1
|
Tzen YT, Sambandam S, Delmore B, Wang J, Chu A, Wukich DK. Clinical Risk Factors of Perioperative Pressure Injury in Older Adult Patients with a Hip Fracture. Adv Skin Wound Care 2023; 36:642-650. [PMID: 37983577 DOI: 10.1097/asw.0000000000000068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To examine the clinical risk factors of perioperative pressure injury (PrI) in older adults with a hip fracture, including preoperative chronic comorbidities and postoperative complications. METHODS In this retrospective study, the authors queried the PearlDiver Patient Records database between January 2011 and January 2020. Data from 54,194 patients without preexisting PrI were included for analyses. Patients were separated into two groups: (1) one or more perioperative PrI and (2) no PrI. Clinical factors as outcome variables include 21 comorbidities and 10 complications. RESULTS Univariate analyses were computed to compare the variables between groups, and two logistic regression models were developed to find comorbidity predictors and complication predictors. Of all patients, 1,362 (2.5%) developed one or more perioperative PrI. Patients with perioperative PrIs were more likely to be older men. One-year mortality for patients with perioperative PrI was 2.5 times that of patients without PrI. The regression models showed that predictors of perioperative PrI are malnutrition, hypoalbuminemia, frailty, peripheral vascular disease, dementia, urinary tract infection, perioperative red blood cell transfusion, and atrial fibrillation. CONCLUSIONS Screening for these comorbidities and complications may assist in determining the risk of PrI in older adults undergoing hip fracture surgery. Determining PrI risk enables the appropriate prevention strategies to be applied perioperatively.
Collapse
Affiliation(s)
- Yi-Ting Tzen
- Yi-Ting Tzen, PhD, is Assistant Professor, Department of Applied Clinical Research, and Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Senthil Sambandam, MD, is Assistant Professor, Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, and Division of Orthopedic Surgery, Veterans Affairs North Texas Health Care System, Dallas. Barbara Delmore, PhD, RN, CWCN, MAPWCA, FAAN, is Senior Nurse Scientist, Center for Innovations in the Advancement of Care, and Clinical Assistant Professor, Hansjörg Wyss, Department of Plastic Surgery, NYU Langone Health, New York. Jijia Wang, PhD, is Assistant Professor, Department of Applied Clinical Research, University of Texas Southwestern Medical Center. Andy Chu, MS, RD, CDN, CNSC, is Registered Dietitian, Food and Nutrition Services, NYU Langone Health. Dane K. Wukich, MD, is Professor, Department of Orthopedic Surgery, University of Texas Southwestern Medical Center. Conflict of Interest: Dr Wukich serves as consultant with Orthofix Medical Inc, Stryker, and Wright Medical and receives royalties from Arthrex Inc. The authors have disclosed no other financial relationships related to this article. Submitted August 5, 2022; accepted in revised form January 4, 2023
| | | | | | | | | | | |
Collapse
|
2
|
Closure of pressure injury and mortality in internal medicine wards. Eur Geriatr Med 2023; 14:373-380. [PMID: 36780106 DOI: 10.1007/s41999-023-00757-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/01/2023] [Indexed: 02/14/2023]
Abstract
PURPOSE The prevalence of pressure injury (PI) in hospitalized patients ranges from 5 to 15%, and is significantly greater in critical care and palliative care units. Prevalence of PI is considered an indicator of health care quality and is associated with increased morbidity and mortality. The study aims to determine the features of PI and its association with mortality among hospitalized patients in the inpatient service of a university hospital. METHODS The present study comprised 89 patients hospitalized on the internal medicine inpatient service who had PI at the time of hospitalization and or who developed PI during hospitalization. Patients were categorized based on the state of PI closure (complete/incomplete). Mortality rates for 1 month, 3 months, 6 months, and 1 year were computed. RESULTS The median age was 74. (IQR: 62-82). Forty-eight patients were female, and 15.7% of hospitalized patients had PI. A third of patients died during their index hospitalization. Patients with completely closed PI had decreased one-month, three-month, six-month, and one-year mortality rates. Complete closure of PI influenced all four mortality rates independently of other parameters, as determined by Cox regression analysis of the factors impacting mortality. CONCLUSION As life expectancy rises, the frequency of PI increases, resulting in a rise in health care expenses. To reduce these expenses, prevention, early identification, and treatment of PI are essential. The primary finding of the study is that complete closure of PI in hospitalized patients reduces the risk of death.
Collapse
|
3
|
Modifiable factors associated with postoperative atrial fibrillation in older patients with hip fracture in an orthogeriatric care pathway: a nested case–control study. BMC Geriatr 2022; 22:845. [DOI: 10.1186/s12877-022-03556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Few data are available regarding post-operative atrial fibrillation (POAF) in non-cardiothoracic surgery, particularly orthopedic surgery. Hence, given the frequent incidence of POAF after surgery and its marked impact, we need to identify modifiable factors associated with POAF after hip fracture surgery in older patients.
Methods
We conducted a nested case–control study in the unit for perioperative geriatric care of an academic hospital in Paris from July 1, 2009 to December 31, 2019, enrolling all consecutive patients aged ≥ 70 years with hip fracture surgery and no history of permanent AF before admission (retrospective analysis of prospectively collected data). Patients with and without POAF were matched 1:5 on 5 baseline characteristics (age, hypertension, diabetes, coronary artery disease, cardiac failure).
Results
Of the 757 patients included, 384 were matched, and 64 had POAF. The incidence of POAF was 8.5%. The mean age was 86 ± 6 years, 298 (78%) patients were female, and the median Charlson Comorbidity Index was 6 (interquartile range 4–8). The median time from surgery to the occurrence of POAF was 2 days (1–4). On multivariable conditional logistic regression analysis (matched cohort), the modifiable factors present at admission associated with POAF were time to surgery > 48 h (odds ratio [OR] = 1.66, 95% confidence interval [1.01–2.81]) and > 2 units of packed red blood cells (OR = 3.94, [1.50–10.03]).
