia; School of Population Health, UNSW Medicine & Health, UNSW, Sydney, Australia.
| | - N L Payne
- Neuroscience Research Australia, Sydney, Australia
| | - A Tan
- Nepean Hospital, Sydney, Australia
| | - J Zhang
- School of Population Health, UNSW Medicine & Health, UNSW, Sydney, Australia
| | - Y C Lai
- Khoo Teck Puat Hospital, Singapore
| | - M E Taylor
- Neuroscience Research Australia, Sydney, Australia; School of Population Health, UNSW Medicine & Health, UNSW, Sydney, Australia; Ageing Futures Institute, UNSW Sydney, Sydney, Australia
| | - E Armstrong
- Neuroscience Research Australia, Sydney, Australia; School of Population Health, UNSW Medicine & Health, UNSW, Sydney, Australia
| | - C McVeigh
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
| | | | - R Hairu
- Neuroscience Research Australia, Sydney, Australia; School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
| | - T A Scott
- Prince of Wales Hospital, Sydney, Australia
| | - M Bishop
- Concord Repatriation General Hospital, Sydney, Australia
| | - Jct Close
- Neuroscience Research Australia, Sydney, Australia; School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
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3
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Mazeda C, Barcelos A. Gender differences in osteoporosis. Osteoporos Int 2023; 34:1805-1806. [PMID: 37470799 DOI: 10.1007/s00198-023-06858-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Carolina Mazeda
- Rheumatology Department, Centro Hospitalar Do Baixo Vouga, Rua Artur Navarra, 3814-501, Aveiro, Portugal.
- Centro Académico Clínico Egas Moniz, Health Alliance, Aveiro, Portugal.
- EpiDoc Unit, Nova Medical School, NOVA University Lisbon, Lisboa, Portugal.
| | - Anabela Barcelos
- Rheumatology Department, Centro Hospitalar Do Baixo Vouga, Rua Artur Navarra, 3814-501, Aveiro, Portugal
- Centro Académico Clínico Egas Moniz, Health Alliance, Aveiro, Portugal
- EpiDoc Unit, Nova Medical School, NOVA University Lisbon, Lisboa, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
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Park JW, Ha YC, Kim JW, Kim TY, Kim JW, Baek SH, Lee YK, Koo KH. The Korean hip fracture registry study. BMC Musculoskelet Disord 2023; 24:449. [PMID: 37268896 DOI: 10.1186/s12891-023-06546-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The purpose of the Korean Hip Fracture Registry (KHFR) Study is to establish a nationwide, hospital-based prospective cohort study of adults with hip fracture to explore the incidence and risk factors of second osteoporotic fractures for a Fracture Liaison Service (FLS) model. METHODS The KHFR, a prospective multicenter longitudinal study, was launched in 2014. Sixteen centers recruited participants who were treated for hip fracture. The inclusion criteria were patients, who were treated for proximal femur fracture due to low-energy trauma and aged 50 or more at the time of injury. Until 2018, 5,841 patients were enrolled in this study. Follow-up surveys were conducted annually to determine occurrence of second osteoporotic fracture, and 4,803 participants completed at least one follow-up survey. DISCUSSION KHFR is a unique resource of individual level on osteoporotic hip fracture with radiological, medical, and laboratory information including DXA (dual energy x-ray absorptiometry), bone turnover marker, body composition, and hand grip strength for future analyses for FLS model. Modifiable factors for mortality after hip surgery is planned to be identified with nutritional assessment and multi-disciplinary interventions from hospitalization to follow-ups. The proportions of femoral neck, intertrochanteric, and subtrochanteric fractures were 517 (42.0%), 730 (53.6%), and 60 (4.4%), respectively, from 2014 to 2016, which was similar in other studies. Radiologic definition of atypical subtrochanteric fracture was adopted and 17 (1.2%) fractures among 1,361 proximal femoral fractures were identified. Internal fixation showed higher reoperation rate compared to arthroplasty in unstable intertrochanteric fractures (6.1% vs. 2.4%, p = 0.046) with no significant difference in mortality. The KHFR plans to identify outcomes and risk factors associated with second fracture by conducting a 10-year cohort study, with a follow-up every year, using 5,841 baseline participants. TRIAL REGISTRATION Present study was registered on Internet-based Clinical Research and Trial management system (iCReaT) as multicenter prospective observational cohort study (Project number: C160022, Date of registration: 22th, Apr, 2016).
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Affiliation(s)
- Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, South Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Seoul, South Korea
| | - Tae-Young Kim
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, South Korea
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Hoon Baek
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Kim CH, Han J, Kim JW. One-year change in handgrip strength in patients with hip fracture: a prospective comparison with hip disease. BMC Geriatr 2023; 23:65. [PMID: 36726064 PMCID: PMC9893558 DOI: 10.1186/s12877-023-03782-9] [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] [Received: 09/17/2022] [Accepted: 01/30/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Handgrip strength (HGS) has been adopted as one of the diagnostic tools for sarcopenia and is gaining attention because of its association with osteoporotic hip fractures. Longitudinal data of HGS at multiple follow-up intervals in older hip fractures are lacking. We aimed to investigate and compare the HGS changes in patients with hip fracture within 1-year with those in patients with hip diseases. METHODS This prospective study was conducted between June 2018 and July 2020. The HGS was measured preoperatively, at predischarge, and at 3, 6, and 12 months postoperatively. We prospectively compared the number of patients with low muscle strength (LMS) as well as the HGS changes over time between the two groups. RESULTS A total of 115 consecutive patients with hip fracture (n = 58) and hip disease (57) were enrolled. The rate of preoperative LMS was higher in the hip fracture group than control (P = 0.005), but there was no significant difference in the postoperative period (P = 0.343). The mean HGS was lower in the hip fracture group at all measured time periods. The preoperative HGS increased right before discharge (15.2 kg to 17.0 kg), and plateaued thereafter 1-year in the fracture group, whereas there were no statistically significant changes in serial follow-up trends in the control group. CONCLUSIONS The preoperative HGS in fracture patients may have been underestimated, due to different position of the arm, insufficient practice, or pain. Subsequently, HGS was rather constant during 1-year indicating no development of general sarcopenia after treatment for hip fracture. Therefore, in hip fracture patients, the predischarge HGS might be more reliable than preoperative HGS.
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Affiliation(s)
- Chul-Ho Kim
- grid.267370.70000 0004 0533 4667Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea ,grid.254224.70000 0001 0789 9563Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jeongae Han
- grid.267370.70000 0004 0533 4667University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Wan Kim
- grid.267370.70000 0004 0533 4667Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Jang SY, Cha Y, Park NK, Kim KJ, Choy WS. Effect Modification on Death by Age and Sex in Elderly Hip Fracture. J Bone Metab 2022; 29:235-243. [PMID: 36529866 PMCID: PMC9760768 DOI: 10.11005/jbm.2022.29.4.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/13/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study compared the effects of hip fractures on mortality according to sex and age in a nationwide cohort of elderly patients with hip fractures and controls. METHODS Patients with hip fractures and matched controls were selected from the National Health Insurance Service-Senior cohort. Time-dependent propensity score matching was estimated from a Cox proportional hazards model with January 1, 2005, as the baseline and hip fracture as an event. Patients were matched by age and sex to participants at risk of developing a hip fracture at time zero. The effect size is presented as hazard ratio (HR) using a Cox proportional hazards model with a robust variance estimator that accounts for clustering within the matched pairs. RESULTS Altogether, 14,283 patients with incident hip fractures and 28,566 matched controls were identified. The HR of male sex in hip fractures was 1.31 (95% confidence interval [CI], 1.22-1.40; Pinteraction<0.01). Moreover, the HR of age group in hip fractures was 0.73 (95% CI, 0.66-0.80; Pinteraction<0.01) between the 65 to 74 and 75 to 84 years groups, 0.76 (95% CI, 0.71-0.81; Pinteraction<0.01) between the 75 to 84 and ≥85 years groups, and 0.55 (95% CI, 0.50-0.61; Pinteraction<0.01) between the 65 to 74 and ≥85 years groups. CONCLUSIONS Male sex increases the risk of death in elderly patients with hip fractures versus matched controls, but the increased risk of death with age in hip fractures was decreased compared to that in matched controls.
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Affiliation(s)
- Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul,
Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon,
Korea
| | - Na-Kyum Park
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon,
Korea
| | - Kap-Jung Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon,
Korea
| | - Won-Sik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon,
Korea
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Jang S, Lee YK, Ha YC, Jang S. The Potential Economic Benefits of an Alarm Service in Order Communication Systems in Korea: a Cost-Effectiveness Analysis of Less-Intensive Fracture Liaison Services Based on a Prospective Cohort Study. Calcif Tissue Int 2022; 111:380-390. [PMID: 35790553 DOI: 10.1007/s00223-022-01000-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/08/2022] [Indexed: 11/02/2022]
Abstract
An alarm service in an order communication system (OCS) was found to be effective at increasing the rate of dual-energy X-ray absorptiometry (DXA) testing and treatment in South Korea, but its cost-effectiveness remains unknown. We used a Markov model to determine the cost-effectiveness of the alarm service in the OCS compared to no alarm service for the post-fracture management of subjects aged 50 years and older with fragility fractures. DXA testing and treatment data were collected from a prospective cohort study. The prevalence of osteoporotic fractures, the subsequent risk of hip fracture, and healthcare costs were obtained using Korea National Health Insurance claims data. The lifetime cost and quality-adjusted life-years (QALYs) gained were estimated from a healthcare perspective. A probabilistic sensitivity analysis was performed to examine the uncertainty of the results. The alarm service increased treatment by 125 per 1000 patients and prevented 3 hip fractures per 1000 patients. The alarm service cost an additional 249,393 KRW and resulted in an increase of 0.008 QALYs per patient compared to no alarm service. The incremental cost-effectiveness ratio was 31,174,125 KRW (26,843 USD) per QALY gained. The alarm service was cost-effective than no alarm service if the willingness to pay setting as 1GDP per capita (29,288 USD) per QALY gained. This study shows that less-intensive fracture liaison services, such as an alarm service, are cost-effective for patients aged 50 years and older with osteoporotic fractures in Korea. An intensive model, including enhanced identification and education, could further prevent the risk of refracture and improve cost-effectiveness.
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Affiliation(s)
- Suhyun Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoe-Ro, Yeonsu-Gu, Incheon, 21936, Republic of Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, College of Medicine, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Republic of Korea
| | - Yong-Chan Ha
- Department of Orthopedic Surgery, BUMIN Hospital, 389 Gonghang-daero, Gangseo-gu, Seoul, 07590, Republic of Korea.
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoe-Ro, Yeonsu-Gu, Incheon, 21936, Republic of Korea.
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Yoon HE, Lee YH, Lee JE, Lee J, Kim H, Chung BH, Shin SJ. Seasonality in hip fracture among hemodialysis patients and kidney transplant recipients in South Korea. Nephrology (Carlton) 2022; 27:925-933. [PMID: 36136601 DOI: 10.1111/nep.14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/21/2022] [Accepted: 09/06/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The seasonality of hip fracture in hemodialysis (HD) patients and kidney transplant recipients (KTRs) have not been reported. We assessed seasonal variations in hip fractures among patients with end-stage kidney disease who undergo maintenance HD and KTRs. METHODS Using the Korean National Health Insurance System database from January 2012 to December 2017, monthly counts of hip fracture were calculated among HD patients (n = 77,420) and KTRs (n = 8,921). The 6-year normalized monthly fraction and seasonal fractions of hip fractures were calculated. A cosinor analysis was performed to determine the seasonality of the monthly incidence of hip fractures. RESULTS The 6-year average monthly fraction of hip fractures was lowest in June and highest in October in HD patients, and lowest in February and highest in November in KTRs. The 6-year average seasonal fraction among HD patients was lowest in summer and highest in winter, and lowest in summer and highest in autumn among KTRs, but there was no significant difference. The incidence ratio of hip fractures was lowest in June and highest in January in HD patients, and lowest in August and highest in November in KTRs. On cosinor analysis, HD patients showed significant seasonality in hip fracture incidence, with a trough in summer and a peak in winter (P = 0.031), whereas KTRs did not exhibit a significant trend (P = 0.44). CONCLUSION Hip fractures occurred more frequently in winter and less frequently in summer in patients undergoing HD, whereas KTRs did not show a seasonal trend.
