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Guerra-Farfan E, Borges FK, Bhandari M, Garcia-Sanchez Y, Nuoez JH, Mestre-Torres J, Tomas-Hernandez J, Teixidor-Serra J, Balaguer-Castro M, Castillon P, Dealbert A, De Caso Rodriguez J, Aguado HJ, Guerado E, Popova E, Tonelli AC, Balasubramanian K, Vincent J, Harvey V, Kocaqi E, Slobogean G, Devereaux PJ. Mortality, perioperative complications and surgical timelines in hip fracture patients: Comparison of the Spanish with the non-Spanish Cohort of the HIP ATTACK-1 trial. Injury 2024; 55:111827. [PMID: 39217648 DOI: 10.1016/j.injury.2024.111827] [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: 11/08/2023] [Revised: 06/21/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Hip fractures carry a substantial risk of complications and death. This study aimed to report the 90-day incidence of mortality, major perioperative complications and in-hospital timelines after a hip fracture in the Spanish HIP ATTACK-1 trial cohort, comparing with the non-Spanish cohort. METHODS Prospective cohort study of Spanish patients nested in the HIP ATTACK-1 trial. The HIP ATTACK-1 was an international, randomized, controlled trial (17 countries, 69 hospitals, 7 in Spain, highest recruiting country). Patients were randomized to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. Participants were ≥45 years of age who presented with a low-energy hip fracture requiring surgery. RESULTS Among 534 patients in the Spanish cohort, 69 (12.9 %) patients died at 90 days follow-up, compared to 225 (9.2 %) in the non-Spanish cohort (p = 0.009), mostly due to higher nonvascular related mortality. A composite of major postoperative complication occurred in 126 patients (23.6 %). The most common perioperative complications were myocardial injury (189 patients, 35.4 %), infection with no sepsis (86 patients, 16.1 %) and perioperative delirium (84 patients, 15.7 %); all these complication rates in Spain were significantly higher than the non-Spanish patients (29.2 % p = 0.005; 11.9 % p = 0.008 and 9.2 % p < 0.0001, respectively). Spanish cohort patients were older and had more comorbidities than the non-Spanish cohort, evidencing their greater frailty at baseline. Among Spanish patients, the median time from hip fracture diagnosis to surgery was 30.0 h (IQR 21.1-53.9) in the standard-care group, with 68.8 % of patients receiving surgery within 48 h of diagnosis. This median time was lower in the non-Spanish cohort (22.8 h, IQR 9.5-37.0), where 82.1 % of patients were operated within 48 h. CONCLUSIONS In the HIP ATTACK-1 trial, 1 in 8 patients died 90 days after a hip fracture in Spain. The most common complication after a hip fracture was myocardial injury, followed by infection and delirium. Spanish patients had worse outcomes than non-Spanish patients. Research needs to focus on new interventions such as accelerated surgery and perioperative troponin measurement with the appropriate investment of resources, to prevent and identify early these complications with a goal of improving mortality for this high-risk population. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ernesto Guerra-Farfan
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery and Traumatology, Artro-Esport, Centro Médico Teknon, Barcelona, Spain
| | - Flavia K Borges
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yaiza Garcia-Sanchez
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
| | - Jorge H Nuoez
- Department of Orthopaedic Surgery and Traumatology, Artro-Esport, Centro Médico Teknon, Barcelona, Spain; Department of Orthopaedic Surgery and Traumatology, University Hospital of Mutua de Terrassa, Terrassa, Barcelona, Spain
| | - Jaume Mestre-Torres
- Department of Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Tomas-Hernandez
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Teixidor-Serra
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mariano Balaguer-Castro
- Department of Orthopaedic Surgery and Traumatology, Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain; Department of Orthopaedic Surgery and Traumatology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Pablo Castillon
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Mutua de Terrassa, Terrassa, Barcelona, Spain
| | - Alfred Dealbert
- Department of Orthopaedic Surgery and Traumatology, Consorci Sanitari Del Garraf, Barcelona, Spain
| | - Julio De Caso Rodriguez
- Biomedical Research Institute, (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona Spain
| | - Hector J Aguado
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Enrique Guerado
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costal Del Sol, Medical School. University of Málaga, Marbella, Málaga, Spain
| | - Ekaterine Popova
- Biomedical Research Institute, (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona Spain
| | - Ana Claudia Tonelli
- Internal Medicine Service, Hospital de Clinicas de Porto Alegre (HCPA), Brazil
| | | | - Jessica Vincent
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Valerie Harvey
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Etri Kocaqi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gerard Slobogean
- R Adams Cowley Shock Trauma (STC) at the University of Maryland Medical Center's Division of Orthopaedic Traumatology, Baltimore, US
| | - P J Devereaux
- Population Health Research Institute, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Nishimura H, Suzuki H, Tokutsu K, Muramatsu K, Kawasaki M, Yamanaka Y, Uchida S, Nakamura E, Fushimi K, Matsuda S, Sakai A. Early surgical treatment using regional clinical pathways to reduce the length of postoperative hospital stay in hip fracture patients: A retrospective analysis using the Japanese Diagnosis Procedure Combination database. PLoS One 2024; 19:e0282766. [PMID: 39083486 PMCID: PMC11290638 DOI: 10.1371/journal.pone.0282766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/04/2024] [Indexed: 08/02/2024] Open
Abstract
Hip fracture is a common injury in older adults; however, the optimal timing of surgical treatment remains undetermined in Japan. Therefore, this retrospective study aimed to ascertain the rate of early surgery among hip fracture patients and investigate its effectiveness, along with "regional clinical pathways" (patient plan of care devised by Japanese clinicians), in reducing the length of hospital stay (LOS) postoperatively. We hypothesized that performing early surgery along with a regional clinical pathway is effective to reduce the postoperative LOS and complications among hip fracture patients. We examined the data of patients diagnosed with femoral neck and peritrochanteric fractures retrieved from the Japanese Diagnosis Procedure Combination database between April 2016 and March 2018. Patients were divided into the early (43,928, 34%; surgery within 2 days of admission) and delayed (84,237, 66%; surgery after 2 days of admission) surgery groups. The difference in postoperative LOS between the two groups was 3 days (early vs. delayed: 29 days vs. 32 days). The early surgery group had more cases of intertrochanteric fractures (57% vs. 43%) and internal fixation (74% vs. 55%) than did the delayed surgery group. In contrast, the delayed surgery group had more cases of femoral neck fractures (43% vs. 57%) and bipolar hip arthroplasty (25% vs. 42%) or total hip arthroplasty (1.2% vs. 3.0%). Moreover, the early surgery group showed a lower incidence of complications, except anemia (12% vs. 8.8%). Logistic regression analysis using the adjusted model revealed that early surgery and implementation of regional clinical pathways reduced LOS by 2.58 and 8.06 days, respectively (p<0.001). Early surgery and implementation of regional clinical pathways for hip fracture patients are effective in reducing postoperative LOS, allowing regional clinical pathways to have a greater impact. These findings will help acute care providers when treating hip fracture patients.
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Affiliation(s)
- Haruki Nishimura
- Department of Orthopaedics Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hitoshi Suzuki
- Department of Orthopaedics Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kei Tokutsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Makoto Kawasaki
- Department of Orthopaedics Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiaki Yamanaka
- Department of Orthopaedics Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Soshi Uchida
- Department of Orthopaedics Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Eiichiro Nakamura
- Department of Orthopaedics Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedics Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Woodcroft-Brown V, Bell J, Pulle CR, Mitchell R, Close J, McDougall C, Hurring S, Sarkies M. Patient, surgical and hospital factors predicting actual first-day mobilisation after hip fracture surgery: An observational cohort study. Australas J Ageing 2024. [PMID: 38616338 DOI: 10.1111/ajag.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES To examine patient, surgical and hospital factors associated with Day-1 postoperative mobility after hip fracture surgery in older adults. METHODS A cohort study using Australia and New Zealand Hip Fracture Registry was conducted. Participants were aged older than 50 years and underwent hip fracture surgery between 1 January 2020 and 31 December 2020 inclusive. The outcome was standing and step transferring out of bed onto a chair and/or walking Day-1 after hip fracture surgery. RESULTS Mean age was 82 years and 68% were women. Of 12,318 patients with hip fracture, 5981 (49%) actually mobilised Day-1. Odds of actual first-day mobilisation were lower for individuals usually walking with either stick or crutch (OR = 0.71, 95% CI 0.62-0.82) or two aids or frame (OR = 0.57, 95% CI 0.52-0.64) or wheelchair/bed bound (OR = 0.24, 95% CI 0.17-0.33); who had impaired cognition preadmission (OR = 0.57, 95% CI 0.51-0.64); from aged care facilities (OR = 0.59, 95% CI 0.52-0.67); had an American Society of Anaesthesiologists grade 2 (OR = 0.63, 95% CI 0.41-0.97), 3 (OR = 0.31, 95% CI 0.20-0.47) or 4 or 5 (OR = 0.21, 95% CI 0.14-0.32); surgery delay >48 h (OR = 0.81, 95% CI 0.71-0.91); and restricted/non-weight-bearing status immediately postoperatively (OR = 0.53, 95% CI 0.42-0.67). CONCLUSIONS Both non-modifiable and modifiable patient and surgical factors influence first-day mobilisation after hip fracture surgery. Reducing time to surgery might assist future quality improvement efforts to increase Day-1 postoperative mobility.
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Affiliation(s)
- Victoria Woodcroft-Brown
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jack Bell
- The Prince Charles Hospital Allied Health Research Collaborative (AHRC), The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Chrysanth Ranjeev Pulle
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine McDougall
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Hurring
- Older Person's Health Specialist Service, Te Whatu Ora Waitaha, Canterbury, New Zealand
| | - Mitchell Sarkies
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Sydney School of Health Services, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Implementation Science Academy, Sydney Health Partners, Sydney, New South Wales, Australia
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Sermon A, Verhulst E, Aerden L, Hoekstra H. A retrospective chart analysis with 5-year follow-up of early care for geriatric hip fracture patients: why we should continue talking about hip fractures. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02514-x. [PMID: 38592463 DOI: 10.1007/s00068-024-02514-x] [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: 12/24/2023] [Accepted: 03/30/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Timing of surgery remains a topic of debate for hip fracture treatment in the geriatric patient population. The quality indicator "early surgery" was implemented in 2014 at the Department of Trauma Surgery of the University Hospitals Leuven to enhance timely operative treatment. In this follow-up study, we aim to evaluate the performance of this quality indicator, the clinical outcomes, and room for improvement. METHODS The charts of 1190 patients surgically treated for an acute hip fracture were reviewed between June 2017 and May 2022 at the University Hospitals Leuven. Primary endpoints were adherence to early surgery, defined as surgery within the next calendar day, and the evaluation of the reasons for deviating from this protocol. Secondary endpoints were length of stay (LOS); intensive care unit (ICU) admission and length of ICU stay; mortality after 30 days, 60 days, 90 days, and 6 months; and 90-day readmission rate. Pearson's Chi-square test and Mann-Whitney U test were used for data analysis. RESULTS One thousand eighty-four (91.1%) patients received early surgery versus 106 (8.9%) patients who received delayed surgery. The main reasons for surgical delay were the use of anticoagulants (33%), a general health condition not allowing safe surgery and/or existing comorbidities requiring workup prior to surgery (26.4%), and logistical reasons (17.9%). Patient delay and transfer from other hospitals were responsible for respectively 8.5% and 6.6% of delayed surgery. Early surgery resulted in a significantly shorter LOS and ICU stay (12 [8-25] vs. 18 [10-36] and 3 [2-6] vs. 7 [3-13] days, early vs. delayed surgery, respectively). No significant reduction was observed in ICU admission, mortality, and readmission rate. CONCLUSION We have been able to maintain the early surgery hip fracture protocol in approximately 90% of the patients. Comorbidities and anticoagulant use were responsible for delayed surgery in the majority of the patients. Correct implementation of the existing protocol on anticoagulant use could lead to a one-third decrease in the number of delayed surgeries. Subsequently, since the LOS and ICU stay in the delayed surgery group were significantly longer, a further increase of early surgery will lower the current economic burden.
