1
|
Lovera D, Sandberg O, Mohaddes M, Gyllensten H. Cost-effectiveness of implant movement analysis in aseptic loosening after hip replacement: a health-economic model. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:88. [PMID: 37986000 PMCID: PMC10662297 DOI: 10.1186/s12962-023-00498-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE To investigate the cost-effectiveness of using Implant Movement Analysis (IMA) to follow up suspected aseptic loosening when the diagnosis after an initial X-ray is not conclusive, compared with a diagnostic pathway with X-ray follow-up. METHODS A health-economic model in the form of a decision tree was developed using quality-adjusted life years (QALY) from the literature, cost-per-patient data from a university hospital and the probabilities of different events from expert physicians' opinions. The base case incremental cost-effectiveness ratio (ICER) was compared with established willingness-to-pay thresholds and sensitivity analyses were performed to account for assumptions and uncertainty. RESULTS The base case ICER indicated that the IMA pathway was cost effective (SEK 99,681, compared with the SEK 500,000 threshold). In the sensitivity analysis, the IMA pathway remained cost effective during most changes in parameters. ICERs above the threshold value occurred in cases where a larger or smaller proportion of people receive immediate surgery. CONCLUSION A diagnostic pathway using IMA after an inconclusive X-ray for suspected aseptic loosening was cost effective compared with a pathway with X-ray follow-up.
Collapse
Affiliation(s)
- Davide Lovera
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sectra, Linköping, Sweden
| | | | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P. O. Box 457, 405 30, Gothenburg, Sweden.
| |
Collapse
|
2
|
Tsumura H, McConnell ES, Xue T(M, Wei S, Lee C, Pan W. Impact of Dementia on Incidence and Severity of Postoperative Pulmonary Complications Following Hip Fracture Surgery Among Older Patients. Clin Nurs Res 2023; 32:1145-1156. [PMID: 37592720 PMCID: PMC10811580 DOI: 10.1177/10547738231194098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Postoperative pulmonary complications (PPCs) are the leading cause of death following hip fracture surgery. Dementia has been identified as a PPC risk factor that complicates the clinical course. By leveraging electronic health records, this retrospective observational study evaluated the impact of dementia on the incidence and severity of PPCs, hospital length of stay, and postoperative 30-day mortality among 875 older patients (≥65 years) who underwent hip fracture surgery between October 1, 2015 and December 31, 2018 at a health system in the southeastern United States. Inverse probability of treatment weighting using propensity scores was utilized to balance confounders between patients with and without dementia to isolate the impact of dementia on PPCs. Regression analyses revealed that dementia did not have a statistically significant impact on the incidence and severity of PPCs or postoperative 30-day mortality. However, dementia significantly extended the hospital length of stay by an average of 1.37 days.
Collapse
Affiliation(s)
| | - Eleanor S. McConnell
- Duke University School of Nursing Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System Durham, NC, USA
| | - Tingzhong (Michelle) Xue
- Duke University School of Nursing Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System Durham, NC, USA
| | - Sijia Wei
- Center for Education in Health Sciences, Institute for Public Health and Medicine Northwestern University Feinberg School of Medicine Chicago, IL, USA
| | - Chiyoung Lee
- University of Washington Bothell School of Nursing & Health Studies Bothell, WA, USA
| | - Wei Pan
- Duke University School of Nursing Durham, NC, USA
- Department of Population Health Sciences Duke University School of Medicine Durham, NC, USA
| |
Collapse
|
3
|
Farhad SA, Anders B, Erik N, Martin N, Martin A. Mortality after benign thyroid surgery in patients aged 80 years or older. Langenbecks Arch Surg 2022; 407:1659-1665. [PMID: 35286467 PMCID: PMC9283352 DOI: 10.1007/s00423-022-02463-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/07/2022] [Indexed: 11/22/2022]
Abstract
Introduction A recent report from the United Nations showed that aged people are increasing worldwide. Few data exist on overall survival for patients 80 years or older undergoing benign thyroid surgery. Short- and long-term survival and risk factors for death in patients undergoing thyroid surgery for benign disease were evaluated, using a nationwide, population-based quality register. Methods Patients operated for benign thyroid disease, 2004 to 2017, were collected from the national quality register for thyroid surgery. Mortality data were retrieved from the Swedish National Board of Health and Welfare. Mortality at 30 days, 90 days, and 1 year after surgery, for patients 80 years or older, was calculated. Overall survival was calculated using the Kaplan–Meier estimate. Risk factors for mortality were assessed with Cox’s multiple regression analysis. The standardized mortality ratio was calculated. Results There were 17,969 patients. Among them, 483 patients were 80 years or older, and of these, 397 (82.2%) were women. The mortality rate at 0–30 days, 31–90 days, and at 91–365 days after surgery was 0.4%, 0.2%, and 2.5%, respectively. The median (IQR) follow-up time was 4.5 (2.9–7.2) and the median (IQR) survival time was 8.0 (4.1–12.5) years. Apart from age, there was no other risk factor for death. The standardized mortality ratio (SMR) was 0.67 (0.49–0.91) for men and 0.76 (0.65–0.89) for women. Conclusion Mortality after surgery for benign thyroid disease in patients 80 years or older was lower than the general population with no specific risk factors for death except for age.