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Affiliation(s)
- Hye Eun Yoon
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon Hee Lee
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo Eun Lee
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jungkuk Lee
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Hoseob Kim
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Joon Shin
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Validation of Operational Definition to Identify Patients with Osteoporotic Hip Fractures in Administrative Claims Data. Healthcare (Basel) 2022; 10:healthcare10091724. [PMID: 36141336 PMCID: PMC9498336 DOI: 10.3390/healthcare10091724] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022] Open
Abstract
As incidences of osteoporotic hip fractures (OHFs) have increased, identifying OHFs has become important to establishing the medical guidelines for their management. This study was conducted to develop an operational definition to identify patients with OHFs using two diagnosis codes and eight procedure codes from health insurance claims data and to assess the operational definition’s validity through a chart review. The study extracted data on OHFs from 522 patients who underwent hip surgeries based on diagnosis codes. Orthopedic surgeons then reviewed these patients’ medical records and radiographs to identify those with true OHFs. The validities of nine different algorithms of operational definitions, developed using a combination of three levels of diagnosis codes and eight procedure codes, were assessed using various statistics. The developed operational definition showed an accuracy above 0.97 and an area under the receiver operating characteristic curve above 0.97, indicating excellent discriminative power. This study demonstrated that the operational definition that combines diagnosis and procedure codes shows a high validity in detecting OHFs and can be used as a valid tool to detect OHFs from big health claims data.
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Choo YW, Mohd Tahir NA, Mohamed Said MS, Li SC, Makmor Bakry M. Cost-effectiveness of Denosumab for the Treatment of Postmenopausal Osteoporosis in Malaysia. Osteoporos Int 2022; 33:1909-1923. [PMID: 35641572 DOI: 10.1007/s00198-022-06444-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/23/2022] [Indexed: 12/09/2022]
Abstract
UNLABELLED From the perspective of Malaysian health care providers, denosumab was cost-effective in the treatment of postmenopausal osteoporosis, with an optimal outcome starting at age 60 years. Our results provide important insights into the value for money of anti-osteoporotic agents that can serve as a reference for other countries with comparable epidemiological data. INTRODUCTION The study aimed to compare the cost-effectiveness of denosumab with alendronate and no treatment in the management of postmenopausal osteoporosis among the Malaysian population. METHODS A well-validated Markov model was used to estimate the cost-effectiveness of denosumab in a hypothetical cohort of postmenopausal osteoporotic women between 50 and 80 years old who had no history of fractures. A 10-year time horizon from the perspective of Malaysian health care providers was used in this analysis. The model parameters, including transition probabilities and costs, were based on Malaysian sources. Treatment efficacy data were obtained from a network meta-analysis. The study outcomes were presented as incremental cost per quality-adjusted life-year (QALY) gained. Sensitivity analyses were performed to ensure the robustness of the results. A cost-effectiveness threshold was set at MYR 21,438 (USD 5175) per QALY. RESULTS Denosumab was found to be a cost-effective option for postmenopausal osteoporotic women aged 60 and older. The incremental cost-effectiveness ratios (ICERs) for denosumab versus alendronate ranged from MYR 16,955 (USD 4093) per QALY at age 60 to MYR 4380 (USD 1057) per QALY at age 80. The cost-effectiveness of denosumab improved monotonically with increasing age. Denosumab was 72.8-92.7% likely to be cost-effective at the cost-effectiveness threshold. Sensitivity analyses demonstrated that the results were robust across all parameter variations, with the annual cost of denosumab being the most sensitive. CONCLUSIONS From the perspective of the Malaysian health care provider, denosumab appears to be a cost-effective treatment choice for postmenopausal osteoporotic women over 60 years of age.
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Affiliation(s)
- Y W Choo
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
- Pharmacy Department, Kuala Lipis Hospital, Ministry of Health Malaysia, 27200, Kuala Lipis , Pahang, Malaysia
| | - N A Mohd Tahir
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - M S Mohamed Said
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Cheras, Malaysia
| | - S C Li
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - M Makmor Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
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11
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Yu MH, Hong N, Lee S, Kim HY, Park HS, Park SM, Lee YK, Kim TY, Ha YC, Rhee Y, Koo KH. Operational Definition Identifying Osteoporotic Vertebral Fractures in the Claims Database. J Korean Med Sci 2022; 37:e249. [PMID: 35971763 PMCID: PMC9424695 DOI: 10.3346/jkms.2022.37.e249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/07/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We analyzed the International Classification of Diseases, 10th edition (ICD-10) diagnostic codes, procedure codes, and radiographic image codes for vertebral fracture (VF) used in the database of Health Insurance Review and Assessment Service (HIRA) of Korea to establish a validated operational definition for identifying patients with osteoporotic VF in claims data. METHODS We developed three operational definitions for detecting VFs using 9 diagnostic codes, 5 procedure codes and 4 imaging codes. Medical records and radiographs of 2,819 patients, who had primary and subordinated codes of VF between January 2016 and December 2016 at two institutions, were reviewed to detect true vertebral fractures. We evaluated the sensitivity and positive predictive value (PPV) of the operational definition in detecting true osteoporotic VF and obtained the receiver operating characteristic (ROC) curve. RESULTS Among the 2,819 patients who had primary or secondary diagnosis codes for VF, 995 patients satisfied at least one of the criteria for the operational definition of osteoporotic VF. Of these patients, 594 were judged as having true fractures based on medical records and radiographic examinations. The sensitivity and PPV were 62.5 (95% confidence interval [CI], 59.4-65.6) and 59.7(95% CI, 56.6-62.8) respectively. In the receiver operating characteristic analysis, area under the curve (AUC) was 0.706 (95% CI, 0.688-0.724). CONCLUSION Our findings demonstrate the validity of our operational definitions to identify VFs more accurately using claims data. This algorithm to identify VF is likely to be useful in future studies for diagnosing osteoporotic VF.
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Affiliation(s)
- Min Heui Yu
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seunghyun Lee
- Department of Internal Medicine, Yonsei Wonju College of Medicine, Wonju, Korea
| | - Ha-Young Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hye-Sun Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Min Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Tae-Young Kim
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital and Kay Joint Center at Cheil Orthopaedic Hospital, Seoul, Korea
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12
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Abdel Hamid OI, Attia ME, Hirshon JM, El-Shinawi M, El-Hussaini M, El-Setouhy M. Psychiatric Disorders and Genotoxicity Following Primary Metal on Polyethylene Total Hip Arthroplasty and Their Correlation to Cobalt/Chromium Levels. Drug Healthc Patient Saf 2022; 14:97-111. [PMID: 35880007 PMCID: PMC9308046 DOI: 10.2147/dhps.s360643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Hip arthroplasty (HA) using implantable metal components is among the commonest orthopedic interventions. However, it can be followed by several complications following corrosion and the release of metal ions. Several studies proved that damaged genomic DNA may contribute to the pathophysiology of mental disorders. Aim The current work aims to evaluate the psychiatric disorders in metal on polyethylene hip arthroplasty (MOP-HA) patients and its correlation to cobalt/chromium (Co/Cr) levels and genotoxicity. Methods The work was a longitudinal follow-up study including 34 adults with unilateral primary MOP-HA meeting the inclusion and exclusion criteria. Preoperatively, 6, 12-months-postoperatively, patients were examined for cognitive impairment using mini-mental-state-examination (MMSE), depression using major-depressive-inventory (MDI), and blood samples were collected for estimation of Co/Cr, detection of genotoxicity by single-cell-gel-electrophoresis (comet assay) and serum 8-hydroxy-2'-deoxyguanosine (8-OHdG). Results Cognitive impairment was reported in 18.5% and 14.8% at 6-months, and 12-months postoperative, respectively. Depressive disorder was recorded in 22.2% at 6-months and 14.8% at 12-months postoperative. The marginal homogeneity tests proved a non-significant difference. There was a non-significant difference in preoperative, 6-months, 12-months postoperative MMSE, and MDI scores. There were significantly increased Co/Cr levels at 6-months postoperative. The levels decreased at 12-months postoperative, however, still significantly higher than preoperative values. There was a significant increase in serum 8-OHdG and the levels were positively correlated to cobalt levels at both 6 and 12-months-postoperative. There was a non-significant difference among preoperative, 6-months, and 12-months postoperative comet assay measurements. Conclusion From previous findings, we can conclude that will-functioning MOP hip arthroplasty can induce increased ion levels and positively correlated increase in biochemical markers of genotoxicity (8-OHdG).
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Affiliation(s)
- Omaima I Abdel Hamid
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed E Attia
- Orthopedics Departments, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Jon M Hirshon
- Department of Emergency Medicine, University of Maryland, School of Medicine, Baltimore, MD, USA
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Mohamed El-Shinawi
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Galala University, Galala City, Suez, Egypt
| | - Moustafa El-Hussaini
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maged El-Setouhy
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Family and Community Medicine, Faculty of Medince, Jazan University, Jazan, Kingdom of Saudi Arabia
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13
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Kim TL, Byun SJ, Seong MY, Oh BM, Park SJ, Seo HG. Fracture risk and impact of osteoporosis in patients with Parkinson's disease: a nationwide database study. J Bone Miner Metab 2022; 40:602-612. [PMID: 35347431 DOI: 10.1007/s00774-022-01322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients with Parkinson's disease (PD) showed an increased risk of fractures in previous studies and a high prevalence of osteoporosis is reportedly a potential contributor. We conducted a nationwide database study on the risk of fractures and the impact of osteoporosis on patients with PD compared to controls. MATERIALS AND METHODS Using a nationwide database in South Korea, we identified incident patients with PD in 2004-2006 and selected four age- and sex-matched controls. We checked the occurrence rates of overall and hip fractures and plotted Kaplan-Meier curves and a Cox proportional hazards model to determine risk. We also conducted stratified analyses according to the presence or absence of osteoporosis. RESULTS We identified 9126 patients with PD and 35,601 controls. Patients with PD had a greater probability of fractures throughout the study period in Kaplan-Meier curves, and an increased risk of overall (aHR 1.35, 95% CI 1.297-1.405) and hip (aHR 1.814, 95% CI 1.66-1.983) fractures in a Cox proportional hazards model. In the stratified analysis, the increased risk of overall fracture (aHR 1.333, 95% CI 1.273-1.396 and aHR 1.412, 95% CI 1.301-1.532, respectively) and hip fracture (aHR 1.773, 95% CI 1.604-1.96 and aHR 2.008, 95% CI 1.657-2.434, respectively) due to PD was similar between patients with and without osteoporosis. DISCUSSION Patients with PD, with or without osteoporosis, are more likely to experience fractures, especially hip fractures. There seems to be no interaction between PD and osteoporosis in regard to the occurrence of fractures, and therefore no effect modification by osteoporosis.
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Affiliation(s)
- Tae-Lim Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Songnam, Republic of Korea
| | - Min Yong Seong
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Gyeonggi-do, Republic of Korea
- Institute of Aging, Seoul National University, Seoul, Republic of Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Songnam, Republic of Korea.
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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14
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Lim JY, Yoo JI, Kim RB, Koo HJ, Kong GM, Ha YC. Comparison of the incidence rates of hip and vertebral fragility fractures according to cataract surgery in elderly population: a nationwide cohort study. Arch Osteoporos 2022; 17:30. [PMID: 35113279 DOI: 10.1007/s11657-021-01018-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023]
Abstract
Elderly patients who underwent cataract surgery showed lower prevalence and cumulative incidence rates of hip and vertebral fragility fractures than those who did not. Therefore, cataract surgery in elderly patients may reduce the incidence of hip and vertebral fragility fractures. PURPOSE The purpose of this study was to compare the incidence rates of hip and vertebral fragility fractures between patients who underwent cataract surgery and those who did not, and to investigate the effect of cataract surgery on the incidence of fragility fracture in elderly population using nationwide claims data. METHODS A total of 558,147 participants from the National Health Insurance Service - Senior cohort were included. The participants were set into the hip fracture group (507,651) and vertebral fracture group (507,899) depending on the type of fracture. RESULTS The number of hip fractures that occurred in the non-cataract surgery (NC) group was 36,971 (9.9%), while 8850 (6.6%) hip fractures occurred in the cataract surgery (C) group. The number of vertebral fractures that occurred in the NC group was 38,689 (10.3%), while 10,112 (7.6%) vertebral fractures occurred in the C group (all p < .001). The hazard ratios of hip and vertebral fractures were 0.58 and 0.60 for the total population that had undergone cataract surgery (all p < .001). The cumulative incidence rates of both fractures in the cataract surgery group were significantly lower than those in the non-cataract surgery group during 10 years (all p < .0001). CONCLUSION Elderly patients who underwent cataract surgery showed a lower prevalence of hip and vertebral fragility fractures than those who did not. In addition, the cumulative incidence rates of both fractures in the cataract surgery group were lower than those in the non-cataract surgery group. Therefore, cataract surgery in elderly patients may reduce the incidence of hip and vertebral fragility fractures.
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Affiliation(s)
- Jae-Young Lim
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, South Korea
| | - Rock Beum Kim
- Department of Preventive Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Hyung Jun Koo
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Gyu Min Kong
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea.
