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Guo J, He Q, Li Y. Development and validation of machine learning models to predict perioperative transfusion risk for hip fractures in the elderly. Ann Med 2024; 56:2357225. [PMID: 38902847 PMCID: PMC11191839 DOI: 10.1080/07853890.2024.2357225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/09/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Patients with hip fractures frequently need to receive perioperative transfusions of concentrated red blood cells due to preoperative anemia or surgical blood loss. However, the use of perioperative blood products increases the risk of adverse events, and the shortage of blood products is prompting us to minimize blood transfusion. Our study aimed to construct a machine learning algorithm predictive model to identify patients at high risk for perioperative transfusion early in hospital admission and to manage their patient blood to reduce transfusion requirements. METHODS This study collected patients hospitalized for hip fractures at a university hospital from May 2016 to November 2022. All patients included in the analysis were randomly divided into a training set and validation set according to 70:30. Eight machine learning algorithms, CART, GBM, KNN, LR, NNet, RF, SVM, and XGBoost, were used to construct the prediction models. The models were evaluated for discrimination, calibration, and clinical utility, and the best prediction model was selected. RESULTS A total of 805 patients were included in the study, of whom 306 received transfusions during the perioperative period. We screened eight features used to construct the prediction model: age, fracture time, fracture type, hemoglobin, albumin, creatinine, calcium ion, and activated partial thromboplastin time. After evaluating and comparing the performance of each of the eight models, the model constructed by the XGBoost algorithm had the best performance, with MCC values of 0.828 and 0.939 in the training and validation sets, respectively. In addition, it had good calibration and clinical utility in both the training and validation sets. CONCLUSION The model constructed by the XGBoost algorithm has the best performance, using this model to identify patients at high risk for transfusion early in their admission and promptly incorporating them into a patient blood management plan can help reduce the risk of transfusion.
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Affiliation(s)
- Jiale Guo
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qionghan He
- Department of Infectious Diseases, Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yehai Li
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China
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[Translated article] Hip fracture in centenarians, what can we expect? Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sinclair RCF, Bowman MJA, Moppett IK, Gillies MA. Perioperative intravenous iron to treat patients with fractured hip surgery: A systematic review and meta‐analysis. Health Sci Rep 2022; 5:e633. [PMID: 35620535 PMCID: PMC9125168 DOI: 10.1002/hsr2.633] [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: 12/10/2021] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Treatment of preoperative anemia with intravenous iron is common within elective surgical care pathways. It is plausible that this treatment may improve care for people with hip fractures many of whom are anemic because of pre‐existing conditions, fractures, and surgery. Objective To review the evidence for intravenous iron administration on outcomes after hip fracture. Design We followed a predefined protocol and conducted a systematic review and meta‐analysis of the use of intravenous iron to treat anemia before and after emergency hip fracture surgery. The planned primary outcome was a difference in length of stay between those treated with intravenous iron and the control group. Other outcomes analyzed were 30‐day mortality, requirement for blood transfusion, changes in quality of life, and hemoglobin concentration on discharge from the hospital. Data Sources EMBASE, MEDLINE, The Cochrane Library (CENTRAL, DARE) databases, Clinicaltrials.gov, and ISRCTN trial registries. Date of final search March 2022. Eligibility Criteria Adult patients undergoing urgent surgery for hip fracture. Studies considered patients who received intravenous iron and were compared with a control group. Results Four randomized controlled trials (RCT, 732 patients) and nine cohort studies (2986 patients) were included. The RCTs were at low risk of bias, and the nonrandomized studies were at moderate risk of bias. After metanalysis of the RCTs there was no significant difference in the primary outcome, length of hospital stay, between the control group and patients receiving intravenous iron (mean difference: −0.59, 95% confidence interval [CI]; −1.20 to 0.03; I2 = 30%, p = 0.23). Intravenous iron was not associated with a difference in 30‐day mortality (n = 732, OR: 1.14, 95% CI: 0.62−2.1; I2 = 0%, p = 0.50), nor with the requirement for transfusion (n = 732, OR: 0.85, 95% CI: 0.63−1.14; I2 = 0%, p < 0.01) in the analyzed RCTs. Functional outcomes and quality of life were variably reported in three studies. Conclusion The evidence on the use of intravenous iron in patients with hip fracture is low quality and shows no difference in length of acute hospital stay and transfusion requirements in this population. Improved large, multicentre, high‐quality studies with patient‐centered outcomes will be required to evaluate the clinical and cost‐effectiveness of this treatment.
