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Iliopoulos E, Tosounidis T, Moustafa RM, Tilkidis F, Daskalakis I, Melissaridou D, Serenidis D, Giannatos V, Sentona M, Grammatikopoulos D, Gkiatas I, Tatani I, Zidrou C, Savvidou O, Potoupnis M, Drosos G. The use of minimum common data set in the development of the Greek Fragility Hip Fracture Registry in the Greek health care setting: the first year of its pilot implementation. Arch Osteoporos 2024; 19:85. [PMID: 39240297 DOI: 10.1007/s11657-024-01443-x] [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: 05/29/2024] [Accepted: 08/21/2024] [Indexed: 09/07/2024]
Abstract
The first Fragility Hip Fracture Registry has been established in Greece. The in-hospital length of stay was 10.8 days and was significantly influenced by the delayed surgical fixation. The increased age, the higher ASA grade, and the male gender influenced negatively the 30-day mortality, which reached 7.5%. BACKGROUND The increased incidence of fragility hip fractures constitutes a great challenge to the health care professionals and causes a significant burden on national health care systems around the globe. Fragility hip fracture registries have been used in many countries in order to document the cotemporary situation in each country and to identify potential weaknesses of the local health care systems. AIM The aim of the herein study is to present the results of the pilot implementation of the first fragility hip fracture registry in Greece, which was developed by the Greek Chapter of Fragility Fracture Network (FFN Gr), and use the neural networks in the analysis of the results. MATERIALS AND METHODS Seven orthopaedic departments from six different hospitals in Greece participated in the present pilot study. All fragility hip fractures from September 2022 until December 2023 were prospectively collected and documented using a central database. For this purpose, the 22 points of minimum common data set, proposed by the Global Fragility Fracture Network, with the addition of the 30-day mortality was used. RESULTS A total of 1009 patients who sustained a fragility hip fracture were included in the study. The mean age of the cohort was 82.2 ± 8.6 years with the majority of patients being female (72%). Sixty percent (60%) of the patients had an extracapsular hip fracture, with a mean ASA grade 2.6 ± 0.8. Intramedullary nailing and hip hemiarthroplasty were the surgical treatments of choice in the majority of extra- and intra-capsular hip fractures respectively. The mean hospital length of stay of the patients was 10.8 ± 8.5 days, and the 30-day mortality was 7.5%. The multivariant analysis revealed that the age, the ASA grade and the male gender had a significant contribution to the 30-day mortality. The neural network model had a significant under-the-curve predictive value (0.778), with age being the most important predictive factor. The length of stay was significantly influenced only by the delayed surgical fixation (more than 36 h from admission). CONCLUSIONS The present pilot study provides evidence that establishing a fragility hip fracture registry in Greece is feasible and demonstrates that the minimum common data set can be used as the base of any new registry. In Greece, patients with a fragility hip fracture stay in the hospital for approximately 11 days and have 7.5% 30-day mortality. Unfortunately, due to the logistics of the public healthcare system, they do not receive surgical fixation in a timely manner, which is a factor that negatively affects their length of in-hospital stay.
