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Malhotra R, Huq SS, Chong M, Murphy D, Daruwalla ZJ. Outcomes in Nonagenarians with Hip Fractures Treated Conservatively and Surgically. Malays Orthop J 2021; 15:21-28. [PMID: 34966491 PMCID: PMC8667238 DOI: 10.5704/moj.2111.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/14/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction We aimed to assess the clinical outcomes in nonagenarians following a hip fracture. We also further investigated the factors that influence these outcomes, such as method of treatment (operative versus conservative), co-morbidities, and pre-morbid function. Materials and methods We studied 65 nonagenarians that were identifiable from our hospital hip fracture database. We reviewed various parameters of these patients admitted after sustaining a hip fracture (neck of femur or intertrochanteric) and investigated how these parameters affected patient outcomes. The main outcomes studied were: inpatient morbidity, and mortality at one year. Results Inpatient morbidity was more likely in patients with an ASA grade of 3 to 5. Urinary tract infection was the most common medical complication. The 1-year mortality was 15.4% and was significantly influenced by advancing age. Surgically managed patients had a 1-year mortality rate (14.3%) slightly less than non-operative patients (17.4%). Post injury mobility was significantly better in those who received operative treatment with 63% of surgical cases regaining ambulatory status versus 7% of conservatively managed patients. Conclusions We presented the outcomes of hip fractures in an extreme age group in the population. In nonagenarians with hip fractures surgery was associated with a 1-year mortality rate of 14.3% which is comparable to the general hip fracture population and less than the mortality rate of conservatively managed patients (17.4%). The primary advantage of surgery would be that two-thirds of patients return to ambulatory status. This information is useful to counsel patients and their families especially since the elderly are often more fearful of surgical intervention.
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Affiliation(s)
- R Malhotra
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - S S Huq
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - M Chong
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - D Murphy
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - Z J Daruwalla
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
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Issa M, Kiening KL, Unterberg AW, Scherer M, Younsi A, Fedorko S, Oskouian RJ, Chapman JR, Ishak B. Morbidity and Mortality in Patients over 90 Years of Age Following Posterior Stabilization for Acute Traumatic Odontoid Type II Fractures: A Retrospective Study with a Mean Follow-Up of Three Years. J Clin Med 2021; 10:jcm10173780. [PMID: 34501228 PMCID: PMC8432090 DOI: 10.3390/jcm10173780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/15/2021] [Accepted: 08/21/2021] [Indexed: 11/16/2022] Open
Abstract
Odontoid type II fractures represent the most common cervical spine injuries in the elderly. The decision for surgical treatment in very elderly patients is still controversial. The aim of this study was to assess morbidity and mortality in patients over 90 years of age undergoing CT-guided posterior stabilization for unstable odontoid type II fractures. A total of 15 patients with an acute traumatic odontoid type II fracture who received surgical treatment for unstable odontoid type II fractures were retrospectively analyzed. Complications, morbidity, and mortality as well as length of ICU and hospital stay were determined. Clinical follow-up evaluation was based on outpatient presentation and information from family members and general practitioners. Finally, we conducted a comparison of complications rates between patients over 90 years of age and patients between 65 and 89 years old with a type II odontoid fracture after CT-guided posterior stabilization in our institution. The mean age was 91.4 years. Patients were predominately female (87%). In-hospital deaths did not occur. The average length of the hospital stay was 13.4 days and 1.9 days for the ICU. Blood transfusion was necessary in two patients (13%). Two patients (13%) developed urinary tract infection, one patient (7%) a delirium, and another epistaxis (7%). One patient (7%) developed pneumonic sepsis and fully recovered within several weeks. The mean follow-up was 36 months (range 9–72 months). Implant-related complications developed in one patient (7%). Five patients died during the follow-up period, with an average time to death of 26.6 months. Postoperative bracing was not needed in any of the patients. Posterior stabilization of unstable odontoid fractures type II using CT-guided navigation in patients over 90 years of age is a safe and effective procedure with low complications and mortality rates.
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Affiliation(s)
- Mohammed Issa
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
| | - Karl L. Kiening
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
| | - Andreas W. Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
| | - Moritz Scherer
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
| | - Alexander Younsi
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
| | - Stepan Fedorko
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
| | - Rod J. Oskouian
- Complex Spine Surgery, Swedish Neuroscience Institute, Seattle, WA 98122, USA; (R.J.O.); (J.R.C.)
| | - Jens R. Chapman
- Complex Spine Surgery, Swedish Neuroscience Institute, Seattle, WA 98122, USA; (R.J.O.); (J.R.C.)
| | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (M.I.); (K.L.K.); (A.W.U.); (M.S.); (A.Y.); (S.F.)