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Affiliation(s)
| | | | - Iain K. Moppett
- Professor of Anaesthesia and Perioperative Medicine, Anaesthesia and Critical Care Research Group, Division of Clinical Neuroscience, Queens Medical Centre University of Nottingham Nottingham UK
| | - Michael A. Gillies
- Consultant and Honorary Professor in Intensive Care Royal Infirmary of Edinburgh, NHS Lothian Edinburgh UK
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Sarasa-Roca M, Torres-Campos A, Redondo-Trasobares B, Angulo-Castaño MC, Gómez-Vallejo J, Albareda-Albareda J. Hip fracture in centenarians, what can we expect? Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:267-273. [PMID: 34344619 DOI: 10.1016/j.recot.2021.04.004] [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: 02/08/2021] [Revised: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Hip fractures in centenarians are rising due to the increase in life expectancy. The objective of this study is to compare the characteristics of centenarians' hip fracture with a younger control group, and to analyze whether there are differences in terms of in-hospital mortality, complications, and short-medium-term survival between them. MATERIAL AND METHODS Retrospective case-control study, with a series of 24 centenarians and 48 octogenarians with a hip fracture. Comorbidities and Charlson index, surgical delay, complications and mortality during admission, and hospital stay were analyzed. At discharge, early mortality, survival after one year, and return to previous functionality were assessed. RESULTS No significant differences were found in baseline parameters or comorbidities (P>.05), and the type of was a woman with an extracapsular fracture. Hospital stay was longer in the control group (P=.038), and the most frequent complication was anemia requiring transfusion (23/24 in centenarians, P<.0001). In-hospital mortality and accumulated at one year in the centenarians was 33 and 67%, respectively, compared to 10 and 25% in the octogenarians (P=.017, OR=4.3 [1,224-15,101] and P=.110). Only 2 centenarian patients were able to walk again after the intervention, while in the control group 53.84% returned to the previous functional situation (P=.003). CONCLUSIONS Compared to a control group of younger patients, in-hospital mortality and in the first year after a hip fracture is significantly higher in centenarians, and very few recover activity prior to the fracture.
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Affiliation(s)
- M Sarasa-Roca
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - A Torres-Campos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - B Redondo-Trasobares
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - M C Angulo-Castaño
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J Gómez-Vallejo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J Albareda-Albareda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Blanco-Rubio N, Gómez-Vallejo J, Torres-Campos A, Redondo-Trasobares B, Albareda-Albareda J. Is the mortality higher in patients who have suffered a hip fracture? Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Blanco-Rubio N, Gómez-Vallejo J, Torres-Campos A, Redondo-Trasobares B, Albareda-Albareda J. Is the mortality higher in patients who have suffered a hip fracture? Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:85-90. [PMID: 33516655 DOI: 10.1016/j.recot.2020.08.001] [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: 03/02/2020] [Revised: 07/17/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The aim of this study is to value whether patients who have suffered a hip fracture have a higher mortality than expected. MATERIAL AND METHODS A prospective, observational study was carried out where patients with hip fracture were collected as a sample over a year. The study included 284 patients and a minimum follow-up was 2 years. The mean age of these patients was 84.26 years, with 21.48% (61/284) males and 78.5% (223/284) females. Survival and previous diseases that affect mortality, as risk factors, were collected and analyzed using the Kaplan-Meier method and the Cox regression model. Actual mortality was compared with that expected according to the Charlson Comorbidity Index, adjusted for age. RESULTS Previous pathology was the main mortality factor, with heart disease being the most significant (OR 1.817, CI95%: 1.048; 3.149). The real mortality at one year of the sample was 22.5%, while the estimated annual mortality according to the Charlson Comorbidity Index was 29.68% (CI95%:44,36-15). CONCLUSIONS Hip fracture does not cause an increase in mortality according to the Charlson Comorbidity Index estimate.