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Affiliation(s)
- Efthymios Iliopoulos
- Metabolic Disease and Fragility Fractures Unit, Academic Orthopaedic Department of General University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Theodoros Tosounidis
- Academic Department of Orthopaedic Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Reichan Molla Moustafa
- Metabolic Disease and Fragility Fractures Unit, Academic Orthopaedic Department of General University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Fotios Tilkidis
- Academic Orthopaedic Department of General University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Ioannis Daskalakis
- Academic Department of Orthopaedic Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Dimitra Melissaridou
- 1st Academic Orthopaedic Department, 'Attikon' General University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Serenidis
- 1st Academic Orthopaedic Department, 'Attikon' General University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Giannatos
- Academic Orthopaedic Department, Patras General University Hospital, University of Patras, Patras, Greece
| | - Maria Sentona
- 2nd Orthopaedic Department, 'Papageorgiou' General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Grammatikopoulos
- 3rd Academic Orthopaedic Department, 'Papageorgiou' General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Gkiatas
- Academic Orthopaedic Department of General University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Irini Tatani
- Academic Orthopaedic Department, Patras General University Hospital, University of Patras, Patras, Greece
| | - Christianna Zidrou
- 2nd Orthopaedic Department, 'Papageorgiou' General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Olga Savvidou
- 1st Academic Orthopaedic Department, 'Attikon' General University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Potoupnis
- 3rd Academic Orthopaedic Department, 'Papageorgiou' General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Drosos
- Metabolic Disease and Fragility Fractures Unit, Academic Orthopaedic Department of General University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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de Haan E, van Oosten B, van Rijckevorsel VAJIM, Kuijper TM, de Jong L, Roukema GR. Validation of the Charlson Comorbidity Index for the prediction of 30-day and 1-year mortality among patients who underwent hip fracture surgery. Perioper Med (Lond) 2024; 13:67. [PMID: 38961483 PMCID: PMC11223422 DOI: 10.1186/s13741-024-00417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION The aim of our study was to validate the original Charlson Comorbidity Index (1987) (CCI) and adjusted CCI (2011) as a prediction model for 30-day and 1-year mortality after hip fracture surgery. The secondary aim of this study was to verify each variable of the CCI as a factor associated with 30-day and 1-year mortality. METHODS A prospective database of two-level II trauma teaching hospitals in the Netherlands was used. The original CCI from 1987 and the adjusted CCI were calculated based on medical history. To validate the original CCI and the adjusted CCI, the CCI was plotted against the observed 30-day and 1-year mortality, and the area under the curve (AUC) was calculated. RESULTS A total of 3523 patients were included in this cohort study. The mean of the original CCI in this cohort was 5.1 (SD ± 2.0) and 4.6 (SD ± 1.9) for the adjusted CCI. The AUCs of the prediction models were 0.674 and 0.696 for 30-day mortality for the original and adjusted CCIs, respectively. The AUCs for 1-year mortality were 0.705 and 0.717 for the original and adjusted CCIs, respectively. CONCLUSIONS A higher original and adjusted CCI is associated with a higher mortality rate. The AUC was relatively low for 30-day and 1-year mortality for both the original and adjusted CCIs compared to other prediction models for hip fracture patients in our cohort. The CCI is not recommended for the prediction of 30-day and 1-year mortality in hip fracture patients.
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Affiliation(s)
- Eveline de Haan
- Surgery Department, Maasstad Hospital, Rotterdam, 3007 AC, the Netherlands.
- Surgery Department, Franciscus Hospital, Rotterdam, 3045 PM, the Netherlands.
| | - Benthe van Oosten
- Surgery Department, Maasstad Hospital, Rotterdam, 3007 AC, the Netherlands
| | | | - T Martijn Kuijper
- Maasstad Academy, Maasstad Hospital, Rotterdam, 3079 DZ, the Netherlands
| | - Louis de Jong
- Surgery Department, Maasstad Hospital, Rotterdam, 3007 AC, the Netherlands
| | - Gert R Roukema
- Surgery Department, Maasstad Hospital, Rotterdam, 3007 AC, the Netherlands
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Dray J, Soubieux A, Chenailler C, Varin R, Dujardin F, Curado J, Barat E. Economic impact of a clinical pharmacist in the orthopaedic sector: a review of the literature. Eur J Hosp Pharm 2024:ejhpharm-2023-003727. [PMID: 38503475 DOI: 10.1136/ejhpharm-2023-003727] [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: 06/13/2023] [Accepted: 02/20/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES This review of the literature aimed to evaluate the economic impact of a clinical pharmacist in the orthopaedic sector. METHODS The review followed the PRISMA recommendations. A bibliographic search was conducted on 23 June 2023 using PubMed, Cochrane Library and Web of Science. All articles in French or English with economic data on clinical pharmacy activities in orthopaedics were included. Articles not mentioning the term 'orthopaedics' and those published prior to 1990 were excluded. Data from the studies were compiled in an Excel table. A bias analysis using the ROBINS-I Cochrane tool was performed. The methodology of the studies was compared and weighted using the CHEERS and STROBE checklists. RESULTS Among 529 articles initially identified, 10 were included in the review. The cost-benefit ratio of a clinical pharmacist in orthopaedics ranged from 0.47:1 to 28:1. The maximum savings reached US$73 410 /year in the American study and €1 42 356 /year in the French study. For three studies, the cost of a clinical pharmacist was not evaluated. Eight studies showed a positive economic impact. The Dutch study showed a balance and the Danish study showed a negative economic impact of €3442/month. CONCLUSIONS This literature review has shown an economic benefit of a clinical pharmacist in the orthopaedic sector despite several biases and methodological limitations. The two studies that did not confirm this benefit only evaluated a limited number of expected benefits. Nevertheless, the economic impact of the clinical pharmacist in the orthopaedic sector seems positive and undervalued.