- Correspondence: ; Tel.: +49-6221-560
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Bolton D, Bush C, Wallace MT. Nonagenarian hip fractures: Morbidity and mortality at a single institution. J Clin Orthop Trauma 2020; 14:69-73. [PMID: 33717899 PMCID: PMC7919977 DOI: 10.1016/j.jcot.2020.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/18/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The incidence of hip fractures continues to rise dramatically, but few studies have examined these injuries in the population of individuals over 90 years of age, which is one of the fastest growing populations. We present the largest such study specifically examining hip fractures in the super-elderly. METHODS A review of 216 hip fracture patients over 90 years of age were examined for immediate postoperative complications and in-house, 30-day, and 1-year mortality. RESULTS Overall 1-year mortality was 38.1%. Statistically-significant risk factors for 1-year mortality included oncologic fracture, dementia, and CHF. Fracture classification and hospital length of stay were associated with perioperative complications including anemia and pneumonia. CONCLUSION The nonagenarian hip fracture is associated with a higher 1-year mortality than prior reported rates of mortality for elderly hip fractures. Factors previously reported to influence the risk of 1-year mortality in hip fractures are not observed in the super-elderly.
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Affiliation(s)
- Dane Bolton
- Orthopaedic Resident, Wellspan Orthopaedics, 25 Monument Rd., Suite 290, York, PA, 17403, USA
| | - Chelsea Bush
- Wellspan Orthopaedics, 25 Monument Rd., Suite 290, York, PA, 17403, USA
| | - Matthew T. Wallace
- Orthopaedic Oncologist, MedStar Georgetown Cancer Insitute, MedStar Franklin Square Medical Center, 9103 Franklin Square Drive, Suite 2300 Baltimore, MD, 21237, USA,Corresponding author. Orthopaedic Oncologist, MedStar Georgetown Cancer Insitute, MedStar Franklin Square Medical Center, 9103 Franklin Square Drive, Suite 2300 Baltimore, MD, 21237, USA.
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Hip Fracture in Nonagenarians: Characteristics and Factors Related to 30-Day Mortality in 1177 Patients. J Arthroplasty 2020; 35:1186-1193. [PMID: 31992530 DOI: 10.1016/j.arth.2019.12.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/16/2019] [Accepted: 12/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The number of nonagenarian patients with hip fracture is increasing. The goals of this study were to describe the characteristics and in-hospital course of a cohort of 1177 nonagenarians admitted for hip fracture compared with younger patients and to identify risk factors for 30-day mortality after admission. METHODS This is a retrospective observational cohort study including patients aged 65 years or older admitted for hip fracture during various periods from February 1997 to December 2016. We defined 3 age groups: 65-79, 80-89, and 90 years and older. We included sociodemographic variables, baseline functional status, comorbidities, fracture and surgical characteristics, postoperative complications, length of stay, and in-hospital and 30-day mortality. Multiple logistic regression analysis was used to study risk factors for 30-day mortality in surgically treated nonagenarians. RESULTS Nonagenarians were more likely to be women and to have dementia and heart disease. Some 72% walked independently before the fracture. The most relevant treatable risk factor for 30-day mortality in nonagenarians (in terms of higher odds ratio [OR]) was developing respiratory infection (OR: 4.56, 95% confidence interval [CI]: 2.73-7.63). Better prefracture functional status (higher Katz score; OR: 0.83, 95% CI: 0.74-0.92) and spinal anesthesia (OR: 0.19, 95% CI: 0.05-0.68) decreased risk of 30-day mortality. CONCLUSIONS Nonagenarian patients with hip fracture differ significantly from younger patients concerning clinical characteristics, medical complications, and in-hospital and 30-day mortality rates. We identified several variables on which we could act to reduce 30-day mortality, such as respiratory infection, electrolyte disorders, polypharmacy, cardiac arrhythmia, and spinal anesthesia.
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Liu Y, Zhang CW, Zhao XD. Long-term survival of femoral neck fracture patients aged over ninety years: Arthroplasty compared with nonoperative treatment. BMC Musculoskelet Disord 2020; 21:217. [PMID: 32268893 PMCID: PMC7140318 DOI: 10.1186/s12891-020-03249-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/27/2020] [Indexed: 02/08/2023] Open
Abstract
Background The aging of the Chinese population is expected to lead to an increase in nonagenarians and centenarians. The mortality rate in nonagenarian hip fracture patients is equivalent to the mortality rate in the average population at 5 years after injury. It is imperative to evaluate 5-year mortality in this small but very challenging subgroup of patients to optimize patient management. The primary purpose of the current retrospective study was to compare five-year survival in patients aged over 90 years who received arthroplasty or nonoperative treatment for femoral neck fracture during a 16-year period. Methods From January 1998 to December 2014, all consecutive nonagenarian and centenarian patients with femoral neck fracture admitted to our hospital were included in the evaluation. The primary outcome was defined as thirty-day, 1-year, 3-year, and 5-year mortality after injury. Survival analysis was performed with the Kaplan-Meier method. Using the log-rank test, stratified analyses were performed to compare differences in the overall cumulative mortality and mortality at three time points (1 year, 3 years, and 5 years) after injury and differences in survival distributions. Results Over the 16-year study period, the arthroplasty group and the nonoperative treatment group included 33 and 53 patients, respectively. The long-term survival probability of the arthroplasty group was significantly higher than that of the nonoperative treatment group (p = 0.002). The survival time of the arthroplasty group was significantly higher than that of the nonoperative treatment group (median (P75-P25) = 53 (59) versus median (P75-P25) = 22 (52), p = 0.001). The mortality differences, except for 30-day mortality, at five time points (1, 2, 3, 4, and 5 years) between the nonoperative group and arthroplasty group were significant. The stratified analyses of overall cumulative mortality and mortality at three time points (1, 3, and 5 years) after injury demonstrated that the nonoperative treatment group had significantly higher cumulative mortality than the arthroplasty group. Conclusions Our study demonstrates that arthroplasty is more likely to improve long-term survival in femoral neck fracture patients aged over 90 years than nonoperative treatment. It can be expected that nearly half of patients will survive more than 5 years after surgery.