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Affiliation(s)
- N Blanco-Rubio
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - J Gómez-Vallejo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - A Torres-Campos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - B Redondo-Trasobares
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J Albareda-Albareda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Elhenawy AM, Meyer SR, Bagshaw SM, MacArthur RG, Carroll LJ. Role of preoperative intravenous iron therapy to correct anemia before major surgery: a systematic review and meta-analysis. Syst Rev 2021; 10:36. [PMID: 33485392 PMCID: PMC7824930 DOI: 10.1186/s13643-021-01579-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Preoperative anemia is a common comorbidity that often necessitates allogeneic blood transfusion (ABT). As there is a risk associated with blood transfusions, preoperative intravenous iron (IV) has been proposed to increase the hemoglobin to reduce perioperative transfusion; however, randomized controlled trials (RCT) investigating this efficacy for IV iron are small, limited, and inconclusive. Consequently, a meta-analysis that pools these studies may provide new and clinically useful information. METHODS/DESIGN Databases of MEDLINE, EMBASE, EBM Reviews; Cochrane-controlled trial registry; Scopus; registries of health technology assessment and clinical trials; Web of Science; ProQuest Dissertations and Theses; Clinicaltrials.gov; and Conference Proceedings Citation Index-Science (CPCI-S) were searched. Also, we screened all the retrieved reference lists. SELECTION CRITERIA Titles and abstracts were screened for relevance (i.e., relevant, irrelevant, or potentially relevant). Then, we screened full texts of those citations identified as potentially applicable. RESULTS Our search found 3195 citations and ten RCTs (1039 participants) that met our inclusion criteria. Preoperative IV iron supplementation significantly decreases ABT by 16% (risk ratio (RR): 0.84, 95% confidence interval [CI]: 0.71, 0.99, p = 0.04). In addition, preoperatively, hemoglobin levels increased after receiving IV iron (mean difference [MD] between the study groups: 7.15 g/L, 95% CI: 2.26, 12.04 g/L, p = 0.004) and at follow-up > 4 weeks postoperatively (MD: 6.46 g/L, 95% CI: 3.10, 9.81, p = 0.0002). Iron injection was not associated with increased incidence of non-serious or serious adverse effects across groups (RR: 1.13, 95% CI: 0.78, 1.65, p = 0.52) and (RR: 0.96, 95% CI: 0.44, 2.10, p = 0.92) respectively. CONCLUSIONS With moderate certainty, due to the high risk of bias in some studies in one or two domains, we found intravenous iron supplementation is associated with a significant decrease in the blood transfusions rate, and modest hemoglobin concentrations rise when injected pre-surgery compared with placebo or oral iron supplementation. However, further full-scale randomized controlled trials with robust methodology are required. In particular, the safety, quality of life, and cost-effectiveness of different intravenous iron preparations require further evaluation.
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Affiliation(s)
- Abdelsalam M Elhenawy
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. .,Division of Cardiothoracic Surgery, Al Azhar University, Cairo, Egypt.
| | - Steven R Meyer
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sean M Bagshaw
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Roderick G MacArthur
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Linda J Carroll
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Bielza R, Llorente J, Thuissard IJ, Andreu-Vázquez C, Blanco D, Sanjurjo J, López N, Herráez MR, Molano C, Morales A, Arias E, Neira M, Lung A, Escalera J, Portillo L, Larrubia Y, García C, Zambrana F, Gómez Cerezo J. Effect of intravenous iron on functional outcomes in hip fracture: a randomised controlled trial. Age Ageing 2021; 50:127-134. [PMID: 32542370 DOI: 10.1093/ageing/afaa107] [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: 01/30/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES to determine the safety and effect of intravenous iron sucrose on functional outcomes, delirium, nosocomial infections and transfusion requirements in older patients with hip fracture. DESIGN single-centre randomised, double-blind, placebo-controlled clinical trial. SETTING AND PARTICIPANTS orthogeriatric share care service at an academic tertiary care hospital. A total of 253 patients were recruited: 126 patients were assigned to intravenous iron and 127 to placebo. METHODS on days 1, 3 and 5 after admission, the iron group received 200 mg Venofer® (iron sucrose) in 100 ml saline and the placebo group 100 ml saline. The primary outcome was absolute functional gain, considered as Barthel index (BI) at discharge minus BI on admission. Secondary outcomes included incidence of postoperative delirium according to the confusion assessment method, proportion of patients recovering prior functional status at 3 months, postoperative transfusion requirements, haemoglobin at 3 months, incidence of nosocomial infections and safety. RESULTS the median participant age was 87 (interquartile range, 82.5-91.5) years. Most patients were female (72.7%), and the median previous BI was 81(59-95). No significant effect of intravenous iron was observed for the primary outcome: the median AFG score was 17.1 points (4.8-23.3) in the intravenous iron group and 16 points (6-26) in the placebo group (P = 0.369). No significant treatment effects were observed for other functional outcomes or secondary end points. CONCLUSION while we found no impact of intravenous iron sucrose on functional recovery, incidence of postoperative delirium, transfusion requirements, haemoglobin at 3 months, mortality and nosocomial infections rates in older patients with hip fracture, we did find that the intervention was safe.
