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Ichida K, Noda H, Maemoto R, Mizusawa Y, Matsuzawa N, Tamaki S, Abe I, Endo Y, Inoue K, Fukui T, Takayama Y, Muto Y, Futsuhara K, Watanabe F, Miyakura Y, Mieno M, Rikiyama T. Contrasting seasonality of the incidence of incisional surgical site infection after general and gastroenterological surgery: An analysis of 8,436 patients in a single institute. J Hosp Infect 2024:S0195-6701(24)00221-4. [PMID: 38950864 DOI: 10.1016/j.jhin.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/27/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND While seasonality of hospital-acquired infections, including incisional SSI after orthopaedic surgery, is recognized, the seasonality of incisional SSI after general and gastroenterological surgeries remains unclear. STUDY DESIGN This retrospective single-institute observational study analysed the seasonality and risk factors of incisional SSI after general and gastroenterological surgeries using univariate and multivariable analyses. The evaluated variables included age, sex, surgical approach, surgical urgency, operation time, wound classification, and the American Society of Anesthesiologists physical status (ASA-PS). RESULTS 8,436 patients were enrolled. General surgeries (n=2,241) showed a pronounced SSI incidence in summer (3.9%; odds ratio [OR] 1.87; 95% confidence interval [CI] 1.05-3.27; p=0.025) compared to other seasons (2.1%). Conversely, gastroenterological surgeries (n=6,195) showed a higher incidence in winter (8.3%; OR 1.38; 95% CI 1.10-1.73; p=0.005) than in other seasons (6.1%). Summer for general surgery (OR 1.90; 95% CI 1.12-3.24; p=0.018) and winter for gastroenterological surgery (OR 1.46; 95% CI 1.17-1.82; p=0.001) emerged as independent risk factors for incisional SSI. Open surgery (OR, 2.72; 95% CI 1.73-4.29, p<0.001) and an ASA-PS score ≥3 (OR, 1.64; 95% CI 1.08-2.50, p=0.021) were independent risk factors for incisional SSI in patients undergoing gastroenterological surgery during winter. CONCLUSION Seasonality exists in the incisional SSI incidence following general and gastroenterological surgeries. Recognizing these trends may help enhance preventive strategies, highlighting the elevated risk in summer for general surgery and in winter for gastroenterological surgery.
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Affiliation(s)
- Kosuke Ichida
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroshi Noda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Ryo Maemoto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuki Mizusawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Natsumi Matsuzawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Sawako Tamaki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Iku Abe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuhei Endo
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koetsu Inoue
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taro Fukui
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuji Takayama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuta Muto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kazushige Futsuhara
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Fumiaki Watanabe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Makiko Mieno
- Department of Medical Statistics, Center for Information, Jichi Medical University, Shimotsuke, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Moriwaki M, Takae A, Toba M, Sasaki M, Ogata Y, Obayashi S, Kakehashi M, Fushimi K. Factors associated with proximal femoral fractures in older adults during hospital stay: a cross-sectional study. BMJ Qual Saf 2024:bmjqs-2023-016865. [PMID: 38902020 DOI: 10.1136/bmjqs-2023-016865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/06/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Proximal femoral fractures in older adults affect prognosis, quality of life and medical expenses. Therefore, identifying patients with an elevated risk for proximal femoral fractures and implementing preventive measures to mitigate their occurrence are crucial. OBJECTIVE This study aimed to develop an accurate in-hospital fracture prediction model that considers patients' daily conditions and medical procedure status. Additionally, it investigated the changes in their conditions associated with fractures during hospital stays. DESIGN A retrospective observational study. SETTINGS Acute care hospitals in Japan. PARTICIPANTS Participants were 8 514 551 patients from 1321 medical facilities who had been discharged between April 2018 and March 2021 with hip and proximal femoral fractures. METHODS Logistic regression analysis determined the association between patients' changes in their ability to transfer at admission and the day before fracture, and proximal femoral fracture during hospital stays. RESULTS Patients were classified into fracture and non-fracture groups. The mean ages were 77.4 (SD: 7.7) and 82.6 (SD: 7.8), and the percentages of women were 42.7% and 65.3% in the non-fracture and fracture groups (p<0.01), respectively. Model 4 showed that even if a patient required partial assistance with transfer on the day before the fracture, the fracture risk increased in each category of change in ability to transfer in the following order: 'declined', 'improved' and 'no change'. CONCLUSIONS Patients showing improved ability to transfer during their hospitalisation are at a higher risk for fractures. Monitoring patients' daily conditions and tracking changes can help prevent fractures during their hospital stays.
