1
|
Loyst RA, Mahboubi Ardakani R, Liu SH, Cerri-Droz P, Marchese R, Komatsu DE, Wang ED. Postoperative complications associated with congestive heart failure in aseptic revision total shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2589-2594. [PMID: 38700517 DOI: 10.1007/s00590-024-03965-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/16/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE The aim of this study is to explore potential complications and risk factors associated with revision TSA in patients with congestive heart failure (CHF). METHODS This study examined all individuals who underwent revision total shoulder arthroplasty (TSA) from 2015 to 2022, sourced from the American College of Surgeons National Surgical Quality Improvement database. The analysis encompassed patient demographics, comorbidities, and 30-day postoperative complications. Logistic regression was employed to analyze the postoperative complications linked to patients with preoperative CHF. RESULTS Compared to patients without CHF, patients with CHF were significantly associated with dependent functional status (P < .001), chronic obstructive pulmonary disease (P < .001), and hypertension (P = .002). Compared to patients without CHF, patients with CHF were independently associated with a significantly greater likelihood of experiencing any complication (OR 2.19, 95% CI 1.12-4.29; P = .022) and non-home discharge (OR 3.02, 95% CI 1.37-6.65; P = .006). CONCLUSION Congestive heart failure was identified as an independent risk factor for experiencing any complication and non-home discharge in patients undergoing revision TSA. Awareness of the cardiovascular health status of a patient and its severity can influence the decision-making process when considering revision TSA. LEVEL OF EVIDENCE III Retrospective Cohort Comparison Using Large Database; Prognosis Study.
Collapse
Affiliation(s)
- Rachel A Loyst
- Department of Orthopedics, Renaissance School of Medicine, Stony Brook University Hospital, Stony Brook, NY, 11794-8181, USA.
| | - Rustin Mahboubi Ardakani
- Department of Orthopedics, Renaissance School of Medicine, Stony Brook University Hospital, Stony Brook, NY, 11794-8181, USA
| | - Steven H Liu
- Department of Orthopedics, Renaissance School of Medicine, Stony Brook University Hospital, Stony Brook, NY, 11794-8181, USA
| | - Patricia Cerri-Droz
- Department of Orthopedics, Renaissance School of Medicine, Stony Brook University Hospital, Stony Brook, NY, 11794-8181, USA
| | - Richard Marchese
- Department of Orthopedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - David E Komatsu
- Department of Orthopedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Edward D Wang
- Department of Orthopedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| |
Collapse
|
2
|
Hamdan M, Haddad BI, Almohtasib J, Eid M, Al-Din TJ, Rayyan HA, Altantawi AM, Akaheal AS, Alshrouf MA. Postoperative pneumonia after femoral fracture surgery: an in-depth retrospective analysis. BMC Musculoskelet Disord 2024; 25:413. [PMID: 38802816 PMCID: PMC11129372 DOI: 10.1186/s12891-024-07529-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Femoral fractures significantly contribute to disability, predominantly in the elderly. Despite this, data on postoperative pneumonia following femoral fracture surgeries remains sparse. Our study sought to explore the incidence and impact of postoperative pneumonia on outcomes following such surgeries. METHODS A retrospective study analyzed femoral fracture patients hospitalized from 2016 to 2022. We scrutinized postoperative outcomes, including pneumonia, hospital stay duration, intensive care unit (ICU) admissions, and in-hospital mortality. We established stringent diagnostic criteria for postoperative pneumonia, incorporating both clinical signs and radiological evidence, excluding patients with prior infections or those discharged within 24 h post-surgery. Statistical analyses involved Chi-square and t-tests, linear regression, and logestic regression using SPSS. RESULTS Out of 636 patients, 10.8% were diagnosed with postoperative pneumonia. The average age was 79.55 ± 8.57 years, with a male prevalence of 47.8%. Common comorbidities were hypertension (78.3%), diabetes (60.9%), and cardiovascular diseases (40.6%). Surgical interventions were categorized as intramedullary nailing (40.6%), partial hip replacement (37.7%), and dynamic hip screw (21.7%). Postoperative pneumonia was associated with older age (AOR = 1.053, 95% CI 1.020 to 1.087, p = 0.002), ICU admission (AOR = 2.283, 95% CI 1.256 to 4.148, p = 0.007), and longer length of hospital stay (AOR = 1.079, 95% CI 1.030 to 1.130, p = 0.001). The presence of pneumonia was associated with a 2.621-day increase in hospitalization after adjusting for other variables (p < 0.001, 95% CI: 1.454 to 3.789). CONCLUSION This study accentuates the clinical significance of postoperative pneumonia in femoral fracture patients, with a noted incidence of 10.8%. A notable association with older age, prolonged hospital stays, and ICU admissions was observed, underscoring the necessity of addressing this complication to improve patient outcomes and healthcare resource allocation.