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Affiliation(s)
- Yang Liu
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041.
| | - Chong-Wei Zhang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041
| | - Xiao-Dan Zhao
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041
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Ergin ÖN, Bayram S, Anarat FB, Yağcı TF, Balcı Hİ. Prognostic factors affecting survival of patients with intertrochanteric femoral fractures over 90 years treated with proximal femoral nailing. Eur J Trauma Emerg Surg 2020; 46:663-669. [DOI: 10.1007/s00068-020-01355-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/24/2020] [Indexed: 01/14/2023]
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Kim JW, Kim DH, Jang EC, Lee YK, Koo KH, Ha YC. Mortality and its risk factors in nonagenarians after hip fractures. J Orthop Sci 2019; 24:850-854. [PMID: 30904205 DOI: 10.1016/j.jos.2019.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/29/2019] [Accepted: 02/04/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The purpose of this study was to assess mortality with a minimum of 2-year follow-up, related risk factors for mortality, and functional outcomes after surgical interventions in nonagenarian patients with hip fractures at the latest follow up. METHODS Between June 2003 and November 2015, 260 nonagenarians (271 hips) with femoral neck and intertrochanteric fractures were included in this retrospective study. Cumulative mortality using the Kaplan-Meier method and risk factors for mortality using Cox proportional-hazards regression model were estimated. As functional outcome, ambulatory ability was assessed before injury and at the latest follow-up. RESULTS Six-teen patients (16 hips) were lost to follow-up. The mean age at the time of surgery was 92.2 years (range 90-108 years). Mortality rates were 23.4% (57 of 244 patients) at 1 year and 40.6% (99 of 244 patients) at 2 years. Both genders had elevated standardized mortality ratio at 2-year post-fracture compared to that a 1-year post fracture. Multivariate analysis showed that American Society of Anesthesiologists (OR, 1.371; 95% CI, 1.021-1.843; P = 0.036) and time interval from trauma to operation (OR, 1.043; 95% CI, 1.002-1.086; P = 0.039) were significantly associated with risk of mortality. Of 58 patients alive, 13 patients (22.4%) had the same ambulatory ability before and after injury. CONCLUSIONS This study demonstrates that mortality is higher in nonagenarians with hip fracture. Risk factors for mortality in nonagenarians with hip fracture are American Society of Anesthesiologists and time interval from trauma to operation. And, nonagenarians with hip fractures have lower rate of maintaining pre-injury ambulatory ability.
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Affiliation(s)
- Jin-Woo Kim
- Department of Orthopaedic Surgery, Eulji Medical Center, Eulji University College of Medicine, Seoul, South Korea
| | - Dong-Hyun Kim
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Eui-Chan Jang
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea.
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Outcome of Spinal Surgery in Patients Older Than Age 90 Years. World Neurosurg 2019; 123:e457-e464. [DOI: 10.1016/j.wneu.2018.11.188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/21/2022]
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Hip fractures in the oldest old. Comparative study of centenarians and nonagenarians and mortality risk factors. Injury 2018; 49:2198-2202. [PMID: 30274759 DOI: 10.1016/j.injury.2018.09.043] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 09/24/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Centenarians and nonagenarians constitute a rapidly growing age group in Western countries and they are expected to be admitted to hospital with hip fractures. The aim of this study was to compare outcomes of centenarian and nonagenarian patients following a hip fracture and to identify risk factors related to in-hospital and post-discharge mortality in both groups. PATIENTS AND METHODS A prospective evaluation of centenarian patients and nonagenarian controls admitted to a tertiary university hospital in Barcelona with hip fractures over a period of 5 years and 9 months. Baseline characteristics and outcomes in both patient groups were compared. Variables associated with in-hospital, 30-day, 3-month and 1-year mortality were also analyzed. RESULTS Thirty-three centenarians and 82 nonagenarians were included. The most relevant statistically significant differences found were: Barthel index at admission (61.90 vs. 75.22), number of drugs before admission (4.21vs 5.55), in-hospital complication rates (97 vs. 78%), readmissions at 3 months and 1 year (0 vs 11.7% and 3.4 vs. 19.5% respectively) and mortality at 3 months and 1 year (41.4 vs. 20.8% and 62.1 vs. 29.9%, respectively). Mean number of complications, rapid atrial fibrillation, mean age, and urinary tract infection were risk factors associated with mortality. CONCLUSIONS Centenarian patients had similar in-hospital outcomes to nonagenarians, but experienced more complications and twice the 3-month and 1-year mortality rate. The mean number of complications was the risk factor most consistently related to in-hospital and post-discharge mortality. These findings emphasize the need to improve care in very old patients to prevent complications.