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Affiliation(s)
- Mutsuko Moriwaki
- Quality Management Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Asuka Takae
- School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mikayo Toba
- Quality Management Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan
- Department of Clinical Quality and Safety, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Miki Sasaki
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yasuko Ogata
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Satoshi Obayashi
- Department of Obstetrics & Gynecology, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
| | - Masayuki Kakehashi
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Kiyohide Fushimi
- Quality Management Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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Hawkins AD, Scott EJ, De Guzman J, Ratcliffe SJ, Mehaffey JH, Hawkins RB, Strobel RJ, Speir A, Joseph M, Yarboro LT, Teman NR. Temporal Cluster Analysis of Deep Sternal Wound Infection in a Regional Quality Collaborative. J Surg Res 2023; 291:67-72. [PMID: 37352738 DOI: 10.1016/j.jss.2023.05.023] [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] [Received: 02/01/2023] [Revised: 03/31/2023] [Accepted: 05/15/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Deep sternal wound infection (DSWI) is a rare complication associated with high mortality. Seasonal variability in surgical site infections has been demonstrated, however, these patterns have not been applied to DSWI. The purpose of this study was to assess temporal clustering of DSWIs. METHODS All cardiac surgery patients who underwent sternotomy were queried from a regional Society of Thoracic Surgeons database from 17 centers from 2001 to 2019. All patients with the diagnosis of DSWI were then identified. Cluster analysis was performed at varying time intervals (monthly, quarterly, and yearly) at the hospital and regional level. DSWI rates were calculated by year and month, and compared using mixed-effects negative binomial regression. RESULTS A total of 134,959 patients underwent a sternotomy for cardiac surgery, of whom 469 (0.35%) developed a DSWI. Rates of DSWI per hospital across all years ranged from 0.12% to 0.69%. Collaborative-level rates of DSWIs were the greatest in September (0.44%) and the lowest in January (0.30%). Temporal clustering was not seen across seasonal quarters (high rate in preceeding quarter was not associated with a high rate in the next quarter) (P = 0.39). There were yearly differences across all institutions in the DSWI rates. A downward trend in DSWI rates was seen from 2001 to 2019 (P < 0.001). A difference among hospitals in the cohort was observed (P < 0.001). CONCLUSIONS DSWI are a rare event within our region. Unlike other surgical site infection, there does not appear to be a seasonal pattern associated with DSWI.