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Affiliation(s)
- Rafael Bielza
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Jesús Llorente
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
- Department of Pharmacy, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Israel J Thuissard
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Cristina Andreu-Vázquez
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - David Blanco
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
- Department of Orthopedics, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Jorge Sanjurjo
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
- Department of Orthopedics, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Néstor López
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
- Department of Orthopedics, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - María Regina Herráez
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
- Department of Hematology, San Sebastián de los Reyes, Madrid, Spain
| | - Cristina Molano
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Adoración Morales
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Estefanía Arias
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Marta Neira
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Ana Lung
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Javier Escalera
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
- Department of Orthopedics, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Laura Portillo
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
- Department of Pharmacy, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Yolanda Larrubia
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
- Department of Pharmacy, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Cristina García
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
- Department of Pharmacy, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Francisco Zambrana
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
- Department of Oncology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Jorge Gómez Cerezo
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
- Department of Internal Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
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Rubinger DA, Cahill C, Ngo A, Gloff M, Refaai MA. Preoperative Anemia Management: What’s New in 2020? CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00385-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Moppett IK, Rowlands M, Mannings AM, Marufu TC, Sahota O, Yeung J. The effect of intravenous iron on erythropoiesis in older people with hip fracture. Age Ageing 2019; 48:751-755. [PMID: 31127269 DOI: 10.1093/ageing/afz049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND anaemia following hip fracture is common and associated with worse outcomes. Intravenous iron is a potential non-transfusion treatment for this anaemia and has been found to reduce transfusion rates in previous observational studies. There is good evidence for its use in elective surgical populations. OBJECTIVE to examine the impact of intravenous iron on erythropoiesis following hip fracture. DESIGN two-centre, assessor-blinded, randomised, controlled trial of patients with primary hip fracture and no contra-indications to intravenous iron. METHOD the intervention group received three doses of 200 mg iron sucrose over 30 min (Venofer, Vifor Pharma, Bagshot Park, UK) on three separate days. Primary outcome was reticulocyte count at day 7 after randomisation. Secondary outcomes included haemoglobin concentration, complications and discharge destination. Eighty participants were randomised. RESULTS there was a statistically significantly greater absolute final reticulocyte count in the iron group (89.4 (78.9-101.3) × 109 cells l-1 (n = 39) vs. the control (72.2 (63.9-86.4)) × 109 cells l-1 (n = 41); P = 0.019; (mean (95% confidence intervals) of log-transformed data). There were no differences in final haemoglobin concentration (99.9 (95.7-104.2) vs. 102.0 (98.7-105.3) P = 0.454) or transfusion requirements in the first week (11 (28%) vs. 12 (29%); P = 0.899). Functional and safety outcomes were not different between the groups. CONCLUSIONS although intravenous iron does stimulate erythropoiesis following hip fracture in older people, the effect is too small and too late to affect transfusion rates. Trial Registry Numbers: ISRCTN:76424792; EuDRACT: 2011-003233-34.