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Lai YC, Tang PL, Kuo TJ, Hsu CJ. Different impacts of dementia on two-year mortality after osteosynthesis and hemiarthroplasty in treating geriatric hip fractures. Arch Gerontol Geriatr 2018; 79:116-122. [PMID: 30196144 DOI: 10.1016/j.archger.2018.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Geriatric hip fractures are mostly managed by internal fixation (IF) or hemiarthroplasty (HA). Survivorship of dementia patients following these surgeries has not been extensively compared in literature. By analysis of nationwide database, this study aimed to investigate the impact of dementia on two-year mortality after IF and HA in treating geriatric hip fractures. METHOD From retrospective review of Taiwan's National Health Insurance Research Database, we enrolled 153,623 subjects aged 65 years and older with hospitalization for first hip fracture operated by IF (93,029 cases) or HA (60,594 cases) between 2000 and 2011. Postoperative mortality was compared between subjects with and without dementia after adjustments of age, gender, Charlson comorbidity index and hospital level. RESULTS The prevalence of dementia was 5.24% in the IF and 5.29% in the HA group. In the IF group, dementia increased adjusted hazard ratio of one-year (1.06, 95%CI:1.00-1.13) and two-year mortality (1.10, 95%CI:1.05-1.16). However, short and long-term mortality following HA was not significantly impacted by dementia (in-hospital OR:0.79, 95%CI:0.60-1.03; three-month HR:0.99, 95%CI:0.87-1.12; one-year HR:1.01, 95%CI:0.93-1.10; two-year HR:1.03, 95%CI:0.96-1.09). In a subgroup of dementia patients, mortality following IF was 15% higher than HA in one (p = 0.004) and two years (p < 0.001). The negative prognostic factors included female (HR:1.10; 95%CI:1.03-1.18) and aging 65-84 years (HR:1.15; 95%CI:1.00-1.32). CONCLUSION Dementia increased one and two-year mortality following geriatric hip fracture treated by IF, rather than HA. Dementia patients undergoing HA, especially female or 65-84 years old, sustained better one and two-year survival than those receiving IF.
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Affiliation(s)
- Yu-Cheng Lai
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Occupational Therapy, Shu Zen junior College of Medicine and Management, Kaohsiung, Taiwan; Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan.
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Nursing, Meiho Unervisity, Pingtung, Taiwan; College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Tsu-Jen Kuo
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Dental Technology, Shu-Zen junior College of Medicine and Management, Kaohsiung, Taiwan.
| | - Chien-Jen Hsu
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Nursing, Fooyin University, Kaohsiung, Taiwan.
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Matsuo M, Yamagami T, Higuchi A. Impact of age on postoperative complication rates among elderly patients with hip fracture: a retrospective matched study. J Anesth 2018; 32:452-456. [PMID: 29663067 DOI: 10.1007/s00540-018-2494-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/12/2018] [Indexed: 12/18/2022]
Abstract
This study was performed to assess the impact of age of ≥ 90 years on predicting postoperative complications. We retrospectively identified all patients aged ≥ 65 years who underwent surgical repair of hip fractures over a 4.5-year period in our hospital. In total, 261 patients were identified (mean age, 86.2 ± 6.8 years). Ninety-one patients were aged ≥ 90 years (oldest-old group), and the remaining 170 were aged < 89 years (control old group). Postoperative complications developed in 54 of 261 patients (20.7%). The oldest-old group had a significantly higher proportion of patients with a Japanese long-term care insurance need level and trochanteric fracture than the control group. Spinal anesthesia was more frequently performed in the oldest-old group. After propensity adjustment for these characteristics, postoperative complication rates in the oldest-old group remained significantly higher than those in the matched control group (odds ratio (OR) 2.76, 95% confidence interval (95% CI) 1.24-6.49; P = 0.011). Major complications also developed more frequently in the oldest-old group than control group (OR 9.78, 95% CI 1.31-4.36; P = 0.018). Anesthesiologists and surgeons should pay attention to potential complications following hip fracture surgery for patients aged ≥ 90 years regardless of American Society of Anesthesiologists class or social dependency.