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Affiliation(s)
- Joshua Dray
- Department of Pharmacy, Rouen University Hospital, Rouen, France
| | | | | | - Remi Varin
- Department of Pharmacy, Rouen University Hospital, Rouen, France
| | - Franck Dujardin
- Department of Orthopedics, Rouen University Hospital, Rouen, France
| | - Jonathan Curado
- Department of Orthopedics, Rouen University Hospital, Rouen, France
| | - Eric Barat
- Department of Pharmacy, Rouen University Hospital, Rouen, France
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Lu Y, Chen W, Guo Y, Wang Y, Wang L, Zhang Y. Risk factors for short-term mortality in elderly hip fracture patients with complicated heart failure in the ICU: A MIMIC-IV database analysis using nomogram. J Orthop Surg Res 2023; 18:829. [PMID: 37924144 PMCID: PMC10625197 DOI: 10.1186/s13018-023-04258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/02/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Hip fracture is a prevalent and hazardous injury among the elderly population that often results in intensive care unit (ICU) admission due to various complications, despite advanced medical science. One common complication experienced in the ICU by elderly hip fracture patients is heart failure, which significantly impacts short-term survival rates. Currently, there is a deficit of adequate predictive models to forecast the short-term risk of death following heart failure for elderly hip fracture patients in the ICU. This study aims to identify independent risk factors for all-cause mortality within 30 days for elderly patients with hip fractures and heart failure while in the ICU in order to develop a predictive model. METHOD A total of 641 elderly patients with hip fractures combined with heart failure were recruited from the Medical Information Mart for Intensive Care IV dataset and randomized to the training and validation sets. The primary outcome was all-cause mortality within 30 days. The least absolute shrinkage and selection operator regression was used to reduce data dimensionality and select features. Multivariate logistic regression was used to build predictive models. Consistency index (C-index), receiver operating characteristic curve, and decision curve analysis (DCA) were used to measure the predictive performance of the nomogram. RESULT Our results showed that these variables including MCH, MCV, INR, monocyte percentage, neutrophils percentage, creatinine, and combined sepsis were independent factors for death within 30 days in elderly patients with hip fracture combined with heart failure in the ICU. The C-index was 0.869 (95% CI 0.823-0.916) and 0.824 (95% CI 0.749-0.900) for the training and validation sets, respectively. The results of the area under the curve and decision curve analysis (DCA) confirmed that the nomogram performed well in predicting elderly patients with hip fractures combined with heart failure in the ICU. CONCLUSION We developed a new nomogram model for predicting 30-day all-cause mortality in elderly patients with hip fractures combined with heart failure in the ICU, which could be a valid and useful clinical tool for clinicians for targeted treatment and prognosis prediction.
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Affiliation(s)
- Yining Lu
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Wei Chen
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yuhui Guo
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yujing Wang
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Ling Wang
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
| | - Yingze Zhang
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
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Ladegaard TH, Sørensen MS, Petersen MM. Major surgery for metastatic bone disease is not a risk for 30-day mortality: a population-based study from Denmark. Acta Orthop 2023; 94:447-452. [PMID: 37614143 PMCID: PMC10448382 DOI: 10.2340/17453674.2023.18394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/02/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND AND PURPOSE Surgery for bone metastases in the appendicular skeleton (aBM) is a trade-off between limb function and survival. A previous study from a highly specialized center found that extended surgery is not a risk for 30-day mortality and hypothesized that wide resection and reconstruction might reduce postoperative mortality. The study aimed to investigate whether parameters describing the surgical trauma (blood loss, duration of surgery, and degree of bone resection) pose a risk for 30-day mortality in patients treated with endoprostheses (EPR) or internal fixation (IF) in a population-based cohort. PATIENTS AND METHODS A population-based cohort having EPR/IF for aBM in the Capital Region of Denmark 2014-2019 was retrospectively assessed. Intraoperative variables and patient demographics were evaluated for association with 30-day mortality by logistic regression analysis. Kaplan-Meier estimate was used to evaluate survival with no loss to follow-up. RESULTS 437 patients had aBM surgery with EPR/IF. No parameters describing the magnitude of the surgical trauma (blood loss/duration of surgery/degree of bone resection) were associated with mortality. Overall 30-day survival was 85% (95% confidence interval [CI] 81-88). Univariate analysis identified ASA group 3+4, Karnofsky score < 70, fast-growth primary cancer, and visceral and multiple bone metastases as risk factors for 30-day mortality. Male sex (OR 2.8, CI 1.3-6.3), Karnofsky score < 70 (OR 4.2, CI 2.1-8.6), and multiple bone metastases (OR 3.4, CI 1.2-9.9) were independent prognostic factors for 30-day-mortality in multivariate analysis. CONCLUSION The parameters describing the surgical trauma were not associated with 30-day mortality but, instead, general health status and extent of primary cancer influenced survival post-surgery.