Collapse
|
4
|
Wojtowicz AL, Al-Azzani W, Nåtman J, Rolfson O, Rogmark C, Cnudde PHJ. Hip arthroplasty for acute hip fracture in patients with neurological disorders: A report Of 9,702 cases from the Swedish arthroplasty register. Injury 2022; 53:1202-1208. [PMID: 34602245 DOI: 10.1016/j.injury.2021.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/16/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate neurological disorder as a risk factor for dislocation following arthroplasty for acute hip fractures. We also analysed medical and surgical adverse events (AE), readmission, reoperation, revision, and mortality as secondary outcomes. METHODS A longitudinal cohort study using prospectively collected and aggregated data from the Swedish Hip Arthroplasty Register (SHAR) and the Swedish national patient register. All patients presenting with an acute hip fracture and treated with an arthroplasty in the period from 2005 to 2014 from the SHAR were identified. Patients in receipt of bilateral arthroplasties were excluded. Patients with a relevant pre-existing and diagnosed neurological disorder, as defined by ICD-10 codes, were identified (n = 9,702). All other cases (n = 29,411) were available for logistic regression propensity score matching. Patients were 1:1 matched on age, sex, Charlson comorbidity index, total versus hemiarthroplasty, head size, surgical approach, and year of surgery. Dislocations, adverse events, readmission, reoperation, revision, and mortality were studied using Kaplan-Meier analysis and Cox regression. RESULTS The risk of dislocations was higher for patients with neurological disorder (HR=1.19, CI 1.03- 1.39, p<0.05). Neurological disorder was associated with increased risk of encountering an adverse event (p<0.001 at 90-days); these patients were at higher risk of dying (HR=1.51, CI 1.47-1.56, p<0.001) however they were less likely to be readmitted (HR=0.73, CI 0.70- 0.76, p<0.001). No excess risks of reoperation (HR=1.02, CI 0.90-1.17; p = 0.73) or revision (HR=1.00, CI 0.86-1.17; p = 0.99) were identified in the study group. DISCUSSION Compared to matched controls, individuals with a preoperatively identified neurological diagnosis had higher rates of mortality, dislocations, and adverse events, but this cohort was not at increased risk of reoperation or revision. This study highlights an area of focus for future research to improve the long-term outcomes in patients with neurological disease undergoing arthroplasty for an acute hip fracture.