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Affiliation(s)
- Andrew D Hawkins
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Erik J Scott
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Jeison De Guzman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Sarah J Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Raymond J Strobel
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Alan Speir
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Mark Joseph
- Division of Cardiothoracic Surgery, Virginia Tech Carillion School of Medicine, Roanoke, Virginia
| | - Leora T Yarboro
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Nicholas R Teman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
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Uthoff H, Teruzzi E, Boesch P, Hofer M, Spinedi L, Bossart S, Staub D, Keo HH. Safety and efficacy of endovenous thermal ablation for treatment of symptomatic varicose veins during summertime. VASA 2023; 52:332-341. [PMID: 37341558 DOI: 10.1024/0301-1526/a001080] [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] [Indexed: 06/22/2023]
Abstract
Background: Traditionally, varicose vein treatment is predominately performed during the colder seasons. However, data whether higher outdoor temperatures affect the outcome and/or complication rate of endovenous thermal ablation (ETA) for treatment of symptomatic varicose veins are missing. Patients and methods: In this observational study, the medical records of all patients who had ETA of the great saphenous vein (GSV), accessory saphenous vein (ASV), or small saphenous vein (SSV) between September 2017 and October 2020 were reviewed. Results: In total 846 ETA interventions in 679 patients with 1239 treated truncal veins and an average length of 69 cm phlebectomy were included. The highest temperature recorded on and within the first 14 days after treatment was on average 19.0°C (SD±7.2°C) with a minimum and maximum of -1°C and 35.9°C. Interventions were categorized according to the recorded temperature (<25°C n=584; 25-29.9°C n=191; and ≥30°C n=71). The occlusion rates were excellent (99-100%) across groups. Despite a significantly higher proportion of patients with obesity, personal history of superficial vein thrombosis and length of phlebectomies in the high temperature groups, no significant difference regarding days of work loss, patients' satisfaction or complications including bleeding or thromboembolic events was observed. Infections were rare (0.8%), but more frequently observed in the 25-29.9°C group (2.6%; p=0.058). No infection was observed in the ≥30°C group and pain 6 weeks after the intervention was even lower (VAS 0.5±1.0 and 0.5±1.2 vs. 0.0±0.1, p=0.008). Conclusions: Given the minimal invasive nature of ETA, our results can reassure clinicians and patients that ETA varicose vein treatment is possible and safe throughout the year, even on hot summer days. A non-significant trend to more infections was observed but was not associated with other adverse outcomes such as prolonged analgetics intake or inability to work.
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Affiliation(s)
- Heiko Uthoff
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | - Elisa Teruzzi
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | - Patricia Boesch
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | - Manuel Hofer
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | | | - Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | - Hak Hong Keo
- Department of Angiology, University Hospital, University of Basel, Switzerland
- Vascular Institute Central Switzerland, Aarau, Switzerland
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Risk Factors and Outcomes of Extended Length of Stay in Older Adults with Intertrochanteric Fracture Surgery: A Retrospective Cohort Study of 2132 Patients. J Clin Med 2022; 11:jcm11247366. [PMID: 36555982 PMCID: PMC9784786 DOI: 10.3390/jcm11247366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/17/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
We aimed to identify the risk factors associated with an extended length of hospital stay (eLOS) in older hip-fracture patients and to explore the relationships between eLOS and mortality and functional outcomes. In this retrospective analysis of surgically treated intertrochanteric fracture (IF) patients, all variables were obtained and compared between the eLOS group and the normal LOS group. All participants were followed-up for a minimum of two years and the relation between the eLOS and all-cause mortality and functional outcomes were compared. After adjustment for potential confounders, we identified that patients with high modified Elixhauser's Comorbidity Measure (mECM) had the highest likelihood of eLOS, followed by obesity, admission in winter, living in urban, pulmonary complications, admission in autumn, and time from injury to surgery. In addition, our results showed no significant difference in the mortality and functional outcomes between the two groups during follow-up. By identifying these risk factors in the Chinese geriatric population, it may be possible to risk-stratify IF patients and subsequently streamline inpatient resource utilization. However, the differences between health care systems must be taken into consideration. Future studies are needed to preemptively target the modifiable risk factors to demonstrate benefits in diminishing eLOS.
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Schermann H, Ashkenazi I, Graif N, Ogawa T, Morgan S, Ben Tov T, Khoury A, Warschawski Y. Would giving priority in surgery timing to the oldest patients result in lower mortality? INTERNATIONAL ORTHOPAEDICS 2022; 46:1701-1706. [PMID: 35678841 DOI: 10.1007/s00264-022-05466-2] [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: 03/02/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Early hip fracture surgery in elderly patients is recognized as a positive prognostic factor. When applied as an intervention, it does not always reduce overall patient mortality. A plausible explanation for this is that not all patients equally benefit from early surgery. The purpose of the study is to investigate the effect of early surgery on mortality in patients ages 80 and older. METHODS This is a retrospective cohort of 3463 patients with hip fractures, operated upon within seven days of admission in a tertiary medical center between 2010 and 2018. Patients were divided into five groups: ages 80-84, 85-89, 90-94, 95-99, and 100 or above. Baseline characteristics were compared between groups. Mortality at one year post-operatively as a function of surgery delay was visualized for each group, using restricted spline curve analysis. RESULTS Patients with increasing age were operated on earlier, had increased co-morbidities with a higher ASA score and experienced higher mortality. Spline curve analysis in younger patients, ages 80 to 94, demonstrated an inflection point at 48 hours after admission, prior to which mortality was rising rapidly and after which it continued rising slowly. In the two oldest age cohorts, there was no increased mortality with an increasing surgical delay. CONCLUSIONS In patients ages 80-94 surgery on day one may be preferable to surgery on day two. In patients ages 95 and older, surgery time did not influence mortality. Pursuit of better patient outcomes may include prioritizing early surgery in younger patients.