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Affiliation(s)
- An Sermon
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Evelyne Verhulst
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laurens Aerden
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Harm Hoekstra
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium.
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.
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5
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Strage KE, Hadeed MM, Mauffrey C, Parry JA. Identifying Reasons for Nonmedical Delays in Fixation of Femur, Pelvis, and Acetabular Fractures at a Level 1 Trauma Center. J Orthop Trauma 2023; 37:553-556. [PMID: 37348037 DOI: 10.1097/bot.0000000000002656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To identify reasons for nonmedical delays in femur, pelvis, and acetabular fracture fixation at an institution with a dedicated orthopaedic trauma room (DOTR) and an early appropriate care practice model. DESIGN Retrospective review of a prospective registry. SETTING Urban Level 1 trauma center. PATIENTS/PARTICIPANTS Two hundred ninety-four patients undergoing 313 procedures for 226 femur, 63 pelvis, and 42 acetabular fractures. INTERVENTION Definitive fixation. MAIN OUTCOME MEASUREMENTS Reasons for delays in fixation after hospital day 2. RESULTS Delays occurred in 12.5% of procedures (39/313), with 7.7% (24/313) having medical delays and 4.8% (15/313) having nonmedical delays. Nonmedical delays were most commonly due to the operating room being at-capacity (n = 6) and nonpelvic trauma specialists taking weekend call (n = 5). Procedures with nonmedical delays were associated with younger age (median difference -16.0 years, 95% confidence interval [CI], -28 to -5.0; P = 0.006), high-energy mechanisms (proportional difference [PD] 58.5%, 95% CI, 37.0-69.7; P < 0.0001), Thursday through Saturday hospital admission (PD 30.3%, 95% CI, 5.0-50.0; P < 0.0001), pelvis/acetabular fractures (PD 51.8%, 95% CI, 26.7-71.0%; P < 0.0001), and external fixation (PD 33.0%, 95% CI, 11.8-57.3; P < 0.0001). CONCLUSION Only 4.8% of procedures experienced nonmedical delays using an early appropriate care model and a DOTR. Nonmedical delays were most commonly due to 2 modifiable factors-the DOTR being at-capacity and nonpelvis trauma specialists taking weekend call. Patients with nonmedical delays were more likely to be younger, with pelvis/acetabular fractures, high-energy mechanisms, external fixation, and to be admitted between Thursday and Saturday. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Katya E Strage
- Department of Orthopaedics, Denver Health Medical Center, Denver, CO
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Ghosh AK, Patel S, Chouhan D, Samra T, Kanojia RK, Bhalla A. Pre-Hospital Delays Represent Unnoticed Intervals That Affect Mortality Rates in Geriatric Hip Fractures: A Prospective Cohort Study. Cureus 2023; 15:e44773. [PMID: 37809112 PMCID: PMC10557467 DOI: 10.7759/cureus.44773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Surgery is recommended within 24-48 hours for geriatric hip fractures. In developing countries. However, delayed presentation to the hospital due to various factors often precludes surgery from occurring within these recommended intervals. Therefore, our objective was to identify the hurdles that prevent early surgery for geriatric hip fractures and assess their effect on mortality. Methods A prospective cohort study was conducted with 78 geriatric patients (age > 60 years) who suffered hip fractures between September 2019 and November 2020. The demographic, American Society of Anesthesiologists (ASA) classification, Charlson Comorbidity Index (CCI), injury to admission, admission to surgery, and injury to surgery time were all recorded for each patient. A follow-up was conducted at one month and six months postoperatively for each patient. Mortality rate at 30 days and causes for delay in presentation to the hospital and delayed surgery were assessed. Multivariate logistic regression was done to assess the risk factors for 30-day mortality. Results The mean age of the patients was 74.2 years, and 64.1% of the patients were female. The mean (SD) injury-to-admission time was 3.45 (5.50) days, and the admission-to-surgery time was 4.28 (3.03) days. A total of 41% of patients had delayed presentation, commonly due to a lack of local healthcare infrastructure, financial constraints, and a lack of care providers. Furthermore, 65.3% of the patients underwent delayed surgery, and 44% faced organizational delays. Thus, the 30-day mortality rate was calculated at 19.2%, while the six-month mortality rate was 25.6%. The injury to admission time (OR 1.22 [1.03-1.44; p = 0.018]) and CCI were found to be risk factors in the 30-day mortality (OR 1.76 [0.93-3.33; p = 0.085]). Conclusions Pre-hospital delays and CCI are risk factors for short-term mortality following hip fractures. This underlines the need to generate awareness, improve the referral chain, and establish protocol-based care in hospitals. Further studies are required to assess the socioeconomic factors involved in the delayed treatment of geriatric hip fractures in developing countries.
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Affiliation(s)
- Akash K Ghosh
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sandeep Patel
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Devendra Chouhan
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Tanvir Samra
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Rajendra K Kanojia
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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Merchán-Galvis AM, Muñoz-García DA, Solano F, Velásquez JC, Sotelo NF, Molina DA, Caicedo JP, Concha JM, Calvache JA, Martínez-Zapata MJ. Delayed surgery and health related quality of life in patients with proximal femoral fracture. Sci Rep 2023; 13:11131. [PMID: 37429947 DOI: 10.1038/s41598-023-33592-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/15/2023] [Indexed: 07/12/2023] Open
Abstract
This study aimed to establish factors associated with delayed surgery in patients with proximal femoral fracture and to assess patients' health-related quality of life (HRQoL) after surgery including all-cause 6-months mortality. This was a single-center, observational, prospective cohort study that included patients with a proximal femur fracture. We described patients' HRQoL measured by EuroQoL (EQ-5D-5L and EQ-VAS) questionnaire and perioperative complications (including mortality) 6 months after surgery. We included 163 patients with a mean age of 80.5 years, the majority were women and 76.1% reported falling from their own height. The mean time between hospital admission and surgery was 8.3 days (SD 4.9 days) and the mean hospital stay was 13.5 days (SD 10.4 days). After adjustment, the principal factor associated with delayed surgery was adjournment in surgery authorization (3.7 days). EQ-5D-5L index values and the VAS score at 1 month after surgery were 0.489 and 61.1, at 3 months were 0.613 and 65.8, and at 6 months 0.662 and 66.7 respectively. Mortality at 6 months of follow-up was 11% (18 patients). In conclusion, administrative authorization was the strongest associated factor with delayed time from hospital admission to surgery. HRQoL of patients with a proximal femoral fracture improved 6 months after surgery.Trial registration: NCT04217642.
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Affiliation(s)
- Angela María Merchán-Galvis
- Iberoamerican Cochrane Centre-Public Health and Clinical Epidemiology, IIBSant Pau, Barcelona, Spain.
- Department of Social Medicine and Family Health, Universidad del Cauca, Popayán, Colombia.
| | | | - Felipe Solano
- Department of Anaesthesiology, Universidad del Cauca, Popayán, Colombia
| | | | | | | | | | - Juan Manuel Concha
- Department of Surgical Sciences, Universidad del Cauca, Popayán, Colombia
| | - José Andrés Calvache
- Department of Anaesthesiology, Universidad del Cauca, Popayán, Colombia
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - María José Martínez-Zapata
- Iberoamerican Cochrane Centre-Public Health and Clinical Epidemiology, IIBSant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER of Epidemiology and Public Health), Madrid, Spain
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Chen Q, Hao P, Wong C, Zhong X, He Q, Chen Y. Development and validation of a novel nomogram of 1-year mortality in the elderly with hip fracture: a study of the MIMIC-III database. BMJ Open 2023; 13:e068465. [PMID: 37202145 DOI: 10.1136/bmjopen-2022-068465] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE Hip fracture is a prevalent condition with a significant death rate among the elderly. We sought to develop a nomogram-based survival prediction model for older patients with hip fracture. DESIGN A retrospective case-control study. SETTING The data from Medical Information Mart for Intensive Care III (MIMIC-III V.1.4). PARTICIPANTS The clinical features of elderly patients with hip fracture, including basic information, comorbidities, severity score, laboratory tests and therapy, were filtered out based on the MIMIC-III V.1.4. METHODS AND MAIN OUTCOME MEASURES All patients included in the study were from critical care and randomly divided into training and validation sets (7:3). On the basis of retrieved data, the least absolute shrinkage and selection operator (LASSO) regression and multiple logistic regression analysis were used to identify independent predictive variables of 1-year mortality, and then constructed a risk prediction nomogram. The predictive values of the nomogram model were evaluated by the concordance indexes (C-indexes), receiver operating characteristic curve, decision curve analysis (DCA) and calibration curve. RESULTS A total of 341 elderly patients with hip fracture were included in this study; 121 cases died within 1 year. After LASSO regression and multiple logistic regression analysis, a novel nomogram contained the predictive variables of age, weight, the proportion of lymphocyte count, liver disease, malignant tumour and congestive heart failure. The constructed model proved satisfactory discrimination with C-indexes of 0.738 (95% CI 0.674 to 0.802) in the training set and 0.713 (95% CI 0.608 to 0.819) in the validation set. The calibration curve shows a good degree of fitting between the predicted and observed probabilities and the DCA confirms the model's clinical practicability. CONCLUSIONS The novel prediction model provides personalised predictions for 1-year mortality in elderly patients with hip fractures. Compared with other hip fracture models, our nomogram is particularly suitable for predicting long-term mortality in critical patients.
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Affiliation(s)
- Qian Chen
- Department of Orthopedics, Sun Yat-Sen University, Guangzhou, China
| | - Peng Hao
- Department of Surgical Intensive Care Unit, Sun Yat-Sen University, Guangzhou, China
| | - Chipiu Wong
- Department of Orthopedics, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoxin Zhong
- Department of Surgical Intensive Care Unit, Sun Yat-Sen University, Guangzhou, China
| | - Qing He
- Department of Surgical Intensive Care Unit, Sun Yat-Sen University, Guangzhou, China
| | - Yantao Chen
- Department of Orthopedics, Sun Yat-Sen University, Guangzhou, China
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9
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Skouras AZ, Antonakis-Karamintzas D, Tsolakis C, Tsantes AE, Kourlaba G, Zafeiris I, Soucacos F, Papagiannis G, Triantafyllou A, Houhoula D, Savvidou O, Koulouvaris P. Pre- and Postoperative Exercise Effectiveness in Mobility, Hemostatic Balance, and Prognostic Biomarkers in Hip Fracture Patients: A Study Protocol for a Randomized Controlled Trial. Biomedicines 2023; 11:biomedicines11051263. [PMID: 37238934 DOI: 10.3390/biomedicines11051263] [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: 03/15/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Hip fractures are a major health concern, particularly for older adults, as they can reduce life quality, mobility loss, and even death. Current evidence reveals that early intervention is recommended for endurance in patients with hip fractures. To our knowledge, preoperative exercise intervention in patients with hip fractures remains poorly researched, and no study has yet applied aerobic exercise preoperatively. This study aims to investigate the short-term benefits of a supervised preoperative aerobic moderate-intensity interval training (MIIT) program and the added effect of an 8-week postoperative MIIT aerobic exercise program with a portable upper extremity cycle ergometer. The work-to-recovery ratio will be 1-to-1, consisting of 120 s for each bout and four and eight rounds for the pre- and postoperative programs, respectively. The preoperative program will be delivered twice a day. A parallel group, single-blinded, randomized controlled trial (RCT) was planned to be conducted with 58 patients each in the intervention and control groups. This study has two primary purposes. First, to study the effect of a preoperative aerobic exercise program with a portable upper extremity cycle ergometer on immediate postoperative mobility. Second, to investigate the additional effect of an 8-week postoperative aerobic exercise program with a portable upper extremity cycle ergometer on the walking distance at eight weeks after surgery. This study also has several secondary objectives, such as ameliorating surgical and keeping hemostatic balance throughout exercise. This study may expand our knowledge of preoperative exercise effectiveness in hip fracture patients and enhance the current literature about early intervention benefits.