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Affiliation(s)
- I K Moppett
- Anaesthesia and Critical Care Research Group, Division of Clinical Neuroscience, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - M Rowlands
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A M Mannings
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - T C Marufu
- Department of Healthcare of Older Life, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - O Sahota
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Yeung
- Warwick Medical School, University of Warwick, Warwick, UK
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Results of an anaemia treatment protocol complementary to blood transfusion in elderly patients with hip fracture. Rev Esp Geriatr Gerontol 2019; 54:272-279. [PMID: 31266660 DOI: 10.1016/j.regg.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 03/21/2019] [Accepted: 05/03/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Anaemia is a very common condition in elderly patients with hip fracture. The side effects of blood transfusions are well known, and further research on potential alternative therapies is needed. OBJECTIVES AND DESIGN A non-controlled descriptive study, conducted on 138 patients admitted for hip fracture, aimed at analysing the effects of an anaemia treatment protocol adjunctive to transfusion, based on the use of supra-physiological doses of intravenous iron and erythropoietin (IS/EPOS). The variables collected were, medical history, physical and cognitive status prior to fracture, as well as the need of blood products, medical complications during admission and their functional outcome at three and six months after the fracture were evaluated. Transfusion rates were compared with a historical control group when the only treatment for acute anaemia was transfusion (2011). RESULTS Almost half (63, 48%) of the patients received blood transfusion, with (91,70%) IS/EPOD. Intravenous iron did not reduce the percentage of transfused patients (56% vs. 44%), but it did reduce the number of blood units required (0.7 units less in IS/EPO group). Patients who required transfusion had a longer hospital stay, (1.7 days; 13.2 vs. 11.5; p<0.005). Patients who received IS had better functional recovery assessed with Barthel index and the Functional Ambulation Categories (FAC scale) at 3 and 6 months after the fracture. Patients with malnutrition or subtrochanteric fracture needed more tabletransfusions (p<0.005). Functional recovery at 3 and 6 months after fracture was better in patients who received intravenous iron. Neither blood transfusions nor intravenous iron were associated with infectious complications or increased mortality. The patient series of this study was compared with a group of patients with hip fracture and similar characteristics seen in 2011, before intravenous iron was available, revealing a 17% reduction in blood transfusion needs (p<0.005). CONCLUSION The use of intravenous iron in elderly patients with hip fracture may help to reduce the number of blood units needed for the treatment of anaemia, although a causal relationship cannot be established due to not having a control group. Transfusions were associated with longer hospital stay in elderly patients with hip fracture.
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Shin HW, Park JJ, Kim HJ, You HS, Choi SU, Lee MJ. Efficacy of perioperative intravenous iron therapy for transfusion in orthopedic surgery: A systematic review and meta-analysis. PLoS One 2019; 14:e0215427. [PMID: 31059515 PMCID: PMC6502310 DOI: 10.1371/journal.pone.0215427] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/02/2019] [Indexed: 01/07/2023] Open
Abstract
Perioperative anemia frequently occurs in patients undergoing orthopedic surgery. We aimed to evaluate the efficacy of perioperative intravenous iron therapy (IVIT) on transfusion and recovery profiles during orthopedic surgery. We searched PubMed, Embase, Cochrane, and Google Scholar for eligible clinical trials (randomized controlled trials, RCTs; case-control studies, CCSs) in comparing IVIT and no iron therapy, up to September 2018. Primary outcomes were the effects of IVIT on the proportion of patients transfused and units of red blood cells (RBCs) transfused perioperatively. Secondary outcomes were the effects of IVIT on recovery profiles, such as length of hospital stay (LOS), post-operative infection, and mortality. Subgroup analysis was performed based on iron dose (low: ≤ 300 mg, high: > 400 mg), IVIT period (pre-operative, post-operative, perioperative), and study design. We identified 12 clinical trials (4 RCTs with 616 patients and 8 CCSs with 1,253 patients). IVIT significantly reduced the proportion of patients transfused by 31% (RR, 0.69; P = 0.0002), and units of RBCs transfused by 0.34 units/person (MD, -0.34; P = 0.0007). For subgroup analysis by iron dose, low- or high-dose IVIT significantly reduced the proportion of patients transfused (RR, 0.73, P = 0.005; RR, 0.68, P = 0.008), and RBC units transfused (MD, -0.47, P < 0.0001; MD, -0.28, P = 0.04). For subgroup analysis by period, IVIT administered post-operatively significantly reduced the proportion of patients transfused (post-operative: RR, 0.60, P = 0.002; pre-operative: RR, 0.74, P = 0.06) and RBC units transfused (post-operative: MD, -0.44, P <0.00001; pre-operative: MD, -0.29, P = 0.06). For subgroup analysis by study design, IVIT decreased the proportion of patients transfused and RBC units transfused in the group of CCSs, but IVIT in the group of RCTs did not. IVIT significantly shortened LOS by 1.6 days (P = 0.0006) and reduced post-operative infections by 33% (P = 0.01). IVIT did not change mortality. Perioperative IVIT during orthopedic surgery, especially post-operatively, appears to reduce the proportion of patients transfused and units of RBCs transfused, with shorter LOS and decreased infection rate, but no change in mortality rate. These were only found in CCSs and not in RCTs due to the relatively small number of RCTs with low to high risk of bias.
