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Dong X, Zhang X, Hu F, Yang S, Hong Z, Geng Q. Association of frailty with adverse outcomes in surgically treated geriatric patients with hip fracture: A meta-analysis and trial sequential analysis. PLoS One 2024; 19:e0305706. [PMID: 38905251 PMCID: PMC11192356 DOI: 10.1371/journal.pone.0305706] [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: 01/24/2024] [Accepted: 06/04/2024] [Indexed: 06/23/2024] Open
Abstract
OBJECTIVE Some studies have associated frailty and prognostic outcomes in geriatric hip fracture patients, but whether frailty can predict postoperative outcomes remains controversial. This review aims to assess the relationship between frailty and adverse postoperative outcomes in geriatric patients with hip fracture. METHODS Based on electronic databases, including PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, Chinese National Knowledge Infrastructure, and WanFang Data, we systematically searched for studies that investigated the association between frailty and adverse outcomes among patients aged 60 or over after hip fracture surgery. Stata 17.0 and Trial Sequential Analysis viewer software were used to obtain pooled estimates and verify whether the sample size was sufficient and the evidence robust. RESULTS Twenty-one studies involving 49,196 patients were included for quantitative analysis. Compared with nonfrail patients, frail patients had a higher risk of inpatient mortality (risk ratio [RR] = 1.93, 95% confidence interval [CI]: 1.66-2.23), 30-day mortality (RR = 2.13, 95% CI: 1.23-3.70), and 1-year mortality (RR = 2.44, 95% CI: 1.47-4.04). Frailty can significantly predict postoperative complications (RR = 1.76, 95% CI: 1.38-2.23), including delirium, pneumonia, cardiac complications, urinary tract infection, and surgical site infection; the association between frailty and deep venous thrombosis/pulmonary embolism and acute kidney injury needs further analysis. Trial sequential analysis showed that the findings regarding mortality were reliable and robust. CONCLUSION This meta-analysis provides detailed information indicating that frailty is a substantial predictor of mortality and selected postoperative complications.
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Affiliation(s)
- Xiaomeng Dong
- Department of 2 Operating Room, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Xiuguo Zhang
- Department of Nursing, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Fang Hu
- Department of 2 Operating Room, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Shuhong Yang
- Department of 2 Operating Room, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Zengchao Hong
- Department of 2 Operating Room, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Qian Geng
- Department of Nursing, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
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Forssten MP, Cao Y, Mohammad Ismail A, Tennakoon L, Spain DA, Mohseni S. Comparative Analysis of Frailty Scores for Predicting Adverse Outcomes in Hip Fracture Patients: Insights from the United States National Inpatient Sample. J Pers Med 2024; 14:621. [PMID: 38929842 PMCID: PMC11204756 DOI: 10.3390/jpm14060621] [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: 05/06/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
The aim of the current investigation was to compare the ability of several frailty scores to predict adverse outcomes in hip fracture patients. All adult patients (18 years or older) who suffered a hip fracture due to a fall and underwent surgical fixation were extracted from the 2019 National Inpatient Sample (NIS) Database. A combination of logistic regression and bootstrapping was used to compare the predictive ability of the Orthopedic Frailty Score (OFS), the Nottingham Hip Fracture Score (NHFS), the 11-factor modified Frailty Index (11-mFI) and 5-factor (5-mFI) modified Frailty Index, as well as the Johns Hopkins Frailty Indicator. A total of 227,850 patients were extracted from the NIS. In the prediction of in-hospital mortality and failure-to-rescue (FTR), the OFS surpassed all other frailty measures, approaching an acceptable predictive ability for mortality [AUC (95% CI): 0.69 (0.67-0.72)] and achieving an acceptable predictive ability for FTR [AUC (95% CI): 0.70 (0.67-0.72)]. The NHFS demonstrated the highest predictive ability for predicting any complication [AUC (95% CI): 0.62 (0.62-0.63)]. The 11-mFI exhibited the highest predictive ability for cardiovascular complications [AUC (95% CI): 0.66 (0.64-0.67)] and the NHFS achieved the highest predictive ability for delirium [AUC (95% CI): 0.69 (0.68-0.70)]. No score succeeded in effectively predicting venous thromboembolism or infections. In summary, the investigated frailty scores were most effective in predicting in-hospital mortality and failure-to-rescue; however, they struggled to predict complications.
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Affiliation(s)
- Maximilian Peter Forssten
- Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro 701 82, Sweden
- School of Medical Sciences, Orebro University, 701 82 Orebro, Sweden;
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, 701 82 Orebro, Sweden;
| | | | - Lakshika Tennakoon
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (L.T.); (D.A.S.)
| | - David A. Spain
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (L.T.); (D.A.S.)