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Affiliation(s)
- Apostolos Z Skouras
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Dimitrios Antonakis-Karamintzas
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Charilaos Tsolakis
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Sports Performance Laboratory, School of Physical Education & Sports Science, National and Kapodistrian University of Athens, 17237 Athens, Greece
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgia Kourlaba
- Faculty of Health, Department of Nursing, University of Peloponnese, 23100 Sparta, Greece
| | - Ioannis Zafeiris
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Fotini Soucacos
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgios Papagiannis
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece
| | - Athanasios Triantafyllou
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece
| | - Dimitra Houhoula
- Department of Food Science and Technology, University of West Attica, 12244 Egaleo, Greece
| | - Olga Savvidou
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Panagiotis Koulouvaris
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
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Tian C, Zhu H, Shi L, Chen X, Xie T, Rui Y. Is There a "Black Friday" for Geriatric Hip Fracture Surgery? Orthop Surg 2023; 15:1304-1311. [PMID: 37052064 PMCID: PMC10157697 DOI: 10.1111/os.13741] [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: 09/29/2022] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES Reports show an increase in the short-term mortality rates of hip fracture patients admitted on weekends. However, there are few studies on whether there is a similar effect in Friday admissions of geriatric hip fracture patients. The aim of this study was to evaluate the effects of Friday admission on mortality and clinical outcomes in elderly patients with hip fractures. METHODS A retrospective cohort study was performed at a single orthopaedic trauma centre and included all patients who underwent hip fracture surgery between January 2018 and December 2021. Patient characteristics, including age, sex, BMI, fracture type, time of admission, ASA grade, comorbidities, and laboratory examinations, were collected. Data pertaining to surgery and hospitalization were extracted from the electronic medical record system and tabulated. The corresponding follow-up was performed. The Shapiro-Wilk test was applied to evaluate the distributions of all continuous variables for normality. The overall data were analyzed by Student's t test or the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables, as appropriate. Univariate and multivariate analyses were used to further test for the independent influencing factors of prolonged time to surgery. RESULTS A total of 596 patients were included, and 83 patients (13.9%) were admitted on Friday. There was no evidence supporting that Friday admission had an effect on mortality and outcomes, including length of stay, total hospital costs and postoperative complications. However, the patients admitted on Friday had delayed surgery. Then, patients were regrouped into two groups according to whether surgery was delayed, and 317 patients (53.2%) underwent delayed surgery. The multivariate analysis showed that younger age (p = 0.014), Friday admission (p < 0.001), ASA classification III-IV (p = 0.019), femoral neck fracture (p = 0.002), time from injury to admission more than 24 h (p = 0.025), and diabetes (p = 0.023) were risk factors for delayed surgery. CONCLUSIONS Mortality and adverse outcome rates for elderly hip fracture patients admitted on Friday were similar to those admitted at other time periods. However, Friday admission was identified as one of the risk factors for delayed surgery.
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Affiliation(s)
- Chuwei Tian
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, 210009, PR China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, Nanjing, 210009, PR China
- School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, 210009, PR China
| | - Huanyi Zhu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, 210009, PR China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, Nanjing, 210009, PR China
- School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, 210009, PR China
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, 210009, PR China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, Nanjing, 210009, PR China
- School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, 210009, PR China
| | - Xiangxu Chen
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, 210009, PR China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, Nanjing, 210009, PR China
- School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, 210009, PR China
| | - Tian Xie
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, 210009, PR China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, Nanjing, 210009, PR China
- School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, 210009, PR China
| | - Yunfeng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, 210009, PR China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, Nanjing, 210009, PR China
- School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, 210009, PR China
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Schlauch AM, Michelson JD, Holleran A, Ames E. The high-risk hip fracture patient and the palliative care consult : A retrospective study to investigate risks of complications and the utility of a palliative care consult in hip fracture patients undergoing surgical fixation. Osteoporos Int 2023; 34:507-513. [PMID: 36515729 DOI: 10.1007/s00198-022-06634-1] [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: 08/29/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
UNLABELLED We evaluated the utility of a palliative care consult (PCC) in high-risk hip fracture patients. The main result was that a PCC reflects certain risk factors for post-surgical complications and is associated with a delay to surgery in the high-risk patient population that it served. PURPOSE The objective of this study was to identify risks of complications in surgically managed hip fractures and determine the utility of a PCC in this population, particularly regarding time to the operating room (OR). METHODS Retrospective cohort at a Level I academic trauma center. RESULTS Four hundred sixty-two patients were treated surgically for hip fracture. Decreased pre-injury ambulatory status (OR 2.18, 95% CI 1.13-4.20, p = .02), time to OR > 48 h (OR 4.76, 95% CI 1.43-15.87, p = .011), and obtaining a pre-operative PCC (OR 3.03, 95% CI 1.34-6.85, p = .008) were independent risk factors for post-surgical complications. Multivariate risk factors for obtaining a PCC included older age (OR 1.1, CI 1.0-1.1, p = .007), pre-injury ambulatory status (OR 2.2, CI 1.3-3.9, p = .005), renal failure (OR 3.1, CI 1.1-9.0, p = 0.032), and higher ASA category (OR 2.6, CI 1.2-5.5, p = .014). A delay of more than 48 h was associated with being male ( OR 4.6, CI 1.4-15.0, p = .013) or having obtained a PCC (OR 5.5, CI 1.4-22.7, p = .017). CONCLUSIONS Obtaining a PCC can reflect risks of complications and mortality. It is a valuable resource for use in high-risk patients who are inherently at risk for delays to surgery and should be used judiciously.
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Affiliation(s)
- Adam M Schlauch
- San Francisco Orthopaedic Residency Program, 450 Stanyan Street, San Francisco, CA, 94610, USA.
| | | | - Amanda Holleran
- Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, USA
| | - Elizabeth Ames
- University of Vermont Medical Center, Burlington, VT, USA
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12
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López-Martín N, Escalera-Alonso J, Thuissard-Vasallo IJ, Andreu-Vázquez C, Bielza-Galindo R. [Result of the update of the clinical pathway for hip fracture in the elderly at a university hospital in Madrid]. Rev Esp Geriatr Gerontol 2023; 58:61-67. [PMID: 36804952 DOI: 10.1016/j.regg.2023.01.004] [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: 10/17/2022] [Revised: 12/13/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Orthogeriatric management with clinical pathways (CP) in hip fracture (HF) has been shown to be superior to other models. We studied whether updating the CP, through prioritization of admission and surgery, improvement in the prevention and treatment of delirium, management of anticoagulants and antiplatelet agents and the use of perioperative peripheral nerve block, modifies surgical delay, stay, readmissions, mortality, suffering delirium and functional status at discharge. MATERIAL AND METHOD A retrospective observational study of unicenter cohorts of 468 patients with HF, 220 from 2016 (old VC) and 248 from 2019 (new VC). The variables are: intervention in the first 48hours, surgical delay (hours), stay (days), stay less than 15 days, delirium, functional loss at discharge (Barthel prefracture scale less Barthel scale at discharge), readmission at one month, and mortality at admission, month and year. RESULTS Median age: 87.0 [interquartile range 8.0], mostly women (76.7%). Significantly, with the new VC, there was a greater number of patients operated on in the first 48hours (27,7% vs 36,8% p=0.036), less surgical delay (72.5 [47,5-110,5] vs 64.0 [42,0-88,0] p<0.001), shorter stay (10,0 [7,0-13,0] vs 8,0 [6,0-11,0] p<0.001), greater number of discharges in 15 days (78,2% vs 91,5% p<0.001), lower delirium (54,1% vs 43,5% p=0.023). No significant changes in readmissions, functional loss at discharge, mortality at admission, 3 months or year. CONCLUSIONS Updating the VC brings benefits to the patient (less surgical delay, equal functional status at discharge with fewer days of admission) and benefits in management (lower admission) without modifying mortality.
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Affiliation(s)
- Néstor López-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
| | - Javier Escalera-Alonso
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Israel John Thuissard-Vasallo
- Facultad de Ciencias Biomédicas y de la Salud, Departamento de Medicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Cristina Andreu-Vázquez
- Facultad de Ciencias Biomédicas y de la Salud, Departamento de Medicina, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
| | - Rafael Bielza-Galindo
- Sección de Geriatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
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13
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Mortality following hip fracture: Trends and geographical variations over the last SIXTY years. Injury 2023; 54:620-629. [PMID: 36549980 DOI: 10.1016/j.injury.2022.12.008] [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: 08/17/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The management of hip fractures has advanced on all aspects from prevention pre-operatively, specialised hip fracture units, early operative intervention and rehabilitation. This is in line with the appropriate recognition over the past years of an important presentation with significant mortality and socioeconomic consequences of ever increasing incidence in an aging population. It is therefore imperative to continue to gather data on the incidence and trends of hip fractures to guide future management planning of this important presentation. METHODS A review of all articles published on the outcome after hip fracture over a twenty year period (1999-2018) was undertaken to determine any changes that had occurred in the demographics and mortality over this period. This article complements and expands upon the findings of a previous article by the authors assessing a four decade period (1959 - 1998) and attempts to present trends and geographical variations over sixty years. RESULTS The mean age of patients sustaining hip fractures continues to be steadily increasing at approximately just over 1 year of age for every 5-year time period. The mean age of patients sustaining hip fractures increased from 73 years (1960s) to 81 years (2000s) to 82 years (2010s). Over the six decade period one-year mortality has reduced from an overall mean of 27% (1960s) to 20% (2010s). The proportion of female hip fractures has decreased from 84% (1960s) to 70% (2010s). There is a decreasing trend in the proportion of intracapsular fractures from 54% (1970s) to 49% (2000s) and 48% (2010s). CONCLUSION Our study indicates that significant progress has been made with preventative planning, medical management, specialised orthogeriatric units and surgical urgency all playing a role in the improvements in mean age of hip fracture incidence and reduction in mortality rates. While geographical variations do still exist there has been an increase in the study of hip fractures globally with results now being published from more widespread institutions indicating appropriate increased attention and commitment to an ever-increasing presentation.
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Gonzalez-Morgado D, Loya de la Cerda DG, Barro V. Simultaneous ipsilateral knee dislocation and hip fracture: A case report. Trauma Case Rep 2023; 43:100767. [PMID: 36691630 PMCID: PMC9860466 DOI: 10.1016/j.tcr.2023.100767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/11/2023] Open
Abstract
Hip fracture is one of the main causes of medical attendance in trauma centers. By contrast, knee dislocation is a challenging and limb-threatening injury. We report a case of a 68-year-old male who sustained a simultaneous ipsilateral hip fracture and knee dislocation after a low-energy fall. Popliteal artery and common peroneal nerve injuries were associated. Knee dislocation treatment included closed reduction, external fixation and popliteal artery repair. Hip hemiarthroplasty was performed using a direct anterior approach. Revision multiligament knee reconstruction surgery was not considered. A rehabilitation program achieved a good long-term functional outcome. Simultaneous ipsilateral knee dislocation and associated proximal femoral injuries are rare and challenging, potentially requiring long-term staged management. The direct anterior approach to the hip is worth consideration when additional lower limb injuries are present, especially in the setting of a knee spanning external fixator.