Collapse
Affiliation(s)
- Mohammad Hamdan
- Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Bassem I Haddad
- Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Jamil Almohtasib
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Mira Eid
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | | | - Hashem A Rayyan
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | | | - Abdussalam S Akaheal
- Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | | |
Collapse
|
3
|
Sun Z, Cheng K, Jin G, Jia J. Increasing serum miR-409-3p predicts the major adverse cardiac adverse events in elderly patients after hip fracture surgery. BMC Musculoskelet Disord 2023; 24:920. [PMID: 38017411 PMCID: PMC10683352 DOI: 10.1186/s12891-023-07049-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Major adverse cardiovascular events (MACE) are critical complications responsible for the morbidity and mortality of elderly hip fracture patients. There was an urgent need to explore an effect biomarker for predicting MACE in elderly patients receiving hip fracture surgery. OBJECTIVE This study focused on an age-related miRNA, miR-409-3p, and assessed its significance in elderly hip fracture patients. METHODS A total of 267 hip fracture patients were enrolled in this study including 104 elderly patients (age ≥ 60 years). All patients were followed up for 1 year to monitor the occurrence of MACE. The risk factors for the occurrence of MACE were evaluated by the logistic regression analysis. RESULTS Elderly age and reduced cardiac and renal function were identified as risk factors for MACE in hip fracture patients. Elderly patients also showed a high incidence of MACE. In elderly hip fracture patients, significant upregulation of miR-409-3p was observed, which was associated with patients' elderly age, higher level of revised cardiac risk index (RCRI), lower left ventricular ejection fraction (LVEF), and higher levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase-MB (CK-MB), and high sensitivity troponin I (hsTnI). Additionally, miR-409-3p was identified as an independent factor for the MACE in elderly patients received hip fracture surgery. CONCLUSION Upregulated miR-409-3p was an age-related miRNA and could predict the occurrence of MACE in elderly hip fracture patients.
Collapse
Affiliation(s)
- Zhengtao Sun
- Department of Osteoarticular Surgery, Linfen People's Hospital, No.319 Gulou West Street, Yao Du District, Linfen, 041000, China
| | - Kai Cheng
- Department of Osteoarticular Surgery, Linfen People's Hospital, No.319 Gulou West Street, Yao Du District, Linfen, 041000, China
| | - Guochao Jin
- Department of Osteoarticular Surgery, Linfen People's Hospital, No.319 Gulou West Street, Yao Du District, Linfen, 041000, China
| | - Jian Jia
- Department of Osteoarticular Surgery, Linfen People's Hospital, No.319 Gulou West Street, Yao Du District, Linfen, 041000, China.