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 701 82 Orebro, Sweden;
- Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi P.O. Box 11001, United Arab Emirates
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Alexiou K, Koutalos AA, Varitimidis S, Karachalios T, Malizos KN. Development of Prediction Model for 1-year Mortality after Hip Fracture Surgery. Hip Pelvis 2024; 36:135-143. [PMID: 38825823 PMCID: PMC11162873 DOI: 10.5371/hp.2024.36.2.135] [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: 06/28/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 06/04/2024] Open
Abstract
Purpose Hip fractures are associated with increased mortality. The identification of risk factors of mortality could improve patient care. The aim of the study was to identify risk factors of mortality after surgery for a hip fracture and construct a mortality model. Materials and Methods A cohort study was conducted on patients with hip fractures at two institutions. Five hundred and ninety-seven patients with hip fractures that were treated in the tertiary hospital, and another 147 patients that were treated in a secondary hospital. The perioperative data were collected from medical charts and interviews. Functional Assessment Measure score, Short Form-12 and mortality were recorded at 12 months. Patients and surgery variables that were associated with increased mortality were used to develop a mortality model. Results Mortality for the whole cohort was 19.4% at one year. From the variables tested only age >80 years, American Society of Anesthesiologists category, time to surgery (>48 hours), Charlson comorbidity index, sex, use of anti-coagulants, and body mass index <25 kg/m2 were associated with increased mortality and used to construct the mortality model. The area under the curve for the prediction model was 0.814. Functional outcome at one year was similar to preoperative status, even though their level of physical function dropped after the hip surgery and slowly recovered. Conclusion The mortality prediction model that was developed in this study calculates the risk of death at one year for patients with hip fractures, is simple, and could detect high risk patients that need special management.
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Affiliation(s)
- Konstantinos Alexiou
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University General Hospital of Larissa, Larissa, Greece
| | - Antonios A. Koutalos
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University General Hospital of Larissa, Larissa, Greece
| | - Sokratis Varitimidis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Theofilos Karachalios
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Jones HG, Hathaway I, Glossop S, Bhachoo H, Hoade L, Froud J, Scourfield L, Poacher AT. The clinical frailty scale as a predictor of orthopaedic outcomes: a narrative review. Injury 2024; 55:111450. [PMID: 38493521 DOI: 10.1016/j.injury.2024.111450] [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: 12/10/2023] [Revised: 02/10/2024] [Accepted: 02/24/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The Clinical Frailty Scale (CFS) is a 9-point scaling system used to categorise the frailty of patients. The CFS is well-established as a prognostic tool for decision-making within healthcare settings. However, the relationship between the CFS as a predictor for orthopaedic outcomes is limited. This review aims to provide an overview of the efficacy of the CFS as a prognostic tool for predicting orthopaedic outcomes. METHODS Systematic review using PRISMA checklist (PROSPERO registered: CRD42023456648). Ovid and PubMed databases were searched using defined search terms to identify English language papers between 2007 and June 2023 which fit the inclusion criteria. Abstract screening was carried out independently and included studies proceeded to full-text review. RESULTS 10 studies were identified. Studies used a range of outcome measures to assess success, including gross outcomes like mortality rates, as well as more specific functional outcomes, such as joint functionality scores. Studies identified that higher CFS scores correlate to poorer outcomes within orthopaedic patients. These include higher rates of mortality (41.7 % at one-year post proximal femur fracture for CFS ≥ 7), longer length of hospital stay and increased risk of adverse events post-procedure (both increased linearly from CFS 1 to 4). Additionally, the CFS was shown to be a strong prognostic tool when compared to other frailty scales. The number of studies that evaluated the relationship between the CFS and joint functionality scores is limited. CONCLUSION Higher CFS scores are associated with poorer orthopaedic outcomes. However, it is difficult to quantify the true impact due to the limited number of high-quality studies. Further work to characterise the relationship between both gross and functional outcomes associated with the utilisation of the CFS in orthopaedic settings is essential to ascertain the utility of this simple score to improve resource allocation and provide effective consent to patients.
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Affiliation(s)
- Harri G Jones
- Cardiff and Vale University Health Board, Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - Isaac Hathaway
- Swansea Bay UHB, Department of Surgery, Morriston Hospital, Swansea, UK
| | - Sean Glossop
- Cardiff University School of Medicine, Cardiff, UK
| | | | - Lucy Hoade
- Cardiff and Vale University Health Board, Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - Joseph Froud
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lily Scourfield
- King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Arwel T Poacher
- Cardiff and Vale University Health Board, Department of Surgery, University Hospital of Wales, Cardiff, UK; Cardiff University, Cardiff, Wales, UK.
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Bui M, Nijmeijer WS, Hegeman JH, Witteveen A, Groothuis-Oudshoorn CGM. Systematic review and meta-analysis of preoperative predictors for early mortality following hip fracture surgery. Osteoporos Int 2024; 35:561-574. [PMID: 37996546 PMCID: PMC10957669 DOI: 10.1007/s00198-023-06942-0] [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: 04/13/2023] [Accepted: 10/04/2023] [Indexed: 11/25/2023]
Abstract
Hip fractures are a global health problem with a high postoperative mortality rate. Preoperative predictors for early mortality could be used to optimise and personalise healthcare strategies. This study aimed to identify predictors for early mortality following hip fracture surgery. Cohort studies examining independent preoperative predictors for mortality following hip fracture surgery were identified through a systematic search on Scopus and PubMed. Predictors for 30-day mortality were the primary outcome, and predictors for mortality within 1 year were secondary outcomes. Primary outcomes were analysed with random-effects meta-analyses. Confidence in the cumulative evidence was assessed using the GRADE criteria. Secondary outcomes were synthesised narratively. Thirty-three cohort studies involving 462,699 patients were meta-analysed. Five high-quality evidence predictors for 30-day mortality were identified: age per year (OR: 1.06, 95% CI: 1.04-1.07), ASA score ≥ 3 (OR: 2.69, 95% CI: 2.12-3.42), male gender (OR: 2.00, 95% CI: 1.85-2.18), institutional residence (OR: 1.81, 95% CI: 1.31-2.49), and metastatic cancer (OR: 2.83, 95% CI: 2.58-3.10). Additionally, six moderate-quality evidence predictors were identified: chronic renal failure, dementia, diabetes, low haemoglobin, heart failures, and a history of any malignancy. Weak evidence was found for non-metastatic cancer. This review found relevant preoperative predictors which could be used to identify patients who are at high risk of 30-day mortality following hip fracture surgery. For some predictors, the prognostic value could be increased by further subcategorising the conditions by severity.