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Affiliation(s)
- Hye Won Shin
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
- * E-mail:
| | - Jeong Jun Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hyun Jung Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hae Sun You
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sung Uk Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Mee Ju Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
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Schack A, Berkfors AA, Ekeloef S, Gögenur I, Burcharth J. The Effect of Perioperative Iron Therapy in Acute Major Non-cardiac Surgery on Allogenic Blood Transfusion and Postoperative Haemoglobin Levels: A Systematic Review and Meta-analysis. World J Surg 2019; 43:1677-1691. [DOI: 10.1007/s00268-019-04971-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Gómez-Ramírez S, Maldonado-Ruiz MÁ, Campos-Garrigues A, Herrera A, Muñoz M. Short-term perioperative iron in major orthopedic surgery: state of the art. Vox Sang 2018; 114:3-16. [DOI: 10.1111/vox.12718] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/13/2018] [Accepted: 09/18/2018] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | - Antonio Herrera
- Ortopaedic and Trauma Surgery; School of Medicine; Zaragoza Spain
| | - Manuel Muñoz
- Perioperative Transfusion Medicine; School of Medicine; Málaga Spain
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Bielza Galindo R, Llorente Gutiérrez J, Pérez González JL, Mora Casado A, Blanco Díaz D, Escalera Alonso J, Morales Fernández A, Molano Ortiz C, García López BE, Del Amo Del Arco N, Barro Ordovas JP, Arias Muñana E, Neira Álvarez M, Sanz Rosa D, Gómez Cerezo JF. [Intravenous iron, functional recovery and delirium in patients with hip fracture. FEDEREF study. Single-centre randomised, placebo-controlled, and double-blind clinical trial. 2014-001923-53: EudraCT number]. Rev Esp Geriatr Gerontol 2018; 53:38-44. [PMID: 28292532 DOI: 10.1016/j.regg.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/17/2016] [Accepted: 01/16/2017] [Indexed: 06/06/2023]
Abstract
INTRODUCTION There are no previous studies evaluating the effect of intravenous iron therapy on functional and cognitive status of patients with hip fracture (HF). MATERIAL AND METHODS A single-centre randomised, placebo-controlled, double-blind and parallel treatment, clinical trial has been designed to assess the efficacy of intravenous iron therapy during the peri-operative period in elderly patients suffering from a HF. Blinding will be ensured by the packaging of the drug infusion system. On days 1, 3, and 5 from admission, the intervention group will receive 200mg Venofer® (iron sucrose) diluted in 100ml saline, and the control group 100ml saline, also on days 1, 3 and 5. Patients will received conventional treatment in ortho-geriatric unit of the Hospital Infanta Sofia. Functional variables (activities of daily living and walking), cognitive (cognitive status and delirium), surgical, demographic and clinical characteristics will be collected during admission in order to assess the impact of treatment. A safety analysis of the treatment will also performed. Patients will be followed-up at 3, 6, and 12 months. RESULTS The study will attempt to provide evidence on the impact of the intravenous iron administration on functional recovery. It will be determined whether iron therapy negatively affects the incidence of post-operative delirium. Finally, report will be presented on the safety data of intravenous iron in elderly HF patients, as well as the impact on allogenic blood transfusion savings. CONCLUSIONS The inclusion of elderly HF patients admitted to an ortho-geriatric unit, in a clinical trial, will help to improve the knowledge of the treatment impact on a usual scenario, and provide useful data for use in other units.
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Affiliation(s)
- Rafael Bielza Galindo
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España.
