1
|
Pass B, Sieben D, Malek F, Hussmann B, Maek T, Aigner R, Bliemel C, Dirkmann D, Lendemans S, Schoeneberg C. Liberal intraoperative fluid management leads to increased complication rates in geriatric patients with hip fracture. Eur J Trauma Emerg Surg 2023; 49:2485-2493. [PMID: 37436466 DOI: 10.1007/s00068-023-02326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/01/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Fractures of the proximal femur in geriatric patients are life-changing and life-threatening events. Previous research has identified fluid volume as an independent factor contributing to trauma patients' complications. Therefore, we aimed to investigate the impact of intraoperative fluid volume on outcomes in geriatric patients undergoing hip fracture surgery. METHODS We conducted a retrospective single-center study with data from the hospital information systems. Our study included patients aged 70 years or older who had sustained a proximal femur fracture. We excluded patients with pathologic, periprosthetic, or peri-implant fractures and those with missing data. Based on the fluids given, we divided patients into high-volume and low-volume groups. RESULTS Patients with a higher American Society of Anesthesiologists (ASA) grade and more comorbidities were more likely to receive more than 1500 ml of fluids. We observed significant differences in anesthesiologic management between the two groups, with a higher rate of invasive blood pressure management (IBP) and central venous catheter usage in the high-volume group. High-volume therapy was associated with a higher rate of complications (69.7% vs. 43.6%, p < 0.01), a higher transfusion rate (odds ratio 1.91 [1.26-2.91]), and an increased likelihood of patients being transferred to an intensive care unit (17.1% vs. 6.4%, p = 0.009). These findings were confirmed after adjusting for ASA grade, age, sex, type of fracture, Identification-of-Seniors-At-Risk (ISAR) score, and intraoperative blood loss. CONCLUSIONS Our study suggests that intraoperative fluid volume is a significant factor that impacts the outcome of hip fracture surgery in geriatric patients. High-volume therapy was associated with increased complications.
Collapse
Affiliation(s)
- Bastian Pass
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Denis Sieben
- Department of Orthopedics, Emergency Surgery and Hand Surgery, Florence-Nightingale-Hospital, Duesseldorf, Germany
| | - Fahd Malek
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Bjoern Hussmann
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
- Department of Orthopedics and Trauma Surgery, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
- Department of Orthopedics and Trauma Surgery, Alfried Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany.
| | - Teresa Maek
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Rene Aigner
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Daniel Dirkmann
- Department of Anesthesiology, Intensive Care and Pain Medicine, Alfried Krupp Hospital, Essen, Germany
| | - Sven Lendemans
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany
| | - Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany
| |
Collapse
|
2
|
Babagoli M, Ghaseminejad Raeini A, Sheykhvatan M, Baghdadi S, Shafiei SH. Influencing factors on morbidity and mortality in intertrochanteric fractures. Sci Rep 2023; 13:12090. [PMID: 37495718 PMCID: PMC10372085 DOI: 10.1038/s41598-023-38667-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023] Open
Abstract
We aimed to evaluate the effect of the patient's clinical and paraclinical condition before and after surgery on short-term mortality and complication and long-term mortality. A retrospective cohort study was conducted and multivariate logistic regression was applied to determine the effect of demographic characteristics (sex, age, AO/OTA classification, height, weight, body mass index), medical history (hypertension, ischemic heart disease, diabetes mellitus, thyroid malfunction, cancer, osteoporosis, smoking) lab data (Complete blood cell, blood sugar, Blood Urea Nitrogen, Creatinine, Na, and K), surgery-related factors (Anesthesia time and type, implant, intraoperative blood transfusion, postoperative blood transfusion, and operation time), duration of admission to surgery and anticoagulant consumption on short-term mortality and complication and long-term mortality. Three hundred ten patients from November 2016 to September 2020 were diagnosed with an intertrochanteric fracture. 3.23% of patients died in hospital, 14.1% of patients confronted in-hospital complications, and 38.3% died after discharge till the study endpoint. ΔNumber of Neutrophiles is the primary determinant for in-hospital mortality in multivariate analysis. Age and blood transfusion are the main determinants of long-term mortality, and Na before surgery is the primary variable associated with postoperative complications. Among different analytical factors Na before surgery as a biomarker presenting dehydration was the main prognostic factor for in hospital complications. In hospital mortality was mainly because of infection and long-term mortality was associated with blood transfusion.