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Affiliation(s)
- Michael Bui
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands.
| | - Wieke S Nijmeijer
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609, PP, Almelo, The Netherlands
| | - Johannes H Hegeman
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609, PP, Almelo, The Netherlands
| | - Annemieke Witteveen
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
| | - Catharina G M Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
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Cedeno-Veloz B, Lozano-Vicario L, Rodríguez-García A, Zambom-Ferraresi F, Galbete A, Fernández-Irigoyen J, Santamaría E, García-Hermoso A, Calvani R, Ramírez-Vélez R, Izquierdo M, Martínez-Velilla N. Serum biomarkers related to frailty predict negative outcomes in older adults with hip fracture. J Endocrinol Invest 2024; 47:729-738. [PMID: 37603268 DOI: 10.1007/s40618-023-02181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE Hip fracture is a public health problem worldwide. Traditional prognostic models do not include blood biomarkers, such as those obtained by proteomics. This study aimed to investigate the relationships between serum inflammatory biomarkers and frailty in older adults with hip fracture as well as adverse outcomes at one and three months after discharge. METHODS A total of 45 patients aged 75 or older who were admitted for hip fracture were recruited. At admission, a Comprehensive Geriatric Assessment (CGA) was conducted, which included a frailty assessment using the Clinical Frailty Scale (CFS). Blood samples were collected before surgery. Participants were followed up at one and three months after discharge. The levels of 45 cytokines were analyzed using a high-throughput proteomic approach. Binary logistic regression was used to determine independent associations with outcomes, such as functional recovery, polypharmacy, hospital readmission, and mortality. RESULTS The results showed that IL-7 (OR 0.66 95% CI 0.46-0.94, p = 0.022) and CXCL-12 (OR 0.97 95% CI 0.95-0.99, p = 0.011) were associated with better functional recovery at three months after discharge, while CXCL-8 (OR 1.07 95% CI 1.01-1.14, p = 0.019) was associated with an increased risk of readmission. CONCLUSIONS These findings suggest that immunology biomarkers may represent useful predictors of clinical outcomes in hip fracture patients.
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Affiliation(s)
- B Cedeno-Veloz
- Geriatric Department, Navarre University Hospital (HUN), Irunlarrea 3, 31008, Pamplona, Navarra, Spain.
- Navarrabiomed-Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008, Pamplona, Navarra, Spain.
- Public University of Navarre, Av Cataluña s/n, 31006, Pamplona, Navarra, Spain.
| | - L Lozano-Vicario
- Geriatric Department, Navarre University Hospital (HUN), Irunlarrea 3, 31008, Pamplona, Navarra, Spain
- Navarrabiomed-Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008, Pamplona, Navarra, Spain
- Public University of Navarre, Av Cataluña s/n, 31006, Pamplona, Navarra, Spain
| | - A Rodríguez-García
- Geriatric Department, Navarre University Hospital (HUN), Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - F Zambom-Ferraresi
- Geriatric Department, Navarre University Hospital (HUN), Irunlarrea 3, 31008, Pamplona, Navarra, Spain
- Navarrabiomed-Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008, Pamplona, Navarra, Spain
- Public University of Navarre, Av Cataluña s/n, 31006, Pamplona, Navarra, Spain
| | - A Galbete
- Public University of Navarre, Av Cataluña s/n, 31006, Pamplona, Navarra, Spain
| | - J Fernández-Irigoyen
- Navarrabiomed-Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - E Santamaría
- Navarrabiomed-Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - A García-Hermoso
- Navarrabiomed-Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - R Calvani
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168, Rome, Italy
| | - R Ramírez-Vélez
- Navarrabiomed-Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008, Pamplona, Navarra, Spain
- Public University of Navarre, Av Cataluña s/n, 31006, Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
| | - M Izquierdo
- Navarrabiomed-Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008, Pamplona, Navarra, Spain
- Public University of Navarre, Av Cataluña s/n, 31006, Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
| | - N Martínez-Velilla
- Geriatric Department, Navarre University Hospital (HUN), Irunlarrea 3, 31008, Pamplona, Navarra, Spain
- Navarrabiomed-Institute for Health Research of Navarra (IDISNA), Irunlarrea 3, 31008, Pamplona, Navarra, Spain
- Public University of Navarre, Av Cataluña s/n, 31006, Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Av Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