| |
Collapse
|
4
|
Gao Y, Zhang Y, Shi L, Gao W, Li Y, Chen H, Rui Y. What are Risk Factors of Postoperative Pneumonia in Geriatric Individuals after Hip Fracture Surgery: A Systematic Review and Meta-Analysis. Orthop Surg 2022; 15:38-52. [PMID: 36519396 PMCID: PMC9837248 DOI: 10.1111/os.13631] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Postoperative pneumonia (POP) is a common postoperative complication. Negative consequences associated with POP included prolonged hospital length of stay, more frequent intensive care unit (ICU) stays, and a higher rate of sepsis, readmission, and mortality. This meta-analysis aimed to assess the incidence and risk factors associated with POP after hip fracture surgery in elderly patients. PubMed, Web of Science, and Cochrane Library were searched (up to March 31, 2022). All studies on the risk factors for POP after hip fracture surgery in elderly patients, published in English, were reviewed. The qualities of the included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled, and a meta-analysis was performed. Ten studies, including 12,084 geriatric patients undergoing hip fracture surgery, were included. Of these 12,084 patients, POP occurred in 809 patients. The results indicated that age (mean difference [MD] = 4.95, 95% confidence interval [CI]: 3.22-6.69), male (odds ratio [OR] = 1.41, 95% CI: 1.02-1.93), the American Society of Anaesthesiologists classification ≥3 (OR = 3.48, 95% CI: 1.87-6.47), dependent functional status (OR = 5.23, 95% CI: 2.18-12.54, P = 0.0002), smoking (OR = 1.33, 95% CI: 1.07-1.65), chronic obstructive pulmonary disease (OR = 3.76, 95% CI: 2.07-6.81), diabetes mellitus (OR = 1.19, 95% CI: 1.01-1.40), coronary heart disease (OR = 1.74, 95% CI: 1.23-2.46), arrhythmia (OR = 1.47, 95% CI: 1.01-2.14), cerebrovascular disease (OR = 1.88, 95% CI: 1.56-2.27), dementia (OR = 2.36, 95% CI: 1.04-5.36), chronic renal failure (OR = 1.85, 95% CI: 1.29-2.67), hip arthroplasty (OR = 1.30, 95% CI: 1.08-1.56), delayed surgery (OR = 6.40, 95% CI: 3.00-13.68), preoperative creatinine (MD = 5.32, 95% CI: 0.55-10.08), and preoperative serum albumin (MD = -3.01, 95% CI: -4.21 - -1.80) were risk factors for POP. Related prophylactic measures should be provided in geriatric patients with the above-mentioned risk factors to prevent POP after hip fracture surgery.
Collapse
Affiliation(s)
- Yu‐Cheng Gao
- Department of Orthopaedics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina,School of MedicineSoutheast UniversityNanjingChina,Orthopaedic Trauma Institute (OTI)Southeast UniversityNanjingChina,Trauma Center, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Yuan‐Wei Zhang
- Department of Orthopaedics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina,School of MedicineSoutheast UniversityNanjingChina,Orthopaedic Trauma Institute (OTI)Southeast UniversityNanjingChina,Trauma Center, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina,School of MedicineSoutheast UniversityNanjingChina,Orthopaedic Trauma Institute (OTI)Southeast UniversityNanjingChina,Trauma Center, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Wang Gao
- Department of Orthopaedics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina,School of MedicineSoutheast UniversityNanjingChina,Orthopaedic Trauma Institute (OTI)Southeast UniversityNanjingChina,Trauma Center, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Ying‐Juan Li
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina,Department of Geriatrics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Hui Chen
- Department of Orthopaedics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina,School of MedicineSoutheast UniversityNanjingChina,Orthopaedic Trauma Institute (OTI)Southeast UniversityNanjingChina,Trauma Center, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Yun‐Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina,Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda HospitalSchool of Medicine, Southeast UniversityNanjingChina,School of MedicineSoutheast UniversityNanjingChina,Orthopaedic Trauma Institute (OTI)Southeast UniversityNanjingChina,Trauma Center, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| |
Collapse
|
5
|
Rosas S, Hegde V, Plate FJ, Dennis D, Jennings J, Bracey DN. Bacteremia in Patients Undergoing Debridement, Antibiotics, and Implant Retention Leads to Increased Reinfections and Costs. Arthroplast Today 2022; 16:259-263.e1. [PMID: 36092133 PMCID: PMC9458898 DOI: 10.1016/j.artd.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background Debridement, antibiotics, and implant retention (DAIR) is a common treatment for acute prosthetic joint infection (PJI). The effects of concurrent bacteremia at the time of DAIR are poorly understood. This study sought to determine whether patients with bacteremia at the time of DAIR have higher reinfection rates. Material and methods A retrospective review of a national database was performed. Patients treated with DAIR (hip or knee arthroplasty) after a diagnosis of PJI were identified. DAIR patients who also had a diagnosis of bacteremia were matched to patients without bacteremia by comorbidities and Charlson Comorbidity Index score. The primary outcome was reinfection or continued infection at 90 days and 6, 12, and 24 months after DAIR. Ninety-day Medicare charges were compared between groups. Survival probabilities were used for survival comparisons. Results A total of 9945 patients underwent DAIR after a diagnosis of PJI. Seven hundred seven patients underwent DAIR with an associated diagnosis of bacteremia. Three hundred thirty-four DAIR patients with bacteremia were successfully matched to patients without bacteremia by age, gender, and comorbidities. DAIR survivorship was significantly worse in those with bacteremia at 90 days (51.5% vs 65.9%) and 6 (43.1% vs 60.5%), 12 (36.5% vs 56.0%), and 24 months (32.6% vs 53.3%) after DAIR. The 90-day costs of DAIR were significantly greater in PJI patients with bacteremia (mean: $14,722 standard deviation: $4086 vs mean: $8,052, standard deviation: $4,153, P < .01). Conclusions Patients undergoing DAIR with bacteremia are at an increased risk of reinfection or continued infection. Ninety-day costs are significantly increased (over 50%) in patients with bacteremia vs those without bacteremia.