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15
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Ahn J, Chang JS, Kim JW. Postoperative Pneumonia and Aspiration Pneumonia Following Elderly Hip Fractures. J Nutr Health Aging 2022; 26:732-738. [PMID: 35842764 DOI: 10.1007/s12603-022-1821-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The present study aimed to investigate the incidence of and risk factors for postoperative pneumonia and aspiration pneumonia after hip fracture surgery. DESIGN Retrospective cohort study from 2005 to 2021. SETTING Asan Medical Center in Seoul, Republic of Korea. PARTICIPANTS A total 1,208 patients aged ≥ 65 years who underwent hip fracture surgery. MEASUREMENTS Postoperative pneumonia was defined as cases with new infiltration on chest x-ray or chest computed tomography (CT) after surgery or confirmed by a pulmonologist's consultation and diagnosis. Aspiration pneumonia was defined as: 1) radiologic findings of hospital-acquired pneumonia on chest radiographs or CT, medical record of aspiration pneumonia confirmed by a pulmonologist's consultation, and history of vomiting or aspiration, or 2) gravity-dependent opacity on chest CT when the history of vomiting or aspiration is ambiguous. Patient demographics, past medical history, pre-injury Koval score, Charlson Comorbidity Index (CCI), blood test results, length of hospital stay, and in-hospital mortality were evaluated. A comparison analysis and binary logistic regression were performed to identify the incidence and risk factors for postoperative pneumonia and aspiration pneumonia. RESULTS Postoperative pneumonia was diagnosed in 47 patients (3.9%), including 20 with aspiration pneumonia (1.7%). In the multivariate analysis, postoperative delirium (odds ratio [OR], 3.42; P < 0.001), American Society of Anesthesiologists (ASA) scores ≥ 3 (OR, 2.11; P = 0.021), and CCI (OR, 1.21; P = 0.013) were significant risk factors for postoperative pneumonia. Male sex (OR, 3.01; P = 0.017), postoperative delirium (OR, 3.16; P = 0.014), and preoperative serum albumin levels < 3.5 g/dL (OR, 7.00; P = 0.010) were significant risk factors for aspiration pneumonia. CONCLUSION ASA classification ≥ 3, higher CCI, and postoperative delirium were the risk factors for postoperative pneumonia. Male sex, postoperative delirium, and lower preoperative serum albumin level were the risk factors for aspiration pneumonia. Thus, physicians should pay attention to patients with the risk factors.
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Affiliation(s)
- J Ahn
- Ji Wan Kim, Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea, Phone: +82-2-3010-3530, Fax: +82-2-2045-4542, Email address: , ORCID: 0000-0002-3524-8706
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Chung JW, Ha YC, Lee MK, Kim JH, Park JW, Koo KH. Hip Fracture Management during the COVID-19 Pandemic in South Korea. Clin Orthop Surg 2021; 13:474-481. [PMID: 34868496 PMCID: PMC8609206 DOI: 10.4055/cios21123] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background The purpose of this study was to introduce a screening system for coronavirus disease 2019 (COVID-19), to evaluate the overall orthopedic management in hip fracture patients during the COVID-19 pandemic in South Korea, and to compare the surgical results in hip fracture patients during the COVID-19 pandemic with those of the previous year. Methods Hip fracture patients who visited emergency rooms were screened at the screening clinics before admission. The medical management was carried out with the medical staff wearing surgical masks, meticulous hand hygiene observed, and a minimum distance of 2 m between patients maintained. The demographics, operative parameters, and surgical results of patients treated during the pandemic were compared with those from the previous year. Results From January 2020 to July 21, 2020, 119 patients with hip fractures (33 men and 86 women) were admitted to our institution for surgical treatment. Five patients showed symptoms of pneumonia, but no patient was positive for COVID-19. The mortality rate during the study period was 4.2%, and none of the patients died due to COVID-19. The interval between admission and surgery and the length of hospital stay were significantly shorter (p = 0.008, p = 0.002) and the proportion of spinal anesthesia was greater in hip fracture patients during the COVID-19 pandemic compared to those from the previous year (p = 0.011). Conclusions The COVID-19 screening system for hip fracture patients has proven to be effective in preventing intrahospital spread of the disease. Hip fracture surgery performed during the COVID-19 pandemic has shown comparable results without any COVID-19 infection and COVID-19-related mortality.
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Affiliation(s)
- Jin Won Chung
- Department of Infectious Diseases, Chung-Ang University Hospital, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Mi-Kyung Lee
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin-Hak Kim
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Jung-Wee Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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17
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Jang SY, Cha Y, Lee JC, Kim H, Kim KJ, Choy W. Population-based Analysis for Risk of Suicide Death in Elderly Patients after Osteoporotic Fracture: a Nested Case-Control Study. J Korean Med Sci 2021; 36:e225. [PMID: 34519185 PMCID: PMC8438184 DOI: 10.3346/jkms.2021.36.e225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The purpose of study was to investigate the incidence rate of suicide in elderly patients with osteoporotic fractures in a nested case-control model and to analyze the change in the risk of suicide death over time after each osteoporotic fracture. METHODS We used the National Health Insurance Service-Senior cohort of South Korea. Suicide cases and controls were matched based on sex and age at the index date. Controls were randomly selected at a 1:5 ratio from the set of individuals who were at risk of becoming a case at the time when suicide cases were selected. Conditional logistic regression analysis was performed to evaluate the association between each type of osteoporotic fracture and the risk of suicide death. RESULTS Three thousand seventy suicide cases and 15,350 controls were identified. Patients with hip fracture showed an increased risk of suicide death within 1 year of fracture (adjusted odds ratio [aOR] = 2.64; 95% confidence interval [CI], 1.57-4.46; P < 0.001) compared to controls. However, the increased risk of suicide death in patients with hip fracture lasted up to 2 years (aOR = 1.59; 95% CI, 1.04-2.41; P = 0.031). Spine fracture increased the risk of suicide deaths for all observation periods. There was no evidence that humerus fracture increased the risk of suicide death during the observational period. Radius fracture increased only the risk of suicide death within 2 years of fracture (aOR = 1.43; 95% CI, 0.74-2.77; P = 0.282). CONCLUSION There were noticeable differences in both degree and duration of increased suicide risks depending on the type of osteoporotic fracture. Mental stress and suicide risk in elderly patients after osteoporotic fracture should be assessed differently depending on the types of fracture.
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Affiliation(s)
- Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Je Chan Lee
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Hayong Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Kap-Jung Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Wonsik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
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18
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Jiang Y, Luo Y, Lyu H, Li Y, Gao Y, Fu X, Wu H, Wu R, Yin P, Zhang L, Tang P. Trends in Comorbidities and Postoperative Complications of Geriatric Hip Fracture Patients from 2000 to 2019: Results from a Hip Fracture Cohort in a Tertiary Hospital. Orthop Surg 2021; 13:1890-1898. [PMID: 34431625 PMCID: PMC8523760 DOI: 10.1111/os.13142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/30/2021] [Accepted: 08/02/2021] [Indexed: 01/14/2023] Open
Abstract
Objective To describe the secular trends in comorbidities and postoperative complications of geriatric hip fracture patients from the Chinese People's Liberation Army General Hospital Hip Fracture Cohort between 2000 and 2019. Methods We included 2,805 hip fracture patients aged 65 years or older and received surgical treatment from 25 January 2000 to 19 December 2019. Demographic characteristics, comorbidities, postoperative complications, length of hospital stay, and the time to surgery were extracted and examined in each 5‐year period based on the admission year, namely 2000–2004, 2005–2009, 2010–2014, and 2015–2019. Categorical data were analyzed by chi‐squared or Fisher's exact test, with ordinal data by row mean scores difference test and continuous data by one‐way analysis of variance. Trends in comorbidities and postoperative complications were examined by the Cochran–Armitage trend test. Results The average age of the included population was 79.1 ± 7.3 years (mean ± standard deviation), and 69.1% were female. From 2000 to 2019, the proportion of females increased from 59.8% to 73.0% (P for trend <0.05). Hypertension (51.8%), type 2 diabetes (23.6%), coronary heart disease (20.9%), stroke (18.7%), and arrhythmia (11.2%) were the most prevalent five comorbidities. The proportion of hypertension was 27.0%, 45.4%, 53.0%, and 57.2% in each 5‐year period with an increasing trend (P for trend <0.05). The proportion of type 2 diabetes was 9.8%, 22.8%, 23.5%, and 26.0% in each 5‐year period (P for trend <0.05). Similar increasing trends were found in myocardial infarction, arrhythmia, and tumor. On the contrary, the proportion of patients with major postoperative complications decreased from 2000 to 2019, with 23.0%, 14.6%, 6.5%, and 5.6% in each 5‐year period (P for trend <0.05). For each specific postoperative complication, i.e. pneumonia, cardiovascular event, respiratory failure, and in‐hospital death, similar decreasing trends were found (all P for trend <0.05). Conclusion This descriptive analysis sheds light on the fact that the health status of the hip fracture population tends to shift gradually. Improving concepts and practices of clinical interventions may help reduce postoperative complications, whereas challenges in the management of comorbidities increase.
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Affiliation(s)
- Yu Jiang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Yan Luo
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Houchen Lyu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Yi Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Yuan Gao
- Nursing Department, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaojie Fu
- Nursing Department, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Huan Wu
- Research of Medical Big Data Center, Chinese PLA General Hospital, Beijing, China
| | - Rilige Wu
- Research of Medical Big Data Center, Chinese PLA General Hospital, Beijing, China
| | - Pengbin Yin
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
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19
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Kim JA, Sung Lee J, Song E, Roh E, Hee Yu J, Hoon Kim N, Jin Yoo H, Seo JA, Gon Kim S, Hee Kim N, Hyun Baik S, Mook Choi K. Association Between Visit-to-Visit Fasting Plasma Glucose Variability and Osteoporotic Fractures in Nondiabetic Subjects. J Clin Endocrinol Metab 2021; 106:e3449-e3460. [PMID: 34037762 DOI: 10.1210/clinem/dgab370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Indexed: 01/21/2023]
Abstract
CONTEXT Although long-term glucose variability has been reported to be a risk factor associated with osteoporosis, there have been no previous studies between the relationship of glucose variability and fractures in people without diabetes. OBJECTIVE We assessed visit-to-visit variations in fasting plasma glucose (FPG) as a prognostic factor in predicting osteoporotic fractures in individuals without diabetes. METHODS Using a nationwide cohort database, we examined the impact of FPG on the development of osteoporotic fractures in men and women (aged ≥50 years). The primary outcomes were the number of total fractures and vertebral fractures. FPG variability was measured using standard deviation (FPG-SD), coefficient of variation (FPG-CV), and variability independent of the mean (FPG-VIM). RESULTS Of the 92 929 participants, 5262 (5.7%) developed osteoporotic fractures during the mean follow-up of 8.4 years. Individuals in the highest quartile of FPG-SD showed an 11% and 16% increase in risk of total and vertebral fractures, respectively, compared with those in the lowest quartile after adjustment for mean FPG and other risk factors. Analyses using FPG-CV and FPG-VIM demonstrated similar results. Subgroup analyses and sensitivity analyses to explore potential heterogeneity showed consistent results. CONCLUSION FPG variability may be a novel risk factor for osteoporotic fractures independent of risk factors in the general population without diabetes.
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Affiliation(s)
- Jung A Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea
| | - Eyun Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji Hee Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Pluskiewicz W, Wilk R, Adamczyk P, Hajzyk M, Swoboda M, Sladek A, Koczy B. The incidence of arm, forearm, and hip osteoporotic fractures during early stage of COVID-19 pandemic. Osteoporos Int 2021; 32:1595-1599. [PMID: 33515269 PMCID: PMC7846903 DOI: 10.1007/s00198-020-05811-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/23/2020] [Indexed: 12/01/2022]
Abstract
UNLABELLED The study analyzes whether the COVID-19 pandemic affects the incidence of arm, forearm, and hip fractures. Additionally, the change in the overall cost of those fractures treatment was estimated. During the COVID-19 pandemic, the incidence of arm, forearm, and hip fractures and the cost of fracture management are decreased. INTRODUCTION Purposes of the study were to analyze if COVID-19 pandemic influences the incidence of arm, forearm, and hip osteoporotic fractures and to estimate the changes in costs of their management. METHODS Data on arm, forearm, and hip fracture incidence were collected for inhabitants aged over 50 years in the district of Tarnowskie Góry and the city of Piekary Śląskie, South Poland, in the early stage of COVID-19 pandemic (77 days, from March 16th to May 31st 2020). These results were compared with the number of fractures noted in years 2015-2019 in the same period of the year. The ratio of analyzed fractures per 100,000 inhabitants was calculated. RESULTS The recorded numbers of fractures of arm, forearm, and hip were 13, 43, and 29, respectively. The respective mean number for fractures reported in corresponding period in 2015-2019 years was 23.6, 52, and 33. The year fracture incidence calculated per 100,000 inhabitants decreased by 45.8%, 18.4%, and 13.4%, respectively. The estimated numbers of avoided fractures extrapolated for the whole country for arm, forearm, and hip were 1722, 1548, and 947, respectively. The total number of avoided fractures was 4217. The expected nationwide cost reduction for the arm, forearm, and hip fracture management was estimated at € 568,260, € 332,820, and € 1,628,840, respectively. The total cost reduction was € 2,529,920 over the period of observation. CONCLUSION During COVID-19 pandemic, a decrease of arm, forearm, and hip fracture incidence was observed which may result in decrease of total costs for Polish healthcare system.