Collapse
Affiliation(s)
- Alex L Wojtowicz
- Hywel Dda University Health Board, Dept. of Orthopaedics, Prince Philip Hospital, Bryngwynmawr, Llanelli, SA14 8QF, NSW, United Kingdom; University of Bristol Medical School, First Floor, Tyndall Avenue, Bristol, BS8 1UD, United Kingdom.
| | - Waheeb Al-Azzani
- Hywel Dda University Health Board, Dept. of Orthopaedics, Prince Philip Hospital, Bryngwynmawr, Llanelli, SA14 8QF, NSW, United Kingdom.
| | - Jonatan Nåtman
- Swedish Arthroplasty Register, Registercentrum Västra Götaland, 413 45 Gothenburg, Sweden.
| | - Ola Rolfson
- Swedish Arthroplasty Register, Registercentrum Västra Götaland, 413 45 Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Box 400, 405 30, Gothenburg, Sweden.
| | - Cecilia Rogmark
- Swedish Arthroplasty Register, Registercentrum Västra Götaland, 413 45 Gothenburg, Sweden; Dept. of Orthopaedics, Skåne University Hospital, Lund University, Södra Förstadsgatan 101, 205 02, Malmö, Sweden
| | - Peter H J Cnudde
- Hywel Dda University Health Board, Dept. of Orthopaedics, Prince Philip Hospital, Bryngwynmawr, Llanelli, SA14 8QF, NSW, United Kingdom; Swedish Arthroplasty Register, Registercentrum Västra Götaland, 413 45 Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Box 400, 405 30, Gothenburg, Sweden.
| |
Collapse
|
5
|
Lakhani K, Mimendia I, Porcel JA, Martín-Domínguez LA, Guerra-Farfán E, Barro V. Direct anterior approach provides better functional outcomes when compared to direct lateral approach in hip hemiarthroplasty following femoral neck fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022; 32:137-143. [PMID: 33760998 DOI: 10.1007/s00590-021-02941-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aims to compare the differences between direct anterior approach (DAA) and direct lateral approach (DLA) in hip hemiarthroplasty (HHA) after displaced femoral neck fracture (FNF) in early functional outcome, hospital length of stay, morbidity and mortality rates. METHODS This non-interventional retrospective study, carried out at a tertiary trauma centre within the Spanish National Health System, included all patients who underwent a bipolar HHA between 1st January 2018 and 31st December 2019 performed by 2 of our hip unit surgeons. RESULTS A total of 94 patients were included (40 in DAA group and 54 in DLA group). Median follow-up was 19.2 months (range 8-30.8 months). Postoperative degree of mobilisation showed statistically significant differences in favour of DAA group, where 35% of patients were able to walk with no assistance after surgery. DAA group had 1 day less of hospitalisation in contrast with DLA group overall (8 days vs 9 days, respectively, p < 0.05). Statistically significant differences were not detected in comparing postoperative complications, re-operations rates or 6-months mortality rate. CONCLUSION Our study highlights the benefits of DAA for HHA after displaced FNF in terms of postoperative mobilisation degree and hospitalisation length of stay when compared to DLA.
Collapse
Affiliation(s)
- Kushal Lakhani
- Department of Traumatology and Orthopedic Surgery, Hospital Universitari Valld'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Iñaki Mimendia
- Department of Traumatology and Orthopedic Surgery, Hospital Universitari Valld'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Department of Traumatology and Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Juan Antonio Porcel
- Department of Traumatology and Orthopedic Surgery, Hospital Universitari Valld'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Lidia A Martín-Domínguez
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitari Dexeus, Barcelona, Spain
| | - Ernesto Guerra-Farfán
- Department of Traumatology and Orthopedic Surgery, Hospital Universitari Valld'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Department of Traumatology and Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Víctor Barro
- Department of Traumatology and Orthopedic Surgery, Hospital Universitari Valld'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Department of Traumatology and Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
6
|