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Arjan K, Weetman S, Hodgson L. Validation and updating of the Older Person's Emergency Risk Assessment (OPERA) score to predict outcomes for hip fracture patients. Hip Int 2023; 33:1107-1114. [PMID: 36787163 DOI: 10.1177/11207000231154879] [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] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Hip fractures are associated with significant morbidity and mortality in older people. Accurate risk stratification is important for planning of care, informed decision-making and communication with patients and relatives. The Older Persons' Emergency Risk Assessment (OPERA) score is a risk stratification score for older people admitted to hospital. Our aims were to validate OPERA in hip fracture patients, update the score and compare performance with the Nottingham Hip Fracture Score (NHFS). METHODS This dual-centre 3-year observational study (2016-2018) included acutely admitted hip fracture patients managed surgically aged ⩾65 years. The primary outcome was 30-day mortality. Secondary outcomes included residence at 120 days and 1-year mortality. Model performance was assessed using area under the curve (AUC) analysis and Brier scores (discrimination) and calibration curves. The OPERA score was updated using regression analysis with additional independent predictors and validated using bootstrap analysis. RESULTS 2142 patients (median age 86 [80-91] years) were included with a 30-day mortality of 5.2% and a 1-year mortality of 31.4%. 30-day mortality AUC for OPERA was 0.75 (95% CI, 0.73-0.77) and for NHFS 0.68 (0.65-0.70). For 1-year mortality AUC for OPERA was 0.74 (0.73-0.75) and for NHFS 0.70 (0.69-0.71). The OPERA Score was updated to Hip-OPERA, including ASA grade. Hip-OPERA demonstrated an AUC for 30-day mortality of 0.77 (0.73-0.81) and an AUC for 1-year mortality of 0.76 (0.75-0.77). AUC for new residential care status at 120 days was 0.79 (0.78-0.80). CONCLUSIONS Hip-OPERA demonstrated superior discrimination to the NHFS and OPERA for 30-day mortality, 1-year mortality and residence at 120 days following hip fracture. External validation is desirable.
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Affiliation(s)
- Khushal Arjan
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Stefan Weetman
- Intensive Care Department, Worthing hospital, University Sussex Hospitals NHS Foundation Trust, Worthing, UK
- Department of Clinical and Experimental Medicine, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Luke Hodgson
- Intensive Care Department, Worthing hospital, University Sussex Hospitals NHS Foundation Trust, Worthing, UK
- Department of Clinical and Experimental Medicine, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
- Honorary Clinical Reader, Brighton and Sussex Medical School, Brighton, UK
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Karres J, Eerenberg JP, Vrouenraets BC, Kerkhoffs GMMJ. Prediction of long-term mortality following hip fracture surgery: evaluation of three risk models. Arch Orthop Trauma Surg 2023; 143:4125-4132. [PMID: 36334140 PMCID: PMC10293368 DOI: 10.1007/s00402-022-04646-4] [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: 08/16/2022] [Accepted: 10/07/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Several prognostic models have been developed for mortality in hip fracture patients, but their accuracy for long-term prediction is unclear. This study evaluates the performance of three models assessing 30-day, 1-year and 8-year mortality after hip fracture surgery: the Nottingham Hip Fracture Score (NHFS), the model developed by Holt et al. and the Hip fracture Estimator of Mortality Amsterdam (HEMA). MATERIALS AND METHODS Patients admitted with a fractured hip between January 2012 and June 2013 were included in this retrospective cohort study. Relevant variables used by the three models were collected, as were mortality data. Predictive performance was assessed in terms of discrimination with the area under the receiver operating characteristic curve and calibration with the Hosmer-Lemeshow goodness-of-fit test. Clinical usefulness was evaluated by determining risk groups for each model, comparing differences in mortality using Kaplan-Meier curves, and by assessing positive and negative predictive values. RESULTS A total of 344 patients were included for analysis. Observed mortality rates were 6.1% after 30 days, 19.1% after 1 year and 68.6% after 8 years. The NHFS and the model by Holt et al. demonstrated good to excellent discrimination and adequate calibration for both short- and long-term mortality prediction, with similar clinical usefulness measures. The HEMA demonstrated inferior prediction of 30-day and 8-year mortality, with worse discriminative abilities and a significant lack of fit. CONCLUSIONS The NHFS and the model by Holt et al. allowed for accurate identification of low- and high-risk patients for both short- and long-term mortality after a fracture of the hip. The HEMA performed poorly. When considering predictive performance and ease of use, the NHFS seems most suitable for implementation in daily clinical practice.