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Affiliation(s)
- Mitsuhiro Matsuo
- Department of Anesthesiology, Itoigawa General Hospital, 457-1 Takegahana, Itoigawa, Niigata, 941-8502, Japan.
| | - Tohru Yamagami
- Department of Orthopedic Surgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan
| | - Akiko Higuchi
- Department of Anesthesiology, Itoigawa General Hospital, 457-1 Takegahana, Itoigawa, Niigata, 941-8502, Japan
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Scarano KA, Philp FH, Westrick ER, Altman GT, Altman DT. Evaluating Postoperative Complications and Outcomes of Orthopedic Fracture Repair in Nonagenarian Patients. Geriatr Orthop Surg Rehabil 2018; 9:2151459318758106. [PMID: 29619274 PMCID: PMC5871047 DOI: 10.1177/2151459318758106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/21/2017] [Accepted: 01/05/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction: The United States and the world are currently experiencing a tremendous growth in the elderly population. Moreover, individuals surpassing the ages of 80 and 90 are also continuing to increase. As this unique division of society expands, it is critical that the medical community best understands how to assess, diagnose, and treat this population. The purpose of this study was to analyze morbidity, mortality, and overall outcome of patients aged 90 years and older after orthopedic surgical fracture repair. Such knowledge will guide patients and their families in making decisions when surgery is required among nonagenarians. Methods: The trauma registry of our level I academic medical center was queried to identify potential study participants over the past decade. Two hundred and thirty-three surgical procedures among 227 patients were included and retrospectively assessed. Parameters of specific interest were injury type, mechanism of injury (including high energy vs low energy and height of falls), injury severity score, preoperative comorbidities, postoperative complications, length of hospital stay, discharge destination, and postoperative mortality rate. Results: Overall, 4.3% of the cohort died in the hospital following surgery. Of the patients who survived, 89.7% were discharged to a professionally supervised setting. The nonagenarian population displayed a considerable follow-up rate, as 82.8% of individuals returned for their first postoperative office visit. Discussion: Historically, surgical morbidity and mortality are highly associated with this age group. However, the number of nonagenarians in the United States is increasing, as are these surgical procedures. The epidemiologic and clinical findings of our study support this trend and add further insight into the matter. Conclusion: This investigation demonstrates that orthopedic surgery is an appropriate treatment in this population with an acceptable complication rate. Furthermore, nonagenarians have the potential to demonstrate a substantial follow-up rate, but postoperative discharge to a professionally supervised setting may be necessary.
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Affiliation(s)
| | - Frances H Philp
- Department of Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Edward R Westrick
- Allegheny Orthopedic Associates and Allegheny General Hospital, Pittsburgh, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Gregory T Altman
- Allegheny Orthopedic Associates and Allegheny General Hospital, Pittsburgh, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA.,Temple University School of Medicine, Philadelphia, PA, USA
| | - Daniel T Altman
- Allegheny Orthopedic Associates and Allegheny General Hospital, Pittsburgh, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA.,Temple University School of Medicine, Philadelphia, PA, USA
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Lin JCF, Liang WM. Mortality, readmission, and reoperation after hip fracture in nonagenarians. BMC Musculoskelet Disord 2017; 18:144. [PMID: 28376876 PMCID: PMC5381150 DOI: 10.1186/s12891-017-1493-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 03/20/2017] [Indexed: 12/21/2022] Open
Abstract
Background Osteoporotic hip fractures are associated with high mortality and morbidity in people of advanced age; however, few studies have investigated the complication rates in nonagenarians. In this study, we applied a competing risk analysis to estimate the mortality, readmission, and reoperation rates after surgery for hip fracture among nonagenarians. Methods A total of 11,184 nonagenarians (aged ≥ 90) who received surgery for hip fracture during the period 1 January 1997 and 31 December 2010 were selected from Taiwan’s National Health Insurance (NHI) database. Nonagenarians were followed up until the end of 2012, death, or the date they left the NHI program. Cumulative mortality was estimated using the Kaplan-Meier analysis and risk factors for mortality were investigated using a Cox proportional hazards model. Competing risk analysis was used to estimate cumulative incidence rates and to assess the risk factors for reoperation and readmission. Results The mortality rates were 29.5% at 1 year, 45.0% at 2 years and 78.1% at 5 years. The cumulative incidence rates of reoperation were 7.3% at 1 year, 9.2% at 2 years and 11.6% at 5 years whereas those of readmission were 18.9% at 1 month and 24.1% at 3 months. Significant risk factors for death included age, male gender, trochanteric fracture, and higher Charlson comorbidity index (CCI) whereas those for reoperation were age, cervical fracture and higher CCI. Furthermore, age, male gender, and higher CCI were risk factors for readmission. Conclusions The overall 2-years mortality rate among nonagenarians in Taiwan was around 45%, the 2-years reoperation rate was around 9% and the 90-days medical complication rate was around 24%. High complication rates are associated with increased risk for death. Postoperative care to prevent medical complications is likely the most effective strategy to reduce mortality rates among nonagenarians with hip fracture.