Cnudde PHJ, Nåtman J, Hailer NP, Rogmark C. Total, hemi, or dual-mobility arthroplasty for the treatment of femoral neck fractures in patients with neurological disease : analysis of 9,638 patients from the Swedish Hip Arthroplasty Register. Bone Joint J 2022; 104-B:134-141. [PMID: 34969279 DOI: 10.1302/0301-620x.104b1.bjj-2021-0855.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients. METHODS We undertook a longitudinal cohort study linking the Swedish Hip Arthroplasty Register with the National Patient Register, including patients with a neurological disease presenting with a femoral neck fracture and treated with HA, a conventional THA (cTHA) with femoral head size of ≤ 32 mm, or a dual-mobility component THA (DMC-THA) between 2005 and 2014. The dislocation rate at one- and three-year revision, reoperation, and mortality rates were recorded. Cox multivariate regression models were fitted to calculate adjusted hazard ratios (HRs). RESULTS A total of 9,638 patients with a neurological disease who also underwent unilateral arthroplasty for a femoral neck fracture were included in the study. The one-year dislocation rate was 3.7% after HA, 8.8% after cTHA < 32 mm), 5.9% after cTHA (= 32 mm), and 2.7% after DMC-THA. A higher risk of dislocation was associated with cTHA (< 32 mm) compared with HA (HR 1.90 (95% confidence interval (CI) 1.26 to 2.86); p = 0.002). There was no difference in the risk of dislocation with DMC-THA (HR 0.68 (95% CI 0.26 to 1.84); p = 0.451) or cTHA (= 32 mm) (HR 1.54 (95% CI 0.94 to 2.51); p = 0.083). There were no differences in the rate of reoperation and revision-free survival between the different types of prosthesis and sizes of femoral head. CONCLUSION Patients with a neurological disease who sustain a femoral neck fracture have similar rates of dislocation after undergoing HA or DMC-THA. Most patients with a neurological disease are not eligible for THA and should thus undergo HA, whereas those eligible for THA could benefit from a DMC-THA. Cite this article: Bone Joint J 2022;104-B(1):134-141.
Collapse
Affiliation(s)
- Peter H J Cnudde
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden.,Department of Orthopaedics, Goteborgs Universitet Sahlgrenska Akademin, Goteborg, Sweden.,Department of Orthopaedics, Hywel Dda University Health Board, Llanelli, UK
| | | | - Nils P Hailer
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Cecilia Rogmark
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden.,Department of Orthopaedics, Lund University Faculty of Medicine, Malmö, Sweden
| |
Collapse
|
7
|
Duijnisveld BJ, Koenraadt KLM, van Steenbergen LN, Bolder SBT. Mortality and revision rate of cemented and uncemented hemiarthroplasty after hip fracture: an analysis of the Dutch Arthroplasty Register (LROI). Acta Orthop 2020; 91:408-413. [PMID: 32285730 PMCID: PMC8023919 DOI: 10.1080/17453674.2020.1752522] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Femoral neck fractures are commonly treated with cemented or uncemented hemiarthroplasties (HA). We evaluated differences in mortality and revision rates in this fragile patient group.Patients and methods - From January 1, 2007 until December 31, 2016, 22,356 HA procedures from the Dutch Arthroplasty Register (LROI) were included. For each HA, follow-up until death, revision, or end of follow-up (December 31, 2016) was determined. The crude revision rate was determined by competing risk analysis. Multivariable Cox regression analyses were performed to evaluate the effect of fixation method (cemented vs. uncemented) on death or revision. Age, sex, BMI, Orthopaedic Data Evaluation Panel (ODEP) rating, ASA grade, surgical approach, and previous surgery were included as potential confounders.Results - 1-year mortality rates did not differ between cemented and uncemented HA. 9-year mortality rates were 53% (95% CI 52-54) in cemented HA compared to 56% (CI 54-58) in uncemented HA. Multivariable Cox regression analysis showed similar mortality between cemented and uncemented HA (HR 1.0, CI 0.96-1.1). A statistically significantly lower 9-year revision rate of 3.1% (CI 2.7-3.6) in cemented HA compared with 5.1% (CI 4.2-6.2) in the uncemented HA was found with a lower hazard ratio for revision in cemented compared with uncemented HA (HR 0.56, CI 0.47-0.67).Interpretation - Long-term mortality rates did not differ between patients with a cemented or uncemented HA after an acute femoral neck fracture. Revision rates were lower in cemented compared with uncemented HA.