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Affiliation(s)
- Julian Karres
- Department of Orthopaedic Surgery, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | | | | | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Ou Y, Wang H, Yang L, Jiang W. Frailty is associated with an increased risk of postoperative pneumonia in elderly patients following surgical treatment for lower-extremity fractures: A cross-sectional study. Medicine (Baltimore) 2023; 102:e33557. [PMID: 37058022 PMCID: PMC10101317 DOI: 10.1097/md.0000000000033557] [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: 01/07/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
Elderly patients with lower-extremity fractures are at high risk of postoperative pneumonia (POP) after surgery due to longtime bed rest. This study aimed to explore whether preoperative frailty is an independent risk factor for POP in elderly patients undergoing surgical treatment for lower-extremity fractures. The study adopted a cross sectional design with 568 patients (≥60 years) admitted to a tertiary hospital in China from January 1, 2021 to June 30, 2022, for surgical intervention of a significant lower-extremity fracture. Preoperative frailty was assessed using the CFS (Clinical Frailty Scale). POP was assessed based on the classic diagnostic criteria reported in previous studies. Univariate and multiple logistic regression analyses were conducted to determine the impacts of preoperative frailty on POP. Of the 568 elderly patients, 65 (11.4%) developed pneumonia during postoperative hospitalization. There were significant differences among gender, hypoproteinemia, type of anesthesia, history of chronic obstructive pulmonary disease (COPD), and CFS scores. Multiple regression analysis revealed that the risk of POP in vulnerable, mildly frail, and severely frail patients increased by 2.38 times (P = .01, 95% CI [1.22-1.91]), 3.32 (P = .00, 95% CI [2.39-5.61]), and 5.36 (P = .00, 95% CI [3.95-6.52]), significantly. 12.8% of patients with hip fractures and 8.9% of patients with other main types of lower-extremity fractures developed POP. However, the difference between hip and non-hip fractures was not statistically significant (P > .05). Preoperative frailty increases the risk of POP in elderly patients after surgical treatment of main lower-extremity fractures. The severer the preoperative frailty is, the higher the risk of preoperative pneumonia is in elderly patients with lower-extremity fractures. CFS is simple and feasible for the assessment of frailty in elderly patients with lower-extremity fractures. Preoperative frailty assessment and appropriate management strategies should be considered in the perioperative management of elderly patients with lower-extremity fractures.
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Affiliation(s)
- Yili Ou
- Department of Orthopedics, Deyang People’s Hospital/Orthopedic Center of Deyang City, Deyang, China
| | - Hong Wang
- Department of Orthopedics, Deyang People’s Hospital/Orthopedic Center of Deyang City, Deyang, China
| | - Ling Yang
- Department of Orthopedics, Deyang People’s Hospital/Orthopedic Center of Deyang City, Deyang, China
| | - Wei Jiang
- Department of Orthopedics, Deyang People’s Hospital/Orthopedic Center of Deyang City, Deyang, China
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Stubbs TA, Doherty WJ, Chaplin A, Langford S, Reed MR, Sayer AA, Witham MD, Sorial AK. Using pre-fracture mobility to augment prediction of post-operative outcomes in hip fracture. Eur Geriatr Med 2023; 14:285-293. [PMID: 37002428 PMCID: PMC10113355 DOI: 10.1007/s41999-023-00767-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023]
Abstract
Abstract
Purpose
Pre-operative scores based on patient characteristics are commonly used to predict hip fracture outcomes. Mobility, an indicator of pre-operative function, has been neglected as a potential predictor. We assessed the ability of pre-fracture mobility to predict post-operative outcomes following hip fracture.
Methods
We analysed prospectively collected data from hip fracture surgery patients at a large-volume trauma unit. Mobility was classified into four groups. Post-operative outcomes studied were mortality and residence at 30 days, medical complications within 30- or 60-days post-operatively, and prolonged length of stay (LOS, ≥ 28 days). We performed multivariate regression analyses adjusting for age and sex to assess the discriminative ability of the Nottingham Hip Fracture Score (NHFS), with and without mobility, for predicting outcomes using the area under the receiver operating characteristic curve (AUROC).
Results
1919 patients were included, mean age 82.6 (SD 8.2); 1357 (70.7%) were women. Multivariate analysis demonstrated patients with worse mobility had a 1.7–5.5-fold higher 30-day mortality (p ≤ 0.001), and 1.9–3.2-fold higher likelihood of prolonged LOS (p ≤ 0.001). Worse mobility was associated with a 2.3–3.8-fold higher likelihood of living in a care home at 30-days post-operatively (p < 0.001) and a 1.3–2.0-fold higher likelihood of complications within 30 days (p ≤ 0.001). Addition of mobility improved NHFS discrimination for discharge location, AUROC NHFS 0.755 [0.733–0.777] to NHFS + mobility 0.808 [0.789–0.828], and LOS, AUROC NHFS 0.584 [0.557–0.611] to NHFS + mobility 0.616 [0.590–0.643].
Conclusion
Incorporating mobility assessment into risk scores may improve casemix adjustment, prognostication following hip fracture, and identify high-risk patient groups requiring enhanced post-operative care at admission.
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Affiliation(s)
- Thomas A Stubbs
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle-Upon-Tyne, NE4 5PL, UK
| | - William J Doherty
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle-Upon-Tyne, NE4 5PL, UK
| | - Andrew Chaplin
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, NE27 0QJ, UK
| | - Sarah Langford
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, NE27 0QJ, UK
| | - Mike R Reed
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, NE27 0QJ, UK
| | - Avan A Sayer
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle-Upon-Tyne, NE4 5PL, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle-Upon-Tyne, NE4 5PL, UK.
| | - Antony K Sorial
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, NE27 0QJ, UK.
- Institute for Cell and Molecular Biosciences, Newcastle University, International Centre for Life, Newcastle Upon Tyne, NE1 3BZ, UK.