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Affiliation(s)
- Haggai Schermann
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel.
| | - Itay Ashkenazi
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Nadav Graif
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Takahisa Ogawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Tomer Ben Tov
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
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Probert N, Andersson ÅG, Magnuson A, Kjellberg E, Wretenberg P. Surgical-site infection after hip fracture surgery: preoperative full-body disinfection compared to local disinfection of the surgical site-a population-based observational cohort study. Eur Geriatr Med 2022; 13:1089-1097. [PMID: 35391660 PMCID: PMC9553784 DOI: 10.1007/s41999-022-00640-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/21/2022] [Indexed: 11/20/2022]
Abstract
Aim To compare preoperative full-body disinfection (FBD) prior to hip fracture surgery with local disinfection (LD) of the surgical site regarding incidence of postoperative surgical-site infection (SSI), both procedures performed with 4% chlorhexidine. Findings There were 16 (6.8%) cases of SSI in 2018 when FBD was performed and 8 (3.1%) cases in 2019 when LD was performed. FBD (2018) compared to LD (2019) presented an adjusted OR of 2.0 (95% CI 0.8–5.1) in the logistic regression analysis. Message Results suggest that LD is not inferior to FBD regarding SSI prevention, meaning patients could potentially be spared significant levels of pain caused by FBD. Purpose Swedish national guidelines recommend full-body disinfection (FBD) with 4% chlorhexidine before hip fracture surgery to prevent surgical-site infection (SSI) despite little evidence. Our objective was to compare preoperative FBD with local disinfection (LD) of the surgical site regarding SSI incidence. Methods All patients with hip fracture, operated at a hospital in Sweden, January 1, 2018 to December 31, 2019 were included. Patients in 2018 (n = 237) were prepared with FBD and patients in 2019 (n = 259) with LD. Primary outcome was SSI and secondary outcome was SSI and/or death. We adjusted for potential confounders with logistic regression. The adjusted analysis was performed in two models to enable assessment of variables that lacked either outcome; in the first model, these variables were not adjusted, and the second model was restricted to a sub-population not affected by respective variables. Results There were 16 (6.8%) cases of SSI in 2018 and 8 (3.1%) cases in 2019. FBD (2018) compared to LD (2019) presented an adjusted OR of 1.9 (95%CI 0.8–4.9, P = 0.16) respectively 2.0 (95%CI 0.8–5.1, P = 0.14) in the two models of the logistic regression. In addition, 40 (16.9%) patients in 2018 and 29 (11.2%) patients in 2019 had the combined outcome of SSI and/or death, adjusted OR 1.6 (95% CI 0.9–2.8, P = 0.08) respectively 1.7 (95% CI 0.9–2.9, P = 0.06). Conclusion We found a non-significant increased risk of SSI 2018 compared to 2019 after adjustment. Randomized control trials are needed. Nonetheless, results suggest that LD is not inferior to FBD regarding SSI prevention, meaning patients could potentially be spared substantial pain.