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Affiliation(s)
- W Pluskiewicz
- Department and Clinic of Internal Diseases, Diabetology, and Nephrology, Metabolic Bone Diseases Unit, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
| | - R Wilk
- Municipal Hospital, Department of Orthopedic and Trauma Surgery, Sosnowiec, Poland
| | - P Adamczyk
- Department of Paediatrcs, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - M Hajzyk
- Department of Pediatric Orthopedics & Traumatology, Combined City Hospitals, Chorzów, Poland
| | - M Swoboda
- Department of General and Vascular Surgery, City Hospital, Ruda Śląska, Poland
| | - A Sladek
- Department of General and Vascular Surgery, City Hospital, Ruda Śląska, Poland
| | - B Koczy
- Department of Trauma and Orthopedics, District Hospital of Orthopedics and Trauma Surgery, Piekary Śląskie, Poland
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21
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Lee H, Lee SH. Analysis of Home-Based Rehabilitation Awareness, Needs and Preferred Components of Elderly Patients with Hip Fracture Surgery in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147632. [PMID: 34300083 PMCID: PMC8306015 DOI: 10.3390/ijerph18147632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022]
Abstract
The importance and necessity of home-based rehabilitation with professional and systematic interventions should be considered since home-based rehabilitation has been institutionalized as it is more feasible, cost effective, and even safer than in-hospital rehabilitation in most countries—though not in South Korea. In addition, the need for home-based rehabilitation is increasing due to the increasing number of hip fracture patients and limited capacity of acute hospital rehabilitation. Therefore, the purpose of this study was to investigate the awareness, needs, and preferred components of home-based rehabilitation services after discharge for elderly patients with hip fracture surgery in South Korea. A survey of 98 elderly patients who recently underwent hip fracture surgery was performed using a questionnaire. More than 75% of patients agreed on the need for home-based rehabilitation, even though most had never heard of it. The reason for the need for home-based rehabilitation was that it is possible to receive continuously ongoing treatment (53.0%), and it alleviates the inconvenience of visiting hospitals (27.7%). In addition to this, about 15.7% of patients responded that they could achieve mental comfort. In other words, patients can recover in an emotionally stable environment without the psychological anxiety they might experience in hospital. Thus, in order to maximize the effectiveness of home-based rehabilitation and provide comprehensive guidance including exercise, education, motivational support, and environmental modification, to patients undergoing hip fracture surgery, the component of the rehabilitation program must be developed based upon rehabilitation experts’ knowledge and patients’ value. Additionally, corresponding policies should be established.
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Affiliation(s)
- Haneul Lee
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea;
| | - Seon-Heui Lee
- Department of Nursing, College of Nursing, Gachon University, Incheon 21936, Korea
- Correspondence: ; Tel.: +82-32-820-4230
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22
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Kim EG, Bae G, Kwon HY, Yang H. Aging and direct medical costs of osteoporotic fractures. J Bone Miner Metab 2021; 39:589-597. [PMID: 33417008 DOI: 10.1007/s00774-020-01192-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/03/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This study estimated the direct medical costs of osteoporotic fractures from a large claims database in Korea. MATERIALS AND METHODS We compared the medical costs of hip, vertebral, and wrist fractures between two age groups (50-64 years vs 65 years and older). We used a generalized linear model to investigate the drivers of osteoporotic fracture medical costs. RESULTS Hip fractures had the highest costs, regardless of age, followed by vertebral and wrist. The cost of hip fracture was USD 7285 for those aged 65 years and over and USD 6589 for those aged 50-64 years. The length of hospital days was higher in hip fracture patients, regardless of age, followed by vertebral and wrist. As the number of hospitalizations increased, the medical cost increased by 33.0% (p < 0.0001). Patients older than 65 years who were hospitalized for a fracture had a longer total length of hospital stay, compared to patients aged 50-64, regardlessness of the site of the fracture. The cost of treating fractures among those 65 years and older increased by 31.8% compared to those 50-64 years old (p < 0.0001). The direct medical costs increased by 8.6% as the number of fractures increased (p = 0.041). CONCLUSIONS We identified that osteoporotic fracture-related medical costs and hospitalization days increased with age. Interventions are effective in reducing fracture risk the potential to yield substantial cost savings.
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Affiliation(s)
- Eu Gene Kim
- Graduate school of Public Health, Seoul National University, Seoul, Korea
| | - Green Bae
- Collge of Pharmacy, Ewha Woman's University, Seoul, South Korea
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23
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Burden AM, Tanaka Y, Xu L, Ha YC, McCloskey E, Cummings SR, Glüer CC. Osteoporosis case ascertainment strategies in European and Asian countries: a comparative review. Osteoporos Int 2021; 32:817-829. [PMID: 33305343 PMCID: PMC8043871 DOI: 10.1007/s00198-020-05756-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023]
Abstract
While many clinical guidelines recommend screening for osteoporosis for early detection and treatment, there is great diversity in the case-finding strategies globally. We sought to compare case-finding strategies, focusing on the approaches used in European and Asian countries. This article provides an overview of the current case-finding strategies in the UK, Germany (including Austria and German-speaking regions of Switzerland), China, Japan, and Korea. We conducted a review of current treatment guidelines in each country and included expert opinions from key opinion leaders. Most countries define osteoporosis among patients with a radiographically identified fracture of the hip or the vertebrae. However, for other types of fractures, or in the absence of a fracture, varying combinations of risk-factor assessment and areal bone mineral density (aBMD) assessed by dual X-ray absorptiometry are used to define osteoporosis cases. A T-score ≤ - 2.5 is accepted to identify osteoporosis in the absence of a fracture; however, not all countries accept DXA alone as the sole criteria. Additionally, the critera for requiring clinical risk factors in addition to aBMD differ across countries. In most Asian countries, aBMD scanning is only provided beyond a particular age threshold. However, all guidelines recommend fracture risk assessment in younger ages if risk factors are present. Our review identified that strategies for case-finding differ regionally, particularly among patients without a fracture. More homogenized ways of identifying osteoporosis cases are needed, in both the Eastern and the Western countries, to improve osteoporosis case-finding before a fracture occurs.Case-finding in osteoporosis is essential to initiate treatment and minimize fracture risk. We identified differences in case-finding strategies between Eastern and Western countries. In the absence of a diagnosed fracture, varying combinations of risk factors and bone density measurements are used. Standardized case-finding strategies may help improve treatment rates.
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Affiliation(s)
- A M Burden
- Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog-Weg 4, CH-8093, Zurich, Switzerland.
| | - Y Tanaka
- University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Kitakyushu, 807-8555, Japan
| | - L Xu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
| | - Y-C Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - E McCloskey
- Metabolic Bone Centre, United Kingdom, Sorby Wing, Northern General Hospital, Herries Road, Sheffield, 557AU, UK
| | - S R Cummings
- San Francisco Coordinating Center, Sutter Health and the Department of Epidemiology and Biostatistics, University of California, San Francisco, Mission Hall: Box #0560, 550-16th Street, 2nd Floor, San Francisco, CA, 94143, USA
| | - C C Glüer
- Section Biomedical Imaging, Department of Radiology and Neuroradiology, Christian-Albrechts-University, Am Botanischen Garten 14, 24118, Kiel, Germany
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Ahn EJ, Bang SR. Risk factors associated with treatment of hyperactive postoperative delirium in elderly patients following hip fracture surgery under regional anesthesia: a nationwide population-based study. Braz J Anesthesiol 2021; 72:213-219. [PMID: 33915191 PMCID: PMC9373072 DOI: 10.1016/j.bjane.2021.03.020] [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: 01/28/2020] [Revised: 01/14/2021] [Accepted: 03/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background and objectives Delirium is common but is frequently undetected by clinicians, despite the fact that it can be life-threatening. This study aimed to identify the incidence of delirium and the preoperative factors associated with perioperative use of drugs to treat hyperactive delirium in elderly patients who underwent hip fracture surgery under regional anesthesia. Methods We retrospectively reviewed records of all patients ≥ 65 years of age who had undergone hip-fracture surgery under regional anesthesia, covered by the Korean National Health Insurance, between January 1, 2009 and December 31, 2015. A univariate and stepwise logistic regression model with the occurrence of hyperactive delirium as the dependent variable was used to identify the perioperative factors for this sample of patients. Results Among the 70,696 patients who underwent hip fracture surgery, 58,972 patients who received regional anesthesia were included in our study; of these, perioperative use of drugs to treat hyperactive delirium was diagnosed in 8,680 (14.7%) patients. Performing stepwise logistic regression, preoperative variables found to be associated with delirium were: male sex, age ≥ 85 years, hospital type (medical center), ICU and ventilator care, the presence of a neurodegenerative disorder, uncomplicated diabetes mellitus, peptic ulcer disease, and previously diagnosed psychoses and/or depression (OR = 1.49 [1.42–1.58], 4.7 [4.15–5.37], 13.3 [7.57–23.8], 1.52 [1.43–1.60], 1.19 [1.01–1.40], 1.20 [1.14–1.27], 1.09 [1.04–1.14], 0.87 [0.96–0.00], 2.23 [1.48–3.37], and 1.38 [1.32–1.46], respectively). Conclusions Postoperative hyperactive delirium may affect approximately 15% of elderly patients submitted to hip fracture repair under regional anesthesia. This study has identified multiple preoperative risk factors associated with postoperative hyperactive delirium and its pharmacological management strategies.
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Affiliation(s)
- Eun-Jin Ahn
- Chung-Ang University College of Medicine, Chung-Ang University Medical Center, Department of Anesthesiology and Pain Medicine, Seoul, Korea.
| | - Si Ra Bang
- Inje University Seoul Paik Hospital, Department of Anesthesiology and Pain Medicine, Seoul, Korea.
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Association between BMI variability and risk of fracture among Korean men and women: a population based study. Arch Osteoporos 2021; 16:67. [PMID: 33839996 DOI: 10.1007/s11657-021-00918-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED In Korean adults aged 50 years and older, the overall risk of fractures increased with greater BMI variability among both men and women, specifically, spinal fractures for men and both spinal and hip fractures for women. PURPOSE The bone-health-related outcome, such as fractures due to BMI fluctuation, has been understudied within Asian populations. In this large-scale, population-based cohort study in Korea, we aimed to investigate the relationship between variability in body mass index (BMI) and the risk of fractures. METHODS The study included 166,932 subjects aged ≥ 50 years from the National Health Insurance Service-Health Screening Cohort. The BMI variability value from three follow-up examinations during 2002-2007 was categorized into quartiles. The hazard ratios (HRs) with 95% confidence intervals (CIs) for the effects of BMI variability on the risk of admission from hip, spine, and upper extremity fractures during 2008-2015 were evaluated using a Cox proportional hazards regression analysis. RESULTS Compared to those in the lowest BMI variability (1st quartile), men in the highest BMI variability (4th quartile) showed an increased risk of spinal fractures (aHR 1.21, 95% CI 1.07-1.36) with a significant linear trend (P for trend = 0.021). Compared to those in the lowest BMI variability (1st quartile), women in the highest BMI variability (4th quartile) showed an increased risk of hip and spinal fractures (aHR 1.35, 95% CI 1.05-1.69; aHR 1.16, 95% CI 1.05-1.28) with significant linear trends (P for trend = 0.021; P for trend = 0.003, respectively). There was no association between BMI variability and incidents of upper extremity fractures for men or women. CONCLUSION Association between BMI variability and increased fracture risk depended on sex and fracture types. BMI maintenance, instead of high BMI fluctuation, may be beneficial in terms of lowering the overall fracture risk for Korean adults over 50 years old.
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Hagino H. Current and Future Burden of Hip and Vertebral Fractures in Asia. Yonago Acta Med 2021; 64:147-154. [PMID: 34025188 DOI: 10.33160/yam.2021.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/05/2022]
Abstract
The increase in the incidence of hip fractures over time disappeared in Northern European and North American Caucasians after 2000, while an increase was observed in Asian countries including Japan until 2010. However, a decrease in the incidence was observed after 2010. The prevalence of vertebral fractures in Asians, Europeans, and American Caucasians is similar, and the incidences of clinical and morphometric vertebral fractures are higher in Asians compared with European Caucasians. The decrease in the incidence of vertebral fractures over time has been observed in Japan. Although the stabilization or decrease over time in the incidence of hip and vertebral fractures have been observed, the number of patients with these fractures is expected to increase rapidly with increases in the elderly population. Multidisciplinary measures to prevent fragility fractures are an urgent issue in Asia at this time. This narrative review outlines the recent trends in incidence and future burdens of hip fracture and vertebral fracture in Asia.