Collapse
|
6
|
Darbandi AD, Saadat GH, Butler BA, Bokhari F. Clinical Outcomes and Surgical Complications Among Patients with Bleeding Disorders After Acute Hip Fracture Surgery. J Orthop Trauma 2022; 36:104-110. [PMID: 35061653 DOI: 10.1097/bot.0000000000002212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare short-term (≤30 days) outcomes of hip fracture between patients with and without bleeding disorders. DESIGN Retrospective database review. SETTING The study setting included hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program database. PATIENTS Patients with acute hip fractures were identified from the National Surgical Quality Improvement Program database between 2016 and 2019. INTERVENTION Open reduction internal fixation or hemiarthroplasty. MAIN OUTCOME MEASUREMENTS Mortality, readmission, reoperation, length of stay, and complication were main outcome measurements. RESULTS There were 63,718 patients undergoing hip surgery, and 16.0% had a bleeding disorder. After adjusting for confounders, multivariable regression models showed that cases with bleeding disorders were associated with higher rates of transfusion [odds ratio (OR) 1.404; confidence interval (CI), 1.335-1.479], myocardial infarction (OR 1.367; CI, 1.190-1.572), pneumonia (OR 1.193; CI, 1.078-1.321), renal failure (OR 1.843; CI, 1.363-2.491), surgical site infections (OR 1.429; CI, 1.185-1.175), sepsis (OR 1.25; CI, 1.034-1.511), and readmission (OR 1.314; CI, 1.224-1.408). However, bleeding disorders were not associated with mortality (OR 0.947; CI, 0.866-1.036) or reoperation (OR 1.061; CI, 0.925-1.220). CONCLUSIONS Hip fracture surgery in patients with bleeding disorders is not associated with higher risks of short-term mortality or reoperation. However, special consideration should be taken when calculating preoperative risks of complications among bleeding disorder patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
| | - Ghulam H Saadat
- Department of Trauma and Burns, John H Stroger Hospital of Cook County, Chicago, IL; and
| | - Bennet A Butler
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, IL
| | - Faran Bokhari
- Department of Trauma and Burns, John H Stroger Hospital of Cook County, Chicago, IL; and
| |
Collapse
|
7
|
Ju J, Zhang P, Wang Y, Kou Y, Fu Z, Jiang B, Zhang D. A clinical nomogram predicting unplanned intensive care unit admission after hip fracture surgery. Surgery 2021; 170:291-297. [PMID: 33622571 DOI: 10.1016/j.surg.2021.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/26/2020] [Accepted: 01/08/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite the improvement of surgical procedures and perioperative management, a portion of patients were still at high risk for intensive care unit admission owing to severe morbidity after hip fracture surgeries. The purpose of this study was to analyze influencing factors and to construct a clinical nomogram to predict unscheduled intensive care unit admission among inpatients after hip fracture surgeries. METHODS We enrolled a total of 1,234 hip fracture patients, with 40 unplanned intensive care unit admissions, from January 2011 to December 2018. Demographics, chronic coexisting conditions at admission, laboratory tests, and surgical variables were collected and compared between intensive care unit admission and nonadmission groups using univariate analysis. The optimal lasso model was refined to the whole data set, and multivariate logistic regression was used to assign relative weights. A nomogram incorporating these predictors was constructed to visualize these predictors and their corresponding points of the risk for unplanned intensive care unit admission. The model was validated temporally using an independent data set from January 2019 to December 2019 by receiver operating characteristic area under the curve analysis. RESULTS In the development group, we identified age, chronic heart failure, coronary heart disease, chronic obstructive pulmonary disease, Parkinson disease, and serum albumin and creatinine concentration were associated with unscheduled intensive care unit admission using multivariate analysis. The final model had an area under the curve of 0.854 (95% confidence interval, 0.742-0.966). The median calculated odds ratio of intensive care unit admission based on the nomogram was significantly higher for patients in the intensive care unit admission group than in the non-intensive care unit admission group (65.93% vs 0.02%, P < .01). The validation group proved its high predictive power with an area under the curve of 0.96 (95% confidence interval, 0.91-0.99). CONCLUSION In this study, we identified several independent factors that may increase the risk for unexpected intensive care unit admission after hip fracture surgery and developed a clinical nomogram based on these variables. Preoperative evaluation using this nomogram might facilitate advanced intensive care unit resource management for high-risk patients whose conditions might easily deteriorate if not closely monitored in general wards after surgeries.