Conclusions
This study provides new information about POAF in older patients with hip fracture surgery, a surgical emergency whose complexity requires multidisciplinary care.
Collapse
|
4
|
Sasabe Y, Niitani M, Teramoto C, Yamaga S, Shime N, Tanabe K, Kataoka T, Sawatari H. Deep sedation predicts pressure injury in patients admitted to intensive care units. Nurs Crit Care 2022; 27:877-884. [PMID: 35048476 DOI: 10.1111/nicc.12753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/22/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients in intensive care units (ICU) are frequently prescribed sedatives, which might increase the risk for pressure injury (PI). Although the association between sedation and incidence of PI has been noted, the adequate sedation level to prevent the incidence of PI in patients admitted to ICU is still unclear. AIM This study aimed to investigate the association between fluctuating sedation levels and the incidence of PI in patients admitted to ICU. STUDY DESIGN We retrospectively reviewed the medical records of 104 patients admitted to ICU. Data regarding the length of ICU stay (LOS) and comorbid infection were abstracted from medical records. The Richmond Agitation-Sedation Scale (RASS) was scored twice per day, and the standardized RASS (S-RASS, summation of RASS values divided by the number of samples) was used to evaluate changes in sedation levels. RESULTS Among the 104 included patients, 65 patients (62.5%) were male (median age: 68.0 years), and 13 patients (12.5%) had PI during ICU admission. S-RASS scores were lower in patients with PI than in those without PI (P = .0001) even after adjustment for confounders (OR [95%CI]: 0.14 [0.03-0.58], P = .006). The LOS and infections were higher in patients with PI than in those without PI (P < .0001 and P = .005, respectively). The cut-off value of S-RASS for PI incidence was -3.2 (sensitivity: 88%; specificity: 85%), and a significant predictor of PI incidence (HR [95%CI]: 20.07 [2.53-159.11], P = .005). CONCLUSIONS Deeper sedation levels based on S-RASS scores, which account for the effects of fluctuating sedation levels, were a strong, highly accurate predictor of PI incidence in patients admitted to ICU. RELEVANCE TO CLINICAL PRACTICE Assessing fluctuations in the level of sedation using the S-RASS might help to identify sedative-induced PI in patients admitted to ICU.
Collapse
Affiliation(s)
- Yayoi Sasabe
- Department of Nursing, Hiroshima University Hospital, Hiroshima, Japan
| | - Mayumi Niitani
- Department of Nursing, Graduate School of Nursing, Yasuda Women's University, Hiroshima, Japan
| | - Chie Teramoto
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoshi Yamaga
- Department of Radiation Disaster Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuaki Tanabe
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Hiroyuki Sawatari
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
5
|
Impacto do comanejo multidisciplinar em desfechos de pacientes com fratura de quadril. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao014566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
6
|
Amini M, Mansouri F, Vafaee K, Janbakhsh A, Mahdavikian S, Moradi Y, Fallahi M. Factors affecting the incidence and prevalence of pressure ulcers in COVID-19 patients admitted with a Braden scale below 14 in the intensive care unit: Retrospective cohort study. Int Wound J 2022; 19:2039-2054. [PMID: 35322547 PMCID: PMC9111574 DOI: 10.1111/iwj.13804] [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: 11/11/2021] [Accepted: 03/14/2022] [Indexed: 12/24/2022] Open
Abstract
The pandemic of coronavirus (COVID‐19) has significantly increased the admission of patients with extensive complications, especially for respiratory support, to intensive care units (ICUs) worldwide. These patients also suffer from pressure ulcers (PUs) as another complication that occurs due to increased length of hospitalisation and acute conditions of patients. Therefore, this study aimed to evaluate the incidence and prevalence of PU and the factors affecting it in COVID‐19 patients admitted to ICUs. This cohort retrospective study used registry data in Imam Reza Hospital located in west of Iran. Four hundred and forty‐five COVID‐19 patients older than 20 years hospitalised in corona ICUs from 20 March 2020 to 30 December 2020, with a Braden score of less than 14 were included in the study. To investigate the relationship between variables in rate prevalence, univariate logistic regression analysis was used to calculate odds ratio, and for incidence rate in estimating PU risk generated in ICUs, hazard ratio was calculated using cox regression. One hundred and eighty‐three (41.12%) patients were male. The mean age of patients was 63 (SD = ±9.78) years. A total of 1152 cases of PU were generated, with the highest prevalence of PU with 234 cases in the sacrum. One hundred and seventy‐six (55.87%) patients underwent non‐invasive ventilation ulcers. The prevalence of PU was 79.7%. The highest prevalence was found in people over 80 years with 90.67%. The incidence ratio was 46.74%. The highest number of new cases was seen in diabetic patients with 60.96%. First‐degree ulcers were the most common degree of ulceration in 252 (55.38%) patients. Incidence and prevalence excluding first‐degree wounds were 24.04% and 49.66%, respectively. Age, Braden score, BMI, comorbidity, diabetes mellitus, stool incontinence, Glasgow coma scale, vasopressor, and length of hospital stay were significantly associated with PU (P < .05). The incidence and prevalence of PU in patients were high in this study. The length of hospitalisation and Braden score were the most important factors in the development of PU. The widespread prevalence of COVID‐19 and the relatively long stay of patients in the ICU created unfavourable conditions for patients and the treatment system, therefore, it emphasised the use of appropriate measures to prevent PU to avoid double costs and longer stays.