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Affiliation(s)
- Noelle Probert
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden. .,Centre of Clinical Research, Region Värmland, Karlstad, Sweden.
| | - Åsa G Andersson
- Department of Geriatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Elin Kjellberg
- Department of Infectious Diseases, Central Hospital of Kristianstad, Kristianstad, Sweden
| | - Per Wretenberg
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Ogawa T, Schermann H, Khadka A, Moross J, Moriwaki M, Fushimi K, Fujiwara T, Yoshii T, Okawa A, Shirasawa S. Impact of orthogeriatric care management by orthopedic surgeons and physicians on in-hospital clinical outcomes: A difference-in-difference analysis. Geriatr Gerontol Int 2022; 22:138-144. [PMID: 35018706 DOI: 10.1111/ggi.14347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 12/01/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022]
Abstract
AIM The orthopedic surgery unit in our suburb serves a large elderly trauma population in addition to providing elective surgeries. As patients with hip fractures have become older and at higher risk of medical complications, our hospital has initiated integrated co-management of these patients by orthopedic surgeons and geriatricians from the point of hospital admission. The aim of this study was to evaluate the impact of the hospital policy change on hip fracture management and clinical outcome indicators. METHODS Using the difference-in-difference approach, in total, 288 consecutive patients with hip fractures treated during the 1 year before and 2 years after transition to orthogeriatric care from a geriatric consultation model to integrated orthogeriatric care model were compared with 576 patients from other local hospitals. RESULTS Despite a seasonal trend toward increased length of hospital stay in winter, the intervention significantly reduced the change in mean length of stay (mean difference [95% confidence interval], -12.9 days [-21.5 to -4.3]; P = 0.007) and discharge to home tended to change less frequently (-12.6%; P = 0.10). There was no significant reduction in mean time to surgery (-0.2 days; P = 0.83), mortality (-0.8%; P = 0.62), or complications (-1.0%; P = 0.85). CONCLUSIONS Changing our hip fracture service from a geriatric consultation model of care to an integrated orthogeriatric model significantly reduced length of hospital stay probably due to a lower chance of discharge to home. To our knowledge, this is the first study in Japan to compare two orthogeriatric care models considering the nationwide improvement in hip fracture management. AUTHOR Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Takahisa Ogawa
- Department of Orthopedic Surgery, Suwa Central Hospital, Nagano, Japan.,Department of Epidemiology, Harvard T.H.Chan School of Public Health, Boston, Massachusetts, USA.,Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Haggai Schermann
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Aayush Khadka
- Department of Global Health and Population, Harvard University, Dental University, Boston, Massachusetts, USA
| | - Janelle Moross
- Office for Global Education and Career Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mutsuko Moriwaki
- Department of Tokyo Metropolitan Health Policy Advisement, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Ogawa T, Schermann H, Kobayashi H, Fushimi K, Okawa A, Jinno T. Age and clinical outcomes after hip fracture surgery: do octogenarian, nonagenarian and centenarian classifications matter? Age Ageing 2021; 50:1952-1960. [PMID: 34228781 DOI: 10.1093/ageing/afab137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND older patients with hip fractures are arbitrarily classified as octogenarians, nonagenarians and centenarians. We have designed this study to quantify in-hospital mortality and complications among each of these groups. We hypothesised that the associations between age and in-hospital mortality and complications are continuously increasing, and that these risks increase rapidly when patients reach a certain age. METHODS this research is a retrospective cohort study using nationwide database between 2010 and 2018. Patients undergoing hip fracture surgery, and aged 60 or older, were included. The associations between patient age, in-hospital mortality and complications were visualised using the restricted cubic spline models, and were analysed employing multivariable regression models. Then, octogenarians, nonagenarians and centenarians were compared. RESULTS among a total of 565,950 patients, 48.7% (n = 275,775) were octogenarians, 23.0% (n = 129,937) were nonagenarians and 0.7% (n = 4,093) were centenarians. The models presented three types of association between age, in-hospital mortality and complications: (i) a continuous increase (mortality and respiratory complications); (ii) a mild increase followed by a steep rise (intensive care unit admission, heart failure, renal failure and surgical site hematoma) and (iii) a steep increase followed by a limited change (coronary heart disease, stroke and pulmonary embolisms). CONCLUSION we identified three types of association between age and clinical outcomes. Patients aged 85-90 may constitute the upper threshold for age categorisations, because the risk of in-hospital complications changed dramatically at that stage. This information can improve clinical awareness of various complications and support collective decision-making.