Collapse
Affiliation(s)
- Mazyar Babagoli
- Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Mehrdad Sheykhvatan
- Orthopedic Surgery Research Center, Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soroush Baghdadi
- Pediatric Orthopaedic Surgery Department, Montefiore Medical Center, New York, USA
| | - Seyyed Hossein Shafiei
- Orthopedic Surgery Research Center, Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Kusen JQ, Beeres FJP, van der Vet PCR, Poblete B, Geuss S, Babst R, Knobe M, Wijdicks FJG, Link BC. Inter-rater agreement in pPOSSUM scores of geriatric trauma patients: a prospective evaluation. Arch Orthop Trauma Surg 2022; 142:3869-3876. [PMID: 35031826 DOI: 10.1007/s00402-021-04275-3] [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: 06/20/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Risk prediction models are widely used in the perioperative setting to identify high-risk patients who may benefit from additional care and to aid clinical decision-making. pPOSSUM is such a prediction model, however, little is known about the inter-rater agreement when scoring subjective parameters. This study assessed the inter-rater agreement between clinicians of different specialties and work-level when scoring 30 clinical case reports of geriatric hip fracture patients with pPOSSUM. METHODS Eighteen clinicians of the department of Surgery (three specialists, four residents), Anaesthesiology (four specialists, two residents) and Emergency Medicine (three specialists, two residents) who were familiar with the pPOSSUM scoring system were asked to calculate the scores. The kappa statistic and the statistical method of Fleiss were used to analyse inter-rater agreement. RESULTS The response rate was 100%. Among surgeons, Anaesthesiologists and Emergency department doctors (ED), the overall mean kappa values were 0.42, 0.08 and 0.20, respectively. Among surgery, anaesthesiology and ED residents the overall mean kappa values were 0.21, 0.33 and 0.37, respectively. Within the department of Surgery, Anaesthesiology and Emergency Medicine the overall mean kappa values were 0.23, 0.12 and 0.22, respectively. An overall mean kappa value of 0.19 was seen among all specialists. All residents had an overall mean kappa value of 0.21 and all clinicians had an overall mean kappa value of 0.21. CONCLUSION The overall inter-rater agreement of clinicians and interdisciplinary agreement when scoring geriatric hip fracture patients with pPOSSUM was low and prone to subjectivity in our study. A higher work-experience level did not lead to better agreement. When pPOSSUM is calculated without clinical assessment by the same clinician, caution is advised to prevent over-reliance on the pPOSSUM risk prediction model. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Jip Q Kusen
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland.
- Department of Orthopaedic and Trauma Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland
| | - Puck C R van der Vet
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland
- Department of Orthopaedic and Trauma Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Beate Poblete
- Department of Anaesthesiology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Steffen Geuss
- Department of Emergency Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland
- Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland
| | - Franciscus J G Wijdicks
- Department of Orthopaedic and Trauma Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Björn C Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland.
| |
Collapse
|
4
|
Postoperative Dehydration Is Associated with Frailty and Decreased Survival in Older Patients with Hip Fracture. Nutrients 2022; 14:nu14040820. [PMID: 35215470 PMCID: PMC8880665 DOI: 10.3390/nu14040820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Hyperosmolar dehydration (HD) is a risk factor for severe complications in hip fracture in older patients. However, evidence for recommending screening of dehydration is insufficient and its relation with frailty and mortality is unclear. We tested the hypothesis that postoperative HD is associated with frailty and increased mortality. METHODS We recruited 625 older (>65 years) patients surgically treated for hip fracture and co-managed by an orthogeriatric team over one year in 2017. Pre- and postoperative HD (serum osmolarity > 300 mmol/L) was diagnosed. Frailty and associated mortality risk were assessed by the Multidimensional Prognostic Index (MPI). RESULTS The prevalence of preoperative HD was 20.4%. Compared with no-HD, MPI was similar in HD patients despite higher (p < 0.05) prevalence of polypharmacy, arterial hypertension, diabetes, chronic kidney disease and heart failure. After surgery the incidence of HD decreased to 16.5%, but increased (p = 0.003) in the MPI high-risk subgroup. Postoperative HD was associated with more complications and was an independent determinant of adjusted hospital length of stay (LOS) and of 60- to 365-days mortality. CONCLUSIONS Older frail patients with hip fracture are prone to developing postoperative HD, which independently predicts prolonged hospital LOS and mortality. Systematically screening older patients for frailty and dehydration is advisable to customize hydration management in high-risk individuals.
Collapse
|