Collapse
Affiliation(s)
- Mahin Amini
- Behavioral Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Feizollah Mansouri
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kamran Vafaee
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Janbakhsh
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Somayeh Mahdavikian
- Nursing Department, Nursing and Midwifery School, Kermanshah University of Medical Sciences Sciences, Kermanshah, Iran
| | - Yasaman Moradi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Fallahi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
7
|
Chung ML, Widdel M, Kirchhoff J, Sellin J, Jelali M, Geiser F, Mücke M, Conrad R. Risk Factors for Pressure Injuries in Adult Patients: A Narrative Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020761. [PMID: 35055583 PMCID: PMC8776011 DOI: 10.3390/ijerph19020761] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/29/2021] [Accepted: 01/02/2022] [Indexed: 01/27/2023]
Abstract
Pressure injuries remain a serious health complication for patients and nursing staff. Evidence from the past decade has not been analysed through narrative synthesis yet. PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews/sources were screened. Risk of bias was evaluated using a slightly modified QUIPS tool. Risk factor domains were used to assign (non)statistically independent risk factors. Hence, 67 studies with 679,660 patients were included. In low to moderate risk of bias studies, non-blanchable erythema reliably predicted pressure injury stage 2. Factors influencing mechanical boundary conditions, e.g., higher interface pressure or BMI < 18.5, as well as factors affecting interindividual susceptibility (male sex, older age, anemia, hypoalbuminemia, diabetes, hypotension, low physical activity, existing pressure injuries) and treatment-related aspects, such as length of stay in intensive care units, were identified as possible risk factors for pressure injury development. Health care professionals' evidence-based knowledge of above-mentioned risk factors is vital to ensure optimal prevention and/or treatment. Openly accessible risk factors, e.g., sex, age, BMI, pre-existing diabetes, and non-blanchable erythema, can serve as yellow flags for pressure injury development. Close communication concerning further risk factors, e.g., anemia, hypoalbuminemia, or low physical activity, may optimize prevention and/or treatment. Further high-quality evidence is warranted.
Collapse
Affiliation(s)
- Man-Long Chung
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany; (F.G.); (R.C.)
- Correspondence:
| | - Manuel Widdel
- Institute of Product Development and Engineering De sign, Technische Hochschule Köln, 50679 Cologne, Germany; (M.W.); (J.K.); (M.J.)
| | - Julian Kirchhoff
- Institute of Product Development and Engineering De sign, Technische Hochschule Köln, 50679 Cologne, Germany; (M.W.); (J.K.); (M.J.)
| | - Julia Sellin
- Department of Digitalization and General Practice, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.S.); (M.M.)
| | - Mohieddine Jelali
- Institute of Product Development and Engineering De sign, Technische Hochschule Köln, 50679 Cologne, Germany; (M.W.); (J.K.); (M.J.)
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany; (F.G.); (R.C.)
| | - Martin Mücke
- Department of Digitalization and General Practice, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.S.); (M.M.)
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany; (F.G.); (R.C.)
| |
Collapse
|
8
|
Yang Q, Li J, Shi D, Xie H, Wang J, Shi Z, Zhang Y. Incidence and risk factors associated with hospital-acquired pressure ulcers following total hip arthroplasty: A retrospective nationwide inpatient sample database study. J Tissue Viability 2022; 31:332-338. [DOI: 10.1016/j.jtv.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 12/25/2022]
|
9
|
Genet B, Lamy T, Cohen-Bittan J, Glasman P, Verny M, Riou B, Boddaert J, Zerah L. Lack of Association Between Perioperative Medication and Postoperative Delirium in Hip Fracture Patients in an Orthogeriatric Care Pathway. J Am Med Dir Assoc 2021; 23:623-630.e2. [PMID: 34653382 DOI: 10.1016/j.jamda.2021.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/07/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Units for perioperative geriatric care are playing a growing role in the care of older patients after hip fracture surgery. Postoperative delirium is one of the most common complications after hip fracture, but no study has assessed the impact of therapeutics received during a dedicated orthogeriatric care pathway on its incidence. Our main objective was to assess the association between drugs used in emergency, operating, and recovery departments and postoperative delirium during the acute stay. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS All patients ≥70 years old admitted for hip fracture to the emergency department and hospitalized in our unit for perioperative geriatric care after hip fracture surgery under general anesthesia between July 2009 and December 2019 in an academic hospital in Paris. METHODS Demographic, clinical, and biological data and all medications administered pre-, peri-, and postoperatively were prospectively collected by 3 geriatricians. Postoperative delirium in the unit for perioperative geriatric care was assessed by using the confusion assessment method scale. Logistic regression analysis was used to assess variables independently associated with postoperative delirium. RESULTS A total of 490 patients were included [mean (SD) age 87 (6) years]; 215 (44%) had postoperative delirium. The occurrence was not associated with therapeutics administered during the dedicated orthogeriatric care pathway. Probability of postoperative delirium was associated with advanced age [>90 years, odds ratio (OR) 2.03, 95% confidence interval (CI) 1.07-3.89], dementia (OR 3.51, 95% CI 2.14--5.82), depression (OR 1.85, 95% CI 1.14-3.01), and preoperative use of beta-blockers (OR 1.75, 95% CI 1.10-2.79). CONCLUSIONS AND IMPLICATIONS No emergency or anesthetic drugs were significantly associated with postoperative delirium. Further studies are needed to demonstrate a possible causal link between preoperative use of beta-blockers and postoperative delirium.
Collapse
Affiliation(s)
- Bastien Genet
- Department of Geriatric Medicine, Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France.