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Affiliation(s)
- Thea H Ladegaard
- Musculoskeletal Tumor Section of the Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Michala S Sørensen
- Musculoskeletal Tumor Section of the Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael M Petersen
- Musculoskeletal Tumor Section of the Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Lee SS, Kim JH, Lee JJ, Kwon YS, Seo EM. The Impact of Blood Transfusion in Developing Postoperative Delirium in Patients with Hip Fracture Surgery. J Clin Med 2023; 12:4696. [PMID: 37510810 PMCID: PMC10380490 DOI: 10.3390/jcm12144696] [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: 05/27/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Many studies have been conducted to explore the risk factors associated with postoperative delirium (POD) in order to understand its underlying causes and develop prevention strategies, especially for hip fracture surgery. However, the relationship between blood transfusion and POD has been heatedly debated. The purpose of this study was to evaluate the risk factors of POD and the relationship between blood transfusions and the occurrence of POD in hip fracture surgery through big data analysis. METHODS Medical data (including medication history, clinical and laboratory findings, and perioperative variables) were acquired from the clinical data warehouse (CDW) of the five hospitals of Hallym University Medical Center and were compared between patients without POD and with POD. RESULTS The occurrence of POD was 18.7% (228 of 2398 patients). The risk factors of POD included old age (OR 4.38, 95% CI 2.77-6.91; p < 0.001), American Society of Anesthesiology physical status > 2 (OR 1.84 95% CI 1.4-2.42; p < 0.001), dementia (OR 1.99, 95% CI 1.53-2.6; p < 0.001), steroid (OR 0.53 95% CI 0.34-0.82; p < 0.001), Antihistamine (OR 1.53 95% CI 1.19-1.96; p < 0.001), and postoperative erythrocyte sedimentation rate (mm/h) (OR 0.97 95% CI 0.97-0.98; p < 0.001) in multivariate logistic regression analysis. The postoperative transfusion (OR 2.53, 95% CI 1.88-3.41; p < 0.001) had a significant effect on the incidence of POD. CONCLUSIONS big data analytics using a CDW was a good option to identify the risk factors of POD and to prevent POD in hip fracture surgery.
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Affiliation(s)
- Sang-Soo Lee
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
| | - Jong-Ho Kim
- Division of Big Data and Artificial Intelligence, Institute of New Frontier Research, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
| | - Jae-Jun Lee
- Division of Big Data and Artificial Intelligence, Institute of New Frontier Research, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
| | - Young-Suk Kwon
- Division of Big Data and Artificial Intelligence, Institute of New Frontier Research, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
| | - Eun-Min Seo
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
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Pangaud C, Pioger C, Pauly V, Orleans V, Boyer L, Argenson JN, Ollivier M. Total hip arthroplasty reduces the risk of dislocation after femoral neck fracture. Orthop Traumatol Surg Res 2023; 109:103575. [PMID: 36754167 DOI: 10.1016/j.otsr.2023.103575] [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: 08/01/2022] [Revised: 12/28/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Femoral neck fracture in the elderly patient can either be managed using hemi-arthroplasty (HA) or total hip arthroplasty (THA). The aim of this study was to explore the rate of three selected complications in each procedure: is the dislocation rate higher with HA compared to THA? Is the blood transfusion rate higher with THA compared to HA? Do the patients who underwent THA require more ICU transfer than the patients who underwent HA? Is the ICU transfer correlated to the use of cement for stem fixation? METHOD Based on a national health-care database, a comparative and retrospective study was conducted. 96,184 patients were included after having a surgery for femoral neck fracture between 2014 and 2017. The mean follow up was 3.5 years (Min. 2 years-Max. 5 years). The population was divided into two groups: hemiarthroplasty (HA) and total hip arthroplasty (THA). The primary outcome was the dislocation rate and the secondary outcomes were the blood transfusion rate and the need for ICU after surgery. RESULTS At two years of follow up in the Hemiarthroplasty group, 3647 patients had a dislocation episode over 64,106 patients: 5.69%. In the Total Hip Arthroplasty group: 1904 patients had a dislocation episode over 32,078 patients: 5.94% (p=0.26711). The percentage of deceased patient without dislocation was 17.76% in the HA group and 11.56% in the THA group (p<0.001). The univariate hazard ratio for dislocation was higher in the THA group: HR 1.063 IC 95% (0.993-1.138) p=0.077. The multivariate analysis calculating competitive risk with death and dislocation found THA to be a protective factor of dislocation HR 0.926 IC 95% (0.866-0.991) p=0.0266. The rate of blood transfusion was 5.59% in the THA group and 7.03% in the HA group (p<0.001), The multivariate analysis found HR=1.062 IC 95% (0.99-1.139) p=0.0955. The need for ICU transfer after the surgery was 7.04% in the HA group and 8.08% in the THA group (p<0.001). The multivariate analysis found HR 0.995 IC 95% (0.921-1.076) p=0.9094. Finally, only cement was found as an independent risk factor of ICU transfer after surgery: HR 1.254 IC 95% (1.164-1.35) p<0.0001. CONCLUSION THA for femoral neck fracture allows to reduce the risk of dislocation compared to hemiarthroplasty. The multivariate analysis failed to prove the superiority of one procedure over the other regarding blood transfusion risk and the need for ICU transfer. The use of cemented stem appears to be a risk factor of ICU transfer after hip arthroplasty. LEVEL OF EVIDENCE III, Retrospective comparative study.
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Affiliation(s)
- Corentin Pangaud
- Institute of Movement Science UMR 7287, Aix-Marseille université et CNRS, Marseille, France; Institute of Movement and Locomotion, Marseille, France.
| | - Charles Pioger
- Public Teaching Hospital of Paris, Ambroise-Paré Hospital, Paris, France
| | - Vanessa Pauly
- CEReSS-Health Services Research and Quality of Life Center, faculté de médecine, secteur Timone, EA 3279, CEReSS - centre d'étude et de recherche sur les services de santé et la qualité de vie, Aix-Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France; Department of Epidemiology and Health Economics, AP-HM, Marseille, France; Department of Medical Information, AP-HM, Marseille, France
| | - Veronica Orleans
- CEReSS-Health Services Research and Quality of Life Center, faculté de médecine, secteur Timone, EA 3279, CEReSS - centre d'étude et de recherche sur les services de santé et la qualité de vie, Aix-Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France; Department of Epidemiology and Health Economics, AP-HM, Marseille, France; Department of Medical Information, AP-HM, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Services Research and Quality of Life Center, faculté de médecine, secteur Timone, EA 3279, CEReSS - centre d'étude et de recherche sur les services de santé et la qualité de vie, Aix-Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France; Department of Epidemiology and Health Economics, AP-HM, Marseille, France; Department of Medical Information, AP-HM, Marseille, France
| | - Jean Noël Argenson
- Institute of Movement Science UMR 7287, Aix-Marseille université et CNRS, Marseille, France; Institute of Movement and Locomotion, Marseille, France
| | - Matthieu Ollivier
- Institute of Movement Science UMR 7287, Aix-Marseille université et CNRS, Marseille, France; Institute of Movement and Locomotion, Marseille, France
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Chen Q, Hao P, Wong C, Zhong X, He Q, Chen Y. Development and validation of a novel nomogram of 1-year mortality in the elderly with hip fracture: a study of the MIMIC-III database. BMJ Open 2023; 13:e068465. [PMID: 37202145 DOI: 10.1136/bmjopen-2022-068465] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE Hip fracture is a prevalent condition with a significant death rate among the elderly. We sought to develop a nomogram-based survival prediction model for older patients with hip fracture. DESIGN A retrospective case-control study. SETTING The data from Medical Information Mart for Intensive Care III (MIMIC-III V.1.4). PARTICIPANTS The clinical features of elderly patients with hip fracture, including basic information, comorbidities, severity score, laboratory tests and therapy, were filtered out based on the MIMIC-III V.1.4. METHODS AND MAIN OUTCOME MEASURES All patients included in the study were from critical care and randomly divided into training and validation sets (7:3). On the basis of retrieved data, the least absolute shrinkage and selection operator (LASSO) regression and multiple logistic regression analysis were used to identify independent predictive variables of 1-year mortality, and then constructed a risk prediction nomogram. The predictive values of the nomogram model were evaluated by the concordance indexes (C-indexes), receiver operating characteristic curve, decision curve analysis (DCA) and calibration curve. RESULTS A total of 341 elderly patients with hip fracture were included in this study; 121 cases died within 1 year. After LASSO regression and multiple logistic regression analysis, a novel nomogram contained the predictive variables of age, weight, the proportion of lymphocyte count, liver disease, malignant tumour and congestive heart failure. The constructed model proved satisfactory discrimination with C-indexes of 0.738 (95% CI 0.674 to 0.802) in the training set and 0.713 (95% CI 0.608 to 0.819) in the validation set. The calibration curve shows a good degree of fitting between the predicted and observed probabilities and the DCA confirms the model's clinical practicability. CONCLUSIONS The novel prediction model provides personalised predictions for 1-year mortality in elderly patients with hip fractures. Compared with other hip fracture models, our nomogram is particularly suitable for predicting long-term mortality in critical patients.
