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Rabiee Rad M, Ghasempour Dabaghi G, Afshari Safavi A, Moshkdar P, Akbariaghdam H. Adjuvant Vitamin D Injection in Elderly Patients Before Intertrochanteric Fracture Surgery: A Randomised Controlled Trial. Geriatr Orthop Surg Rehabil 2024; 15:21514593231220769. [PMID: 38495917 PMCID: PMC10943710 DOI: 10.1177/21514593231220769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/29/2023] [Accepted: 11/24/2023] [Indexed: 03/19/2024] Open
Abstract
Background There are multiple recommended protocols for Vitamin D (VitD) supplementation in elderly; however, only a few studies achieved to examine the role of VitD supplements before intertrochanteric fracture surgery on mortality and complications after surgery. Methods This single-center block-randomized double-blinded trial was conducted on 80 patients with intertrochanteric fractures and a sufficient level of 25 (OH) VitD. The intervention group received an intramuscular 300,000 IU VitD ampule before surgery. The primary outcome was a 6-month mortality rate, and the secondary outcomes were 1- and 2-year mortality rates and Harris Hip Score (HHS) in 6, 12, and 24 months after surgery. Chi-square, t-test, repeated measure ANOVA, and Cox regression survival model was used for statistical analysis. Results 40 patients were allocated to each group. Demographic, clinical characteristics, and preoperative evaluations were not significantly different between the groups. Mortality rate 6-month after the surgery was 7.5% and 10% for the intervention and placebo groups respectively (P value = .71), 15% and 12.5% at 1-year (P value = .83), and 25% and 27.5% at 2-year (P value = .98). Based on the Cox regression model, only age was significantly associated with mortality (HR = 1.229, P value <.001). Significant HHS changes from baseline through 24 months after surgery were observed within both groups; however, mean differences were not significantly different between groups. Conclusions A single preoperative 300,000 IU VitD did not significantly impact 2-year survival and HHS in patients with intertrochanteric fractures and sufficient serum VitD level.
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Affiliation(s)
- Mehrdad Rabiee Rad
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Alireza Afshari Safavi
- Biostatistics & Epidemiology Department, North Khorasan University of Medical Science, Bojnourd, Iran
| | - Pooya Moshkdar
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Akbariaghdam
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Wu YL, Zhang D, Zhang KY, Yan T, Qiang WS, Zhang T, Zhang BF. The association between admission serum albumin and preoperative deep venous thrombosis in geriatrics hip fracture: a retrospective study of 1819 patients with age ≥ 65 years. BMC Musculoskelet Disord 2023; 24:672. [PMID: 37620804 PMCID: PMC10464240 DOI: 10.1186/s12891-023-06776-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE This study evaluated the association between serum albumin levels and preoperative deep vein thrombosis (DVT) in geriatric hip fractures. METHODS Older adult patients with hip fractures were screened between January 2015 and September 2019. The demographic and clinical characteristics of the patients were collected. Multivariate binary logistic regression and generalized additive model were used to identify the linear and nonlinear association between albumin levels and preoperative DVT. Analyses were performed using EmpowerStats and the R software. RESULTS A total of 1819 patients were included in this study. The average age was 79.37 ± 6.88 years. There were 550 males and 1269 females. The preoperative albumin was 38.19 ± 4.07 g/L. There were 580 (31.89%) preoperative DVTs. Multivariate binary logistic regression showed that albumin level was associated with preoperative DVT (odds ratio [OR] = 0.94, 95% confidence interval [CI]: 0.91-0.97, P = 0.0002) after adjusting for confounding factors. The fully adjusted model showed a DVT risk decrease of 6% when albumin concentration increased by one g/L after controlling for confounding factors. In addition, the trend test and propensity score matching also showed a stable linear correlation between albumin level and preoperative DVT. CONCLUSION Serum albumin is associated with preoperative DVT in geriatric patients with hip fractures, and it could be considered a predictor for the risk of DVT. REGISTRATION ID ChiCTR2200057323.