| | - Tina Lamy
- Department of Geriatric Medicine, Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France
| | - Judith Cohen-Bittan
- Department of Geriatric Medicine, Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France
| | - Pauline Glasman
- Department of Anesthesiology and Critical Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France
| | - Marc Verny
- Department of Geriatric Medicine, Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France; Team Neuronal Cell Biology and Pathology, Sorbonne Université, UMR CNRS 8256, Paris, France
| | - Bruno Riou
- Department of Emergency Medicine and Surgery, Sorbonne Université, UMRS INSERM 1166, IHU ICAN, APHP, Hôpital la Pitié-Salpêtrière, Paris, France
| | - Jacques Boddaert
- Department of Geriatric Medicine, Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France; Sorbonne Université, UMR INSERM 1135, Paris, France
| | - Lorène Zerah
- Department of Geriatric Medicine, Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France; Sorbonne Université, UMRS INSERM 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| |
Collapse
|
10
|
González de Villaumbrosia C, Sáez López P, Martín de Diego I, Lancho Martín C, Cuesta Santa Teresa M, Alarcón T, Ojeda Thies C, Queipo Matas R, González-Montalvo JI. Predictive Model of Gait Recovery at One Month after Hip Fracture from a National Cohort of 25,607 Patients: The Hip Fracture Prognosis (HF-Prognosis) Tool. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073809. [PMID: 33917348 PMCID: PMC8038738 DOI: 10.3390/ijerph18073809] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/20/2022]
Abstract
The aim of this study was to develop a predictive model of gait recovery after hip fracture. Data was obtained from a sample of 25,607 patients included in the Spanish National Hip Fracture Registry from 2017 to 2019. The primary outcome was recovery of the baseline level of ambulatory capacity. A logistic regression model was developed using 40% of the sample and the model was validated in the remaining 60% of the sample. The predictors introduced in the model were: age, prefracture gait independence, cognitive impairment, anesthetic risk, fracture type, operative delay, early postoperative mobilization, weight bearing, presence of pressure ulcers and destination at discharge. Five groups of patients or clusters were identified by their predicted probability of recovery, including the most common features of each. A probability threshold of 0.706 in the training set led to an accuracy of the model of 0.64 in the validation set. We present an acceptably accurate predictive model of gait recovery after hip fracture based on the patients’ individual characteristics. This model could aid clinicians to better target programs and interventions in this population.
Collapse
Affiliation(s)
| | - Pilar Sáez López
- Hospital Universitario Fundación Alcorcón, Instituto de Investigación Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Isaac Martín de Diego
- Data Science Lab, Universidad Rey Juan Carlos, 28933 Móstoles, Spain; (I.M.d.D.); (C.L.M.); (M.C.S.T.)
| | - Carmen Lancho Martín
- Data Science Lab, Universidad Rey Juan Carlos, 28933 Móstoles, Spain; (I.M.d.D.); (C.L.M.); (M.C.S.T.)
| | | | - Teresa Alarcón
- Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz, 28046 Madrid, Spain; (T.A.); (J.I.G.-M.)
| | | | | | - Juan Ignacio González-Montalvo
- Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz, 28046 Madrid, Spain; (T.A.); (J.I.G.-M.)
| | | |
Collapse
|
11
|
Tarazona-Santabalbina FJ, Ojeda-Thies C, Figueroa Rodríguez J, Cassinello-Ogea C, Caeiro JR. Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3049. [PMID: 33809573 PMCID: PMC7999190 DOI: 10.3390/ijerph18063049] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms "hip fracture", "geriatric assessment", "second hip fracture", "surgery", "perioperative management" and "orthogeriatric care", in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.
Collapse
Affiliation(s)
- Francisco José Tarazona-Santabalbina
- Department of Geriatric Medicine, Hospital Universitario de la Ribera, Alzira, 46600 Valencia, Spain
- CIBERFES, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, Instituto Carlos III, 28029 Madrid, Spain
| | - Cristina Ojeda-Thies
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Jesús Figueroa Rodríguez
- Department of Physical Medicine and Rehabilitation, Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | | | - José Ramón Caeiro
- Department of Orthopaedics and Traumatology, Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| |
Collapse
|
12
|
Zhang LM, Hornor MA, Robinson T, Rosenthal RA, Ko CY, Russell MM. Evaluation of Postoperative Functional Health Status Decline Among Older Adults. JAMA Surg 2021; 155:950-958. [PMID: 32822459 DOI: 10.1001/jamasurg.2020.2853] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Functional outcomes have value for older adults who undergo surgical procedures. Preventing postoperative functional decline in this patient population necessitates the identification of the factors associated with this outcome and minimizing their implications. Objectives To assess the prevalence of functional decline 30 days after a surgical procedure among older adults 80 years or older, examine the risk factors of this decline, and identify ways to minimize this decline by addressing its mutable factors. Design, Setting, and Participants This retrospective cohort study used patient data from the Geriatric Surgery Pilot Project, a multi-institutional data registry of the American College of Surgeons National Surgical Quality Improvement Program. Inclusion criteria were patients 80 years or older who underwent a surgical procedure that required an inpatient stay at 1 of 23 hospitals enrolled in the Geriatric Surgery Pilot Project from January 1, 2015, to December 31, 2018, and had preoperative and postoperative functional health status data. Data analysis was performed from January 7, 2019, to December 2, 2019. Exposures Adults 80 years or older who underwent an inpatient surgical procedure. Main Outcomes and Measures The primary outcome was 30-day postoperative functional decline defined by a change in functional health status from admission or before the surgical procedure (ie, from independent to partially or totally dependent, or from partially dependent to totally dependent). Functional health status was measured by a patient's ability to perform activities of daily living. Secondary outcomes were hospital readmission and 30-day postoperative living location. Results Of the 2013 patients analyzed in this study, 1128 were women (56.0%) and the mean (SD) age was 84.9 (3.9) years. Functional decline at 30 days after the surgical procedure was present in 406 patients (20.2%). Prevalence of this outcome increased with age, with 337 of 1751 patients aged 80 to 89 years (19.2%) experiencing decline compared with 69 of 262 patients 90 years or older (26.3%). In a risk-adjusted model, the geriatric-specific risk factors statistically significantly associated with this outcome included preoperative mobility aid use (odds ratio [OR] 1.76; 95% CI, 1.39-2.22; P < .001) and malnutrition (OR, 1.88; 95% CI, 1.04-3.43; P = .04) as well as postoperative delirium (OR, 2.20; 95% CI, 1.60-3.02; P < .001), pressure ulcer (OR, 1.83; 95% CI, 1.02-3.30; P = .04), and mobility aid at discharge (OR, 2.49; 95% CI, 1.72-3.59; P < .001). Among patients with a 30-day functional decline, 106 (26.1%) required hospital readmission and only 219 (53.9%) were living at home compared with 388 patients (95.6%) living at home before the procedure. Conclusions and Relevance In this study, 1 in 5 older adults experienced a functional decline that persisted 30 days after a surgical procedure, an outcome that appeared to be associated with several geriatric-specific risk factors. Future trials are needed to evaluate whether the prevention or mitigation of these factors can decrease the rates of postoperative functional decline in this patient population.