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Affiliation(s)
- Diego Gonzalez-Morgado
- Corresponding author at: Vall d'Hebron University Hospital, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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15
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Change in 1-year mortality after hip fracture surgery over the last decade in a European population. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04719-4. [PMID: 36456765 PMCID: PMC9715409 DOI: 10.1007/s00402-022-04719-4] [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: 10/04/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE There are scarce data on the mortality after hip fracture surgery for patients treated in the most recent years. The objective of this study was to analyze whether the overall initiatives introduced over the last decade for elderly patients with hip fractures had a positive impact on the 1-year mortality. METHODS Patients treated during 2010-2012 were compared with patients treated during 2018-2020 for all-cause 1-year mortality. Variables influencing mortality were collected based on the literature, including demographic, comorbidity, cognitive status, and preinjury physical function. Crude mortalities were compared between periods, as well as with the expected mortality in the general population adjusted for age, gender, and year of surgery using the standardized mortality ratio (SMR). A multivariate model was used to identify mortality risk factors. RESULTS 591 patients older than 65 years were treated during 2010-2012 and 642 patients during 2018-2020. The mean age increased significantly between periods (78.9 vs. 82.6 years, respectively, p = 0.001) in both genders, together with an increase in comorbidity (p = 0.014). The in-hospital mortality risk had no significant difference between periods (2.5 vs. 2.0%, p = 0.339), but the 30-day mortality risk (8.3 vs. 5.5%, p = 0.031) and 1-year mortality risk (16.1 vs. 11.9%, p = 0.023) declined significantly. However, 1-year mortality in 2020 had an excess of 1.33 in SMR. Age older than 80 years, male gender, and Charlson comorbidity index > 2 were significant predictors of 1-year mortality. CONCLUSION The important evolution achieved in the last decade for the management of patients with hip fracture surgery has led to a significant decline in 1-year mortality, but the 1-year mortality remains significantly higher compared to the general population of similar age and gender.
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Liu F, Chang WJ, Wang X, Gong R, Yuan DT, Zhang YK, Xie WP. Risk factors for prolonged preoperative waiting time of intertrochanteric fracture patients undergoing operative treatment. BMC Musculoskelet Disord 2022; 23:912. [PMID: 36229805 PMCID: PMC9559870 DOI: 10.1186/s12891-022-05865-x] [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: 04/05/2022] [Accepted: 09/28/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Intertrochanteric fracture is a common fracture in older adults. We observed the case characteristics of intertrochanteric fracture and analyzed the risk factors for prolonged preoperative waiting time based on patient data from a 6 year period. Investigate the post-admission treatment of intertrochanteric fracture. Methods We retrospectively reviewed the medical records from July 2015 to July 2021 of patients hospitalized for intertrochanteric fracture who had undergone internal fixation surgery in the orthopedic ward of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine. Data regarding gender, age, AO/OTA classification, preoperative waiting time, preoperative medical comorbidities, and complicated deep venous thrombosis (DVT) of lower limbs were collected. Statistical tests were used to evaluate the factors influencing preoperative preparation time and DVT. Results A total of 1812 cases were retrospectively analyzed, 1258 patients (69.43%) had three or more medical comorbidities. The average preoperative waiting time was 5.09 ± 3.27 days. Advanced age, more preoperative medical comorbidities and DVT led to longer preoperative waiting times, and preoperative medical comorbidities were an independent risk factor. Patients with advanced age and preoperative medical comorbidities were more likely to have DVT. Conclusion Age and preoperative medical comorbidities are risk factors for DVT and prolonged preoperative preparation time in intertrochanteric fracture patients. Preoperative medical comorbidities are an independent risk factors affecting the preoperative waiting time, and a combination of multiple comorbidities almost predicts the delay of the operation time.
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Affiliation(s)
- Fei Liu
- First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Wen-Jie Chang
- First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xu Wang
- First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Rui Gong
- First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dao-Tong Yuan
- First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yong-Kui Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Lixia District, 250014, Jinan, Shandong, China. .,Shandong Fupai Pharmaceutical Co., Ltd, Jinan, Shandong, China.
| | - Wen-Peng Xie
- Department of Orthopedic Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Lixia District, 250014, Jinan, Shandong, China.
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Castellanos SC, Marco FL, Domínguez EB, Gálvez EMV, Pérez BM. Does delaying surgery for "healthy" hip fracture patients have increased complications and mortality? Injury 2022; 53:3209-3213. [PMID: 35842349 DOI: 10.1016/j.injury.2022.06.035] [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: 05/18/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical delay is one of the risk factors for mortality and morbidity in patients with HF. One of the causes of delay is due to admission on Thursday-Friday, weekends, holidays or previous periods. The final objective of this study is to analyze administrative-organizational delay in complication and mortality rates. MATERIAL AND METHODS A total of 607 cases of surgically operated hip fractures were analyzed. Two groups were established, one of them operated on in < 48 h (ND group) and the other surgically delayed for administrative organizational reasons (AA group). Demographic variables related to treatment and fracture were analyzed in both groups, as well as the rates of surgical wound complications, general complications and mortality rate in the first 30 days, in the first year and more than one year after surgery. RESULTS We observed a surgical wound seroma and staining rate of 15.7% in the AA group and 9.6% in the ND group; and a surgical wound surface infection rate of 1.9% in the AA group and 0.8% in the ND group (p = 0.275). General complications occurred in 34.4% (AA group) and 29% (ND group). The 30-day mortality rate was 4.8% in the AA group and 1.9% in the ND group (p = 0.081). CONCLUSION We found no statistically significant differences in patients delayed for administrative reasons in terms of mortality and surgical wound and general complication rates. Although the proportion of surgical wound complications and 30-day mortality was higher in the AA group versus the ND group.
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Reasons for Surgical Delay in Patients With Hip Fracture. J Healthc Qual 2022; 44:341-346. [PMID: 35998095 DOI: 10.1097/jhq.0000000000000360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
INTRODUCTION 15% of patients with hip fracture older than 65 years in Israel have delayed surgery. The aim of this study was to determine which patient and/or organizational factors are associated with a delay of beyond 48 hours in hip fracture repair surgery. METHODS A retrospective cohort study of 281 patients with hip fracture who underwent surgery during 2019-2020. Characteristics of patients with early surgery (n = 40) and patients with delayed surgery (n = 241) were compared. RESULTS Presence of a cardiac disease (odds ratio [OR] = 1.38), pulmonary disease (OR = 1.21), or obesity (OR = 1.18) was identified as risk factors for surgical delay. Each additional comorbidity increased the risk. Most of the documented reasons for delay were medical, with antiplatelet therapy the most common (n = 8, 20%). Unavailable operating rooms were another common reason for delays (n = 8, 20%). In addition, a higher percentage of patients with delayed surgery were admitted in August and September (42.5%). CONCLUSIONS It seems that most delays were for medical reasons. However, it is unclear whether allegedly clinically justified delays were indeed of benefit to the patients. Health care organizations should strive to minimize the impact of organizational factors on surgical delay.
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De Luca A, Murena L, Zanetti M, De Colle P, Ratti C, Canton G. Should the early surgery threshold be moved to 72 h in over-85 patients with hip fracture? A single-center retrospective evaluation on 941 patients. Arch Orthop Trauma Surg 2022; 143:3091-3101. [PMID: 35788762 DOI: 10.1007/s00402-022-04509-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/10/2022] [Indexed: 11/02/2022]
Abstract
AIM Aim of the study was to assess whether early surgery and other clinical and orthogeriatric parameters could affect mortality rate in hip fracture patients aged > 85. MATERIALS AND METHODS Data regarding a 42-month period were retrospectively obtained from the institutional medical records and registry data. Gender, age, fracture pattern, surgical technique, type of anesthesia, timing of surgical intervention (within 24, 48 or 72 h from admission), days of hospitalization, mortality rate divided in intra-hospital, at 30 days and at 1 year were collected for the whole population. Some additional data were collected for an orthogeriatric subgroup. RESULTS 941 patients were considered, with a mean age of 89 years. Surgery was performed within 24, 48 and 72 h in 24.4%, 54.5% and 66.1% of cases, respectively. Intra-hospital mortality rate resulted to be 3.4%, while mortality at 30 days and 1 year resulted to be 4.5% and 31%, respectively. Early surgery within 48 and 72 h were significantly associated with a lower intra-hospital and 30-day mortality rate. In the orthogeriatric subgroup (394 patients), a significant association with a higher mortality rate was found for general anesthesia, number of comorbidities, ADL (Activities of Daily Living) < 3, transfer to other departments. CONCLUSIONS In over-85 hip fracture patients, the threshold for early surgery might be moved to 72 h to allow patients pre-operative stabilization and medical optimization as intra-hospital and 30-day mortality rates remain significantly lower. Advanced age, male sex, number of comorbidities, pre-operative dependency in ADL, general anesthesia, length of hospitalization and transfer to other departments were significantly related to mortality rate.
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Affiliation(s)
- Alessandro De Luca
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy. .,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy. .,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.
| | - Luigi Murena
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Michela Zanetti
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Paolo De Colle
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Chiara Ratti
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Gianluca Canton
- Orthopedics and Traumatology Unit, Department of Medical Surgical and Health Sciences, Cattinara Hospital-ASUGI, Trieste University, Strada di Fiume 447, 34149, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, Geriatric Unit ASUGI, University of Trieste, Trieste, Italy.,Department of Medicine ASUGI, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
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20
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Fluck B, Yeong K, Lisk R, Robin J, Fluck D, Fry CH, Han TS. Identification of preoperative factors and postoperative outcomes in relation to delays in surgery for hip fractures. Clin Med (Lond) 2022; 22:313-319. [PMID: 38589130 DOI: 10.7861/clinmed.2021-0590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We evaluated factors and outcomes associated with elapsed time to surgery (ETTS) in 1,081 men and 2,891 women (mean age 83.5 years ±9.1) undergoing hip fracture surgery (from 2009-2019). Mortality rates were 4.8%, 6.3%, 6.2% and 10.3% (chi-squared 19.0; p<0.001), and hospital length of stay (LOS) >19 days were 31.9%, 32.8%, 33.8% and 43.2% (chi-squared 18.5; p<0.001) for ETTS <24 hours, 24-35 hours, 36-47 hours and ≥48 hours, respectively. There were no differences between ETTS categories for failure to mobilise within 1 day of surgery, pressure ulcers or discharge to nursing care. After adjustment for age, sex, American Society of Anesthesiologists' score and years of data collection, compared with Sunday, the risk of ETTS ≥36 hours was highest on Friday (odds ratio (OR) 3.50; 95% confidence interval (CI) 2.43-5.03) and Saturday (OR 4.70; 95% CI 3.26-6.76). Compared with ETTS <24 hours, there were increases in the risk of death when ETTS ≥48 hours (OR 2.31; 95% CI 1.47-3.65) and LOS >19 days (OR 1.34; 95% CI 1.02-1.75). The median (interquartile range (IQR)) LOS for ETTS <24 hours was 12.7 days (IQR 8.0-23.0), 24-35 hours was 13.5 days (IQR 8.4-22.9), 36-47 hours was 14.1 days (IQR 8.9-23.3) and ≥48 hours was 16.9 (IQR 10.8-27.0; p<0.001). The 10-year period of collection did not change the conclusion. Admissions towards the end of the week are associated with delayed ETTS for hip fractures, while delay in surgery, particularly beyond 48 hours, is associated with increased risk of mortality and prolonged LOS.