Collapse
Affiliation(s)
| | - Koen L M Koenraadt
- Foundation for Orthopaedic Research, Care and Education, Amphia Hospital, Breda
| | - Liza N van Steenbergen
- Dutch Arthroplasty Register, Landelijke Registratie Orthopedische Implantaten (LROI), ‘s Hertogenbosch
| | - Stefan B T Bolder
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| |
Collapse
|
8
|
Viswanath A, Malik A, Chan W, Klasan A, Walton NP. Treatment of displaced intracapsular fractures of the femoral neck with total hip arthroplasty or hemiarthroplasty. Bone Joint J 2020; 102-B:693-698. [PMID: 32475248 DOI: 10.1302/0301-620x.102b6.bjj-2019-1459.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Despite few good-quality studies on the subject, total hip arthroplasty (THA) is increasingly being performed for displaced intracapsular fractures of the neck of femur. We compared outcomes of all patients with displacement of these fractures treated surgically over a ten-year period in one institution. METHODS A total of 2,721 patients with intracapsular fractures of the femoral neck treated with either a cemented hemiarthroplasty or a THA at a single centre were retrospectively reviewed. The primary outcomes analyzed were readmission for any reason and revision surgery. We secondarily looked at mortality rates. RESULTS We found no difference in the overall revision rate or rate of infection. However, the rates of readmission due to dislocation, pain, and trochanteric bursitis were significantly higher in the THA group (p = 0.001, p < 0.001, p < 0.001, and p = 0.001, respectively). CONCLUSION Our study, comparing the outcomes of neck of femur fractures treated with a cemented hemiarthroplasty and THA, revealed the perceived superiority of THA was not borne out by our results. This should be carefully considered before any radical change in practice regarding the use of THA for displaced intracapsular fractures of the femoral neck. Cite this article: Bone Joint J 2020;102-B(6):693-698.
Collapse
Affiliation(s)
| | - Anum Malik
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Warwick Chan
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Neil P Walton
- Norfolk and Norwich University Hospital, Norwich, UK
| |
Collapse
|
9
|
Lowe MJ, Lightfoot NJ. The prognostic implication of perioperative cardiac enzyme elevation in patients with fractured neck of femur: A systematic review and meta-analysis. Injury 2020; 51:164-173. [PMID: 31879176 DOI: 10.1016/j.injury.2019.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/11/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Neck of Femur (NOF) fractures are a common injury in comorbid elderly patients which are associated with increased rates of morbidity and mortality following fracture. Because of their injury, patients can experience reductions in quality of life and independent living leading to transfer to nursing home or dependent levels of care. Numerous factors are associated with either complications or reductions in survival following fractured NOF. From the VISION cohort there is evidence that troponin elevation in the post-operative period following a diverse range of non-cardiac surgical procedures may lead to an increased risk of mortality in the absence of classical ischaemic or cardiac symptoms. The aim of this systematic review and meta-analysis is to validate the utility of perioperative troponin elevation as a prognostic indicator for mortality and cardiac morbidity in those with fractured NOF. METHODS The PRISMA guidelines for the conduct of meta-analyses were followed. An electronic search was conducted of the EMBASE, MEDLINE (Ovid) and Biosis databases. Studies were included for analysis if they stratified outcomes by perioperative troponin elevation in surgically managed fractured NOF and reported sufficient data on troponin elevation and mortality following surgery. Primary and secondary outcomes assessed were all-cause post-operative mortality and a composite measure of cardiac complications (myocardial infarction, cardiac failure and arrhythmia) respectively. RESULTS Eleven studies met inclusion criteria giving a total of 1363 patients. Overall, 497 patients (36.5%) experienced an elevation in troponin levels following surgery. Perioperative troponin elevation was significantly associated with all-cause mortality (OR 2.6; 95% CI 1.5 - 4.6; p <0.001) and cardiac complications (OR 7.4; 95% CI 3.5 - 15.8; p <0.001). Patient factors significantly associated with troponin elevation included pre-existing coronary artery disease, cardiac failure, hypertension, previous stroke and previous myocardial infarction. CONCLUSION Perioperative troponin elevation is significantly associated with increased mortality and post-operative cardiac complications following fractured NOF and may be a useful prognostic indicator in these patients. Future research should further stratify patients by the magnitude of troponin elevation and further refine the risk factors.
Collapse
Affiliation(s)
- Matthew J Lowe
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.
| | - Nicholas J Lightfoot
- Department of Anaesthesia and Pain Medicine, Middlemore Hospital, Auckland, New Zealand
| |
Collapse
|