| | - Jesús Llorente Gutiérrez
- Sección de Farmacología. Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - José Luis Pérez González
- Servicio de Traumatología, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Asunción Mora Casado
- Sección de Hematología, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - David Blanco Díaz
- Servicio de Traumatología, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Javier Escalera Alonso
- Servicio de Traumatología, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Adoración Morales Fernández
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Cristina Molano Ortiz
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | | | - Nazaret Del Amo Del Arco
- Análisis Clínicos, Laboratorio de Urgencias, Hospital Infanta Sofía- BR Salud, San Sebastián de los Reyes, España
| | - Juan Pablo Barro Ordovas
- Sección de Farmacología. Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Estefanía Arias Muñana
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Marta Neira Álvarez
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - David Sanz Rosa
- Escuela de Doctorado e Investigación, Universidad Europea de Madrid, España
| | - Jorge Fco Gómez Cerezo
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
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Fernández-Ibáñez J, Morales-Ballesteros M, Crespo-Romero E, Gómez-Gómez S, Fraga-Fuentes M, Cruz-Tejado J, Hernández-Zegarra P, Arias-Arias Á, García-Baltasar M. Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Fernández-Ibáñez JM, Morales-Ballesteros MC, Crespo-Romero E, Gómez-Gómez S, Fraga-Fuentes MD, Cruz-Tejado J, Hernández-Zegarra PA, Arias-Arias Á, García-Baltasar MM. Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:88-95. [PMID: 28214194 DOI: 10.1016/j.recot.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 11/16/2016] [Accepted: 11/27/2016] [Indexed: 01/09/2023] Open
Abstract
AIM To describe the orthogeriatric activity in the elderly with hip fractures in the Hospital Mancha Centro, based on the recommendations of the main guidelines. MATERIAL AND METHOD Observational prospective study, comprising all patients over 65 years of age admitted to the Traumatology Unit with a hip fracture between April 2015 and December 2015. Patients were admitted under the care of the Traumatology Unit with cross-consultation carried out with the Geriatrics Department, which then carried out a pre-operative geriatric assessment and the post-operative follow-ups. RESULTS The mean pre-surgery waiting time was 48h and the overall time in hospital was 10.3±8.2 days. Patients who suffered from delirium (42.1%) did not improve as well, and were referred to nursing homes. Blood transfusions were received by 54.7% of the patients, despite 53.5% of them having received intravenous and/or oral iron after the surgery. Treatment with calcium and vitamin D was prescribed in 79% of the patients on discharge. The Rehabilitation Unit assessed 36% of the patients, with 4.8% fully, and 16.7% partially recovering their prior functional status. Upon discharge, 55% of the patients returned to their homes, and 22% were referred to short-term assisted living facilities. DISCUSSION This article describes how the main clinical problems are handled in the elderly with hip fractures in our hospital, based on recommendations of the main guidelines and publications. CONCLUSIONS Our hospital follows the recommended guidelines. Aspects for improvement include the management of anaemia during admission and rehabilitation.
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Affiliation(s)
- J M Fernández-Ibáñez
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
| | - M C Morales-Ballesteros
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - E Crespo-Romero
- Servicio de Traumatología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - S Gómez-Gómez
- Servicio de Traumatología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - M D Fraga-Fuentes
- Servicio de Farmacia, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - J Cruz-Tejado
- Servicio de Anestesia, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - P A Hernández-Zegarra
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - Á Arias-Arias
- Unidad de Investigación, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - M M García-Baltasar
- Servicio de Trabajo Social, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
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Bernabeu‐Wittel M, Romero M, Ollero‐Baturone M, Aparicio R, Murcia‐Zaragoza J, Rincón‐Gómez M, Monte‐Secades R, Melero‐Bascones M, Rosso CM, Ruiz‐Cantero A. Ferric carboxymaltose with or without erythropoietin in anemic patients with hip fracture: a randomized clinical trial. Transfusion 2016; 56:2199-211. [DOI: 10.1111/trf.13624] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/08/2016] [Accepted: 03/17/2016] [Indexed: 12/11/2022]
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Potter LJ, Doleman B, Moppett IK. A systematic review of pre-operative anaemia and blood transfusion in patients with fractured hips. Anaesthesia 2015; 70:483-500. [PMID: 25764405 DOI: 10.1111/anae.12978] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2014] [Indexed: 12/18/2022]
Abstract
We systematically reviewed the observational associations of anaemia with outcomes and the effects of interventions to increase haemoglobin concentrations following hip fracture in older people. Anaemia on hospital admission was associated with increased mortality, relative risk 1.64 (95% CI 1.47-1.82), p < 0.0001. After adjustment for co-morbidities, the association of anaemia with increased mortality remained in four of eight observational studies. There was no association of postoperative transfusion with mortality after adjusting for covariates. Transfusion at 80 g.l(-1) vs 100 g.l(-1) increased acute myocardial infarction, relative risk 1.67 (95% CI 1.01-2.77), p = 0.05. Transfusion threshold was not associated with differences in other outcomes. There were insufficient high-quality studies to inform pre-operative blood transfusion or the use of peri-operative iron or erythropoietin. Studies for most interventions recruited too few participants to determine effects on infections, mortality or function.