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Affiliation(s)
- Ben Fluck
- Institute of Cardiovascular Research, Egham, UK
| | - Keefai Yeong
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Radcliffe Lisk
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Jonathan Robin
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - David Fluck
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Christopher H Fry
- University of Bristol School of Physiology, Pharmacology and Neuroscience, Bristol, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Egham, UK and Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK.
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21
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Xing F, Luo R, Liu M, Zhou Z, Xiang Z, Duan X. A New Random Forest Algorithm-Based Prediction Model of Post-operative Mortality in Geriatric Patients With Hip Fractures. Front Med (Lausanne) 2022; 9:829977. [PMID: 35646950 PMCID: PMC9130605 DOI: 10.3389/fmed.2022.829977] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/31/2022] [Indexed: 02/05/2023] Open
Abstract
Background Post-operative mortality risk assessment for geriatric patients with hip fractures (HF) is a challenge for clinicians. Early identification of geriatric HF patients with a high risk of post-operative death is helpful for early intervention and improving clinical prognosis. However, a single significant risk factor of post-operative death cannot accurately predict the prognosis of geriatric HF patients. Therefore, our study aims to utilize a machine learning approach, random forest algorithm, to fabricate a prediction model for post-operative death of geriatric HF patients. Methods This retrospective study enrolled consecutive geriatric HF patients who underwent treatment for surgery. The study cohort was divided into training and testing datasets at a 70:30 ratio. The random forest algorithm selected or excluded variables according to the feature importance. Least absolute shrinkage and selection operator (Lasso) was utilized to compare feature selection results of random forest. The confirmed variables were used to create a simplified model instead of a full model with all variables. The prediction model was then verified in the training dataset and testing dataset. Additionally, a prediction model constructed by logistic regression was used as a control to evaluate the efficiency of the new prediction model. Results Feature selection by random forest algorithm and Lasso regression demonstrated that seven variables, including age, time from injury to surgery, chronic obstructive pulmonary disease (COPD), albumin, hemoglobin, history of malignancy, and perioperative blood transfusion, could be used to predict the 1-year post-operative mortality. The area under the curve (AUC) of the random forest algorithm-based prediction model in training and testing datasets were 1.000, and 0.813, respectively. While the prediction tool constructed by logistic regression in training and testing datasets were 0.895, and 0.797, respectively. Conclusions Compared with logistic regression, the random forest algorithm-based prediction model exhibits better predictive ability for geriatric HF patients with a high risk of death within post-operative 1 year.
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Affiliation(s)
- Fei Xing
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Zongke Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Xiang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Duan
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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22
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Preoperative leukocytosis and postoperative outcomes in geriatric hip fracture patients: a retrospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Huang Q, Xu Y, Xue H, Wang Q, Li M, Ren C, Lu Y, Li Z, Zhang K, Ma T. Percutaneous reduction with double screwdrivers versus limited open reduction in the treatment of irreducible extracapsular hip fractures. BMC Musculoskelet Disord 2022; 23:429. [PMID: 35524242 PMCID: PMC9077818 DOI: 10.1186/s12891-022-05390-x] [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: 06/25/2021] [Accepted: 05/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background The reduction in irreducible extracapsular hip fractures has always been controversial. Here, we present a new minimally invasive reduction technique and compare it with limited open reduction (LOR) to treat irreducible extracapsular hip fractures. Methods From January 2016 to January 2018, our institution treated 653 patients with extracapsular hip fractures by intramedullary fixation. Among them, 525 cases got a successful closed reduction. The other 128 were irreducible and reduced by percutaneous reduction with double screwdrivers (PRDS) or LOR. There were 66 cases in the PRDS group while 62 in the LOR group. All fractures were classified using the Evans-Jensen classification. In addition, the differences in incision length, blood loss, fluoroscopic number, operation time, inpatient time, weight training time, Harris score, and complications were analyzed. Results The incision length was 8.4 ± 1.4 cm in the PRDS group and 15.3 ± 3.0 cm in the LOR group, respectively (p < 0.05); blood loss was equal to 151 ± 26 and 319 ± 33 ml, respectively (p < 0.05); fluoroscopic number was 14 ± 3 and 8 ± 2, respectively (p < 0.05); operation time was 44 ± 9 and 73 ± 11 min, respectively (p < 0.05); inpatient time was 6.2 ± 1.7 and 8.4 ± 2.2 days, respectively (p < 0.05); weight training time after the operation was 4.5 ± 1.5 and 10.7 ± 1.8 days, respectively (p < 0.05); and the excellent rate of Harris score was 92.4% and 88.7%, respectively (p > 0.05). There was no significant difference in complication incidence between the two groups (p > 0.05). Conclusions The PRDS group presented better clinical effects for managing irreducible extracapsular hip fractures than the LOR. Therefore, the PRDS technique could be the first reduction choice for patients with irreducible fractures.
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Affiliation(s)
- Qiang Huang
- Department of Orthopedic Surgery, Xi'an Jiaotong University, Hong Hui hospital, Xi'an, 710054, Shaanxi, China
| | - YiBo Xu
- Department of Orthopedic Surgery, Xi'an Jiaotong University, Hong Hui hospital, Xi'an, 710054, Shaanxi, China
| | - HanZhong Xue
- Department of Orthopedic Surgery, Xi'an Jiaotong University, Hong Hui hospital, Xi'an, 710054, Shaanxi, China
| | - Qian Wang
- Department of Orthopedic Surgery, Xi'an Jiaotong University, Hong Hui hospital, Xi'an, 710054, Shaanxi, China
| | - Ming Li
- Department of Orthopedic Surgery, Xi'an Jiaotong University, Hong Hui hospital, Xi'an, 710054, Shaanxi, China
| | - Cheng Ren
- Department of Orthopedic Surgery, Xi'an Jiaotong University, Hong Hui hospital, Xi'an, 710054, Shaanxi, China
| | - Yao Lu
- Department of Orthopedic Surgery, Xi'an Jiaotong University, Hong Hui hospital, Xi'an, 710054, Shaanxi, China
| | - Zhong Li
- Department of Orthopedic Surgery, Xi'an Jiaotong University, Hong Hui hospital, Xi'an, 710054, Shaanxi, China
| | - Kun Zhang
- Department of Orthopedic Surgery, Xi'an Jiaotong University, Hong Hui hospital, Xi'an, 710054, Shaanxi, China.
| | - Teng Ma
- Department of Orthopedic Surgery, Xi'an Jiaotong University, Hong Hui hospital, Xi'an, 710054, Shaanxi, China.
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24
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Darbandi AD, Saadat GH, Alsoof D, Rebic A, Siddiqi A, Butler BA, Bokhari F. Effects of Delayed Hip Fracture Surgery on Severely Ill Patients: Defining the Time to Medical Optimization. Am Surg 2022:31348221080425. [PMID: 35324321 DOI: 10.1177/00031348221080425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with multiple comorbidities often have delayed hip fracture surgery due to medical optimization. The goal of this study is to identify the allowable time for medical optimization in severely ill hip fracture patients. METHODS The 2016-2019 NSQIP database was used to identify patients over age 60 with ASA classification scores 3 and 4 for severe and life-threatening systemic diseases. Patients were divided into immediate (<24 hours), early (24-48 hours), or late (>48 hours) groups based on time to surgery (TTS). Risk-adjusted multivariable logistic regressions were conducted to compare relationships between 30-day postoperative outcomes and TTS. RESULTS 43,071 hip fracture cases were analyzed for the purposes of this study. Compared to patients who underwent surgery immediately, patients who had surgeries between 24 and 48 hours were associated with higher rates of pneumonia (OR 1.357, CI 1.194-1.542), UTIs (OR 1.155, CI 1.000-1.224), readmission (OR 1.136, CI 1.041-1.240), postoperative LOS beyond 6 days (OR 1.249, CI 1.165-1.340), and mortality (OR 1.205, CI 1.084-1.338). Patients with surgeries delayed beyond 48 hours were associated with higher rates of CVA (OR 1.542, CI 1.048-2.269), pneumonia (OR 1.886, CI 1.611-2.209), UTIs (OR 1.546, CI 1.283-1.861), readmission (OR 1.212, CI 1.074-1.366), postoperative LOS beyond 6 days (OR 1.829, CI 1.670-2.003), and mortality (OR 1.475, CI 1.286-1.693) compared to patients with immediate surgery. DISCUSSION Severely ill patients with the hip fracture may have a 24-hour window for medical optimization. Hip fracture surgery performed beyond 48 hours is associated with higher complication rates and mortality among those who are severely ill. Further prospective studies are warranted to examine the effects of early surgical intervention among severely ill patients.
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Affiliation(s)
| | - Ghulam H Saadat
- Department of Trauma and Burn Surgery, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | | | - Ante Rebic
- 32959Kansas City University, Kansas City, MO, USA
| | - Ahmed Siddiqi
- Orthopedic Institute of Central Jersey, a division of Ortho Alliance NJ, Manasquan, NJ, USA; and Department of Orthopedic Surgery, Hackensack Meridian School of Medicine, Jersey Shore University Medical Center
| | - Bennet A Butler
- Department of Trauma and Burn Surgery, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Faran Bokhari
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, IL, USA
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25
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Malnutrition, poor function and comorbidities predict mortality up to one year after hip fracture: a cohort study of 2800 patients. Eur Geriatr Med 2021; 13:433-443. [PMID: 34854063 DOI: 10.1007/s41999-021-00598-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Despite extensive research, a complete understanding of factors influencing mortality risk after hip fractures is lacking. Previous research has focused on static risk factors; however, to improve outcomes, attention should be directed towards risk factors that may be optimised. The present study aimed to investigate the association of 19 risk factors with mortality among patients with hip fracture treated according to a well-defined guideline. METHODS The study was a retrospective analysis of a large prospective patient cohort with all consecutive patients surgically treated for a hip fracture from January 2011 to December 2017 included (n = 2800). Variables were obtained from patient records and the Holstebro Hip Fracture Database comprising prospectively registered data on demographics, comorbidity, malnutrition (low Body Mass Index (BMI) or albumin) and hospital stay (including fracture and surgical data, biochemistry, mobilisation and discharge). Outcomes were 30-day and one-year mortality. RESULTS Patients were predominantly female (66%); median age 81.6 years. Overall mortality was 9% at 30 days and 24% at one year. Age ≥ 75 years, male gender, nursing home residence, cognitive impairment, American Society of Anesthesiologists (ASA) score ≥ 3, BMI < 20 kg/m2, albumin < 35 g/l, creatinine ≥ 100 µmol/l, a low New Mobility Score and no mobilisation were all associated with increased mortality at 30 days and one year. CONCLUSION In addition to non-modifiable risk factors, comorbidities (expressed as high ASA score and creatinine), malnutrition, and failure to achieve early post-operative mobilisation were associated with increased short and long-term mortality among patients with hip fracture: these are potentially modifiable. The effect of optimisation interventions warrants further research.
