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Zhong Y, Liu M, Cheng Z, Yao Y, Yu Y, Luo G, Zheng B, Yan M. "Multidisciplinary fast-track" care can significantly reduce risk of mortality among hip fracture patients at least 80 years old: a single-center retrospective study. BMC Geriatr 2024; 24:592. [PMID: 38987709 PMCID: PMC11238416 DOI: 10.1186/s12877-024-05183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 06/27/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND "Multidisciplinary fast-track" (MFT) care can accelerate recovery and improve prognosis after surgery, but whether it is effective in older people after hip fracture surgery is unclear. METHODS We retrospectively compared one-year all-cause mortality between hip fracture patients at least 80 years old at our institution who underwent hip fracture surgery between January 2014 and December 2018 and who then received MFT or conventional care. Multivariable regression was used to assess the association between MFT care and mortality after adjustment for confounders. RESULTS The final analysis included 247 patients who received MFT care and 438 who received conventional orthopedic care. The MFT group showed significantly lower one-year mortality (8.9% vs. 14.4%, P = 0.037). Log-rank testing of Kaplan-Meier survival curves confirmed the survival advantage. However, the two groups did not differ significantly in rates of mortality during hospitalization or at 30 or 90 days after surgery. Regression analysis confirmed that MFT care was associated with lower risk of one-year mortality (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.281-0.788, P = 0.04), and the survival benefit was confirmed in subgroups of patients with anemia (HR 0.453, 95% CI 0.268-0.767, P = 0.003) and patients with American Society of Anesthesiologists grade III (HR 0.202, 95% CI 0.08-0.51, P = 0.001). CONCLUSIONS MFT care can reduce one-year mortality among hip fracture patients at least 80 years old. This finding should be verified and extended in multi-center randomized controlled trials.
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Affiliation(s)
- Yinbo Zhong
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Mingxia Liu
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang, China
| | - Zhenzhen Cheng
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Yuanyuan Yao
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Yang Yu
- Department of Anesthesiology, The First People's Hospital of Weifang, Weifang, Shandong, China
| | - Ge Luo
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Min Yan
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China.
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Gorman E, DiMaggio C, Frangos S, Klein M, Berry C, Bukur M. Elderly Patients With Cervical Spine Fractures After Ground Level Falls Are at Risk for Blunt Cerebrovascular Injury. J Surg Res 2020; 253:100-104. [DOI: 10.1016/j.jss.2020.03.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 12/17/2022]
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Reguant F, Arnau A, Lorente JV, Maestro L, Bosch J. Efficacy of a multidisciplinary approach on postoperative morbidity and mortality of elderly patients with hip fracture. J Clin Anesth 2018; 53:11-19. [PMID: 30286380 DOI: 10.1016/j.jclinane.2018.09.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/16/2018] [Accepted: 09/26/2018] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE We evaluated the efficacy of a multidisciplinary approach to reduce postoperative complications and 1-year mortality in patients, undergoing hip fracture surgery and the impact of surgical delay on mortality. DESIGN A non-randomized intervention study with a historical control group (CG). SETTING During the hospital stay of patients undergoing hip fracture surgery and subsequent follow-up during 12 months post-discharge. PATIENTS 240 patients undergoing hip fracture surgery were included in the CG. 272 patients were included in the intervention group (IG). INTERVENTIONS CG patients received the standard care given at our hospital. Patients in the IG received a new model of multidisciplinary approach to care. MEASUREMENTS The following variables were collected: study group, age, gender, ASA physical status, comorbidity, type of fracture, type of anaesthesia, surgical delay, postoperative complications, hospital stay, destination after discharge and postoperative mortality. MAIN RESULTS 512 patients (CG = 240; IG = 272). Mean age was 83.8 years in CG and 84.9 years in IG. Patients in the IG had a worse health status according to ASA (III-IV: 68.8% vs 51.7%; p < 0.001) and took more drugs (p < 0.001). Surgery was performed within 48 h of admission in 55.1% of patients of the IG (38.3% CG; p < 0.001). Incidence of postoperative complications (67.3% IG vs 76.2% CG p = 0.025) and hospital stay was shorter in the IG (p < 0.001). A surgical delay of >48 h (HR = 0.61; CI95%: 0.42-0.88) and allocation to the IG (HR = 0.64; CI95%: 0.44-0.93) were the protective factors for mortality. CONCLUSIONS The multidisciplinary approach could be associated with a decrease in postoperative complications, hospital stay and mortality. Surgical delay may not increase the risk of mortality. The main objective in the management of these patients should be the optimization of their general health status before surgery rather than surgical delay.