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11
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Yan B, Sun W, Wang W, Wu J, Wang G, Dou Q. Prognostic significance of frailty in older patients with hip fracture: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2022; 46:2939-2952. [PMID: 36227383 DOI: 10.1007/s00264-022-05605-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Hip fracture (HF) has become a major healthcare concern associated with higher mortality in older patients. Frailty is one of the most important problems in aging population but its prognostic value in HF remains susceptible. This systematic review and meta-analysis aimed to evaluate the association between frailty and adverse outcomes in older patients with HF. METHODS We systematically searched electrical databases including PubMed and Embase to find eligible literature with end-search restriction of February 20, 2021. The main endpoints were all-cause mortality, peri-operative complications, abnormal discharge, and length of stay (LOS). Pooled effect size was calculated by random-effects or fixed-effect model according to study heterogeneity. Three subgroup analyses based on follow-up times, study design, and frailty criteria were conducted. RESULTS We screened 22 studies out of 1599 identified studies in our analysis. Compared with normal patients, frail ones had a higher risk of mortality both before (OR = 3.48, 95% CI: 2.50-4.85, I2 = 87.2%, P < 0.001) and after (OR = 1.87, 95% CI: 1.44-2.44, I2 = 85.5%, P < 0.001) adjustment. The incidence of peri-operative complications, abnormal discharge, and prolonged LOS also significantly increased in frail subjects. There was no publication bias observed and the pooled results were stable based on sensitivity analysis. CONCLUSION Overall, more attention needs to be paid to the prognostic effects caused by frailty in seniors with HF. Better understanding of the association between frailty and adverse outcomes in HF could help doctors perform co-management across orthopaedic and geriatric departments.
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Affiliation(s)
- Bingzi Yan
- West China School of Medicine, Sichuan University, Renmin South Road, No. 17, Wuhou District, Chengdu, 610041, China
| | - Wanting Sun
- West China School of Medicine, Sichuan University, Renmin South Road, No. 17, Wuhou District, Chengdu, 610041, China
| | - Wen Wang
- Chinese Evidence-Based Medicine Center and CREAT Group, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Centre, Chengdu, Sichuan, China
| | - Jinhui Wu
- National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, No. 37, Guoxue Rd, Wuhou District, Chengdu, 610041, China
| | - Guanglin Wang
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, No. 37, Wuhou Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Qingyu Dou
- National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, No. 37, Guoxue Rd, Wuhou District, Chengdu, 610041, China.
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12
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Karres J, Zwiers R, Eerenberg JP, Vrouenraets BC, Kerkhoffs GMMJ. Mortality Prediction in Hip Fracture Patients: Physician Assessment Versus Prognostic Models. J Orthop Trauma 2022; 36:585-592. [PMID: 35605101 PMCID: PMC9555757 DOI: 10.1097/bot.0000000000002412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate 2 prognostic models for mortality after a fracture of the hip, the Nottingham Hip Fracture Score and Hip Fracture Estimator of Mortality Amsterdam and to compare their predictive performance to physician assessment of mortality risk in hip fracture patients. DESIGN Prospective cohort study. SETTING Two level-2 trauma centers located in the Netherlands. PATIENTS Two hundred forty-four patients admitted to the Emergency Departments of both hospitals with a fractured hip. INTERVENTION Data used in both prediction models were collected at the time of admission for each individual patient, as well as predictions of mortality by treating physicians. MAIN OUTCOME MEASURES Predictive performances were evaluated for 30-day, 1-year, and 5-year mortality. Discrimination was assessed with the area under the curve (AUC); calibration with the Hosmer-Lemeshow goodness-of-fit test and calibration plots; clinical usefulness in terms of accuracy, sensitivity, and specificity. RESULTS Mortality was 7.4% after 30 days, 22.1% after 1 year, and 59.4% after 5 years. There were no statistically significant differences in discrimination between the prediction methods (AUC 0.73-0.80). The Nottingham Hip Fracture Score demonstrated underfitting for 30-day mortality and failed to identify the majority of high-risk patients (sensitivity 33%). The Hip fracture Estimator of Mortality Amsterdam showed systematic overestimation and overfitting. Physicians were able to identify most high-risk patients for 30-day mortality (sensitivity 78%) but with some overestimation. Both risk models demonstrated a lack of fit when used for 1-year and 5-year mortality predictions. CONCLUSIONS In this study, prognostic models and physicians demonstrated similar discriminating abilities when predicting mortality in hip fracture patients. Although physicians overestimated mortality, they were better at identifying high-risk patients and at predicting long-term mortality. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Julian Karres
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ruben Zwiers
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, The Netherlands
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13
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Farrow L, Brasnic L, Martin C, Ward K, Adam K, Hall AJ, Clement ND, MacLullich AMJ. A nationwide study of blood transfusion in hip fracture patients. Bone Joint J 2022; 104-B:1266-1272. [DOI: 10.1302/0301-620x.104b11.bjj-2022-0450.r1] [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] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to examine perioperative blood transfusion practice, and associations with clinical outcomes, in a national cohort of hip fracture patients. Methods A retrospective cohort study was undertaken using linked data from the Scottish Hip Fracture Audit and the Scottish National Blood Transfusion Service between May 2016 and December 2020. All patients aged ≥ 50 years admitted to a Scottish hospital with a hip fracture were included. Assessment of the factors independently associated with red blood cell transfusion (RBCT) during admission was performed, alongside determination of the association between RBCT and hip fracture outcomes. Results A total of 23,266 individual patient records from 18 hospitals were included. The overall rate of blood transfusion during admission was 28.7% (n = 6,685). There was inter-hospital variation in transfusion rate, ranging from 16.6% to 37.4%. Independent perioperative factors significantly associated with RBCT included older age (90 to 94 years, odds ratio (OR) 3.04 (95% confidence interval (CI) 2.28 to 4.04); p < 0.001), intramedullary fixation (OR 7.15 (95% CI 6.50 to 7.86); p < 0.001), and sliding hip screw constructs (OR 2.34 (95% CI 2.19 to 2.50); p < 0.001). Blood transfusion during admission was significantly associated with higher rates of 30-day mortality (OR 1.35 (95% CI 1.19 to 1.53); p < 0.001) and 60-day mortality (OR 1.54 (95% CI 1.43 to 1.67); p < 0.001), as well as delays to postoperative mobilization, higher likelihood of not returning to their home, and longer length of stay. Conclusion Blood transfusion after hip fracture was common, although practice varied nationally. RBCT is associated with adverse outcomes, which is most likely a reflection of perioperative anaemia, rather than any causal effect. Use of RBCT does not appear to reverse this effect, highlighting the importance of perioperative blood loss reduction. Cite this article: Bone Joint J 2022;104-B(11):1266–1272.