Collapse
Affiliation(s)
- Jiabao Ju
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Peixun Zhang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Yilin Wang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Yuhui Kou
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Zhongguo Fu
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Baoguo Jiang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Dianying Zhang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China.
| |
Collapse
|
8
|
Blanco JF, da Casa C, Pablos-Hernández C, González-Ramírez A, Julián-Enríquez JM, Díaz-Álvarez A. 30-day mortality after hip fracture surgery: Influence of postoperative factors. PLoS One 2021; 16:e0246963. [PMID: 33592047 PMCID: PMC7886122 DOI: 10.1371/journal.pone.0246963] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/28/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose The 30-day mortality rate after hip fracture surgery has been considered as an indirect indicator of the quality of care. The aim of this work is to analyse preoperative and postoperative factors potentially related to early 30-day mortality in patients over 65 undergoing hip fracture surgery. Methods Prospective cohort study including all consecutive primary hip fracture patients over 65 admitted to Trauma and Orthopaedics department from January 1, 2018 to December 31, 2019. Bed-ridden, non- surgically treated patients, and high energy trauma or tumoral aetiology fractures were excluded. A total of 943 patients were eligible (attrition rate: 2.1%). Follow-up included 30-days after discharge. We noted the 30-day mortality after hip fracture surgery, analysing 130 potentially related variables including biodemographic, fracture-related, preoperative, and postoperative clinical factors. Qualitative variables were assessed by χ2, and quantitative variables by non-parametric tests. Odds ratio determined by binary logistic regression. We selected preventable candidate variables for multivariate risk assessment by logistic regression. Results A total of 923 patients were enrolled (mean age 86.22±6.8, 72.9% women). The 30-day mortality rate was 6.0%. We noted significant increased mortality on men (OR = 2.381[1.371–4.136], p = 0.002), ageing patients (ORyear = 1.073[1.025–1.122], p = 0.002), and longer time to surgery (ORday = 1.183[1.039–1146], p<0.001), on other 20 preoperative clinical variables, like lymphopenia (lymphocyte count <103/μl, OR = 1.842[1.063–3.191], p = 0.029), hypoalbuminemia (≤3.5g/dl, OR = 2.474[1.316–4.643], p = 0.005), and oral anticoagulant intake (OR = 2.499[1.415–4.415], p = 0.002), and on 25 postoperative clinical variables, like arrhythmia (OR = 13.937[6.263–31.017], p<0.001), respiratory insufficiency (OR = 7.002[3.947–12.419], p<0.001), hyperkalaemia (OR = 10.378[3.909–27.555], p<0.001), nutritional supply requirement (OR = 3.576[1.894–6.752], p = 0.021), or early arthroplasty dislocation (OR = 6.557[1.206–35.640], p = 0.029). We developed a predictive model for early mortality after hip fracture surgery based on postoperative factors with 96.0% sensitivity and 60.7% specificity (AUC = 0.863). Conclusion We revealed that not only preoperative, but also postoperative factors have a great impact after hip fracture surgery. The influence of post-operative factors on 30-day mortality has a logical basis, albeit so far they have not been identified or quantified before. Our results provide an advantageous picture of the 30-day mortality after hip fracture surgery.