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Affiliation(s)
- Takahisa Ogawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Haggai Schermann
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Hiroki Kobayashi
- Department of Medicine, Harvard Medical School, Section on Genetics and Epidemiology, Research Division, Joslin Diabetes Center, Boston, USA
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
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Alt V, Giannoudis PV. Musculoskeletal infections: A call for papers to continue the battle against this devastating global challenge. Injury 2021; 52:3187-3188. [PMID: 34740386 DOI: 10.1016/j.injury.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Volker Alt
- Director and Chairman, Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany.
| | - Peter V Giannoudis
- Professor-Section Head, Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, UK
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Ogawa T, Jinno T, Moriwaki M, Yoshii T, Nazarian A, Fushimi K, Okawa A. Association between hospital surgical volume and complications after total hip arthroplasty in femoral neck fracture: A propensity score-matched cohort study. Injury 2021; 52:3002-3010. [PMID: 33714546 DOI: 10.1016/j.injury.2021.02.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND For displaced femoral neck fractures (FNF), total hip arthroplasty (THA) or hemiarthroplasty (HA) is preferred rather than fracture fixation. THA for patients with FNF requires skilled operators since patient with FNF likely to have osteoporosis and a higher risk of complications. Several reports suggest that higher hospital surgical volume was associated with a lower risk of complications after THA for osteoarthritis. However, little is known concerning this association with THA for FNF. Herein, we investigated the association between THA and complication and the recovery of physical function after THA to optimize the quality of FNF. METHODS A nationwide retrospective cohort study of elderly undergoing THA between April 1, 2011, to March 31, 2018 was performed. The association between hospital surgical volume and complication after THA for FNF was visually described with the restricted cubic spline regression analysis. Then the risk of complications was quantified with propensity score matching analysis based on the cutoff point identified by the restricted cubic spline curve. Primary outcome was secondary revision surgery, and the secondary outcomes included surgical and systemic complications, and the recovery of physical function at hospital discharge. RESULTS By visualization of the spline curve, we identified 20 cases per year as cutoff point of low hospital surgical volume. Following 1,396 patients' propensity score-match analysis (mean age 75.2 [SD] 8.8, female 80.4%), the risk of secondary revision surgery was significantly higher among the low hospital surgical volume group (absolute risk difference (RD), 2.44%; p = 0.011). Also, the incidence of blood transfusion was higher in the low hospital surgical volume group (RD, 4.01%; p = 0.049). However, there was no significant difference in the recovery of the transferring and walking ability at discharge between high and low hospital surgical volume groups (63.5% vs 62.6%, 58.5% vs 57.5%; p = 0.74, 0.71, respectively). CONCLUSION Our research demonstrated that an increase in hospital surgical volume significantly reduced the incidence of secondary revision surgery after a certain inflection point, but not significantly improved short-term physical functions.
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Affiliation(s)
- Takahisa Ogawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
| | - Mutsuko Moriwaki
- Department of Tokyo Metropolitan Health Policy Advisement, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
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Deng Y, Zheng Z, Cheng S, Lin Y, Wang D, Yin P, Mao Z, Tang P. The factors associated with nosocomial infection in elderly hip fracture patients: gender, age, and comorbidity. INTERNATIONAL ORTHOPAEDICS 2021; 45:3201-3209. [PMID: 34350473 DOI: 10.1007/s00264-021-05104-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/26/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This is a retrospective case-control study to ascertain the factors influencing nosocomial infection (NI) in elderly patients with hip fractures. METHODS A total of 80,174 patients (≥ 60 years) who suffered hip fractures between 2006 and 2017 were identified through a national inquiry of 94 hospitals. The patients were divided into an NI group and control group according to the occurrence or lack of occurrence of NI within 48 hours after surgery, respectively. Age, gender, hip fracture pattern, whether to operate, surgical treatments, and comorbidities were recorded as variables. RESULTS A total of 9806 elderly hip fracture patients (60 years) were included, 1977 of whom were patients diagnosed with NI. The control group consisted of randomly drawn cases from the 9806 patients from different hospitals with a rate of one NI patient: four patients without NI. Patient gender, age, and in particular the number of comorbidities were associated with occurrence of NI. Using regression models to predict infection outcomes based on the number of comorbidities had an area under the curve (AUC) of 0.714, while using the Charlson comorbidity index (CCI) yielded a smaller value of 0.694. The most common comorbidities of this elderly cohort were chronic respiratory disease, hypertension, diabetes mellitus, cerebrovascular disease, and coronary heart disease. CONCLUSIONS Older age, male gender, and greater number of comorbidities were found to be associated with the occurrence of NI. In particular, the number of comorbidities was the most accurate predictor of NI occurrence, and when used to build a regression model, it had greater predictive capability than CCI to predict NI in elderly hip fracture patients. Additionally, the common diseases of the elderly should be primarily considered when investigating the relationship between comorbidities and NI in older patients.