Collapse
Affiliation(s)
- Lindsey M Zhang
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.,Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Melissa A Hornor
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Thomas Robinson
- Department of Surgery, University of Colorado-Denver, Aurora
| | | | - Clifford Y Ko
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.,Department of Surgery, University of California, Los Angeles, Los Angeles
| | - Marcia M Russell
- Department of Surgery, University of California, Los Angeles, Los Angeles
| |
Collapse
|
13
|
Sayan HE, Girgin NK, Asan A. Prevalence of pressure ulcers in hospitalized adult patients in Bursa, Turkey: A multicentre, point prevalence study. J Eval Clin Pract 2020; 26:1669-1676. [PMID: 32040245 DOI: 10.1111/jep.13354] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/29/2019] [Accepted: 01/01/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Pressure ulcers (PUs), which are preventable complications, increase the cost of health care and the risk of prolonged hospital stay, as well as morbidity and mortality. In this study, we aimed to describe the prevalence, clinical features, and risk factors for PUs among hospitalized patients. METHOD This study was cross-sectional and conducted over a single day in all the care units. Data were recorded on a patient observation form that included demographic data, diagnosis of admission to the hospital or intensive care unit (ICU), comorbidity and chronic diseases, location, stage of PU, and Braden Scale score. Acute physiology and chronic health evaluation (APACHE) II score, Glasgow coma score (GCS), PaO2 /FiO2 ratio, and albumin level were recorded for ICU patients. RESULTS A total of 1548 adult patients participated in the study. Of these patients, 177 (11.43%) had PU. The patients with PU had more advanced age, lower body mass index (BMI), and longer duration of hospital and ICU stay (for all P = .001). Evaluation of PU in the first 24 hours after hospital admission and the last PU evaluation time also showed a significant effect (both P = .001). Braden Scale score less than or equal to 13 in the first evaluation after hospital admission increased the risk of PU. Albumin was 2.78 ± 0.57 gm/dL in ICU patients, and albumin level was significantly lower in patients with PU (P = .001). PUs were located mainly in the sacrum (47.59%) and were classified as stage II (42.76%) for all patients. CONCLUSIONS The prevalence of PU is related to the age and severity of patient clinical status, as predicted by the Braden Scale score and APACHE II score, and length of hospital and ICU stay. Low albumin level is also related to development of PUs in ICU patients.
Collapse
Affiliation(s)
- Halil Erkan Sayan
- Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Nermin Kelebek Girgin
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ali Asan
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| |
Collapse
|
14
|
Moon Y, Han SH, Kim YS, Shin J, Uhm KE, Jeon HJ, Choi J, Lee J. Hospital adverse outcomes of the elderly in a tertiary referral hospital: A prospective cohort study of 9,586 admissions. Arch Gerontol Geriatr 2020; 92:104253. [PMID: 33032184 DOI: 10.1016/j.archger.2020.104253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/21/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate the hospital adverse outcomes (HAO) of admitted older adult patients in a large prospective cohort and investigate the demographic, economic, and health-related characteristics at risk of HAO in all older adult patients admitted in the general ward of a tertiary referral hospital. MATERIALS AND METHODS We recruited admission episodes of older adult patients aged over 65 years who were admitted at the general ward of Konkuk University Medical Center, which is a tertiary referral hospital, from September 2016 to October 2017. Out of 9,586 admission episodes, 8,263 were included. Modified from the Geriatric Screening for Care-10, six common geriatric health issues, namely, dysphagia, polypharmacy, fecal incontinence, functional mobility, depression, and dementia, were evaluated. Fall, hospital-acquired pressure ulcer (HPU), and mortality were checked daily by experienced nurses during the patients' hospital stay. A logistic regression model was used, and P < 0.05 was the threshold of significance. RESULTS The incidence rates of fall and HPU were 1.3 % and 4.0 %, respectively. The hospital mortality was 6.1 %. Older adult patients with dysphagia or dementia upon admission were significantly associated with an increased likelihood of falls. Furthermore, age, ER admission, low income, fecal incontinence, or functional immobility increased the HPU incidence. Meanwhile, age, male, ER admission, fecal incontinence, or functional immobility significantly increased the hospital mortality. CONCLUSION All demographic, economic, and health-related characteristics, except for polypharmacy and depression, affect the incidence of HAO. Intervention to vulnerable older adult patients with HAO risk could improve the treatment outcome.
Collapse
Affiliation(s)
- Yeonsil Moon
- Department of Neurology, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea; Center for Geriatric Neuroscience Research, Institute of Biomedical Science, Konkuk University, Seoul, Republic of Korea
| | - Yoon-Sook Kim
- Department of Quality Improvement, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea
| | - Kyeong Eun Uhm
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hong Jun Jeon
- Department of Psychiatry, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jaekyung Choi
- Department of Family Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea.
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
15
|
Fritz A, Gericke L, Höch A, Josten C, Osterhoff G. Time-to-treatment is a risk factor for the development of pressure ulcers in elderly patients with fractures of the pelvis and acetabulum. Injury 2020; 51:352-356. [PMID: 31843198 DOI: 10.1016/j.injury.2019.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/05/2019] [Accepted: 12/08/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Fractures of the pelvis and acetabulum are associated with pain and immobilization and, hence, pose the risk of developing a pressure ulcer - especially in elderly patients. In the literature, information on risk factors for the occurrence of pressure ulcers related to geriatric pelvic or acetabulum fractures is missing. METHODS Consecutive in-hospital patients aged 55 years or older treated for closed pelvis and/or acetabulum fractures between 2013 and 2017 were retrospectively identified from an institutional prospective database. Epidemiologic characteristics and patient specifics with special focus on the time from admission to treatment, duration of hospitalization and comorbidities were retrospectively assessed by chart review. RESULTS During the evaluated interval, 407 patients with isolated fractures of the pelvis or acetabulum (mean age 78 years, range 55 to 101 years, 69,3% female) were treated. A new pressure ulcer that developed during the hospitalization was observed in 46/407 patients (11.3%). This included pressure ulcers of stage 1 in 18/46 cases (39%), stage 2 in 24/46 cases (52%), and stage 3 in 4/46 cases (9%). No stage 4 ulcers were seen in this cohort. The mean duration of hospitalization was longer in patients with a pressure ulcer (25 days, SD 17) than in patients with no ulcers (12 days, SD 9; p < .001). Patients who developed a pressure ulcer, had waited significantly longer for treatment of their pelvis/acetabulum fracture when compared to patients without an ulcer (5 days, SD 5 vs. 3 days SD 4, p = =.001). A logistic regression analysis confirmed "time to treatment" as an independent risk factor for the occurrence of a pressure ulcer during hospitalization. In an analysis adjusted for the confounders age, male gender, diabetes and malignancy, the odds ratio to develop a pressure ulcer remained 1.10 (CI 1.03 to 1.19; c-value = 0.774, p = .008) for each day of waiting treatment. CONCLUSION "Time to treatment" is an independent risk factor for the occurrence of a pressure ulcer during hospitalization after a pelvis/acetabulum fracture in elderly patients. Each day of waiting treatment increases the risk of developing a pressure ulcer by 10%.