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Affiliation(s)
- Luke Farrow
- Institute of Applied Health Sciences, University of Aberdeen College of Life Sciences and Medicine, Aberdeen, UK
- Grampian Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - Lorena Brasnic
- Institute of Applied Health Sciences, University of Aberdeen College of Life Sciences and Medicine, Aberdeen, UK
| | - Caroline Martin
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - Kirsty Ward
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - Karen Adam
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - Andrew J. Hall
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK
| | - Nick D. Clement
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alasdair M. J. MacLullich
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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14
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Brown R, Gatfield S, Rogers M, Peter N, Torrie A. Clinical frailty score: A useful tool in predicting outcomes in patients with fragility fractures. TRAUMA-ENGLAND 2022. [DOI: 10.1177/14604086221112823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Frailty is a known risk factor for falls and subsequent fractures and is linked to greater hospitalisation, morbidity, and mortality in various areas of medicine. A 2017 Trauma Audit and Research Network (TARN) report identified that further research was needed to determine the effect of frailty on outcomes in trauma patients. The UK Best Practice Tariff currently awards a financial incentive for frailty scoring for all patients sustaining major trauma who are managed at Major Trauma Centres (MTCs). However, this currently does not extend to Trauma Units (TUs) or to patients without major trauma. This retrospective cohort study sought to investigate whether frailty also has a significant effect on outcomes in patients presenting with fragility fractures presenting to trauma units without major trauma. Methods Notes from all patients aged ≥65 admitted to Gloucestershire Royal Hospital in 2019 with any fragility fracture were reviewed retrospectively. Age, injury, length of stay, and mortality were recorded. A Clinical Frailty Score (CFS) was assigned retrospectively using the Rockwood Clinical Frailty Scale. Results Eight hundred sixty patients were reviewed (male:female 258:602, mean age 83 ± 8.2). Each consecutive stepwise increase in CFS was independently associated with an average cumulative increase in mortality rate at 30-day and 1 year (OR 1.55 and 1.58 respectively, p < 0.001), as well as average cumulative percentage increase in length of stay (OR 1.094, p < 0.001). Conclusion Clinical frailty score independently predicts adverse outcome in patients with fragility fractures managed at trauma units. Clinical frailty score could be used to easily identify patients at risk of poorer outcomes and may assist in allocation of limited orthogeriatric resources and future BPT guidelines. Further work should promote recognition of frailty within trauma settings, investigate how additional resources affect outcomes for patients of varying degrees of frailty, and consider multicentre studies relating to frailty-associated outcomes in trauma.
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Affiliation(s)
- Robyn Brown
- Gloucestershire Royal Hospital, Gloucester, UK
| | | | | | - Noel Peter
- Gloucestershire Royal Hospital, Gloucester, UK
| | - Alex Torrie
- Gloucestershire Royal Hospital, Gloucester, UK
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15
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Song Y, Wu Z, Huo H, Zhao P. The Impact of Frailty on Adverse Outcomes in Geriatric Hip Fracture Patients: A Systematic Review and Meta-Analysis. Front Public Health 2022; 10:890652. [PMID: 35844855 PMCID: PMC9280195 DOI: 10.3389/fpubh.2022.890652] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/13/2022] [Indexed: 01/10/2023] Open
Abstract
ObjectiveWith an aging population and advances in medicine, more research focuses on health and longevity in geriatric adults. Recently, frailty has gradually emerged to assess physical conditions. Frailty can be generally described as a multi-dimensional situation of increased vulnerabilities to both endogenous and exogenous stressors. The objective of the review was to evaluate the predictive value of frailty on adverse outcomes in geriatric hip fracture patients.Materials and MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane library for relevant literature about the connection between frailty and poor outcomes in hip fracture elders.ResultsEleven studies involving a total of 45,979 participants were selected in our study. Our results indicated that frailty could significantly predict postoperative and in-patient complications (OR, 1.46; 95% CI, 1.13–1.90; I2 = 77.4%). Frail elders had higher risk of inpatient mortality (OR, 1.68; 95% CI, 1.26–2.25; I2 = 0.0%), 6-month mortality (OR, 1.46; 95% CI, 1.25–1.72; I2 = 0.0%) and ≥1-year mortality (OR, 2.24; 95% CI, 1.66–3.04; I2 = 91.3%). Furthermore, the risk of prolonged hospital stays was 1.15 times more likely in frail patients (95% CI, 1.03–1.28; I2 = 14.8%).ConclusionFrailty can predict adverse outcomes effectively in geriatric hip fracture patients.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails.