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Affiliation(s)
- F Reguant
- Department of Anaesthesiology, Althaia Xarxa Assistencial Universitària de Manresa, C/ Dr. Joan Soler, 1-3, 08243 Manresa, Barcelona, Spain; School of Medicine and Health Sciences, International University of Catalonia (UIC), C/Josep Trueta, s/n., 08195 Sant Cugat del Vallès, Barcelona, Spain.
| | - A Arnau
- School of Medicine and Health Sciences, International University of Catalonia (UIC), C/Josep Trueta, s/n., 08195 Sant Cugat del Vallès, Barcelona, Spain; Clinical Research Unit, Althaia Xarxa Assistencial Universitària de Manresa, C/ Dr, Joan Soler, 1-3, 08243 Manresa, Barcelona, Spain
| | - J V Lorente
- Department of Anaesthesiology, Althaia Xarxa Assistencial Universitària de Manresa, C/ Dr. Joan Soler, 1-3, 08243 Manresa, Barcelona, Spain; School of Medicine and Health Sciences, International University of Catalonia (UIC), C/Josep Trueta, s/n., 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - L Maestro
- Specialized Nursing in Anaesthesia, Althaia Xarxa Assistencial Universitària de Manresa, C/ Dr. Joan Soler, 1-3, 08243 Manresa, Barcelona, Spain
| | - J Bosch
- School of Medicine and Health Sciences, International University of Catalonia (UIC), C/Josep Trueta, s/n., 08195 Sant Cugat del Vallès, Barcelona, Spain
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Gerrish AW, Hamill ME, Love KM, Lollar DI, Locklear TM, Dhiman N, Nussbaum MS, Collier BR. Postdischarge Mortality after Geriatric Low-Level Falls: A Five-Year Analysis. Am Surg 2018. [DOI: 10.1177/000313481808400835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Geriatric trauma patients with low-level falls often have multiple comorbidities and limited physiologic reserve. Our aim was to investigate postdischarge mortality in this population. We hypothesized that five-year mortality would be higher relative to other blunt mechanisms. The registry of our Level 1 trauma center was queried for patients evaluated between July 2008 and December 2012. Adult patients identified were matched with mortality data from 2008 to 2013 from the National Death Index. Low-level falls were identified by E Codes; other types of blunt trauma were based on registry classification. Patients with multiple admissions were excluded. Univariate analysis was performed using Fisher's exact and Wilcoxon tests. Kaplan-Meier curves were plotted to compare postdischarge mortality. Seven thousand nine hundred sixteen patients were evaluated, 35.1 per cent were females. Patients aged less than 65 years and penetrating trauma were excluded, yielding 1997 patients—63.7 per cent with low-level falls versus 36.3 per cent with other blunt traumas. Geriatric patients sustaining low-level falls were older, more likely female, had a higher inpatient mortality, and were less likely to return home at discharge. Injury severity score, hospital length of stay, and intensive care unit length of stay were similar. Survival analysis demonstrated increased postdischarge mortality in the low-level fall group with 25 per cent mortality at 120 days. Geriatric patients with other blunt trauma had a significantly lower postdischarge mortality. Geriatric patients injured in low-level falls have a higher inhospital mortality, are more likely to be functionally dependent on discharge, and have a high post-discharge mortality. Opportunities likely exist for injury prevention, consideration of palliative care, and postdischarge rehabilitation.
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Affiliation(s)
- Ashley W. Gerrish
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Mark E. Hamill
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Katie M. Love
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Daniel I. Lollar
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | | | - Nitasha Dhiman
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
- John T. Mather Memorial Hospital, Port Jefferson, New York
| | - Michael S. Nussbaum
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Bryan R. Collier
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
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Sinha VD, Gupta V, Singh DK, Chopra S, Gupta P, Bagaria H. Geriatric head injuries - Experience and expectations. INDIAN JOURNAL OF NEUROTRAUMA 2017. [DOI: 10.1016/s0973-0508(08)80003-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractIt is widely known that global citizenry is continuing to age. The elderly head trauma patients, comprising 4.83% in our series are important from neurosurgical aspects. We conducted a study of elderly head injury patients admitted to our unit in last 11 years. Out of 620 patients, 423 males and 197 female, constituting a ratio of 2.1∶1. Fall constitutes the principle mode of injury (56.29%) followed by RTA (44.1%). We analyzed all the cases for surgical intervention after careful assessment of neurological condition. Amongst all cases operated for acute trauma, good recovery was seen in 51.8% and mortality in 41.7%, whereas in chronic subdural haematoma 84.2% cases showed good recovery as against mortality in 10.5%. In our society, due to very close family ties and desperation of family members to try active intervention even in patients with expected bleak outcome, we operated a fairly large number of cases and concluded that outcome was better after operative intervention.