Collapse
Affiliation(s)
- Juan F. Blanco
- Trauma and Orthopaedics Department, University Hospital of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Carmen da Casa
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- * E-mail:
| | - Carmen Pablos-Hernández
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Orthogeriatric Unit, University Hospital of Salamanca, Salamanca, Spain
| | - Alfonso González-Ramírez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Orthogeriatric Unit, University Hospital of Salamanca, Salamanca, Spain
| | - José Miguel Julián-Enríquez
- Trauma and Orthopaedics Department, University Hospital of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Agustín Díaz-Álvarez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Anaesthesiology Department, University Hospital of Salamanca, Salamanca, Spain
| |
Collapse
|
9
|
Szulc P. Impact of Bone Fracture on Muscle Strength and Physical Performance-Narrative Review. Curr Osteoporos Rep 2020; 18:633-645. [PMID: 33030682 DOI: 10.1007/s11914-020-00623-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Low muscle strength and poor physical performance are associated with high risk of fracture. Many studies assessed clinical and functional outcomes of fractures. Fewer studies analyzed the impact of fractures on muscle strength and physical performance. RECENT FINDINGS Vertebral fractures (especially multiple and severe ones) are associated with back pain, back-related disability, lower grip strength, lower strength of lower limbs, lower gait speed, and poor balance. Patients with hip fracture have slower gait and lower quadriceps strength. Non-vertebral fractures were associated with lower strength of the muscles adjacent to the fracture site (e.g., grip strength in the case of distal radius fracture, knee extensors in the case of patellar fracture) and poor physical function dependent on the muscles adjacent to the fracture site (e.g., limited range of motion of the shoulder in the case of humerus fracture, gait disturbances in the case of the ankle fracture). Individuals with a fracture experience a substantial deterioration of muscle strength and physical performance which exceeds that related to aging and is focused on the period close to the fracture occurrence. After fracture, muscle strength increased and physical performance improved. The rate of normalization depended partly on the therapeutic approach and on the rehabilitation program. A subgroup of patients, mainly the elderly, never returns to the pre-fracture level of physical performance. The permanent decline of physical function after fracture may be related to the limitation of movements due to pain, low physical activity, poor health before the fracture, and reduced efficacy of retraining after immobilization.
Collapse
Affiliation(s)
- Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
| |
Collapse
|
10
|
Cha YH, Ha YC, Ryu HJ, Lee YK, Park SH, Lee KJ, Koo KH. Effect of heart failure on postoperative short and long-term mortality in elderly patients with hip fracture. Injury 2020; 51:694-698. [PMID: 31948778 DOI: 10.1016/j.injury.2020.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/04/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We designed a comparative study using elderly hip fracture patients with and without heart failure (HF). The purpose of this study was to assess 1) prevalence of HF, compare 2) early and late mortality after elderly hip fracture between HF and non-HF patients and to assess 3) risk factors of mortality after hip fractures in elderly patients with HF. In addition, we also investigated 4) whether there is a difference in mortality according to the severity of left ventricular (LV) systolic dysfunction classified by LV ejection fraction (EF) in HF patients through subgroup analysis. METHODS This study included 1992 patients (1992 hips) who were diagnosed as having unilateral femoral neck or intertrochanteric fractures and who underwent surgery at two hospitals between January 2004 and June 2018. The patients were categorized into a non-HF group (1782 patients) and a HF group (210 patients; mild [119 patients] and moderate-to- severe HF subgroups [91 patients]). The cumulative crude mortality rate was calculated, and 30-day, 60-day, 3-month, 6-month, and 1-year mortality rates were compared between the non-HF and HF. Logistic regression analysis was conducted to identify independent factors associated with mortality. RESULTS Of 1992 patients, 210 (10.5%) patients were diagnosed with HF. The 30-day, 60-day, 3-month, 6-month, and 1-year postoperative cumulative mortality rates were respectively 1.6%, 3.6%, 5.1%, 8.4%, and 12.9% in the non-HF group, and 5.7%, 9.5%, 12.4%, 17.1%, and 25.2% in the HF group (p ≤ 0.001). The factors that affected 1-year mortality were sex (OR, 2.10; 95% CI, 1.62-2.72; p < 0.001) and age (OR, 1.04; 95% CI, 1.02-1.06; p < 0.001) and presence of HF (OR, 1.62; 95% CI, 1.45-1.86; p = 0.005). In subgroup analysis, the factors that affected 30-day mortality were only moderate-to-severe HF (OR, 4.01; 95% CI, 1.10-8.78; p = 0.009). CONCLUSIONS In elderly patients with hip fracture, the comparison between the HF and non-HF patients revealed that HF was an independent factor of mortality at a minimum of 1-year follow-up, and severity of LV systolic dysfunction classified by LVEF in patients with hip fracture was also a risk factor of 30-day mortality.
Collapse
Affiliation(s)
- Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea.
| | - Hyun-Jun Ryu
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Hyun Park
- Division of Cardiology, Department of Internal Medicine, Eulji University Hospital, Daejeon, South Korea
| | - Kwang Je Lee
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| |
Collapse
|