Collapse
Affiliation(s)
- Annemarie Fritz
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig 04103, Germany
| | - Laura Gericke
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig 04103, Germany
| | - Andreas Höch
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig 04103, Germany
| | - Christoph Josten
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig 04103, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig 04103, Germany.
| |
Collapse
|
16
|
Van Damme N, Van Hecke A, Remue E, Van den Bussche K, Moore Z, Gefen A, Verhaeghe S, Beeckman D. Physiological processes of inflammation and edema initiated by sustained mechanical loading in subcutaneous tissues: A scoping review. Wound Repair Regen 2019; 28:242-265. [DOI: 10.1111/wrr.12777] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/23/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Nele Van Damme
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
| | - Eline Remue
- University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- Nursing departmentGhent University Hospital Ghent Belgium
| | - Karen Van den Bussche
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
| | - Zena Moore
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- School of Nursing & MidwiferyRoyal College of Surgeons in Ireland (RCSI) Dublin Ireland
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv University Tel Aviv Israel
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- Department of Health CareVIVES University of Applied Sciences Roeselare Belgium
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- School of Nursing & MidwiferyRoyal College of Surgeons in Ireland (RCSI) Dublin Ireland
- School of Health SciencesÖrebro University Örebro Sweden
- Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health SciencesUniversity of Southern Denmark Odense Denmark
- School of Nursing and MidwiferyMonash University Melbourne Australia
| |
Collapse
|
17
|
Abu-Assi R, Campbell J, Bacchi S, Gill TK, George D, Chehade M. Association between atrial fibrillation and hip fractures and the implications for hip fracture patients: a systematic review. ANZ J Surg 2019; 90:448-453. [PMID: 31628726 DOI: 10.1111/ans.15460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/31/2019] [Accepted: 09/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) and hip fractures are both prevalent in the elderly population. The aim of this study was to systematically review the literature regarding the association between AF and hip fractures, and the impact of AF on hip fracture prognosis. METHODS The literature search was performed using PubMed, MEDLINE, Embase and Scopus. Inclusion was based upon the application of eligibility criteria in duplicate prior to data extraction with a standardized form. RESULTS A total of 42 studies met the inclusion criteria. AF prevalence was found to vary between 6.5% and 35% in cohorts. Large studies with broad inclusion criteria found the prevalence of AF in hip fracture patients to be approximately 12-15%. There were conflicting results as to whether patients with AF have an increased rate of hip fractures, as compared to patients without AF. Several studies demonstrated that hip fracture patients with AF have increased rates of mortality, both as an inpatient and following discharge, and increased readmission rates. CONCLUSION AF and hip fractures frequently coexist, and there is evidence to suggest AF is associated with increased readmission and mortality rates in hip fracture patients. Elements of the relationship between AF and hip fractures remain uncertain and further prospective studies on AF and hip fracture cohorts may clarify this relationship. Interventional studies targeting hip fracture patients with AF may be beneficial.
Collapse
Affiliation(s)
- Rabieh Abu-Assi
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jed Campbell
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Department of Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Tiffany K Gill
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Daniel George
- Discipline of Orthopaedics and Trauma, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Mellick Chehade
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital, The University of Adelaide, Adelaide, South Australia, Australia.,Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia
| |
Collapse
|
18
|
Song YP, Shen HW, Cai JY, Zha ML, Chen HL. The relationship between pressure injury complication and mortality risk of older patients in follow-up: A systematic review and meta-analysis. Int Wound J 2019; 16:1533-1544. [PMID: 31606950 DOI: 10.1111/iwj.13243] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/18/2019] [Indexed: 12/11/2022] Open
Abstract
Pressure injuries (PIs) have now become a common complication of the elderly patients. Some studies have observed that pressure injuries may increase mortality, but this area of evidence has not been evaluated and summarised. The aim of this study was to compare the mortality of patients with pressure injuries and those without pressure injuries. A meta-analysis of observational studies was performed. PubMed, Cochrane Library, Embase, and Web of Science were searched up to April 2019. Studies about mortality among the elderly patients with and without pressure injuries were included. Methodological quality was assessed by the Newcastle-Ottawa Scale (NOS). The fixed effect or random effect model was determined by the test of heterogeneity. The subgroup analysis was performed based on the pressure injuries stages, the region, and the type of study design. The meta-regression analysis was performed to investigate the relationship between the mortality and patients' enrolled year, average age, the incidence of pressure injuries, and gender ratio. The sensitivity analysis was used to explore the impact of an individual study by excluding one at a time. The hazard ratio (HR) and 95% confidence intervals (CIs) in terms of the comparison of two groups were extracted for meta-analysis. A survival curve between two groups by individual patient-level was drew. Eight studies with 5523 elderly patients were included in the analysis. Follow-up periods for the included studies ranged from about 0.5 to 3 years. The elderly patients who complicated with pressure injuries had a higher risk of death. The pooled HR was 1.78 (95% CI 1.46-2.16). A funnel plot showed no publication bias. Further subgroup analysis showed that HR values for the patient stage 3 to 4 pressure injuries (HR:2.41; 95% CI:1.08-5.37) were higher than stage 1-4 and 2-4 pressure injuries (HR: 1.66; 95% CI: 1.35-2.05; HR: 1.74; 95% CI: 1.16-2.60). The meta-regression analysis found that patients' enrolled year, average age, the incidence of pressure injuries, and gender ratio were not the sources of heterogeneity. Sensitivity analyses showed that the outcomes of the study did not change after removing the Onder's article. The survival curve at the individual patient-level also indicated that patients complicated with pressure injuries significantly increased the risk of death (HR: 1.958; 95% CI: 1.79-2.14) in elderly patients. Our meta-analysis indicated that patients complicated with pressure injuries are estimated to have a two times higher risk on mortality compared with patients without pressure injuries during the 3 years follow-up period. Particular attention should be given to the elderly patients who are at higher risk for mortality.