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Affiliation(s)
- Yi-Lun Wu
- Department of Ultrasound Medicine, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi Province, China
| | - Dan Zhang
- Department of Ultrasound Medicine, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi Province, China
| | - Kai-Yuan Zhang
- Department of Ultrasound Medicine, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi Province, China
| | - Ting Yan
- Department of Ultrasound Medicine, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi Province, China
| | - Wen-Si Qiang
- Department of Ultrasound Medicine, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi Province, China
| | - Ting Zhang
- Department of Ultrasound Medicine, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi Province, China
| | - Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, 710054, Shaanxi Province, China.
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Meng S, Tong M, Yu Y, Cao Y, Tang B, Shi X, Liu K. The prevalence of osteoporotic fractures in the elderly in China: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:536. [PMID: 37501170 PMCID: PMC10373275 DOI: 10.1186/s13018-023-04030-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Prevalence information is the first step in developing preventive procedures or health services. This study was conducted to systematically evaluate the epidemiology of osteoporotic fractures in Chinese elderly aged ≥ 60 years and to provide evidence-based evidence for the prevention and treatment of osteoporotic fractures. METHODS We identified relevant studies by searching the literature published in PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, and VIP databases from the establishment of the database until August 2022. We used a random-effects model to obtain prevalence estimates and identified sources of heterogeneity and comparisons of prevalence among different groups through subgroup analysis and sensitivity analysis. RESULTS A total of 29 articles were included in this study, and the prevalence of osteoporosis fractures in elderly Chinese was high (18.9%). The prevalence has increased significantly over the past decade (from 13.2% in 2000-2010 to 22.7% in 2012-2022). The prevalence of osteoporosis is higher in women than in men (18.5% vs 14.3%) and increases with age. The northern region was higher than the southern region (20.3% vs 18.9%), and the spine, hip, and distal forearm were the most common sites of fracture. CONCLUSION The prevalence of osteoporotic fractures in the Chinese elderly is 18.9%, and timely prevention and treatment are necessary.
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Affiliation(s)
- Shilong Meng
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Minghao Tong
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Yang Yu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Yanguang Cao
- Orthopedic Traumatology II, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Binbin Tang
- Orthopedic Traumatology II, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaolin Shi
- Orthopedic Traumatology II, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Kang Liu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
- Orthopedic Traumatology II, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
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Chen M, Du Y, Tang W, Yu W, Li H, Zheng S, Cheng Q. Risk factors of mortality and second fracture after elderly hip fracture surgery in Shanghai, China. J Bone Miner Metab 2022; 40:951-959. [PMID: 35939235 DOI: 10.1007/s00774-022-01358-y] [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: 04/01/2022] [Accepted: 07/01/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Hip fracture is one of the leading causes of death and disability in the elderly. We analyzed the risk factors of mortality and second fracture within 2 years after hip fracture surgery in elderly Chinese patients. MATERIALS AND METHODS A total of 613 elderly patients after hip fracture surgery were selected, including 181 males and 432 females, and the patients were followed for at least 24 months. Information about patients and surgery was collected from medical records. Information on death, secondary fracture, and postoperative activities of daily living (ADL) was obtained by telephone follow-up. Cox regression was performed to identify risk factors associated with mortality and second fracture, measured by hazard ratio (HR). RESULTS The 1-year and 2-year mortality rates after hip fracture were 13.4% and 20.7%, respectively. The second fracture rate within 2 years was 9.5%. Male gender (HR 1.51, P = 0.035), increased age (HR 1.07, P < 0.001), preoperative hypoalbuminemia (HR 1.79, P = 0.004), preoperative pneumonia (HR 2.60, P = 0.005) and poor ADL (P = 0.048) were independent risk factors for 2-year mortality, while high preoperative hemoglobin (HR 0.98, P = 0.002), high preoperative eGFR (HR 0.99, P = 0.031), high preoperative LVEF (HR 0.92, P = 0.048) were protective factors for 2-year mortality. Poor ADL (P = 0.002) was the independent risk factor for second fracture within 2 years. CONCLUSIONS The 2-year mortality rate and second fracture rate after hip fracture in elderly remained high, which was related to old age and complications exists. Postoperative rehabilitation and improving ADL were very important to reduce mortality and second fracture.