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Affiliation(s)
- Jeff Chien-Fu Lin
- Department of Statistics, National Taipei University, Taipei, Taiwan. .,Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Wen-Miin Liang
- Department of Public Health, China Medical University, Taichung, Taiwan.
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Fansa A, Huff S, Ebraheim N. Prediction of Mortality in Nonagenarians Following the Surgical Repair of Hip Fractures. Clin Orthop Surg 2016; 8:140-5. [PMID: 27247737 PMCID: PMC4870315 DOI: 10.4055/cios.2016.8.2.140] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/06/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study is to report on the mortality of nonagenarians who underwent surgical treatment for a hip fracture, specifically in regards to preexisting comorbidities. Furthermore, we assessed the effectiveness of the Deyo score in predicting such mortality. METHODS Thirty-nine patients over the age of 90 who underwent surgical repair of a hip fracture were retrospectively analyzed. Twenty-six patients (66.7%) suffered femoral neck fractures, while the remaining 13 (33.3%) presented with trochanteric type fractures. Patient charts were examined to determine previously diagnosed patient comorbidities as well as living arrangements and mobility before and after surgery. RESULTS Deyo index scores did not demonstrate statistically significant correlations with postoperative mortality or functional outcomes. The hazard of in-hospital mortality was found to be 91% (p = 0.036) and 86% (p = 0.05) less in patients without a history of congestive heart failure (CHF) and chronic pulmonary disease (CPD), respectively. Additionally, the hazard of 90-day mortality was 88% (p = 0.01) and 81% (p = 0.024) less in patients without a history of dementia and CPD, respectively. The hazard of 1-year mortality was also found to be 75% (p = 0.01) and 80% (p = 0.01) less in patients without a history of dementia and CPD, respectively. Furthermore, dementia patients stayed in-hospital postoperatively an average of 5.3 days (p = 0.013) less than nondementia patients and only 38.5% returned to preoperative living conditions (p = 0.036). CONCLUSIONS Nonagenarians with a history of CHF and CPD have a higher risk of in-hospital mortality following the operative repair of hip fractures. CPD and dementia patients over 90 years old have higher 90-day and 1-year mortality hazards postoperatively. Dementia patients are also discharged more quickly than nondementia patients.
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Affiliation(s)
- Ashraf Fansa
- Department of Orthopedics, University of Toledo Medical Center, Toledo, OH, USA
| | - Scott Huff
- College of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Nabil Ebraheim
- Department of Orthopedics, University of Toledo Medical Center, Toledo, OH, USA
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15
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Hong CC, Nashi N, Makandura MC, Tan JHJ, Peter L, Murphy D. The long and short of cephalomedullary nails in the treatment of osteoporotic pertrochanteric fracture. Singapore Med J 2016; 58:85-91. [PMID: 26948107 DOI: 10.11622/smedj.2016048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Pertrochanteric fractures after low-energy trauma are common among osteoporotic patients. Although the use of intramedullary devices to treat such fractures is becoming increasingly popular, there is a paucity of data comparing the outcomes of the use of short cephalomedullary nails (SCN) with the use of long cephalomedullary nails (LCN). This study aimed to compare the outcomes of treatment using LCN with treatment using SCN for patients with osteoporotic pertrochanteric fractures. METHODS A retrospective review of 64 patients with osteoporotic pertrochanteric fractures who were treated with either LCN or SCN and had a minimum follow-up of one year was performed. Primary outcome measures include complications, revision surgeries and union rates. Secondary outcome measures include duration of surgery, estimated blood loss, length of hospital stay, and ambulatory and mortality status at one year. RESULTS There was no significant difference in the clinical and functional outcomes of the patients who were treated with LCN and those who were treated with SCN. However, there was a higher incidence of heterotopic ossification in the latter group, and a slightly greater average estimated blood loss and duration of surgery in the former group. Patients treated with LCN tended to be more osteoporotic. CONCLUSION Our study found no significant difference in terms of complications, revision surgeries, union rates and ambulatory status between the patients who were treated with LCN and those who were treated with SCN. Both LCN and SCN provided safe and reliable outcomes in the treatment of osteoporotic pertrochanteric fractures.