Collapse
Affiliation(s)
- Yi-Ping Song
- School of Nursing, Nantong University, Nantong, China
| | - Hong-Wu Shen
- Affiliated Hospital of Nantong University, Nantong, China
| | - Ji-Yu Cai
- School of Nursing, Nantong University, Nantong, China
| | - Man-Li Zha
- Affiliated Hospital of Nantong University, Nantong, China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China
| |
Collapse
|
19
|
Abstract
This article offers a German perspective on orthopaedic management of geriatric populations in higher-income countries. Specific orthopaedic procedures necessitate a more intensive level of care in older adult patients, especially with co-morbidities, than in younger patients. During the pre-, peri- and post-operative periods, several aspects such as patient blood management principles improve the outcomes of geriatric patients. New interdisciplinary geriatric models of care including geriatric and orthopaedic specialties have to be established to take care of the special needs of geriatric patients.
Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180087
Collapse
Affiliation(s)
- Dieter Wirtz
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Bonn, Germany
| | - Hendrik Kohlhof
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Bonn, Germany
| |
Collapse
|
20
|
Meehan AJ, Maher AB, Brent L, Copanitsanou P, Cross J, Kimber C, MacDonald V, Marques A, Peng L, Queirós C, Roigk P, Sheehan KJ, Skúladóttir SS, Hommel A. The International Collaboration of Orthopaedic Nursing (ICON): Best practice nursing care standards for older adults with fragility hip fracture. Int J Orthop Trauma Nurs 2019; 32:3-26. [DOI: 10.1016/j.ijotn.2018.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
21
|
Liu Y, Wu X, Ma Y, Li Z, Cao J, Jiao J, Liu G, Li F, Song B, Jin J, Liu Y, Wen X, Cheng S, Lin F. The prevalence, incidence, and associated factors of pressure injuries among immobile inpatients: A multicentre, cross-sectional, exploratory descriptive study in China. Int Wound J 2019; 16:459-466. [PMID: 30672116 DOI: 10.1111/iwj.13054] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to assess the prevalence, incidence, and the associated factors of pressure injuries (PIs) among immobile hospitalised patients in China. Being immobile during hospitalisation put these patients at a higher risk of PIs. There is little literature about pressure injury (PI) prevalence or PI incidence in immobile hospitalised patients in hospitals in China. This was a multicentre, cross-sectional, exploratory descriptive study. A total of 23 985 immobile patients were recruited from 25 general hospitals in six provinces of China from November 1, 2015 to March 18, 2016. Information was collected on demographic characteristics, physical assessment information, and treatment and nursing care measures. The PI period prevalence was 3.38%, and the PI cumulative incidence was 1.23%. Most PIs (84.03%) were Stage 1 or Stage 2. A total of 48.22% of PIs occurred in the sacrum or heel region. In the multivariate analysis, the following factors were associated with higher PI prevalence: age, gender, length of immobility, type of hospital, modified Braden Scale score, urinary incontinence, faecal incontinence, low serum albumin, the usage of fixation or restraint devices, and patient's discharge diagnosis (lower limb fracture, malnutrition, and spinal cord injury). PI prevalence for immobile hospitalised patients in the study was lower than those reported in literature. However, because of the large population in China, the number of patients who suffer with PIs can be very high. The relating factors of higher PI prevalence identified in this study were consistent with current literature. Patients with a higher number of these associated factors should be monitored more closely, and preventative measures should be taken to prevent PI occurrence in high-risk populations.
Collapse
Affiliation(s)
- Ying Liu
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Yufen Ma
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Zhen Li
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Cao
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Ge Liu
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Fangfang Li
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Wuhan, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Frances Lin
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia
| |
Collapse
|
22
|
Voeten SC, Krijnen P, Voeten DM, Hegeman JH, Wouters MWJM, Schipper IB. Quality indicators for hip fracture care, a systematic review. Osteoporos Int 2018; 29:1963-1985. [PMID: 29774404 PMCID: PMC6105160 DOI: 10.1007/s00198-018-4558-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/30/2018] [Indexed: 11/26/2022]
Abstract
Quality indicators are used to measure quality of care and enable benchmarking. An overview of all existing hip fracture quality indicators is lacking. The primary aim was to identify quality indicators for hip fracture care reported in literature, hip fracture audits, and guidelines. The secondary aim was to compose a set of methodologically sound quality indicators for the evaluation of hip fracture care in clinical practice. A literature search according to the PRISMA guidelines and an internet search were performed to identify hip fracture quality indicators. The indicators were subdivided into process, structure, and outcome indicators. The methodological quality of the indicators was judged using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. For structure and process indicators, the construct validity was assessed. Sixteen publications, nine audits and five guidelines were included. In total, 97 unique quality indicators were found: 9 structure, 63 process, and 25 outcome indicators. Since detailed methodological information about the indicators was lacking, the AIRE instrument could not be applied. Seven indicators correlated with an outcome measure. A set of nine quality indicators was extracted from the literature, audits, and guidelines. Many quality indicators are described and used. Not all of them correlate with outcomes of care and have been assessed methodologically. As methodological evidence is lacking, we recommend the extracted set of nine indicators to be used as the starting point for further clinical research. Future research should focus on assessing the clinimetric properties of the existing quality indicators.