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Affiliation(s)
- Minmin Chen
- Research Section of Geriatric Metabolic Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, 221 West Yan An Road, Shanghai, 200040, China
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Yanping Du
- Research Section of Geriatric Metabolic Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, 221 West Yan An Road, Shanghai, 200040, China
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Wenjing Tang
- Research Section of Geriatric Metabolic Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, 221 West Yan An Road, Shanghai, 200040, China
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Weijia Yu
- Research Section of Geriatric Metabolic Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, 221 West Yan An Road, Shanghai, 200040, China
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Huilin Li
- Research Section of Geriatric Metabolic Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, 221 West Yan An Road, Shanghai, 200040, China
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Songbai Zheng
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Qun Cheng
- Research Section of Geriatric Metabolic Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, 221 West Yan An Road, Shanghai, 200040, China.
- Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China.
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Xing F, Luo R, Liu M, Zhou Z, Xiang Z, Duan X. A New Random Forest Algorithm-Based Prediction Model of Post-operative Mortality in Geriatric Patients With Hip Fractures. Front Med (Lausanne) 2022; 9:829977. [PMID: 35646950 PMCID: PMC9130605 DOI: 10.3389/fmed.2022.829977] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/31/2022] [Indexed: 02/05/2023] Open
Abstract
Background Post-operative mortality risk assessment for geriatric patients with hip fractures (HF) is a challenge for clinicians. Early identification of geriatric HF patients with a high risk of post-operative death is helpful for early intervention and improving clinical prognosis. However, a single significant risk factor of post-operative death cannot accurately predict the prognosis of geriatric HF patients. Therefore, our study aims to utilize a machine learning approach, random forest algorithm, to fabricate a prediction model for post-operative death of geriatric HF patients. Methods This retrospective study enrolled consecutive geriatric HF patients who underwent treatment for surgery. The study cohort was divided into training and testing datasets at a 70:30 ratio. The random forest algorithm selected or excluded variables according to the feature importance. Least absolute shrinkage and selection operator (Lasso) was utilized to compare feature selection results of random forest. The confirmed variables were used to create a simplified model instead of a full model with all variables. The prediction model was then verified in the training dataset and testing dataset. Additionally, a prediction model constructed by logistic regression was used as a control to evaluate the efficiency of the new prediction model. Results Feature selection by random forest algorithm and Lasso regression demonstrated that seven variables, including age, time from injury to surgery, chronic obstructive pulmonary disease (COPD), albumin, hemoglobin, history of malignancy, and perioperative blood transfusion, could be used to predict the 1-year post-operative mortality. The area under the curve (AUC) of the random forest algorithm-based prediction model in training and testing datasets were 1.000, and 0.813, respectively. While the prediction tool constructed by logistic regression in training and testing datasets were 0.895, and 0.797, respectively. Conclusions Compared with logistic regression, the random forest algorithm-based prediction model exhibits better predictive ability for geriatric HF patients with a high risk of death within post-operative 1 year.
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Affiliation(s)
- Fei Xing
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Zongke Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Xiang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Duan
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Nontuberculous mycobacterial skin and soft tissue infection in Hawai'i. BMC Infect Dis 2022; 22:360. [PMID: 35410188 PMCID: PMC9004129 DOI: 10.1186/s12879-022-07345-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/31/2022] [Indexed: 11/27/2022] Open
Abstract
Background Hawaiʻi has the highest nontuberculous mycobacterial (NTM) lung infection prevalence in the United States. Limited data regarding skin and soft tissue infections (SSTI) due to NTM in Hawaiʻi exists. This study describes patient demographics, clinical courses of infection, treatment patterns, and clinical outcomes of NTM SSTIs in Hawaiʻi.
Methods A retrospective chart review (n = 50) of patients diagnosed and treated at Hawaiʻi Pacific Health facilities for NTM SSTIs between January 2010 and July 2021 was conducted. Patient demographics, clinical course, and treatment data were collected from electronic medical records.