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Affiliation(s)
- Hiroshi Hagino
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
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Park SM, Go SJ, Han H, Park JW, Lee YK, Kim HJ, Yeom JS, Koo KH. Risk factors for subsequent vertebral fractures following a previous hip fracture. J Bone Miner Metab 2021; 39:193-200. [PMID: 32683499 DOI: 10.1007/s00774-020-01133-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/12/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The purpose of our study was to evaluate the incidence and to identify risk factors of subsequent vertebral fractures after hip fractures, and to determine whether the subsequent vertebral fracture increases the mortality rate of elderly hip fracture patients. MATERIALS AND METHODS From January 2009 to July 2016, 1,554 patients were diagnosed as having a hip fracture and were treated surgically at our institution. Among them, 1121 patients age > 50 years at the time of injury and were followed up for 1 year or longer after the hip fracture surgery. In these patients, radiographs of the hip and spine were taken at each follow-up. We reviewed medical records and radiographs of these patients. Among the 1121 patients, 107 patients (9.5%) had subsequent vertebral fractures after the hip fracture during entire follow-up periods. RESULTS In multivariable analysis, previous history of vertebral fracture [odds ratio (OR), 2.62; p < 0.001], medication possession rate (MPR) of osteoporosis treatment < 80% (OR, 1.92; p = 0.014), and a lower lumbar bone mineral density (BMD) (OR, 2.58; p = 0.001) appeared as risk factors for subsequent vertebral fractures. CONCLUSION However, the subsequent vertebral fractures did not affect the mortality after the hip fractures. Age ≥ 70 years [hazard ration (HR) 2.70; p = .039], body mass index < 18.5 kg/m2 (HR, 2.57; p =0 .048), and Charlson comorbidity index ≥ 2 (HR, 2.04; p =0.036) were risk factors of the death. Timely management is warranted to prevent subsequent vertebral fractures in hip fracture patients with risk factors.
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Affiliation(s)
- Sang-Min Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Sung Jun Go
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Heesoo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Jung Wee Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea.
| | - Ho-Joong Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Jin S Yeom
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620, Seongnam-si, South Korea
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Thalmann BH, Latz D, Schiffner E, Jungbluth P, Windolf J, Grassmann J. CCD angle & hip fractures - Predictor of fracture symmetry? J Orthop 2021; 24:1-4. [PMID: 33679019 DOI: 10.1016/j.jor.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background Hip fracture caused by fall is a common injury of the elderly. The risk of sustaining a contralateral hip fracture has been reported to be 5-10%. Aging society heightens the need of efficient prevention tools. To be able to cope with this demand, understanding of biomechanics of hip fractures are mandatory. Previous studies suggest that geometry of the proximal femur could play an important role for fracture probability and fracture type. Thus, analysis of hip geometry could play an important role in the prediction and prevention of bilateral hip fractures. Aim of this study was to elucidate the influence of caput collum diaphyseal angle on the fracture type of proximal femur. Material and methods In a retrospective analysis, data of patients with an acute hip fracture who underwent surgical treatment within five years were included. Data was separated into two groups: (I) intra capsular femur fracture (femoral neck fractures) and (II) extra capsular femur fracture (inter- and subtrochanteric femur fractures). Occurrence of a bilateral fracture, age, gender, weight, height and caput collum diaphyseal angle (standardized measurement of the opposite joint on preoperative digital x-rays) of each group were further analyzed. Results Data of 448 patients were included ((I): 250 vs. (II): 198 patients). Group (I) showed a significant higher mean caput collum diaphyseal angle of 133.9 ± 7.0° (mean ± standard deviation) compared to group (II) with 127.6 ± 6.1° (F (1, 451) = 106.5, p = 0.00). In group (I) 0 patients had a caput collum diaphyseal angle <120° (varus), 214 patients (86%) 120°-140° and 35 patients (14%) angle>140° (valgus). In contrast, in group (II) 21 patients (10%) had a caput collum diaphyseal angle <120° (varus), 175 patients (86%) 120°-140° and 7 patients (4%) >140° (valgus). 52 patients had a bilateral hip fracture. 36 patients (69%) sustained a bilateral hip fracture of the same fracture type. Conclusion Patients with an intra capsular proximal femur fracture showed a significantly higher caput collum diaphyseal angle compared to patients with an extra capsular proximal femur fracture. Moreover, intra capsular femur fractures are correlated with an indifferent (120-140°) or valgus (>140°) femoral neck configuration. Extra capsular femur fractures correlate with an indifferent (120-140°) or varian femoral neck configuration (<120°). The results support the assumption that the caput collum diaphyseal angle has an influence on fracture type of the proximal femur. This could possibly be a predictor for the fracture type of the contralateral hip (second fracture). Based on this, present data may benefit prosthetists in developing new and more efficient hip protectors. Level of evidence Level III. Retrospective comparative study.
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Affiliation(s)
- Ben Hannes Thalmann
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - David Latz
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Erik Schiffner
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Pascal Jungbluth
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Joachim Windolf
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Jan Grassmann
- Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany
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Jung HS, Jang S, Chung HY, Park SY, Kim HY, Ha YC, Lee YK, Nho JH. Incidence of subsequent osteoporotic fractures after distal radius fractures and mortality of the subsequent distal radius fractures: a retrospective analysis of claims data of the Korea National Health Insurance Service. Osteoporos Int 2021; 32:293-299. [PMID: 32876712 DOI: 10.1007/s00198-020-05609-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
UNLABELLED A better understanding of the features of subsequent fractures after distal radius fracture (DRF) is important for the prevention of further osteoporotic fractures. This study found that the cumulative incidence of subsequent osteoporotic fractures in South Korea increased over time and that the mortality rates of subsequent DRFs were lower than those of first-time DRFs. INTRODUCTION We examined the incidence of osteoporotic fractures following distal radius fractures (DRFs) and the mortality rate after subsequent DRFs using claims data from the Korea National Health Insurance (KNHI) Service. METHODS We identified records for 41,417 patients with first-time DRFs in 2012. The occurrence of osteoporotic fractures of the spine, hip, wrist, and humerus at least 6 months after the index DRF was tracked through 2016. All fractures were identified by specific diagnosis and procedure codes. One-year mortality rates and standardized mortality ratios (SMRs) for initial and subsequent DRFs were calculated for all patients. RESULTS The 4-year cumulative incidence of all subsequent osteoporotic fractures was 14.74% (6105/41,417; 9.47% in men, 15.9% in women). The number of associated subsequent fractures was 2850 for the spine (46.68%), 2271 for the wrist (37.2%), 708 for the hip (11.6%), and 276 for the humerus (4.52%). The cumulative mortality rate 1 year after the first-time and subsequent DRF was 1.47% and 0.71%, respectively, and the overall SMR was 1.48 (95% CI: 1.37-1.61) and 0.71 (95% CI: 0.42-1.21), respectively. CONCLUSION The cumulative incidence of osteoporotic fractures following DRFs increased over the study period and was higher among women. The cumulative mortality rates and SMRs of subsequent DRFs were lower than those of first-time DRFs at the 1-year follow-up. Given the increasing incidence rate of DRFs, the incidence of subsequent osteoporotic fractures may also increase.
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Affiliation(s)
- H-S Jung
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - S Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - H-Y Chung
- Department of Endocrinology and Metabolism, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - S Y Park
- Department of Endocrinology and Metabolism, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - H-Y Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Y-C Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Y-K Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - J-H Nho
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.
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Moon NH, Jang JH, Shin WC, Jung SJ. Effects of Teriparatide on Treatment Outcomes in Osteoporotic Hip and Pelvic Bone Fractures: Meta-analysis and Systematic Review of Randomized Controlled Trials. Hip Pelvis 2020; 32:182-191. [PMID: 33335866 PMCID: PMC7724023 DOI: 10.5371/hp.2020.32.4.182] [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: 05/03/2020] [Revised: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 12/03/2022] Open
Abstract
The primary objective of this study was to evaluate randomized controlled trials (RCTs) that have reported the effects of teriparatide on bone-healing in osteoporotic hip and pelvic bone fractures to determine the efficacy of teriparatide in lowering the rate of treatment failure. A total of 2,809 studies were identified using a comprehensive literature search (MEDLINE [n=1,061], Embase [n=1,395], and Cochrane Library n=353]). Five RCTs were included in the final analysis. Treatment failure rates at the last follow-up of osteoporotic hip and pelvic bone fractures between the teriparatide and control groups was the primary outcome. Treatment failure was defined as non-union, varus collapse of the proximal fragment, perforation of the lag screw, and any revision in cases due to mechanical failure of the implant during the follow-up period. The number of treatment failures in the teriparatide and placebo groups were 11.0% (n=20 out of 181) and 17.6% (n=36 out of 205), respectively. Although the rate of treatment failure in the teriparatide group was lower than that in the control group, this difference was not significant (odds ratio, 0.81 [95% confidence interval, 0.42–1.53]; P=0.16; I2=42%). This meta-analysis did not identify any significant differences in the rate of treatment failure between the teriparatide and control groups at final follow-up. Based on these results, we believe that there is a lack of evidence to confirm efficacy of teriparatide in reducing treatment failures in osteoporotic hip and pelvic bone fractures.
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Affiliation(s)
- Nam Hoon Moon
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jae Hoon Jang
- Department of Orthopaedic Surgery and Trauma Center, Pusan National University Hospital, Busan, Korea
| | - Won Chul Shin
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Seok Jin Jung
- Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea
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Reoperation rate, mortality and ambulatory ability after internal fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: a study on Korean Hip Fracture Registry. Arch Orthop Trauma Surg 2020; 140:1611-1618. [PMID: 31970505 DOI: 10.1007/s00402-020-03345-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The treatment of unstable intertrochanteric fracture in elderly patients is challenging and how to treat these patients remains controversial. The purposes of this study were to compare (1) reoperation rate, (2) mortality and (3) the postoperative change of walking ability between patients undergoing internal fixation (IF) and those undergoing bipolar hemiarthroplasty (HA) due to this type of fracture based on the data from the Korean Hip Fracture Registry. MATERIALS AND METHODS Between July 2014 and June 2016, we extracted 623 unstable intertrochanteric fractures (616 patients aged ≥ 65 years) according to the classification of the Association for the Study of Internal Fixation-American Orthopaedic Trauma Association. Among the 564 patients, 396 were treated with IF (IF group) and 168 with bipolar HA (HA group). We compared the reoperation rate and mortality between IF group and HA group. In patients, who were followed up more than 2 years after the surgery, we compared the postoperative change of walking activity from ambulatory outdoors (Koval's grade 1, 2, 3) to housebound (Koval's grade 4, 5, 6). RESULTS The rate of reoperation was higher in the IF group (24/396, 6.1%) than in the HA (4/168, 2.4%) (p = 0.046). At the final follow-up, 79 (35.7%) of the 221 IF patients became housebound, whereas 21 (23.3%) of the 90 HA patients became housebound (p = 0.022). CONCLUSION This study showed HA was associated with lower rate of reoperation and lower decrement rate of walking ability compared to IF in elderly patients with unstable intertrochanteric fractures.
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Lee I, Kim J, Kang H. Cardiorespiratory Fitness is Inversely Associated with Risk of Low Bone Mineral Density in Older Korean Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217907. [PMID: 33126597 PMCID: PMC7663600 DOI: 10.3390/ijerph17217907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
Abstract
Little is known regarding the association between physical fitness and bone health in older Korean men. This study investigated the relationship between estimated cardiorespiratory fitness (eCRF) and bone mineral density (BMD). This cross-sectional study included 2715 Korean men aged 50 years and older selected from those who participated in the 2008–2011 Korea National Health and Nutritional Examination and Survey. eCRF was obtained using a sex-specific algorithm developed on the basis of age, body mass index, resting heart rate, and physical activity and classified into low, middle, and high categories. Femoral neck BMD was assessed by dual X-ray absorptiometry. Odds ratios (OR) and 95% confidence intervals (CI) for osteopenia, osteoporosis, and low BMD were calculated for eCRF categories in models fully adjusted for age, waist circumference, education, income, smoking, heavy alcohol intake, serum vitamin D, serum parathyroid hormone, and dietary intake of energy, protein, calcium, and vitamins A and C. Overall, eCRF levels were positively associated with BMD and negatively with prevalence of osteopenia, osteoporosis, and low BMD. Logistic regression showed inverse trends in the risks of osteopenia (high vs. low: OR = 0.692; 95% CI, 0.328–0.517; p = 0.049) and low BMD (high vs. low: OR = 0.669; 95% CI, 0.497–0.966; p = 0.029) by eCRF category in models fully adjusted for all the measured covariates. The current findings suggest that maintaining high eCRF via regular physical activity may contribute to attenuation of age-related loss of BMD and decreased risk for low BMD in older Korean men.