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Affiliation(s)
- Qian Chen
- Department of Orthopedics, Sun Yat-Sen University, Guangzhou, China
| | - Peng Hao
- Department of Surgical Intensive Care Unit, Sun Yat-Sen University, Guangzhou, China
| | - Chipiu Wong
- Department of Orthopedics, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoxin Zhong
- Department of Surgical Intensive Care Unit, Sun Yat-Sen University, Guangzhou, China
| | - Qing He
- Department of Surgical Intensive Care Unit, Sun Yat-Sen University, Guangzhou, China
| | - Yantao Chen
- Department of Orthopedics, Sun Yat-Sen University, Guangzhou, China
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Schramm S, Kopschina C, Gaßmann KG, Fujak A. Is the conservative treatment of sacral insufficiency fractures still up to date? Retrospective clinical observational study in 46 patients. Orthop Traumatol Surg Res 2023; 109:103495. [PMID: 36455862 DOI: 10.1016/j.otsr.2022.103495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/01/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND According to current forecasts, our society will grow older and older, so that the proportion of 6% of the German population from 2017 who were 80 years or older will increase further. The frequency of falls in this patient population lead to a further increase of sacral insufficiency fractures. HYPOTHESIS The aim of this study is to evaluate the multimodal interdisciplinary conservative therapy regime for sacral insufficiency fractures in geriatric patients, especially on the basis of mobility and the need for assistance. PATIENTS AND METHODS A cohort of patients, who were treated as inpatients at the Waldkrankenhaus St. Marien in Erlangen with ICD-10 for sacral fractures S32.1 as the main diagnosis, was retrospectively examined. Only newly diagnosed sacral insufficiency fractures were taken into account. Patients were divided into groups based on the factors hospital stay, fracture location on the sacrum, and location of concomitant pelvic ring injury. The Barthel Index, the Tinetti's Mobility Test and the Timed Up&Go Test were recorded. RESULTS 46 patients met the inclusion criteria. Using the conservative therapy, improvements were achieved in all patients in terms of need for care, mobility without aids and risk of falling, also patients with an anterior and posterior pelvic ring fracture. Regard a score improvement in the Barthel Index and Tinetti Mobility Test, patients with bilateral sacral insufficiency fracture (n=17, 37.0%) did not differ significantly from patients with unilateral sacral insufficiency fracture (n=22, 47.8%). CONCLUSION In geriatric patients, decisions about therapy should always be made on an individual and interdisciplinary basis. The conservative therapy regimen continues to play an important role in this. The collected tests-consisting of Barthel Index, Tinetti Mobility Test and Timed Up&Go Test-are well suited for further reproducible, objective studies with a larger patient collective. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Simon Schramm
- Department of Trauma and Orthopaedic Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054 Erlangen, Germany.