Collapse
Affiliation(s)
- S C Voeten
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands.
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - P Krijnen
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands
| | - D M Voeten
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - J H Hegeman
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands
| | - M W J M Wouters
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - I B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands
| |
Collapse
|
23
|
Cecchi F, Pancani S, Antonioli D, Avila L, Barilli M, Gambini M, Landucci Pellegrini L, Romano E, Sarti C, Zingoni M, Gabrielli MA, Vannetti F, Pasquini G, Macchi C. Predictors of recovering ambulation after hip fracture inpatient rehabilitation. BMC Geriatr 2018; 18:201. [PMID: 30170554 PMCID: PMC6117966 DOI: 10.1186/s12877-018-0884-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/16/2018] [Indexed: 12/12/2022] Open
Abstract
Background Despite progress in surgery and care, hip fracture (HF) remains a catastrophic event, burdened with high risk of mortality and disability. This study aims at identifying predictors of recovering ambulation after intensive inpatient rehabilitation within the Tuscany Region HF rehabilitation pathway. Methods All HF patients referred from acute care to the two Massa-Carrara Rehabilitation facilities January 2015–June 2017 were enrolled. Comorbidity Total Score (CIRS) defined high- or low-care setting referral. Recovery of ambulation, with or without aid, (assessed by SAHFE) was the primary outcome. Personal data, comorbidity, cognitive (MMSe) and pre-fracture function (mRANKIN) were recorded on admission. Outcomes included hospital readmission, length of stay (LOS) and home discharge. Urinary catheter, bedsores, disability (modified Barthel Index-mBI), communication disability (CDS), trunk control (TCT), pain (NRS), and ambulation were recorded (admission-discharge). Results Of 352 patients enrolled (age 83.9 ± 7.1; 80% women), 1 died and 6 were readmitted to acute-care hospital; 97% patients referred to high-care, and 64% referred to low-care, presented moderate-high comorbidity on admission. Median LOS was 22 days; 95% patients were discharged back home; daily functional gain (mBIscore/LOS) was 1.3 ± 0.7. Patients who recovered ambulation on discharge were 84%. Older age, higher comorbidity, bladder catheter, impaired trunk control, worse cognitive and functional status on admission, and pre-fracture disability were associated to poor outcome, but only higher comorbidity and impaired communication on admission predicted failure to recover ambulation on discharge. Conclusion In HF patients entitled to intensive inpatient rehabilitation, moderate-high comorbidity and impaired communication are frequent findings and predict rehabilitation failure.
Collapse
Affiliation(s)
- Francesca Cecchi
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Silvia Pancani
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy.
| | - Desiderio Antonioli
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Lucia Avila
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Manuele Barilli
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Massimo Gambini
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | | | - Emanuela Romano
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Chiara Sarti
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Margherita Zingoni
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | | | - Federica Vannetti
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Guido Pasquini
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Claudio Macchi
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| |
Collapse
|
24
|
Zerah L, Dourthe L, Cohen-Bittan J, Verny M, Raux M, Mézière A, Khiami F, Tourette C, Neri C, Le Manach Y, Riou B, Vallet H, Boddaert J. Retrospective Evaluation of a Restrictive Transfusion Strategy in Older Adults with Hip Fracture. J Am Geriatr Soc 2018; 66:1151-1157. [PMID: 29676780 DOI: 10.1111/jgs.15371] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To compare the association between a restrictive transfusion strategy and cardiovascular complications during hospitalization for hip fracture with the association between a liberal transfusion strategy and cardiovascular complications, accounting for all transfusions from the emergency department to postacute rehabilitation settings. DESIGN Retrospective study. SETTING Perioperative geriatric care unit. PARTICIPANTS All individuals aged 70 and older admitted to the emergency department for hip fracture and hospitalized in our perioperative geriatric care unit (N=667; n=193 in the liberal transfusion group, n=474 in the restrictive transfusion group) from July 2009 to April 2016. INTERVENTION A restrictive transfusion strategy (hemoglobin level threshold ≥8 g/dL or symptoms) used from January 2012 to April 2016 was compared with the liberal transfusion strategy (hemoglobin level threshold ≥10 g/dL) used from July 2009 to December 2011. MEASUREMENTS Primary endpoint was in-hospital acute cardiovascular complications (heart failure, myocardial infarction, atrial fibrillation or stroke). RESULTS The change to a restrictive transfusion strategy was associated with fewer acute cardiovascular complications (odds ratio=0.45, 95% confidence interval (CI)=0.31-0.67, p<.001), without any noticeable difference in in-hospital or 6-month mortality. The change also led to a reduction in packed red blood cell units used per participant (median 1, interquartile range (IQR) 0-2 in restrictive vs median 2, IQR 0-3 in liberal transfusion strategy, P<.001). In rehabilitation settings, the frequency of transfusion was greater with the restrictive transfusion strategy than the liberal transfusion strategy (18% vs 9%, P<.001). CONCLUSION A restrictive transfusion strategy in older adults with hip fracture was found to be safe and was associated with fewer cardiovascular complications but more transfusions in rehabilitation settings. Prospective studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Lorene Zerah
- Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Lucile Dourthe
- Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Judith Cohen-Bittan
- Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Verny
- Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Mathieu Raux
- Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Unit es Mixtes de Recherche Scientifique (UMRS) Institut National de la Santée et de la Recherche Médicale (INSERM) 1158, Paris, France
| | - Anthony Mézière
- Rehabilitation Geriatric Department, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frédéric Khiami
- Department of Orthopedic Surgery and Trauma, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cendrine Tourette
- Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Christian Neri
- Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Yannick Le Manach
- Department of Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Population Health Research Institute, Perioperative Medicine and Surgical Research Unit, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Bruno Riou
- Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.,Department of Emergency Medicine and Surgery, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hélène Vallet
- Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Jacques Boddaert
- Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| |
Collapse
|