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Nam YJ, Hwang SY, Kim DW, Kim D, Shin SJ, Yoon HE. Sex-specific relationship between vascular calcification and incident fracture in patients with end-stage renal disease. Kidney Res Clin Pract 2020; 39:344-355. [PMID: 32522894 PMCID: PMC7530357 DOI: 10.23876/j.krcp.20.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/14/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022] Open
Abstract
Background Vascular calcification (VC) is a major component of mineral bone disorders in patients with end-stage renal disease (ESRD). Bone metabolism is affected by various factors, including sex hormones. This study investigated whether there was a sex-specific relationship between VC and incident fracture in patients with ESRD. Methods This was a retrospective cohort study of dialysis patients from a single center. VC was assessed by the aortic calcification index (ACI) using abdominal computed tomography. Patients were grouped by sex and stratified into low or high ACI groups, according to the median ACI value. The association between ACI and incident fracture was analyzed. Results Data from 593 patients (male n = 328, median ACI, 14.57; female n = 265, median ACI, 19.44) were included. During a median follow-up of 36.7 months, 71 patients (12.0%) developed fractures. The fracture-free survival rate was significantly lower in the high ACI group versus the low ACI group, both in males (P = 0.021) and females (P = 0.001). In males, multivariate analysis showed that the high ACI group and ACI per se were not significant risks for fracture. However, in females, both the high ACI group (adjusted hazard ratio, 2.720; P = 0.003) and ACI per se (adjusted hazard ratio, 1.768; P = 0.035) were independently associated with fracture after adjustment for confounding variables. Conclusion VC was independently associated with incident fracture in female patients with ESRD. There may be a sex-specific relationship between VC and fracture in patients with ESRD.
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Affiliation(s)
- Yun Jung Nam
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - So Yeon Hwang
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Da Won Kim
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Dongryul Kim
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Seok Joon Shin
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Hye Eun Yoon
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
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Xiang G, Dong X, Xu T, Feng Y, He Z, Ke C, Xiao J, Weng YM. A Nomogram for Prediction of Postoperative Pneumonia Risk in Elderly Hip Fracture Patients. Risk Manag Healthc Policy 2020; 13:1603-1611. [PMID: 32982518 PMCID: PMC7502327 DOI: 10.2147/rmhp.s270326] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/27/2020] [Indexed: 01/23/2023] Open
Abstract
Purpose Pneumonia is one of the common complications of hip fracture. This study aimed to evaluate the risk factors and apply a nomogram to predict postoperative pneumonia in elderly hip fracture patients. Materials and Methods From August 2014 to October 2019, 1113 hip fracture patients who were older than 65 years and underwent surgical treatment in our hospital were subjects of this study. Univariate and multivariate Cox analyses were used to identify independent risk factors. A predictive nomogram model was built, and the discrimination and calibration were determined by receiver operating characteristic and calibration plot. Results A total of 166 patients developed pneumonia after operation (14.91%, pneumonia group) while the remaining 947 patients did not (85.09%, non-pneumonia group). According to the results, body mass index (OR, 0.76, 95% CI, 0.70 to 0.84, P<0.001), serum albumin (OR, 0.86, 95% CI, 0.79 to 0.93, P<0.001), c-reactive protein (OR, 1.01, 95% CI, 1.00 to 1.92, P=0.011), functional status (OR, 2.94, 95% CI, 1.69 to 5.10, P<0.001) and time to surgery (OR, 4.56, 95% CI, 2.64 to 7.88, P<0.001) were identified as independent risk factors of pneumonia. The area under the curve value for postoperative pneumonia risk was 0.905, and the P-value of the Hosmer-Lemeshow calibration test was 0.529. Conclusion Our nomogram model can be used to predict the risk of pneumonia in elderly hip fractures after surgery and provide clinicians with guidance for better perioperative intervention to improve prognosis and reduce mortality.
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Affiliation(s)
- Guangheng Xiang
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, People's Republic of China.,School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, People's Republic of China
| | - Xiaoyu Dong
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, People's Republic of China
| | - Tao Xu
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, People's Republic of China
| | - Yongzeng Feng
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, People's Republic of China
| | - Zili He
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, People's Republic of China
| | - Chenrong Ke
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, People's Republic of China
| | - Jian Xiao
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, People's Republic of China.,School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, People's Republic of China
| | - Yi-Min Weng
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, People's Republic of China
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Kim BS, Lim JY, Ha YC. Recent Epidemiology of Hip Fractures in South Korea. Hip Pelvis 2020; 32:119-124. [PMID: 32953703 PMCID: PMC7476784 DOI: 10.5371/hp.2020.32.3.119] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/29/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022] Open
Abstract
The aging of the Korean population is expected to result in an increase in the prevalence of hip fractures. The aim of this review is to evaluate potential hip-fracture trends in Korea during the last few decades. Data from a hip fracture-related epidemiology study informed by: (1) a cohort study; (2) hospital-based cohort study; and (3) claims database, were reviewed and summarized. The incidence of hip fractures rose from 159.1/100,000 in 2008 to 181.5/100,000 in 2012, and the total number of hip fractures is estimated to increase by 1.4 times over the next 10 years (35,729 in 2016 to 51,259 in 2025). The use of intramedullary nails has greatly surpassed the use of plates for the treatment of intertrochanteric fractures. The 1-year cumulative mortality rates in patients aged ≥50 years after hip fractures based on National Health Insurance Service data were 17.2% (3,575/20,849) in 2008 and 16.0% (4,547/28,426) in 2012; the decrease was mainly observed among women. In addition, the mean 1-year mortality rates were 21% for men and 15% for women, indicating that mortality was 1.4 times higher in men than in women. The number of hip fractures is rapidly increasing, and the incidence of hip fractures demonstrated a slightly increasing trend until 2012. Trends in the use of varying surgical options for treatments for femoral neck and intertrochanteric fractures follow global trends. Although the high mortality rate after hip fractures in Korea remains concerning, a decrease in these rates over the study period was observed.
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Affiliation(s)
- Boo-Seop Kim
- Department of Orthopaedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju, Korea
| | - Jae-Young Lim
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Korea
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Zhang C, Feng J, Wang S, Gao P, Xu L, Zhu J, Jia J, Liu L, Liu G, Wang J, Zhan S, Song C. Incidence of and trends in hip fracture among adults in urban China: A nationwide retrospective cohort study. PLoS Med 2020; 17:e1003180. [PMID: 32760065 PMCID: PMC7410202 DOI: 10.1371/journal.pmed.1003180] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hip fracture is a public health concern because of its considerable morbidity, excess mortality, great risk of disability, and high societal healthcare costs. China has the largest population of older people in the world and is experiencing rapid population aging and facing great challenges from an increasing number of hip fractures. However, few studies reported the epidemiology, especially at a national level. We aimed to evaluate trends in hip fracture incidence and associated costs for hospitalization in China. METHODS AND FINDINGS We conducted a population-based study using data between 2012 and 2016 from the national databases of Urban Employee Basic Medical Insurance and Urban Resident Basic Medical Insurance in China, covering about 480 million residents. Data from around 102.56 million participants aged 55 years and older during the study period were analyzed. A total of 190,560 incident hip fracture patients (mean age 77.05 years, standard deviation 8.94; 63.99% female) were identified. Primary outcomes included the age- and sex-specific incidences of hip fracture. Associated annual costs for hospitalization were also calculated. Incidence was described as per 100,000 person-years at risk, and 95% confidence intervals were computed assuming a Poisson distribution. Hip fracture incidence overall in China did not increase during the study period despite rapid population aging. Incidence per 100,000 was 180.72 (95% CI 137.16, 224.28; P < 0.001) in 2012 and 177.13 (95% CI 139.93, 214.33; P < 0.001) in 2016 for females, and 121.86 (95% CI 97.30, 146.42; P < 0.001) in 2012 and 99.15 (95% CI 81.31, 116.99; P < 0.001) in 2016 for males. For both sexes, declines in hip fracture incidence were observed in patients aged 65 years and older, although incidence was relatively stable in younger patients. However, the total absolute number of hip fractures in those 55 years and older increased about 4-fold. The total costs for hospitalization showed a steep rise from US$60 million to US$380 million over the study period. Costs for hospitalization per patient increased about 1.59-fold, from US$4,300 in 2012 to US$6,840 in 2016. The main limitation of the study was the unavailability of data on imaging information to adjudicate cases of hip fracture. CONCLUSIONS Our results show that hip fracture incidence among patients aged 55 and over in China reached a plateau between 2012 and 2016. However, the absolute number of hip fractures and associated medical costs for hospitalization increased rapidly because of population aging.
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Affiliation(s)
- Chenggui Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Jingnan Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Junxiong Zhu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Jialin Jia
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Lili Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Guozhen Liu
- Peking University Health Information Technology, Beijing, China
| | - Jinxi Wang
- Beijing Healthcom Data Technology, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
- * E-mail: (SZ); (CS)
| | - Chunli Song
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
- * E-mail: (SZ); (CS)
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Won SH, Ahn S, Ji E, Park JW, Kim JK, Lee YK. Hip and Subtrochanteric or Femoral Shaft Fractures after Bisphosphonate Use in Korean Women, Using Korean National Sample Cohort. J Korean Med Sci 2020; 35:e193. [PMID: 32597040 PMCID: PMC7324261 DOI: 10.3346/jkms.2020.35.e193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/27/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Concern about bisphosphonate-associated subtrochanteric and femoral shaft (ST/FS) fractures has been raised. However, its real risk is still debatable, because there is no study to estimate risk and benefit of bisphosphonate. The objective of this study was to evaluate the risk of typical hip fractures and ST/FS fractures among bisphosphonate users using nationwide database. METHODS We performed a retrospective cohort study using National Health Insurance Service-National Sample Cohort. We evaluated occurrence of the ST/FS and femoral neck and intertrochanteric (FN/IT) fractures among female bisphosphonate new users. Incidence rate of ST/FS and FN/IT fractures were compared between long-term users (≥ 1 year) and short-term users (< 1 year). Number needed to harm (NNH) for ST/FS and number needed to treat (NNT) for typical hip fracture were analyzed. RESULTS Among 46,420 bisphosphonate users, we identified 14,689 long-term users and 21,840 short-term users. During the study period, 61 long-term users and 36 short-term users had ST/FS fractures, while 204 long-term users and 511 short-term users had FN/IT fractures. The long-term user showed higher incidence rate of ST/FS fractures (67.1/100,000 person-years; 95% confidence interval [CI], 50.3-83.9) comparing with 31.2/100,000 person-years (95% CI, 21.0-41.4) in the short-term users. The incidence rate of FN/IT fractures was 225.5/100,000 person-years (95% CI, 194.6-256.5) in the long-term users and 448.6/100,000 person-years (95% CI, 409.7-487.5) in the short-term users. The NNH for ST/FS was 400, while the NNT for typical hip fracture was 105. CONCLUSION Our study suggested that physicians keep the significant benefit of bisphosphonate to prevent typical hip fracture in mind, even the concerns about bisphosphonate-associated ST/FS fractures.
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Affiliation(s)
- Seok Hyung Won
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunjeong Ji
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Wee Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Kak Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
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Cha YH, Ha YC, Lim JY, Kim WS. Introduction of the Cost-Effectiveness Studies of Fracture Liaison Service in Other Countries. J Bone Metab 2020; 27:79-83. [PMID: 32572368 PMCID: PMC7297624 DOI: 10.11005/jbm.2020.27.2.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/21/2020] [Accepted: 02/03/2020] [Indexed: 11/30/2022] Open
Abstract
Osteoporosis and osteoporosis related fractures contribute a large part of the medical cost in developed countries. Considering the preventive effect of osteoporotic medications, high rate of mortality and complications, poor quality of life after osteoporosis related fractures, the growing trend of older populations in the future, osteoporosis and osteoporosis related fractures are important targets of preventive treatment and also targets of socioeconomic cost reduction. Treating osteoporosis and preventing osteoporosis related fractures have become an essential element in Korean medical system. Despite the various differences in the health care system, hospitals in many other countries are operating fracture liaison service and they have confirmed its cost-effectiveness. In Korea's health care system, further research on cost-effectiveness as well as its clinical effects is needed.