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Affiliation(s)
- Choon Chiet Hong
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Nazrul Nashi
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Milindu Chanaka Makandura
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Jiong Hao Jonathan Tan
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Luke Peter
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Diarmuid Murphy
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
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16
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Graver A, Merwin S, Collins L, Kohn N, Goldman A. Comorbid Profile Rather than Age Determines Hip Fracture Mortality in a Nonagenarian Population. HSS J 2015; 11:223-35. [PMID: 26981057 PMCID: PMC4773692 DOI: 10.1007/s11420-015-9435-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 02/10/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND In light of poor outcomes with nonoperative management of hip fractures, orthopedic surgeons are faced with difficult decisions about which patients are too ill or too old for surgical treatment. QUESTIONS/PURPOSES This study sought to investigate if patients over 90 years had different preoperative laboratory, clinical, and injury characteristics than younger patients with the same injury. We compared our cohort with previously published data. We wished to identify if there were pre-injury risk factors associated with 30-day mortality, which could be modified to enhance postoperative outcomes. METHODS This is a retrospective review of 198 operatively managed hip fractures in patients 75 years or older. We collected data on demographics, select preoperative laboratory values, injury type, comorbidities, and 30-day mortality. RESULTS Eleven (5.6%) of the cohort died within 30 days of surgery, 6.3% in the younger group, and 3.7% in the older group; the difference was not statistically significant. For baseline characteristics, there was no difference between the age groups for pre-injury comorbidities, hemoglobin, serum albumin, BUN, prevalence of UTI, or fracture type. A total of 67 (35.8%) patients had evidence of UTI on admission. CONCLUSIONS These findings reveal that in our dichotomized cohort, pre-injury characteristics were similar and age alone was not an independent predictor of mortality. These data may inform decision-making for orthopedic surgeons and the medical providers who consult to optimize these patients for surgery. We identified high rates of UTI in both age groups, a potentially remediable factor to optimize outcomes in hip fracture surgery in elderly patients.
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Affiliation(s)
- Adam Graver
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040 USA
| | - Sara Merwin
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040 USA ,Hofstra North Shore-LIJ School of Medicine, 500 Hofstra University, Hempstead, NY 11549 USA
| | - Lewis Collins
- North Shore-LIJ Medical Group, University Orthopaedic Associates, 611 Northern Blvd Suite 200, Great Neck, NY 11021 USA
| | - Nina Kohn
- Biostatistics Unit, Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030 USA
| | - Ariel Goldman
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040 USA ,Hofstra North Shore-LIJ School of Medicine, 500 Hofstra University, Hempstead, NY 11549 USA ,North Shore-LIJ Medical Group, University Orthopaedic Associates, 611 Northern Blvd Suite 200, Great Neck, NY 11021 USA ,North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030 USA
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17
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Liu Y, Peng M, Lin L, Liu X, Qin Y, Hou X. Relationship between American Society of Anesthesiologists (ASA) grade and 1-year mortality in nonagenarians undergoing hip fracture surgery. Osteoporos Int 2015; 26:1029-33. [PMID: 25300530 DOI: 10.1007/s00198-014-2931-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/02/2014] [Indexed: 12/21/2022]
Abstract
UNLABELLED This study retrospectively reviewed 327 nonagenarians who underwent hip fracture surgery at six hospitals. Functional status, postoperative complications, and 1-year mortality were evaluated, and relationships between these factors and American Society of Anesthesiologists (ASA) grade were analyzed. ASA grade was significantly associated with postoperative complications and 1-year mortality. INTRODUCTION Few previous studies have reported outcomes after hip fracture in nonagenarians, and these studies did not report significant associations between ASA grade and mortality. However, most of these studies included only a small number of patients from a single hospital. This study aimed to evaluate the relationships between ASA grade and functional status, postoperative complications, and mortality rate in nonagenarians undergoing hip fracture surgery. METHODS This study included 327 nonagenarians who underwent hip fracture surgery between January 2000 and December 2012. Patients with open fractures, subtrochanteric fractures, polytrauma, and pathological fractures were excluded. The medical records and X-rays were retrospectively reviewed. The relationships between ASA grade and functional status, postoperative complications, and 1-year mortality were analyzed. RESULTS There were significant associations between the ASA grade and the rates of postoperative complications and 1-year mortality (both p < 0.05). All pairwise comparisons showed significant differences in postoperative complication rates between ASA grades (all p < 0.05). All pairwise comparisons, except for grades I vs. II and grades II vs. III, also showed significant differences in mortality rates between ASA grades (all p < 0.05). There were significant associations between the preoperative ability to manage activities of daily living and the rates of postoperative complications and 1-year mortality (both p < 0.05). CONCLUSIONS ASA grade was significantly associated with the rates of postoperative complications and 1-year mortality in nonagenarians undergoing hip fracture surgery. The preoperative functional status was also significantly associated with these outcomes.