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Affiliation(s)
- Yanhong Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ziyi Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Huihui Huo
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ping Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Ping Zhao
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16
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Ma Y, Wang A, Lou Y, Peng D, Jiang Z, Xia T. Effects of Frailty on Outcomes Following Surgery Among Patients With Hip Fractures: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:829762. [PMID: 35402430 PMCID: PMC8984086 DOI: 10.3389/fmed.2022.829762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022] Open
Abstract
Background Frailty is a syndrome of multisystem dysfunction in the elderly. The association between preoperative frailty and postoperative outcomes in patients with hip fractures is unclear. To address this issue, we performed a meta-analysis to determine the association of frailty with postoperative mortality, complications, and readmission in patients with hip fractures. Methods We searched PubMed, Web of Science, Embase, and The Cochrane Library for cohort studies of frailty associated with postoperative adverse events in patients with hip fractures from inception to November 6, 2021. The Newcastle-Ottawa Scale was used to evaluate the quality of the included literature. Statistical analysis of meta-analysis was performed using Review Manager 5.3. Results Twelve retrospective cohort studies and seven prospective cohort studies involving a total of 62,132 patients met the inclusion criteria for this meta-analysis. Compared with non-frail patients, the pooled results showed that frailty was associated with patient in-hospital mortality (relative risk [RR] = 2.93; 95% confidence intervals [CI]: 2.56–3.34), 30-day mortality (RR = 2.85, 95%CI: 1.67–4.85) and total complications (RR = 1.79, 95%CI: 1.50–2.15). Subgroup analysis showed that the type of study design and frailty assessment tool had no significant effect on the results. Sensitivity analysis showed that the polled results of frailty predicted one-year mortality and 30-day readmission was unstable. Conclusions In this meta-analysis, we found that preoperative frailty may be associated with postoperative adverse events in patients with hip fractures, including in-hospital mortality, 30-day mortality, and postoperative complications. Systematic Review Registration: PROSPERO, identifier: CRD42021287739.
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Affiliation(s)
- Yan Ma
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Ansu Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yijiao Lou
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Daojuan Peng
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Zhongyan Jiang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Tongxia Xia
- Nursing School, Zunyi Medical University, Zunyi, China
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- *Correspondence: Tongxia Xia
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17
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Paterni S, Okoye C, Calabrese AM, Niccolai F, Polini A, Caraccio N, Calsolaro V, Monzani F. Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture. Front Endocrinol (Lausanne) 2021; 12:770400. [PMID: 34867813 PMCID: PMC8637116 DOI: 10.3389/fendo.2021.770400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/22/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies have shown increased risk of fracture in older patients with poor or strict glycemic control (glycated hemoglobin, HbA1c, ≥ 8% or < 6-7% respectively); however, these reports did not investigate the oldest-old population. Comprehensive geriatric assessment (CGA) and a patient-centered approach have been proven to improve the quality of care in the management of Type 2 Diabetes Mellitus (T2DM) in the older patients, but data regarding T2DM in patients with fragility fractures are still lacking. AIM To investigate the prognostic role of HbA1c and frailty level in older diabetic patients admitted for hip fracture. METHODS Prospective observational cohort study conducted on diabetic geriatric patients consecutively hospitalized for hip fracture in the orthogeriatric unit of a tertiary care hospital. Preoperative comprehensive geriatric assessment (CGA) was performed. Using the Clinical Frailty Scale (CFS), diabetic patients were categorized in robust (CFS < 5) and frail (CFS ≥ 5), and further stratified according to HbA1c values [Tertile 1 (T1) HbA1c < 48 mmol/mol, Tertile 2 (T2) 48-58 mmol/mol and Tertile 3 (T3) > 58 mmol/mol). Comparisons between continuous variables were performed with analysis of non-parametric test for independent samples, while relationships between categorical variables were assessed by chi-square test. Using logistic multivariate regression, we evaluated the determinants of 1-year all-cause mortality in diabetic older patients with hip fracture. RESULTS Among the 1319 older patients (mean age 82.8 ± 7.5 years, 75.9% females) hospitalized for hip fracture, 204 (15.5%) had a previous diagnosis of T2DM. T2DM patients showed an increased proportion of multiple concurrent fractures occurred during the accidental fall or syncope (12.7% vs 11.2%, p=0.02). One-year mortality after hip fracture surgery was significantly higher in T2DM as compared to not diabetic patients (21.2% vs 12.5%, p<0.001). No significant difference in mortality was found across HbA1c tertiles; however, frail diabetic patients in the second and third HbA1c tertiles showed higher mortality risk compared to the robust counterparts (26.9% vs 5%, p=0.001 for T2 and 43.5% vs 13.3%, p=<0.05 for T3), while no difference was observed among those in T1. CONCLUSIONS Frail patients with HbA1c ≥ 48 mmol/L showed an increased mortality risk as compared to robust counterparts. CFS represents an important tool to select diabetic subjects with higher likelihood of adverse outcome.
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