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26
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Guo J, Ye P, Zhang Q, Gao X, Wang Z, Wang Q, Hou Z, Zhang Y. Is There a "Weekend Effect" in Intertrochanteric Fracture Surgery? Gerontology 2021; 68:877-888. [PMID: 34753144 DOI: 10.1159/000519510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Numerous studies reported poorer outcomes for patients who were admitted at weekends or off-hour, which relates to the underlying concept called the "weekend effect." We aimed to assess the effect of adverse outcomes in older patients with intertrochanteric fracture surgery. METHODS A retrospective cohort study of patients aged ≥65 years with intertrochanteric fracture surgery. Data were collected from computerized medical records and all patients had a long-term follow-up. The association between weekend effect with adverse outcomes and factors for all-cause mortality was studied by 3-group comparison, Spearman and partial correlation analysis, univariate analysis, and multivariate Cox proportional-hazard model. RESULTS Our results showed no evidence supporting the existence of a weekend effect on adverse outcomes, including mortality rates (p = 0.950, log-rank), length of hospital stay, total hospital costs, rate and volume of transfusion, visual analog scale score, Harris Hip Score, and specific complications (all p > 0.05), except for an average of 0.5 days longer surgical delay found in patients admitted on Fridays relative to other days (p = 0.013). Instead, only age group (with a 10-year interval, HR 1.43, 1.28-1.59 95% CI, p < 0.001) and surgical delay (HR 1.05, 1.02-1.07 95% CI, p < 0.001) were identified as significantly associated with all-cause mortality. CONCLUSIONS Older patients with intertrochanteric fracture surgery have similar mortality and adverse outcomes rates when admitted on weekends or holidays compared with weekdays. Our findings suggest that collaborative multidisciplinary team care seems both effective and efficient in the management of older patients with intertrochanteric fractures on any day of the week.
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Affiliation(s)
- Junfei Guo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Pengyu Ye
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Qi Zhang
- Department of Anesthesiology, Children's Hospital of Hebei Affiliated to Hebei, Medical University, Shijiazhuang, China
| | - Xian Gao
- Medical Department, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qiujun Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China.,Chinese Academy of Engineering, Beijing, China
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27
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Lieten S, Herrtwich A, Bravenboer B, Scheerlinck T, Van Laere S, Vanlauwe J. Analysis of the effects of a delay of surgery in patients with hip fractures: outcome and causes. Osteoporos Int 2021; 32:2235-2245. [PMID: 33990873 DOI: 10.1007/s00198-021-05990-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED This study analyzed characteristics of hip fracture patients who did not undergo surgery within 24 hours after hospitalization, as recommended by the Belgian quality standards. Reasons for delay were analyzed. Delay in surgery for hip fracture was related to the medical condition of the patients. INTRODUCTION To compare patients with optimal timing to patients with a delay in hip surgery, with respect to outcome (complications (postoperative) and mortality) and reasons for delay. METHODS A retrospective analysis of medical records compared patients operated on within 24h (Group A) to patients operated on more than 24h after admission (Group B). A follow-up period of 5 years after release or up to the time of data collection was used. Reasons for delay in relation with mortality were analyzed descriptively. Descriptive statistics were used for patient demographics and complications. Relationships causing a delayed surgery and mortality were analyzed using binary logistic regression. Additionally, a survival analysis was provided for overall mortality. RESULTS Respectively, 536 and 304 patients were included in Group A and B. The most prominent reason for delaying surgery was the patient not being medically fit (20.7%). Surgical delay was associated with more cardiovascular (p = 0.010), more pulmonary (p < 0.001), and less hematologic complications (p=0.037). Thirty-day mortality was higher with increasing age (p < 0.001), with hematologic (p < 0.001) or endocrine-metabolic complications (p = 0.001), and lower when no complications occurred (p = 0.004). Mortality at the end of data collection was higher for patients with delayed surgery (OR = 2.634, p < 0.001), an increased age (p = 0.006), male gender (p < 0.001), institutionalized patients (p = 0.009), pulmonary complication (p = 0.002), and having no endocrine-metabolic complications (p = 0.003). Survival analysis showed better survival for patients operated on within 24h (p < 0.001). CONCLUSIONS Delayed surgery for patients with hip fractures was associated with bad additional medical conditions. Survival was higher for patients operated on within 24h of admission.
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Affiliation(s)
- S Lieten
- Department of Orthopedics and Traumatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
- Department of Geriatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - A Herrtwich
- Department of Orthopedics and Traumatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - B Bravenboer
- Department of Geriatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - T Scheerlinck
- Department of Orthopedics and Traumatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - S Van Laere
- Interfaculty Center Data processing and Statistics, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium
| | - J Vanlauwe
- Department of Orthopedics and Traumatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
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28
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Golinelli D, Lenzi J, Adorno E, Gianino MM, Fantini MP. COVID-19 and regional differences in the timeliness of hip-fracture surgery: an interrupted time-series analysis. PeerJ 2021; 9:e12046. [PMID: 34540366 PMCID: PMC8415287 DOI: 10.7717/peerj.12046] [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: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND It is of great importance to examine the impact of the healthcare reorganization adopted to confront the COVID-19 pandemic on the quality of care provided to non-COVID-19 patients. The aim of this study is to assess the impact of the COVID-19 national lockdown (March 9, 2020) on the quality of care provided to patients with hip fracture (HF) in Piedmont and Emilia-Romagna, two large regions of northern Italy severely hit by the pandemic. METHODS We calculated the percentage of HF patients undergoing surgery within 2 days of hospital admission. An interrupted time-series analysis was performed on weekly data from December 11, 2019 to June 9, 2020 (≈6 months), interrupting the series in the 2nd week of March. The same data observed the year before were included as a control time series with no "intervention" (lockdown) in the middle of the observation period. RESULTS Before the lockdown, 2-day surgery was 69.9% in Piedmont and 79.2% in Emilia-Romagna; after the lockdown, these proportions were equal to 69.8% (-0.1%) and 69.3% (-9.9%), respectively. While Piedmont did not experience any drop in the amount of surgery, Emilia-Romagna exhibited a significant decline at a weekly rate of -1.29% (95% CI [-1.71 to -0.88]). Divergent trend patterns in the two study regions reflect local differences in pandemic timing as well as in healthcare services capacity, management, and emergency preparedness.
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Affiliation(s)
- Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Emanuele Adorno
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Forssten MP, Mohammad Ismail A, Borg T, Ahl R, Wretenberg P, Cao Y, Peden CJ, Mohseni S. Postoperative mortality in hip fracture patients stratified by the Revised Cardiac Risk Index: a Swedish nationwide retrospective cohort study. Trauma Surg Acute Care Open 2021; 6:e000778. [PMID: 34395919 PMCID: PMC8314694 DOI: 10.1136/tsaco-2021-000778] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/06/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives The Revised Cardiac Risk Index (RCRI) is a tool that can be used to evaluate the 30-day risk of postoperative myocardial infarction, cardiac arrest and mortality. This study aims to confirm its association with postoperative mortality in patients who underwent hip fracture surgery. Methods All adults who underwent primary emergency hip fracture surgery in Sweden between January 1, 2008 and December 31, 2017 were included in this study. The database was retrieved by cross-referencing the Swedish National Quality Register for hip fractures with the Swedish National Board of Health and Welfare registers. The outcomes of interest were the association between the RCRI score and mortality at 30 days, 90 days and 1 year postoperatively. Results 134 915 cases were included in the current study. There was a statistically significant linear trend in postoperative mortality with increasing RCRI scores at 30 days, 90 days and 1 year. An RCRI score ≥4 was associated with a 3.1 times greater risk of 30-day postoperative mortality (adjusted incidence rate ratio (IRR) 3.13, p<0.001), a 2.5 times greater risk of 90-day postoperative mortality (adjusted IRR 2.54, p<0.001) and a 2.8 times greater risk of 1-year postoperative mortality (adjusted HR 2.81, p<0.001) compared with that observed with an RCRI score of 0. Conclusion An increasing RCRI score is strongly associated with an elevated risk 30-day, 90-day and 1-year postoperative mortality after primary hip fracture surgery. The objective and easily retrievable nature of the variables included in the RCRI calculation makes it an appealing choice for risk stratification in the clinical setting. Levels of evidence Level III.
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Affiliation(s)
- Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Tomas Borg
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Rebecka Ahl
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Per Wretenberg
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Carol J Peden
- Department of Clinical Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA.,Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
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Liu J, Chen L, Long C, Zhang X, Gao F, Duan X, Xiang Z. A retrospective pilot study of preoperative mobilization program for older adults with hip fracture. Geriatr Nurs 2021; 42:908-914. [PMID: 34098444 DOI: 10.1016/j.gerinurse.2021.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate the feasible effect of a preoperative mobilization program for older hip fracture patients who waited more than two days before surgery. METHODS A total of 38 patients with hip fracture were analyzed in this retrospective descriptive pilot study. The modified Barthel index (MBI) was used to measure functional outcome. Visual analogue scale (VAS) was used to evaluate the changes of pain degree during preoperative mobilization. The perioperative complications were recorded. RESULTS After the preoperative mobilization program was implemented, the MBI score was improved immediately and further improved after surgery until 3 months after discharge. On the premise of analgesia, no patient experienced severe pain during preoperative mobilization. Perioperative complications occurred in 2 (5.3%) patients. CONCLUSION For older patients with hip fracture, the preoperative mobilization program may be a feasible method, which may have a positive effect on promoting functional recovery and preventing perioperative complications.
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Affiliation(s)
- Jiaxin Liu
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Li Chen
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Cheng Long
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Xiang Zhang
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Feng Gao
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Xin Duan
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China.
| | - Zhou Xiang
- Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China
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Lin TC, Wang PW, Lin CT, Chang YJ, Lin YJ, Liang WM, Lin JCF. Primary hemiarthroplasty after unstable trochanteric fracture in elderly patients: mortality, readmission and reoperation. BMC Musculoskelet Disord 2021; 22:403. [PMID: 33941152 PMCID: PMC8091504 DOI: 10.1186/s12891-021-04277-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background Most unstable trochanteric fractures are treated with internal fixation and often with high complication rates. Hemiarthroplasty might be an alternative method in difficult condition, especially in unstable comminuted fracture in fragile bone. However, few have investigated the long-term outcomes after hemiarthroplasty for unstable trochanteric fracture. We conducted a population-based retrospective cohort study of trochanteric fracture after primary hemiarthroplasty using competing risk analysis on their long-term outcomes, including mortality, readmission and reoperation. Methods We studied a total of 2798 patients over 60 years old, with a mean age of 79 years, of which 68% are females and 67.23% have at least one comorbidity. They underwent a hemiarthroplasty for unstable trochanteric fracture during the period between January 1, 2000 and December 31, 2010 and were follow-up until the end of 2012, or death. Survival analysis and Cox model were used to characterize mortality. Competing risk analysis and Fine and Gray model were used to estimate the cumulative incidences of the first readmission and the first reoperation. Results The follow-up mortality rate for 1-year was 17.94%; 2-year, 29.76%; 5-year, 56.8%; and 10-year, 83.38%. The cumulative incidence of the first readmission was 16.4% for 1-year and 22.44% for 3-year. The cumulative incidence of the first reoperation was 13.87% for 1-year, 18.11% for 2-year, 25.79% for 5-year, and 38.24% for 10-year. Male gender, older age, higher Charlson Comorbidity Index (CCI) and lower insured amount were all risk factors for the overall mortality. Older age and higher CCI were risk factors for the first readmission. Older age was a protective factor for reoperation, which is likely due to the competing death. Conclusions The mortality and revision rates after hemiarthroplasty for unstable trochanteric fracture are acceptable as a salvage procedure for this fragile sub-population. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04277-7.