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MESH Headings
- Activities of Daily Living
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/mortality
- China/epidemiology
- Female
- Fracture Fixation, Internal/adverse effects
- Fracture Fixation, Internal/methods
- Fracture Fixation, Internal/mortality
- Hemiarthroplasty/adverse effects
- Hemiarthroplasty/methods
- Hemiarthroplasty/mortality
- Hip Fractures/mortality
- Hip Fractures/surgery
- Humans
- Male
- Osteoporotic Fractures/mortality
- Osteoporotic Fractures/surgery
- Retrospective Studies
- Trauma Severity Indices
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Affiliation(s)
- Y Liu
- Department of Orthopedics, Third Hospital of Hebei Medical University, No. 139 Zi Qiang Road, Shijiazhuang, Hebei, 050051, China,
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Tay YWA, Hong CC, Murphy D. Functional outcome and mortality in nonagenarians following hip fracture surgery. Arch Orthop Trauma Surg 2014; 134:765-72. [PMID: 24682524 DOI: 10.1007/s00402-014-1982-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The world's population is ageing and the elderly population itself is growing older. This population shows a high incidence of hip fractures. We performed a retrospective study, reviewing the functional status, postoperative complications and mortality rate of nonagenarians who underwent surgery for hip fracture. METHODS AND SUBJECTS 56 nonagenarian patients underwent hip fracture surgery in our institution between January 2000 and December 2010. Two of these patients had presented with hip fracture on separate occasions, giving a total of 58 hips for analysis. Patients with open fracture, subtrochanteric fracture, polytrauma and pathological fracture were excluded. The case notes, electronic records and X-rays for all those included in the study were reviewed. The main outcome measures were functional status, postoperative complications and mortality rate at 1 year. RESULTS Patients with extracapsular hip fractures were associated with higher risks of postoperative complications (60.7 %; p = 0.037), mortality (25 %; p = 0.003) and more likely to be non-ambulant at 1 year (53.6 vs 16.7 %; p = 0.003). Females were more likely to suffer postoperative complications than males (p = 0.016). 46.6 % of the patients had immediate postoperative complications and most commonly due to urological complications (29.3 %). The 1-year mortality rate was 12.1 %. A notable proportion of patients (65.5 %) remained ambulant 1 year postoperatively, although almost half of the patients (48.3 %) who could ambulate independently pre-injury required a walking aid after hip fracture surgery. CONCLUSION Nonagenarians have good surgical outcomes after hip fracture surgery with low mortality rate. They should be treated similarly as their younger counterparts in terms of decision for surgery. Potential decline in functional status and rehabilitation options should be shared with the patient and family at an early stage.
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Affiliation(s)
- You Wei Adriel Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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19
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Rochon PA, Gruneir A, Wu W, Gill SS, Bronskill SE, Seitz DP, Bell CM, Fischer HD, Stephenson AL, Wang X, Gershon AS, Anderson GM. Demographic Characteristics and Healthcare Use of Centenarians: A Population-Based Cohort Study. J Am Geriatr Soc 2014; 62:86-93. [DOI: 10.1111/jgs.12613] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paula A. Rochon
- Women's College Research Institute; Women's College Hospital; Toronto Ontario Canada
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Andrea Gruneir
- Women's College Research Institute; Women's College Hospital; Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Wei Wu
- Women's College Research Institute; Women's College Hospital; Toronto Ontario Canada
| | - Sudeep S. Gill
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- St. Mary's of the Lake Hospital; Kingston Ontario Canada
- Department of Medicine; Queen's University; Kingston Ontario Canada
| | - Susan E. Bronskill
- Institute of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Dallas P. Seitz
- Department of Psychiatry; Queen's University; Kingston Ontario Canada
| | - Chaim M. Bell
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Mount Sinai Hospital; Toronto Ontario Canada
| | - Hadas D. Fischer
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Anne L. Stephenson
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Keenan Research Centre; Li Ka Shing Knowledge Institute; St. Michael's Hospital; Toronto Ontario Canada
| | - Xuesong Wang
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Andrea S. Gershon
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Sunnybrook Health Sciences Centre; Toronto Ontario Canada
| | - Geoffrey M. Anderson
- Women's College Research Institute; Women's College Hospital; Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
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White PF, White LM, Monk T, Jakobsson J, Raeder J, Mulroy MF, Bertini L, Torri G, Solca M, Pittoni G, Bettelli G. Perioperative care for the older outpatient undergoing ambulatory surgery. Anesth Analg 2012; 114:1190-215. [PMID: 22467899 DOI: 10.1213/ane.0b013e31824f19b8] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As the number of ambulatory surgery procedures continues to grow in an aging global society, the implementation of evidence-based perioperative care programs for the elderly will assume increased importance. Given the recent advances in anesthesia, surgery, and monitoring technology, the ambulatory setting offers potential advantages for elderly patients undergoing elective surgery. In this review article we summarize the physiologic and pharmacologic effects of aging and their influence on anesthetic drugs, the important considerations in the preoperative evaluation of elderly outpatients with coexisting diseases, the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and offer recommendations regarding the management of common postoperative side effects (including delirium and cognitive dysfunction, fatigue, dizziness, pain, and gastrointestinal dysfunction) after ambulatory surgery. We conclude with a discussion of future challenges related to the growth of ambulatory surgery practice in this segment of our surgical population. When information specifically for the elderly population was not available in the peer-reviewed literature, we drew from relevant information in other ambulatory surgery populations.
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Affiliation(s)
- Paul F White
- Department of Anesthesia, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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