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Affiliation(s)
- Yong Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae-Young Lim
- Department of Rehabilitation, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo-Suk Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
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Woo SH, Park KS, Choi IS, Ahn YS, Jeong DM, Yoon TR. Sequential Bilateral Hip Fractures in Elderly Patients. Hip Pelvis 2020; 32:99-104. [PMID: 32566541 PMCID: PMC7295611 DOI: 10.5371/hp.2020.32.2.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/06/2019] [Accepted: 12/05/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the incidence and presentation of osteoporotic sequential bilateral hip fractures (SBHF) in Center for Joint Disease, Chonnam National University Hwasun Hospital as there are limited studies with variable results reported in Korea. Materials and Methods Records of 507 patients aged >60 years old presenting with osteoporotic hip fractures between 2009 and 2015 were retrospectively reviewed to document the occurrence and presentation of sequential hip fractures; mean post-treatment follow-up was 48 months. Additionally, any correlations between sequential fractures and initial fracture and risk factors were assessed. Bone mineral density (BMD) was measured before and after sequential hip fracture for comparison. Results There were 246 femoral neck (Group A) and 261 intertrochanteric (Group B) fractures. The cumulative incidence of SBHF was 8.2% (42 patients total; 29 in Group A and 13 in Group B). Average interval of SBHF for Group A and Group B were 37.4 months and 29.9 months, respectively. There was significant correlation between the initial fracture type and sequential fractures, particularly the trochanteric and subgroup of those with neck fractures. Hypertension as a co-morbidity and female sex have been identified as risk factors for SBHF. No significant findings were noted regarding BMD and risk factors in both groups. Conclusion The clinical presentations of SBHF noted here concur with other worldwide studies and may guide efforts to develop relevant programs to prevent SBHF.
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Affiliation(s)
- Seong-Hwan Woo
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Kyung-Soon Park
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Ik-Sun Choi
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Young-Sub Ahn
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Dong-Min Jeong
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Taek-Rim Yoon
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
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Daraphongsataporn N, Saloa S, Sriruanthong K, Philawuth N, Waiwattana K, Chonyuen P, Pimolbutr K, Sucharitpongpan W. One-year mortality rate after fragility hip fractures and associated risk in Nan, Thailand. Osteoporos Sarcopenia 2020; 6:65-70. [PMID: 32715096 PMCID: PMC7374531 DOI: 10.1016/j.afos.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/12/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives Fragility hip fracture is a common secondary complication of osteoporosis, which leads to significant morbidity and mortality. The incidence and prevalence of hip fractures have increased over recent decades. This study established an objective to determine the mortality rate and potential risk factors in fragility hip fracture patients. Methods Electronic medical records were retrospectively reviewed. A total of 1412 patients, aged 50 years and over, who sustained and received treatment for hip fractures between 2014 and 2018 were subsequently identified. Mortality rate data were retrieved from the official statistics registry for the provincial population. The mortality rates and potential risk factors for mortality were examined using Kaplan-Meier estimates and multivariate Cox proportional hazard models. Results The overall 1-year mortality rate of fragility hip fracture patients was 19%. Compared with the age-matched population in Nan province, hip fractures increased the mortality rate by 6.21 times. Additionally, the mortality of hip fracture patients was significantly higher among those with age above 80 years, nonambulatory status before fracture and upon hospital discharge, end-stage renal disease, delirium, and pneumonia. Conclusions Patients who sustained hip fractures had approximately 6 times higher mortality. Effective strategies for hip fracture prevention as well as improvement in the standard of care are crucial steps towards reducing mortality in patients with hip fracture.
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Affiliation(s)
| | - Surapot Saloa
- Department of Orthopaedic Surgery, Nan Hospital, Nan, Thailand
| | | | | | | | - Prapan Chonyuen
- Department of Orthopaedic Surgery, Nan Hospital, Nan, Thailand
| | - Kununya Pimolbutr
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Cha YH, Ha YC, Ryu HJ, Lee YK, Park SH, Lee KJ, Koo KH. Effect of heart failure on postoperative short and long-term mortality in elderly patients with hip fracture. Injury 2020; 51:694-698. [PMID: 31948778 DOI: 10.1016/j.injury.2020.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/04/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We designed a comparative study using elderly hip fracture patients with and without heart failure (HF). The purpose of this study was to assess 1) prevalence of HF, compare 2) early and late mortality after elderly hip fracture between HF and non-HF patients and to assess 3) risk factors of mortality after hip fractures in elderly patients with HF. In addition, we also investigated 4) whether there is a difference in mortality according to the severity of left ventricular (LV) systolic dysfunction classified by LV ejection fraction (EF) in HF patients through subgroup analysis. METHODS This study included 1992 patients (1992 hips) who were diagnosed as having unilateral femoral neck or intertrochanteric fractures and who underwent surgery at two hospitals between January 2004 and June 2018. The patients were categorized into a non-HF group (1782 patients) and a HF group (210 patients; mild [119 patients] and moderate-to- severe HF subgroups [91 patients]). The cumulative crude mortality rate was calculated, and 30-day, 60-day, 3-month, 6-month, and 1-year mortality rates were compared between the non-HF and HF. Logistic regression analysis was conducted to identify independent factors associated with mortality. RESULTS Of 1992 patients, 210 (10.5%) patients were diagnosed with HF. The 30-day, 60-day, 3-month, 6-month, and 1-year postoperative cumulative mortality rates were respectively 1.6%, 3.6%, 5.1%, 8.4%, and 12.9% in the non-HF group, and 5.7%, 9.5%, 12.4%, 17.1%, and 25.2% in the HF group (p ≤ 0.001). The factors that affected 1-year mortality were sex (OR, 2.10; 95% CI, 1.62-2.72; p < 0.001) and age (OR, 1.04; 95% CI, 1.02-1.06; p < 0.001) and presence of HF (OR, 1.62; 95% CI, 1.45-1.86; p = 0.005). In subgroup analysis, the factors that affected 30-day mortality were only moderate-to-severe HF (OR, 4.01; 95% CI, 1.10-8.78; p = 0.009). CONCLUSIONS In elderly patients with hip fracture, the comparison between the HF and non-HF patients revealed that HF was an independent factor of mortality at a minimum of 1-year follow-up, and severity of LV systolic dysfunction classified by LVEF in patients with hip fracture was also a risk factor of 30-day mortality.
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Affiliation(s)
- Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea.
| | - Hyun-Jun Ryu
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Hyun Park
- Division of Cardiology, Department of Internal Medicine, Eulji University Hospital, Daejeon, South Korea
| | - Kwang Je Lee
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Kong SH, Ahn D, Kim BR, Srinivasan K, Ram S, Kim H, Hong AR, Kim JH, Cho NH, Shin CS. A Novel Fracture Prediction Model Using Machine Learning in a Community-Based Cohort. JBMR Plus 2020; 4:e10337. [PMID: 32161842 PMCID: PMC7059838 DOI: 10.1002/jbm4.10337] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/16/2019] [Accepted: 01/03/2020] [Indexed: 11/11/2022] Open
Abstract
The prediction of fracture risk in osteoporotic patients has been a topic of interest for decades, and models have been developed for the accurate prediction of fracture, including the fracture risk assessment tool (FRAX). As machine-learning methodologies have recently emerged as a potential model for medical prediction tools, we aimed to develop a novel fracture prediction model using machine-learning methods in a prospective community-based cohort. In this study, 2227 participants (1257 females) with a baseline bone mineral density (BMD) and trabecular bone score were enrolled from the Ansung cohort. The primary endpoint was the fragility fractures reported by patients or confirmed by X-rays. We used 3 different models: CatBoost, support vector machine (SVM), and logistic regression. During a mean 7.5-year follow-up (range, 2.5 to 10 years), fragility fractures occurred in 537 (25.6%) of participants. In predicting total fragility fractures, the area under the curve (AUC) values of the CatBoost, SVM, and logistic regression models were 0.688, 0.500, and 0.614, respectively. The AUC value of CatBoost was significantly better than that of FRAX (0.663; p < 0.001), whereas the the SVM and logistic regression models were not. Compared with the conventional models such as SVM and logistic regression, the CatBoost model had the best performance in predicting total fragility fractures (p < 0.001). According to feature importance in the CatBoost model, the top predicting factors (listed in order) were total hip, lumbar spine, and femur neck BMD, subjective arthralgia score, serum creatinine, and homocysteine. The latter three factors were listed higher than conventional predictors such as age or previous fracture history. In summary, we hereby report the development of a prediction model for fragility fractures using a machine-learning method, CatBoost, which outperforms the FRAX model as well as two conventional machine-learning models. The model was also able to propose novel high-ranking predictors. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Sung Hye Kong
- Department of Internal Medicine Seoul National University College of Medicine Seoul Republic of Korea
| | - Daehwan Ahn
- Department of Operations, Information and Decisions, Wharton School University of Pennsylvania Philadelphia PA USA
| | - Buomsoo Raymond Kim
- Department of Management Information Systems, Eller College of Management University of Arizona Tucson AZ USA
| | - Karthik Srinivasan
- Department of Management Information Systems, Eller College of Management University of Arizona Tucson AZ USA
| | - Sudha Ram
- Department of Management Information Systems, Eller College of Management University of Arizona Tucson AZ USA
| | - Hana Kim
- Department of Internal Medicine Seoul National University College of Medicine Seoul Republic of Korea
| | - A Ram Hong
- Department of Internal Medicine Chonnam National University Hwasun Hospital Chonnam
| | - Jung Hee Kim
- Department of Internal Medicine Seoul National University College of Medicine Seoul Republic of Korea
| | - Nam H Cho
- Department of Preventive Medicine Ajou University School of Medicine Suwon Republic of Korea
| | - Chan Soo Shin
- Department of Internal Medicine Seoul National University College of Medicine Seoul Republic of Korea
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Saad RK, Harb H, Bou-Orm IR, Ammar W, El-Hajj Fuleihan G. Secular Trends of Hip Fractures in Lebanon, 2006 to 2017: Implications for Clinical Practice and Public Health Policy in the Middle East Region. J Bone Miner Res 2020; 35:71-80. [PMID: 31505064 DOI: 10.1002/jbmr.3870] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/25/2019] [Accepted: 08/25/2019] [Indexed: 01/17/2023]
Abstract
Country-specific hip fracture incidence rates (IRs) and longevity allow the Fracture Risk Assessment Tool (FRAX) to be adapted to individual countries. Secular trends can affect tool calibration. Data on hip fracture IRs in the Middle East is scarce, and long-term secular trend studies are nonexistent. Using the Ministry of Public Health hip fracture registry, we calculated age- and sex-specific hip fracture IRs in Lebanon, from 2006 to 2017, among individuals aged ≥50 years. We used Kendall's tau-b (τb) test to determine the correlation between time and hip fracture IRs, and calculated both the annual % change in IRs and the % change in IR compared to the baseline period (2006 to 2008). The registry recorded 6985 hip fractures, 74% at the femoral neck, 23% intertrochanteric, and 3% subtrochanteric. Men constituted 32% of the population, and were significantly younger than women (76.5 ± 11.0 years versus 77.7 ± 10.3 years; p < 0.001). Annual overall IRs, per 100,000, ranged from 126.6 in 2014 to 213.2 in 2017 in women, and 61.4 in 2015 to 111.7 in 2017 in men. The average women to men IR ratio was 1.8 (range, 1.5 to 2.1). IRs steadily increased with age, and IR ratios increased in parallel in both sexes, with a steeper and earlier rise (by 5 years) in women. Data showed a consistent decline in hip fracture IRs starting in 2006 in women, and in 2009 in men. There was a significant negative correlation between time (2006 to 2014) and hip fracture IRs in women (τb = -0.611, p = 0.022) but not in men (τb = -0.444, p = 0.095). The steady decrease in IRs reversed after 2015 in both sexes. This long-term data on secular trends in the Middle East is novel and consistent with worldwide changes in hip fracture rates. The impact of such changes on national FRAX-derived estimates is unclear, should be assessed, and may necessitate an update in the FRAX Lebanon calculator. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Randa K Saad
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders at the American University of Beirut-Medical Center, Beirut, Lebanon
| | - Hilda Harb
- Ministry of Public Health, Beirut, Lebanon
| | - Ibrahim R Bou-Orm
- Higher Institute of Public Health, St. Jospeh University of Beirut, Beirut, Lebanon.,Institute for Global Health and Development, Queen Margaret University - Edinburgh, Musselburgh, East Lothian, UK
| | | | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders at the American University of Beirut-Medical Center, Beirut, Lebanon
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Lee SR, Cho MK, Cho YJ, Chun S, Hong SH, Hwang KR, Jeon GH, Joo JK, Kim SK, Lee DO, Lee DY, Lee ES, Song JY, Yi KW, Yun BH, Shin JH, Chae HD, Kim T. The 2020 Menopausal Hormone Therapy Guidelines. J Menopausal Med 2020; 26:69-98. [PMID: 32893509 PMCID: PMC7475284 DOI: 10.6118/jmm.20000] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/19/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moon Kyoung Cho
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea
| | - Yeon Jean Cho
- Department of Obstetrics and Gynecology, Dong-A University Medical Center, Busan, Korea
| | - Sungwook Chun
- Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Seung Hwa Hong
- Department of Obstetrics and Gynecology, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyu Ri Hwang
- Department of Obstetrics & Gynecology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Gyun Ho Jeon
- Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jong Kil Joo
- Department of Obstetrics and Gynecology, Pusan National University Hospital, Busan, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ock Lee
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
| | - Dong Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Seoul, Korea
| | - Eun Sil Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jae Yen Song
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyong Wook Yi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Ho Shin
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Hee Dong Chae
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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Byun SE, Sim JA, Joo YB, Kim JW, Choi W, Na YG, Shon OJ. Changes in patellar fracture characteristics: A multicenter retrospective analysis of 1596 patellar fracture cases between 2003 and 2017. Injury 2019; 50:2287-2291. [PMID: 31627900 DOI: 10.1016/j.injury.2019.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/04/2019] [Accepted: 10/06/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to investigate the characteristics of patellar fracture and the changes in these characteristics over time in Korea. METHODS A total of 1596 patients with patellar fractures who visited 5 university hospitals from 2003 to 2017 were included in the analysis. The demographic characteristics of the patients, including age, sex, body mass index, and fracture characteristics, including the fracture classification, injury mechanism, fixation method, and postoperative complication rate, were analyzed through a review of the medical records and plain radiographs. RESULTS There were 988 (61.9%) male patients and 608 (38.1%) female patients. The mean age was 51.3 (range, 3-97) years for the study group, 47.6 (range, 8-94) years for male patients, and 57.3 (range, 3-97) years for female patients. Increasing trends in the proportion of patients aged ≥60 years and in the proportion of female patients were observed during the study period (p = 0.002 and p < 0.001, respectively). The fixation method also changed significantly during the study period, with decrease of the tension band wiring and increase of the combined method (p < 0.001). The incidence of high-energy injuries and more complex types of fracture was higher in male patients than in female patients (p < 0.001 and p < 0.001, respectively). Patients aged ≥60 years with patellar fractures showed a higher percentage of low-energy injuries and higher postoperative complication rates than younger patients (p < 0.001 and p = 0.002, respectively). CONCLUSIONS Patellar fractures in the female and elderly populations are increasing. Moreover, elderly patients with patellar fractures had a higher postoperative complication rate and also a higher percentage of low-energy injury than younger patients. Therefore, patellar fractures in the elderly population should be considered fragility fractures, and further studies are warranted to suggest a specific treatment plan for fragility patellar fractures.