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Affiliation(s)
- Tzu-Chieh Lin
- Department of Public Health, China Medical University, Taichung, Taiwan.,Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pin-Wen Wang
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chun-Teng Lin
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, 406040, Taiwan
| | - Yu-Jun Chang
- Big Data Center, Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Ying-Ju Lin
- Genetic Center, Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Miin Liang
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, 406040, Taiwan.
| | - Jeff Chien-Fu Lin
- Department of Statistics, National Taipei University, No.67, Sec. 3, Ming-Shen E. Rd, Taipei, 10478, Taipei, Taiwan. .,Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Guo J, Di J, Gao X, Zha J, Wang X, Wang Z, Wang Q, Hou Z, Zhang Y. Discriminative Ability for Adverse Outcomes After Hip Fracture Surgery: A Comparison of Three Commonly Used Comorbidity-Based Indices. Gerontology 2021; 68:62-74. [PMID: 33895736 DOI: 10.1159/000515526] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 02/27/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Preoperative risk assessment can predict adverse outcomes following hip fracture surgery, helping with decision-making and management strategies. Several risk adjustment models based on coded comorbidities such as Charlson Comorbidity Index (CCI), modified Elixhauser's Comorbidity Measure (mECM), and modified frailty index (mFI-5) are currently prevalent for orthopedic patients, but there is no consensus regarding which is optimal. The primary purpose was to identify the risk factors of CCI, mECM, and mFI-5, as well as patient characteristics for predicting (1) 1-month, 3-month, 1-year, and 2-year mortality, (2) perioperative complications, and (3) extended length of stay (LOS) following hip fractured surgery. The secondary aim was to compare the best-performing comorbidity index combined with characteristics identified in terms of their discriminative ability for adverse outcomes. METHODS We retrospectively reviewed 3,379 consecutive patients presenting with intertrochanteric fractures at our Level I trauma center from 2013 to 2018. After eliminated by exclusion criteria, 2,241 patients undergoing hip fracture surgery by PFNA, with age ≥65 years, were included. Three main multivariate logistic regression models were constructed. Cox proportional hazards models were used to calculate hazard ratios for mortality. A base model included age, BMI, surgical delay, anesthesia type, hemoglobin record at admission, and American Society of Anesthesiologists grade (ASA) also was constructed and assessed. RESULTS Base model + mECM outperformed other models for the occurrence of major complications including severe complications, cardiac complications, and pulmonary complications [the area under the receiver operating characteristic curve (AUC), 0.647; 95% CI, 0.616-0.677; AUC, 0.637; 95% CI, 0.610-0.664; AUC, 0.679; 95% CI, 0.642-0.715, respectively], while base model + CCI provided better prediction of minor complications of neurological complications and hematological complications (AUC, 0.659; 95% CI, 0.609, 0.709; AUC, 0.658; 95% CI, 0.635, 0.680). In addition, BMI, surgical delay, anesthesia type, and ASA were found highly relevant to extended LOS. Age-group (with a 10-year interval) was indicated to be mostly associated with all-cause mortality with fully adjusted hazard ratio of 1.35 and 95% CI range 1.20-1.51. CONCLUSIONS In comparison with mFI-5 and CCI, mECM so far may be the best comorbidity index combined with the base model for predicting major complications following hip fracture. The base model already achieved good discrimination for all-cause mortality and extended LOS, further addition of risk adjustment indices led to only 1% increase in the amount of variation explained.
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Affiliation(s)
- Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Jun Di
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xian Gao
- Medical Department, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junpu Zha
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiuli Wang
- Department of Anesthesiology, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qingxian Wang
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China.,Chinese Academy of Engineering, Beijing, China
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Gutiérrez Rodríguez C, Asmar Murgas MA, Camacho Uribe A, Barrios Diaz V, Bonilla León G, Llinás Volpe A. Postoperative morbidity and mortality in total joint arthroplasty: Exploring the limits of early discharge. J Clin Orthop Trauma 2021; 14:1-7. [PMID: 33717890 PMCID: PMC7919967 DOI: 10.1016/j.jcot.2020.10.048] [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: 08/11/2020] [Revised: 10/08/2020] [Accepted: 10/24/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In order to enhance cost-effectiveness, shorter hospital stays have been adopted following hip or knee replacement surgery. This study seeks to describe the incidence of morbidity and mortality, five days after patients were taken to surgery with an expected hospital stay of four days. METHODS Utilizing an Institutional Joint Replacement database, a descriptive study was carried out using a retrospective cohort of 1233 procedures in 1100 patients between 2012 and 2016. These were followed up for three months to evaluate morbidity and mortality in the postoperative period. RESULTS Complications were classified as minor or major (these were defined as any adverse event that can threaten a patient's life or had the potential to result in readmission). Of the cohort, 18 (1.5%) patient procedures presented one or more major complications. On the first postoperative day 3 major complications occurred (including one death). On the second and third day, 4 major complications were registered each day. On the fourth day after surgery, there were no major complications. On the fifth day 1 major complication was identified. After patient discharge there were 6 major complications reported. DISCUSSION The balance between early discharge and out-of-hospital morbidity as well as the frequency of hospital readmission must be the basis to determine whether a patient's hospital stay should be reduced. According to our results, it seems to be safe to shorten hospital stay in young and healthy patients. Furthermore, only orthopedic teams that have minimal rates of outpatient complications and adhere to high standards of care should consider reducing hospital stay.
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Affiliation(s)
- Camilo Gutiérrez Rodríguez
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Carrera 7 No. 117 – 15, Bogotá, Colombia
| | - María Alejandra Asmar Murgas
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Carrera 7 No. 117 – 15, Bogotá, Colombia
| | - Abelardo Camacho Uribe
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Carrera 7 No. 117 – 15, Bogotá, Colombia
| | - Valeria Barrios Diaz
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Carrera 7 No. 117 – 15, Bogotá, Colombia
| | - Guillermo Bonilla León
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá. School of Medicine, Universidad de Los Andes. School of Medicine, Universidad del Rosario, Carrera 7 No. 117 – 15, Bogotá, Colombia
| | - Adolfo Llinás Volpe
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá. School of Medicine, Universidad de Los Andes. School of Medicine, Universidad del Rosario, Carrera 7 No. 117 – 15, Bogotá, Colombia
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Nilsen SM, Asheim A, Carlsen F, Anthun KS, Johnsen LG, Vatten LJ, Bjørngaard JH. High volumes of recent surgical admissions, time to surgery, and 60-day mortality. Bone Joint J 2021; 103-B:264-270. [PMID: 33517718 PMCID: PMC7954185 DOI: 10.1302/0301-620x.103b2.bjj-2020-1581.r1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Few studies have investigated potential consequences of strained surgical resources. The aim of this cohort study was to assess whether a high proportion of concurrent acute surgical admissions, tying up hospital surgical capacity, may lead to delayed surgery and affect mortality for hip fracture patients. METHODS This study investigated time to surgery and 60-day post-admission death of patients 70 years and older admitted for acute hip fracture surgery in Norway between 2008 and 2016. The proportion of hospital capacity being occupied by newly admitted surgical patients was used as the exposure. Hip fracture patients admitted during periods of high proportion of recent admissions were compared with hip fracture patients admitted at the same hospital during the same month, on similar weekdays, and times of the day with fewer admissions. RESULTS Among 60,072 patients, mean age was 84.6 years (SD 6.8), 78% were females, and median time to surgery was 20 hours (IQR 11 to 29). Overall, 14% (8,464) were dead 60 days after admission. A high (75th percentile) proportion of recent surgical admission compared to a low (25th percentile) proportion resulted in 20% longer time to surgery (95% confidence interval (CI) 16 to 25) and 20% higher 60-day mortality (hazard ratio 1.2, 95% CI 1.1 to 1.4). CONCLUSION A high volume of recently admitted acute surgical patients, indicating probable competition for surgical resources, was associated with delayed surgery and increased 60-day mortality. Cite this article: Bone Joint J 2021;103-B(2):264-270.
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Affiliation(s)
- Sara Marie Nilsen
- Center for Health Care Improvement, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Andreas Asheim
- Center for Health Care Improvement, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway.,Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Fredrik Carlsen
- Department of Economics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjartan Sarheim Anthun
- Department of Health Research, SINTEF Digital, Trondheim, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Gunnar Johnsen
- Department of Orthopaedic Surgery, St. Olav's Hospital HF, Trondheim, Norway.,Department of Neuromedicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Johan Vatten
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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Kristiansson J, Hagberg E, Nellgård B. The influence of time-to-surgery on mortality after a hip fracture. Acta Anaesthesiol Scand 2020; 64:347-353. [PMID: 31652349 DOI: 10.1111/aas.13494] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/30/2019] [Accepted: 10/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The effect of time-to-surgery on mortality in acute hip fracture (AHF) patients has been debated and studies are inconsistent regarding from what time limit mortality starts to increase. At Sahlgrenska University Hospital/Mölndal, surgery is recommended within 24 hours leaving little time for pre-operative optimization. However, internationally the definition of early surgery varies between 24 and 48 hours and over. This retrospective study was initiated to investigate the relation between time-to-surgery and 30-day mortality. METHOD Data of AHF patients from January 2007 through December 2016 were collected. The variables analysed were: age, gender, American Society of Anesthesiologists physical status classification, surgical method (prosthesis or osteosynthesis) and time-to-surgery, along with 30-day mortality. Primary outcome was 30-day mortality related to time-to-surgery divided into groups. Secondary outcome was 30-day mortality related to time-to-surgery analysed hour-by-hour. RESULTS From 10,844 eligible patients, 9,270 patients were included into the study. Mean time-to-surgery was 19.4 hours and overall 30-day mortality was 7.6%. Adjusted Cox regression analysis revealed an increased mortality rate in patients with time-to-surgery >48 hours. In the hour-by-hour analysis, significant mortality increase was observed at 39 hours of time-to-surgery. Patients with time-to-surgery >24 hours did not have increased mortality compared to patients with time-to-surgery <24 hours. CONCLUSION In AHF patients, a time-to-surgery exceeding 39-48 hours was associated with increased mortality. Patients with surgeries performed before 39-48 hours did not have increased mortality and this time may, in some patients, be used for optimization prior surgery even if time-to-surgery exceeds 24 hours.
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Affiliation(s)
- Johan Kristiansson
- Department of Anaesthesiology and Intensive Care Sahlgrenska University Hospital
- Institution of Clinical Sciences Sahlgrenska Academy University of Gothenburg
| | - Eva Hagberg
- Department of Clinical Physiology Sahlgrenska University Hospital Mölndal Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care Sahlgrenska University Hospital
- Institution of Clinical Sciences Sahlgrenska Academy University of Gothenburg
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Chen P, Shen X, Xu W, Yao W, Ma N. Comparative assessment of early versus delayed surgery to treat proximal femoral fractures in elderly patients: A systematic review and meta-analysis. Int J Surg 2019; 68:63-71. [DOI: 10.1016/j.ijsu.2019.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/02/2019] [Accepted: 06/18/2019] [Indexed: 12/31/2022]
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Lizaur-Utrilla A, Gonzalez-Navarro B, Vizcaya-Moreno MF, Lopez-Prats FA. Altered seric levels of albumin, sodium and parathyroid hormone may predict early mortality following hip fracture surgery in elderly. INTERNATIONAL ORTHOPAEDICS 2019; 43:2825-2829. [PMID: 31256198 DOI: 10.1007/s00264-019-04368-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 06/19/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyse a wide set of routine laboratory parameters at admission to predict mortality within 30 post-operative days in elderly patients with hip fracture, as well as calculate the critical values of those biomarkers. METHOD Data of 994 patients older than 65 years with hip fracture were analysed of which 89 (8.2%) died within 30 post-operative days. Variables described in the literature with potential influence on early mortality were collected, including demographics, fracture type, American Society of Anesthesiologists score, Charlson's comorbidity index and pre-operative Hodkinson's mental test and the Katz index for activities of daily living. In addition, an exhaustive collection of biomarkers from routine blood testing at admission was performed. Critical levels of biomarkers were calculated by the method of area under ROC curve. RESULTS At admission, early mortality group had significantly higher Charlson's index (p = 0.001) and lower the Katz index (p = 0.001). The surgical delay also was significantly longer in that group (p = 0.001). In univariate analyses, serum concentration at admission of total protein (p = 0.004), albumin (p = 0.001), sodium (p = 0.001), and parathyroid hormone (PTH) (p = 0.001) were significantly different between both groups. In multivariate analysis, serum albumin < 2.9 g/dL (p = 0.013), sodium < 127 mEq/L (p = 0.035) and PTH > 65 pg/mL (p = 0.005) were predictors of early mortality. The three biomarkers together accounted for 67% of the variability in early mortality. CONCLUSION The association of altered levels at admission of serum concentration of albumin, sodium and PTH was predictor of early mortality following hip fracture surgery in elderly patients.