Results Half of the patient population consisted of females, and the average age of patients during infection was 49 years (SD = 25.6). The majority of cases (80%) were caused by rapidly growing mycobacteria (RGM), most commonly Mycobacterium abscessus. NTM SSTI by race were Asian (48%), White (28%), and Native Hawaiian and Other Pacific Islanders (16%). Almost all Asian patients with NTM SSTI were Filipino or Japanese. Diagnosis was frequently delayed. The average time to diagnosis was 116 days. Most patients achieved complete resolution (72%) following a prolonged course of antimicrobial treatment (mean = 196 days) with surgical debridement. Conclusion Increased awareness among physicians and the community of non-mycobacterial skin infections is essential in Hawaiʻi due to the high prevalence of NTM and the high percentage of predisposed populations. Increased awareness of NTM could reduce delayed diagnosis and improve patient care. Further studies are required to inform optimal treatment and diagnostic strategies, improve patient outcomes, and aid public health surveillance efforts.
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Hou XL, Liu JY, Fan XH, Zhang N, Cao GL, Guo ZB, Zhang YY, Yu YH, Tian YQ, Sun XX, Tian FM. Secular trends of incidence and hospitalization cost of hip fracture in Tangshan, China. Osteoporos Int 2022; 33:89-96. [PMID: 34235549 DOI: 10.1007/s00198-021-06050-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
We investigated the secular trends of the incidence and hospitalization cost of hip fracture in Tangshan, China. The incidence of hip fracture and the hospitalization cost were both increasing during the observation period. INTRODUCTION The present study aimed to determine sex-, age-, and fracture type-specific incidence and annual changes in hip fractures in Tangshan, China, between 2007 and 2018. METHODS We analyzed annual hip fracture incidence using urban hospital data during 2007-2018 and calculated incidence rate/100,000 person years in each age group and sex. We assessed annual changes in incidence among people aged >60 years using linear-by-linear association tests and evaluated hospitalization costs with the Kruskal-Wallis test. RESULTS During the study period, we observed an increasing proportion of hip fractures in people >60 years old from 14.2 to 22.79%. Crude hip fracture incidence increased markedly from 140.87 to 306.56/100,000 in women (p < 0.01) and from 124.83 to 167.19/100,000 in men (p < 0.01) in the age group >60 years. Type-specific analysis indicated significantly increased trends in incidence of cervical and trochanteric fractures among women and cervical fracture among men (p < 0.01). In people aged 36-60 years, the trend of hip fracture increased significantly in both sexes. The total and cervical-to-trochanteric ratio in men increased, with significant upward trends (p < 0.01). The proportion of cervical fracture was higher than that for trochanteric fracture in women, with stable levels from 2007 to 2018. Hospitalization costs for cervical and trochanteric fractures increased by 51.91% and 53.20%, respectively, during 2011-2018. CONCLUSION Tangshan will have an increasing burden on health care resources attributable to a considerable rise in hip fracture incidence and the older population. Further investigation of risk factors and subsequent implementation of effective measures to prevent hip fracture are needed.
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Affiliation(s)
- X-L Hou
- School of Public Health, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis, Tangshan, 063210, People's Republic of China
| | - J-Y Liu
- The Second Hospital of Tangshan City, Tangshan, People's Republic of China
| | - X-H Fan
- Kailuan General Hospital, Tangshan, People's Republic of China
| | - N Zhang
- Kailuan General Hospital, Tangshan, People's Republic of China
| | - G-L Cao
- Gongren Hospital, Tangshan, People's Republic of China
| | - Z-B Guo
- Kailuan General Hospital, Tangshan, People's Republic of China
| | - Y-Y Zhang
- School of Public Health, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis, Tangshan, 063210, People's Republic of China
| | - Y-H Yu
- School of Public Health, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis, Tangshan, 063210, People's Republic of China
| | - Y-Q Tian
- School of Public Health, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis, Tangshan, 063210, People's Republic of China
| | - X-X Sun
- Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, Jianshe South Road 73, Tangshan, 063000, People's Republic of China.
| | - F-M Tian
- School of Public Health, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis, Tangshan, 063210, People's Republic of China.
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