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Chehade M, Gill TK, Visvanathan R. Low Energy Trauma in Older Persons: Where to Next? Open Orthop J 2015; 9:361-6. [PMID: 26312120 PMCID: PMC4541454 DOI: 10.2174/1874325001509010361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/26/2015] [Accepted: 05/18/2015] [Indexed: 12/15/2022] Open
Abstract
The global population is increasing rapidly with older persons accounting for the greatest proportion. Associated with this rise is an increased rate of injury, including polytrauma, for which low energy falls has become the main cause. The resultant growing impact on trauma resources represents a major burden to the health system. Frailty, with its related issues of cognitive dysfunction and sarcopenia, is emerging as the unifying concept that relates both to the initial event and subsequent outcomes. Strategies to better assess and manage frailty are key to both preventing injury and improving trauma outcomes in the older population and research that links measures of frailty to trauma outcomes will be critical to informing future directions and health policy. The introduction of "Geriatric Emergency Departments" and the development of "Fracture Units" for frail older people will facilitate increased involvement of Geriatricians in trauma care and aid in the education of other health disciplines in the core principles of geriatric assessment and management. Collectively these should lead to improved care and outcomes for both survivors and those requiring end of life decisions and palliation.
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Affiliation(s)
- Mellick Chehade
- Discipline of Orthopaedics and Trauma, The University of Adelaide, Level 4, Bice Building, The Royal Adelaide
Hospital, North Tce., Adelaide, SA, 5000, Australia
| | - Tiffany K Gill
- School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Renuka Visvanathan
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, SA, 5011,
Australia
- 4Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, Faculty of Health
Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia
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Gonsaga RAT, Silva EMD, Brugugnolli ID, Cabral JL, Thomé Neto O. Padrão e necessidades de atendimento pré-hospitalar a idosos. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2015. [DOI: 10.1590/1809-9823.2015.13171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As principais doenças que atingem os idosos são as crônico-degenerativas, que somadas às frequentes comorbidades desse grupo, demandam maior preocupação por parte das instituições de saúde e, consequentemente, maior utilização de serviços de alta complexidade. O objetivo do estudo foi descrever os atendimentos de idosos pelo Serviço de Atendimento Móvel de Urgência SAMU no município de Catanduva-SP, com base em registros de atendimentos aos indivíduos com idade superior a 59 anos lá realizados. Foram analisados dados demográficos, sinais vitais, tipos de atendimento segundo gênero, nível de atenção à saúde indicado para resolução da ocorrência, horários das ocorrências e relação entre os grupos etários e ocorrências de clínica médica e traumáticas. Foram atendidos 42.629 pacientes, a maioria do sexo feminino 55%; a média de idade foi de 74,2 anos. Houve significância estatística nos sinais vitais quando comparados os gêneros. As ocorrências de maior frequência foram as classificadas como enfermidades clínicas, seguidas por solicitações sociais e transferências intra-hospitalares. Houve aumento dos agravos agudos clínicos e traumáticos nas faixas etárias de maior idade, e 77,9% dos atendimentos necessitaram de uma unidade fixa de atendimento para continuidade do tratamento. Encontrou-se, ainda, predomínio de atendimento nos horários de vigília dos pacientes. Observam-se maiores taxas de ocorrências com o aumento da faixa etária e utilização mais frequente de atendimento hospitalar terciário pós-ocorrências, fato que caracteriza, de maneira geral, o modelo hospitalocêntrico.
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McDaniel DO, Rigney D, Olivier J, McDaniel KY, Brock M, Redmond P, Porter J. Trauma Induced Inflammation, Sepsis and Ageing. AGEING INTERNATIONAL 2013. [DOI: 10.1007/s12126-013-9195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Polytrauma in the elderly: specific considerations and current concepts of management. Eur J Trauma Emerg Surg 2011; 37:539-48. [DOI: 10.1007/s00068-011-0137-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 06/26/2011] [Indexed: 11/26/2022]
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Doerflinger DMC. Older Adult Surgical Patients: Presentation and Challenges. AORN J 2009; 90:223-40; quiz 241-4. [DOI: 10.1016/j.aorn.2009.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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