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Affiliation(s)
- Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Sax s/n, Elda, 03600, Alicante, Spain. .,Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain.
| | - Blanca Gonzalez-Navarro
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Sax s/n, Elda, 03600, Alicante, Spain
| | - Maria F Vizcaya-Moreno
- Clinical Research Group, Faculty of Health Sciences, University of Alicante, Ctra San Vicente Raspeig s/n, San Vicente Raspeig, 03690, Alicante, Spain
| | - Fernando A Lopez-Prats
- Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain
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张 祎, 饶 烽, 皮 伟, 张 培, 姜 保. [Proximal femoral nails antirotation and dynamic hip screws for fixation of unstable intertrochanteric fractures of femur: A meta-analysis]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:493-500. [PMID: 31209421 PMCID: PMC7439035 DOI: 10.19723/j.issn.1671-167x.2019.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) for unstable intertrochanteric fractures using meta-analysis. METHODS The PubMed, Embase, Cocharane Central Register of Controlled Trials, Google Scholar, China Science and Technology Papers and Citation Database (CSTPCD) and China Journal Full-text Database (CNKI) were searched for published randomized controlled trials before January 1, 2019. Two researchers independently screened the literature in the light of the inclusion and exclusion criteria, evaluated the quality of the studies and extracted the data which were consisted of clinical efficacy indexes, such as incision length, operation time,intraoperative blood loss, weight-bearing time,fracture-healing time, Harris hip score and safety indicators like complications. Meta-analysis was performed with the Revman 5.3 software provided by Cochrane Community in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standard. RESULTS Nine randomized controlled trials met the requirement with a total of 779 patients, of whom 383 were fixed with PFNA and 396 with DHS. Meta-analysis demonstrated that PFNA was associated with smaller surgical incision length [MD=-7.43, 95%CI (-9.31, -5.55), P<0.05], shorter operation time [MD=-22.76, 95%CI (-29.57, -11.95), P<0.05], less intraoperative blood loss [MD=-216.34, 95%CI (-275.18, - 157.49), P<0.05], earlier weight bearing after surgery [MD=-12.34, 95%CI (-17.71, -6.97), P<0.05], shorter fracture healing time [MD=-5.00, 95%CI (-7.73, -2.26), P<0.05], higher postoperative Harris hip score [MD=12.22, 95%CI (3.88, 20.55), P<0.05], higher rate of excellent Harris hip score [OR=3.56, 95%CI (1.44, 8.81), P<0.05] and lower incidence rate of postoperative complications [OR=0.48, 95%CI (0.33, 0.70), P<0.05], such as hip varus, wound infection, urinary tract infection, pulmonary infection, pressure sore, deep vein thrombosis, pulmonary embolism, heart failure and cerebral infraction when compared with DHS. No statistical difference was shown between the groups when it came to subgroup analysis by age. However, there was no significant difference (P>0.05) in the duration of hospitalization and the complications resulting in the occurrences of internal fixation loosening, such as femoral shaft fracture (during or post operation), internal fixation fracture, cut-out, displacement or retraction. CONCLUSION Current published evidence supports the superiority of PFNA to DHS for unstable intertrochanteric fractures in terms of clinical efficacy. The conclusion was limited because of the relatively low quality of evidence with low strength of confidence. Large scale and high-quality randomized controlled trials are required to validate the safety of PFNA and DHS for unstable intertrochanteric fractures.
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Affiliation(s)
- 祎然 张
- />北京大学人民医院创伤骨科, 北京 100044Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 烽 饶
- />北京大学人民医院创伤骨科, 北京 100044Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 伟 皮
- />北京大学人民医院创伤骨科, 北京 100044Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 培训 张
- />北京大学人民医院创伤骨科, 北京 100044Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 保国 姜
- />北京大学人民医院创伤骨科, 北京 100044Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
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Higashikawa T, Shigemoto K, Goshima K, Usuda D, Okuro M, Moriyama M, Inujima H, Hangyou M, Usuda K, Morimoto S, Matsumoto T, Takashima S, Kanda T, Sawaguchi T. Urinary retention as a postoperative complication associated with functional decline in elderly female patients with femoral neck and trochanteric fractures: A retrospective study of a patient cohort. Medicine (Baltimore) 2019; 98:e16023. [PMID: 31192952 PMCID: PMC6587656 DOI: 10.1097/md.0000000000016023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Urinary retention (UR) has been recognized as one of the most common postoperative complications after hip surgery in elderly. The objective of the present study was to evaluate risk for postoperative complications of UR in elderly female patients with femoral neck fractures.We recruited 221 female patients (age 85.3 ± 7.0 years) with a history of hip surgery carried out at Toyama Municipal Hospital. UR occurred in 34 out of 221 cases (15.4%). Multiple logistic regression analysis was conducted to investigate the risk factors for UR, including age, body mass index (BMI), serum albumin, cognitive impairment, and activities of daily living (ADL).The results showed significant association of UR with cognitive impairment (P = .005, odds ratio [OR] 4.11, 95% confidence interval [CI] 1.53-11.03), and ADL (P = .029, OR 2.61, 95% CI 1.11-6.18), under adjustment with age and BMI.This study demonstrated that cognitive function and ADL were the important risk factors for UR, suggested that the postoperative management of UR is important with taking account of neurofunctional assistance and nursing care in daily living, especially in elderly female patients receiving surgery of femoral neck and trochanteric fractures.
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Affiliation(s)
- Toshihiro Higashikawa
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi
| | - Kenji Shigemoto
- Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Hokubumachi, Imaizumi, Toyama
| | - Kenichi Goshima
- Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Hokubumachi, Imaizumi, Toyama
| | | | - Masashi Okuro
- Department of Geriatric Medicine, Kanazawa Medical University, Uchinada, Kahoku-gun, Ishikawa
| | - Manabu Moriyama
- Department of Urology, Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi
| | - Hiromi Inujima
- Toyama Municipal Hospital, Hokubumachi, Imaizumi, Toyama
| | | | - Kimiko Usuda
- Toyama Municipal Hospital, Hokubumachi, Imaizumi, Toyama
| | - Shigeto Morimoto
- Department of Geriatric Medicine, Kanazawa Medical University, Uchinada, Kahoku-gun, Ishikawa
| | - Tadami Matsumoto
- Department of Orthopedic Medicine, Kanazawa Medical University, Uchinada, Kahoku-gun, Ishikawa, Japan
| | | | | | - Takeshi Sawaguchi
- Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Hokubumachi, Imaizumi, Toyama
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Mattisson L, Bojan A, Enocson A. Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register. BMC Musculoskelet Disord 2018; 19:369. [PMID: 30314495 PMCID: PMC6186067 DOI: 10.1186/s12891-018-2276-3] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip fractures are a major worldwide public health problem and includes two main types of fractures: the intracapsular (cervical) and the extracapsular (trochanteric and subtrochanteric) fractures. The aim of this study on patients with trochanteric and subtrochanteric hip fractures was to describe the epidemiology, treatment and outcome in terms of mortality within the context of a large register study. METHODS A descriptive epidemiological register study including patients registered in the national Swedish Fracture Register from January 2014 to December 2016. Inclusion criteria were all primary surgically treated traumatic non-pathological trochanteric and subtrochanteric femoral fractures in patients aged 18 years and above. Individual patient data (age, gender, injury location, injury cause, fracture type, treatment and timing of surgery) were retrieved from the register database. Mortality data was obtained via linkage to the Swedish Death Register. RESULTS A total of 10,548 consecutive patients were identified and included in the study. The mean (±SD) age for all patients was 82 ± 11 years and the majority of the patients were females (69%). Most of the fractures were caused by a fall at the same level (83%) at the patients' accommodation (75%). Fractures were classified using the AO/OTA classification as 31-A1 in 29%, as 31-A2 in 49% and as 31-A3 in 22% of the cases. The most commonly used implant was a short antegrade intramedullary nail (42%), followed by a plate with sliding hip screw (37%). With increasing fracture complexity, the proportion of intramedullary nails was increasing, and also the use of long versus short nails. The majority of the patients were operated within 36 h (90%). There was a higher mortality at 30 days and 1 year for males, and for all those who were delayed to surgery > 36 h. CONCLUSION Safety measures to prevent fall at elderly patient's accommodation might be a way to reduce the number of trochanteric and subtrochanteric hip fractures. Surgery as soon as possible without delay should be considered to reduce the mortality rate. The selection of surgical methods depends on the fracture complexity.
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Affiliation(s)
- Leif Mattisson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet. Department of Orthopaedics, Stockholm South General Hospital, 11883 Stockholm, Sweden
| | - Alicja Bojan
- Department of Orthopaedics, Sahlgrenska University Hospital Gothenburg/Mölndal, 431 80 Mölndal, Sweden
| | - Anders Enocson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet. Department of Orthopaedics, Stockholm South General Hospital, 11883 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, 17176 Stockholm, Sweden
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Effect of reduction quality on post-operative outcomes in 31-A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography findings. INTERNATIONAL ORTHOPAEDICS 2018; 43:1951-1959. [PMID: 30116869 PMCID: PMC6647079 DOI: 10.1007/s00264-018-4098-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022]
Abstract
Purpose To determine how the reduction of medial and anteromedial cortices using CT findings in 31-A2 intertrochanteric fractures treated with the intramedullary nail could affect the clinical outcomes and complication rates of the fractures. Methods We retrospectively analyzed the data of 43 patients with 31-A2 intertrochanteric fractures who underwent closed reduction and intramedullary internal fixation (CRIF) between January 2010 and December 2013. Patients were classified into two groups based on the post-operative CT scans taken from the sagittal and coronal planes, respectively. Five radiographic parameters and three clinical parameters were used to evaluate the post-operative functional states and mobilization levels in this study. Post-operative complications were also recorded. Results The mean loss of the femoral neck-shaft angle (FNSA) was significantly smaller in Group C1 than that in Group C2. There were significant differences in the sliding distance of the cephalic nail and the loss of femoral head height between the two groups. In terms of the reduction conditions shown on the sagittal planes, the FNSA, sliding distance of the cephalic nail, and the loss of FHH were significantly different, although differences in TCD were not significant. Patients in groups C1 (3.6%) and S1 (0.0%) had lower complication rates compared to patients in groups C2 (26.7%) and S2 (27.8%). Conclusion Patients with good reduction quality of the medial and anteromedial sustainable cortices had better clinical outcomes and lower complication rates. The sustainable stability and anti-rotational function of these validated reductions might play a critical role in maintaining the fragment positions and reducing the incidence of complications in patients. Electronic supplementary material The online version of this article (10.1007/s00264-018-4098-1) contains supplementary material, which is available to authorized users.
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