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Affiliation(s)
- Yuan Deng
- Department of Orthopedics, Fourth Medical Center, General Hospital of Chinese PLA, Beijing, 100000, China
| | - Zhong Zheng
- Information Center of Logistics Support Department of Central Military Commission, Beijing, 100000, China
| | - Shi Cheng
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150010, China
| | - Yuan Lin
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150010, China
| | - Duanyang Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150010, China
| | - Pengbin Yin
- Department of Orthopedics, Fourth Medical Center, General Hospital of Chinese PLA, Beijing, 100000, China
| | - Zhi Mao
- Department of Critical Care Medicine, First Medical Center, General Hospital of Chinese PLA, Beijing, 100000, China.
| | - Peifu Tang
- Department of Orthopedics, Fourth Medical Center, General Hospital of Chinese PLA, Beijing, 100000, China.
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Ogawa T, Yoshii T, Higuchi M, Morishita S, Fushimi K, Fujiwara T, Okawa A. Seasonality of mortality and in-hospital complications in hip fracture surgery: Retrospective cohort research using a nationwide inpatient database. Geriatr Gerontol Int 2021; 21:398-403. [PMID: 33768645 DOI: 10.1111/ggi.14153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/21/2021] [Accepted: 03/03/2021] [Indexed: 12/24/2022]
Abstract
AIM Among older patients undergoing hip fracture surgery, previous studies have shown a seasonal variation of in-hospital surgical complications. However, little is known about seasonal effects on mortality and systemic complications after hip fracture surgery. In the present study, we evaluated whether mortality and in-hospital systemic complications are influenced by seasonal differences. METHODS We enrolled patients from a nationwide database who underwent hip fracture surgery between 2010 and 2018. The primary outcome was in-hospital mortality. The secondary outcomes were in-hospital systemic complications. The association between the seasonality and in-hospital outcomes was investigated using multivariable Cox, logistic regression and causal mediation analysis. RESULTS With 425 856 patients (mean age 83.5 years; 79% women), overall in-hospital mortality was 5324 (1.2%). Fall and winter were associated with a higher mortality than spring (hazard ratio [HR] 1.16; P < 0.001; HR 1.14; P = 0.001, respectively). Across all the seasons, there were 36 834 overall systemic complications (8.6%), with respiratory infection being the most frequent (18 637 [4.4%]). Among these complications, only respiratory infection showed seasonal variation, with a higher prevalence in fall and winter. The mediated effect of respiratory infection on mortality was significantly higher in fall and winter compared with spring (fall, HR 1.06, proportion mediated 36.7%; winter, HR 1.14, proportion mediated 55.0%; all P < 0.001). CONCLUSIONS We found a significantly higher mortality in fall and winter after hip fracture surgery. Specifically, in winter, the increased in-hospital death was largely attributed to the increased incidence of respiratory infection. Geriatr Gerontol Int 2021; 21: 398-403.
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Affiliation(s)
- Takahisa Ogawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaya Higuchi
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shingo Morishita
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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