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Affiliation(s)
- L J Potter
- Anaesthesia and Critical Care Research Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Pareja Sierra T, Rodriguez Solis J. Tratamiento médico perioperatorio del anciano ingresado por fractura de cadera. Med Clin (Barc) 2014; 143:455-60. [DOI: 10.1016/j.medcli.2014.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 12/29/2022]
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Minguela Pesquera JI, Aurrekoetxea Fernández B, Jimeno Martín I, Ruiz de Gauna López de Heredia R. [Comments about the presurgical administration of intravenous iron]. Med Clin (Barc) 2014; 143:237. [PMID: 24725852 DOI: 10.1016/j.medcli.2013.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 10/31/2013] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Isabel Jimeno Martín
- Servicio de Nefrología, Hospital Universitario Araba-Txagorritxu, Vitoria-Gasteiz, Álava, España
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Barea Mendoza JA, Gredilla Zubiría Í, González Olmedo J, Mateo Alvarez S. Hipofosfatemia, una reacción adversa poco conocida del hierro intravenoso. Med Clin (Barc) 2014; 143:284-5. [DOI: 10.1016/j.medcli.2013.11.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/23/2013] [Accepted: 11/28/2013] [Indexed: 12/21/2022]
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Lizaur-Utrilla A, Calduch Broseta JV, Miralles Muñoz FA, Segarra Soria M, Díaz Castellano M, Andreu Giménez L. [Effectiveness of co-management between orthopaedic surgeons and internists for inpatient elders with hip fracture]. Med Clin (Barc) 2014; 143:386-91. [PMID: 24485164 DOI: 10.1016/j.medcli.2013.07.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Hip fracture is a common injury in elder patients who have comorbidities, and it increases the risk of morbimortality. They could benefit from co-management (CM) between orthopaedic surgeons and internists. The objective was to evaluate the effectiveness of this CM. PATIENTS AND METHOD Prospective study of 138 patients over 64 years with hip fracture treated with CM care and one-year of follow-up. The control group was a cohort of 153 patients with similar criteria who had been treated with conventional care. Several pre- and postsurgical variables, complications, and potential risk factors for mortality were analyzed. The Charlson index, mental test, Katz and SF-12 quality of life questionnaires, and Merle D'Aubigné hip score were used. RESULTS Surgical delay was lower in the CM cohort (P=.001). The rates of complications and readmissions were similar in both cohorts. The average stay was lower (P=.001) in the CM cohort. In-hospital and 3-month mortality were similar, but it was lower in the CM cohort at 6 (P=.04) and 12 months (P=.03). In both cohorts, gender, number of comorbidities, ASA score, Charlson index or surgery type were not predictors of mortality. Surgical delay>2 days was a predictor in the CM cohort, whereas age was a predictor in the control cohort. The final functional outcomes were similar in both cohorts. CONCLUSION Our results show the effectiveness of this CM to reduce surgical delay, hospital stay and mortality at 6 months.
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Affiliation(s)
| | - Juan V Calduch Broseta
- Unidad de Corta Estancia, Servicio de Medicina Interna, Hospital Universitario de Elda, Elda, Alicante, España
| | | | - Mar Segarra Soria
- Unidad de Corta Estancia, Servicio de Medicina Interna, Hospital Universitario de Elda, Elda, Alicante, España
| | - Manuel Díaz Castellano
- Unidad de Corta Estancia, Servicio de Medicina Interna, Hospital Universitario de Elda, Elda, Alicante, España
| | - Lucio Andreu Giménez
- Unidad de Corta Estancia, Servicio de Medicina Interna, Hospital Universitario de Elda, Elda, Alicante, España
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García Erce JA, Gómez Ramírez S, Muñoz Gómez M. [Thoughts about the usefulness of the preoperatory administration of intravenous iron in hip fracture surgery]. Med Clin (Barc) 2013; 141:508-9. [PMID: 23790583 DOI: 10.1016/j.medcli.2013.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 01/24/2013] [Indexed: 11/28/2022]
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