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Affiliation(s)
- Seong-Eun Byun
- Department of Orhopaedic Surgery, CHA Bundang Medical Center, CHA University, Republic of Korea
| | - Jae-Ang Sim
- Department of Orhopaedic Surgery, Gachon University Gil Hospital, Republic of Korea
| | - Yong Bum Joo
- Department of Orhopaedic Surgery, Chungnam National University Hospital, Republic of Korea
| | - Ji Wan Kim
- Department of Orhopaedic Surgery, Asan Medical Center, Ulsan University, Republic of Korea
| | - Wonchul Choi
- Department of Orhopaedic Surgery, CHA Bundang Medical Center, CHA University, Republic of Korea
| | - Young Gon Na
- Department of Orhopaedic Surgery, Gachon University Gil Hospital, Republic of Korea
| | - Oog-Jin Shon
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Republic of Korea.
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Cha YH, Ha YC, Lim JY. Establishment of Fracture Liaison Service in Korea: Where Is It Stand and Where Is It Going? J Bone Metab 2019; 26:207-211. [PMID: 31832386 PMCID: PMC6901692 DOI: 10.11005/jbm.2019.26.4.207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/09/2019] [Accepted: 11/10/2019] [Indexed: 01/18/2023] Open
Abstract
The elderly population growth rate is extremely high in Korean society, and life expectancy is close to 85 years old for women and 80 for men as of people born in 2015. The future hip fracture prediction model of Korea shows that the elderly hip fracture rate will increase by 1.4 times by 2025, which will impose a serious socioeconomic burden on Korean society and become a key issue of public health management. The fracture liaison service (FLS) is defined adequate treatment and services for patients over 50 years old with fragility fractures, enabling systematic identification and decreasing the risk of subsequent osteoporotic fractures. In Korean society, the introduction of FLS, which is verified not only in the socioeconomic aspects but also in the treatment of patients, is thought to be essential. However, the challenges that need to be addressed in order to implement FLS include the lack of awareness regarding the necessity of this system, the lack of healthcare systems, and inadequate policies. In the future, further studies on the FLS and its clinical and socioeconomic effects for the Korean medical system will be necessary.
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Affiliation(s)
- Yong Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae-Young Lim
- Department of Rehabilitation, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Jeong SM, Shin DW, Han K, Jung JH, Chun S, Jung HW, Son KY. Timed up-and-go test is a useful predictor of fracture incidence. Bone 2019; 127:474-481. [PMID: 31323429 DOI: 10.1016/j.bone.2019.07.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The timed up-and-go (TUG) test is a validated screening tool to assess fall risk. This study evaluated the association between the TUG test and future fractures, which are a tangible clinical complication of falling. METHODS We included 1,070,320 participants who participated in the National Screening Program for Transitional Ages for Koreans aged 66 years old from 2009 to 2014. Among them, 355,753 women underwent dual-energy X-ray absorptiometry. TUG times were classified as <10 s or ≥10 s. The incidence of fractures, including vertebral, hip, and other sites, was determined using claims data from the National Health Information database. RESULTS During the mean follow-up period of 4.4 ± 1.8 years, participants with slow TUG times had a significantly increased risk of fractures compared with those who had normal TUG times: any fractures (adjusted hazard ratio [aHR] = 1.08, 95% confidence interval [CI] = 1.06-1.10), vertebral fracture (aHR = 1.14, 95% CI = 1.11-1.16), hip fracture (aHR = 1.21, 95% CI = 1.13-1.29), and other fractures (upper arm, forearm, and lower leg; aHR = 1.02, 95% CI = 1.00-1.05). Among women with bone mineral density (BMD) results, slow TUG performance was associated with an increased risk of fracture independent of BMD. CONCLUSIONS The TUG test, as an indicator of physical performance, can provide information about future fracture risk above that provided by BMD. Conducting the TUG test to assess fracture risk should be considered to improve fracture risk assessment and propose interventions to improve physical performance, thereby reducing fracture risk.
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Affiliation(s)
- Su-Min Jeong
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan School of Medicine, Seoul, Republic of Korea; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan School of Medicine, Seoul, Republic of Korea.
| | - Kyungdo Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Hyung Jung
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sohyun Chun
- International Healthcare Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hee-Won Jung
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki Young Son
- Department of Family Medicine, Asan Medical Center, Seoul, Republic of Korea
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Ahn EJ, Kim HJ, Kim KW, Choi HR, Kang H, Bang SR. Comparison of general anaesthesia and regional anaesthesia in terms of mortality and complications in elderly patients with hip fracture: a nationwide population-based study. BMJ Open 2019; 9:e029245. [PMID: 31501111 PMCID: PMC6738684 DOI: 10.1136/bmjopen-2019-029245] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the effects of anaesthesia on postoperative outcome in elderly patients who underwent hip fracture surgery. SETTING Nationwide National Health Insurance Sharing Service database of Korea. PARTICIPANTS All patients aged ≥65 years old who underwent hip fracture surgery, covered by the Korean National Health Insurance, between 1 January 2009 and 31 December 2015. INTERVENTIONS Hip fracture surgery under general anaesthesia (group GA) or regional anaesthesia (group RA), with a principal diagnosis of femoral fracture. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the anaesthetic-type effect on 30-day mortality and the secondary outcome was postoperative delirium requiring pharmacological intervention. RESULTS Among the 96 289 patients who underwent hip fracture surgery, 25 593 and 70 696 patients received GA and RA, respectively. After propensity score matching, 25 593 remained in each group. Postmatching mortality was lower in the RA than in the GA group (574 (2.24%) vs 654 (2.55%), p=0·0047, 95% CI -0.0099 to 0.0159). Delirium incidence was lower in the RA than in the GA group (5187 (20.27%) vs 5828 (22.77%), p<0·0001, 95% CI 0.019 to 0.045). The incidence of intensive care unit stay and ventilator care was lower in the RA than in the GA group (5838 (22.1%) vs 8055 (31.47%), p<0·0001, 95% CI 0.046 to 0.070 and 459 (1.73%) vs 1207 (4.72%), p<0·0001, 95% CI -0.0024 to 0.023, respectively). CONCLUSION RA was associated with better outcomes than GA, in terms of mortality, delirium, intensive care unit admission and ventilator care, in elderly patients who underwent hip fracture surgery.
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Affiliation(s)
- Eun Jin Ahn
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Hyo Jin Kim
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Kyung Woo Kim
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Hey Ran Choi
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine and Graduate School of Medicine, Seoul, Republic of Korea
| | - Si Ra Bang
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
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Yoon BH, Lee BS, Won H, Kim HK, Lee YK, Koo KH. Preoperative Iron Supplementation and Restrictive Transfusion Strategy in Hip Fracture Surgery. Clin Orthop Surg 2019; 11:265-269. [PMID: 31475045 PMCID: PMC6695329 DOI: 10.4055/cios.2019.11.3.265] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/03/2019] [Indexed: 01/22/2023] Open
Abstract
Background Hip fracture surgery (HFS) is often associated with perioperative blood loss, and it frequently necessitates transfusion. However, the hemoglobin (Hb) threshold for transfusion remains controversial in hip fracture patients. We evaluated the usefulness of the restrictive strategy and preoperative intravenous iron supplementation in HFS. Methods We retrospectively reviewed the medical records of 1,634 patients (> 60 years of age) who underwent HFS between May 2003 and June 2014 and were followed up for 1 year or more after surgery. We used the liberal transfusion strategy until May 2009 to determine the transfusion threshold; afterwards, we switched to the restrictive transfusion strategy. Patients with the restrictive transfusion strategy (restrictive group) received intravenous iron supplementation before surgery. We compared the transfusion rate, morbidity, and mortality of the restrictive group with those of the patients with the liberal transfusion strategy (liberal group). Results Preoperative intravenous iron supplementation was not associated with any adverse reactions. The transfusion rate was 65.3% (506/775) in the liberal group and 48.2% (414/859) in the restrictive group (p < 0.001). The mean hospital stay was shorter in the restrictive group (21.5 vs. 28.8 days, p < 0.001). There was no significant difference in the postoperative medical complications including myocardial infarction and cerebrovascular event. Mortality at postoperative 30, 60, and 90 days was similar between the two groups. Conclusions Our blood management protocol involving restrictive strategy combined with preoperative intravenous iron supplementation appears to be effective and safe in HFS of elderly patients.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Beom Seok Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heejae Won
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung-Kook Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Jang SY, Cha YH, Kim KJ, Kim HY, Choy WS. The effect of surgery type on mortality in elderly patients with pertrochanteric femoral fracture: A Korean nationwide cohort study. Asian J Surg 2019; 43:550-556. [PMID: 31324508 DOI: 10.1016/j.asjsur.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/07/2019] [Accepted: 06/18/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND/OBJECTIVE The purpose of this study is to analyze the effect of surgical methods on mortality and the relative risk of patients who underwent internal fixation (IF) or hemiarthroplasty (HA) after being diagnosed as a pertrochanteric fracture over 65 years old in a Korean nationwide cohort with a single insurance medical system. METHODS The Korean National Health Insurance Service-Senior cohort (NHIS-Senior, NHIS-2018-2-111) was used in this study. The eligibility criteria for incident hip fracture patients were the following: (1) first-time admission to acute care hospitals (index admission) with pertrochanteric fracture (ICD-10 S721), (2) three years of hip fracture-free period, (3) recipients of typical surgeries including IF, HA, (4) age between 65 and 99. RESULTS a total of 7223 patients were enrolled in the cohort. There were 1662 patients (23%) in the HA group and 5561 patients (77%) in the IF group. Mortality rates of the IF group and HA group were 13.46 and 17.94 cases per 100 person-years, respectively. In the multivariable-adjusted Cox proportional hazard model, the HA group had 1.22 times more hazard of all-cause mortality than IF group (aHR 1.22, 95% CI 1.13-1.32). In subgroup analysis, aged 65-79 and female patients showed a prominent association between surgery type and mortality (aHR 1.52, 95% CI 1.29-1.79). CONCLUSIONS In patients with pertrochanter fracture over 65 years, 1.22-fold mortality rate was observed when HA was performed compared to that of IF, and the difference in mortality was particularly prominent within 1-year after surgery.
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Affiliation(s)
- Suk-Yong Jang
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, South Korea
| | - Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea.
| | - Kap-Jung Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Ha-Yong Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
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