| | - Carsten Kopschina
- Department of Trauma and Orthopaedic Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Karl-Günter Gaßmann
- Department of Internal Medicine III (Medicine of Ageing), Geriatrics Center Erlangen, Malteser Waldkrankenhaus St. Marien, Rathsberger Str. 57, 91054 Erlangen, Germany
| | - Albert Fujak
- Department of Trauma and Orthopaedic Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054 Erlangen, Germany
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10
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Debopadhaya S, Marmor MT. Frailty and comorbidity predict 30 day postoperative outcomes, independent of anatomical site of fracture. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04764-7. [PMID: 36648540 DOI: 10.1007/s00402-023-04764-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/31/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Fragility fractures are a major threat to geriatric patients. However, it is unclear whether this patient population's inherent frailty and comorbidity or the physiologic insult caused by the fracture and its surgery contribute more to undesirable patient outcomes. Hence, this study examines if frailty and comorbidity can predict 30 day postoperative outcomes while the effects of multiple fracture sites are accounted for. METHODS A retrospective review of patients ≥ 65 years of age in the National Surgical Quality Improvement Program who underwent surgical treatment between 2013 and 2017 was performed. A total of 52,497 patients were included in the final analysis, including fracture cases of the extremities, limbs, and hip. Demographics, several metrics of preoperative health, temporal variables, and fracture location were tested in bivariate analysis of 30 day postoperative mortality, length of stay in hospital, discharge outcome, and complications. Significant variables were considered for multivariate logistic regression models for each outcome. RESULTS Frailty, comorbidity, and time to surgery were found to be the significant predictors in multivariate analysis of each 30 day postoperative outcome, independent of the effects of fracture site (p < 0.05). Examination of 30 day mortality found that American Society of Anesthesiologists Class ≥ 3 (2.30 Odds Ratio), modified Frailty Index > 0 (1.37 OR), Charleston Comorbidity Index ≥ 6 (1.63 OR), and time to surgery (1.45 OR) were especially important (all p < 0.05). Additionally, the worst outcomes were associated with fractures of the pelvis/hip and femur/knee, including 30 day mortality (5.90 and 5.12 OR, respectively; both p < 0.05). CONCLUSION The effects of the preoperative health were found to be independent of patient demographics and fracture site. Additionally, specific high-risk fracture sites are significant predictors of outcome, supporting the need to prioritize these patients. Clinical care pathways for geriatric patients may benefit from emphasis on these high-risk fractures and preoperative patient health.
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Affiliation(s)
| | - Meir T Marmor
- Orthopaedic Trauma Institute (OTI), San Francisco General Hospital, University of California, San Francisco (UCSF), 2550 23Rd Street, Building 9, 2Nd Floor, San Francisco, CA, 94110, USA.
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11
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Gupta P, Quan T, Abdo MG, Manzi JE, Knapp B, Shaffer G. Thirty-Day Morbidity and Mortality in Patients With COPD Following Open Reduction and Internal Fixation for Rotational Ankle Fractures. J Foot Ankle Surg 2022; 61:1275-1279. [PMID: 35501248 DOI: 10.1053/j.jfas.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/02/2022] [Accepted: 03/29/2022] [Indexed: 02/03/2023]
Abstract
Prior orthopedic literature has found patients with chronic obstructive pulmonary disease (COPD) to be at an increased risk for postoperative morbidity and mortality. Thus, the purpose of this study is to identify whether there are any differences in risk for 30-day morbidity or mortality following ORIF for ankle fractures between adult patients with COPD and without COPD. Patients undergoing operative treatment for ankle fracture were identified in the National Surgical Quality Improvement Program database from 2006 to 2018. Patients were divided into 2 cohorts: non-COPD and COPD patients. In this analysis, demographics data, medical comorbidities, and thirty-day postoperative outcomes were analyzed between the 2 cohorts. Bivariate and multivariate analyses were performed. Of 10,346 total patients who underwent operative treatment for ankle fracture, 9986 patients (96.5%) did not have a history of COPD whereas 360 (3.5%) had COPD. Following adjustment to control for demographic and comorbidity data, relative to patients without COPD, those with COPD had an increased risk of pneumonia (odds ratio [OR] 4.601; p = .001), unplanned intubation (OR 3.085; p = .043), and hospital readmission (OR 1.828; p = .020). Patients with COPD did not have a statistically significant difference with regards to mortality (OR 2.729; p = .080). Adult patients with COPD are at an increased risk for pneumonia, unplanned intubation, and hospital readmission within 30 days following ORIF of ankle fractures compared to patients without COPD. Despite these risks, this is a relatively safe procedure for these patients and the presence of COPD alone should not serve as a barrier to surgery.
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Affiliation(s)
- Puneet Gupta
- Department of Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Theodore Quan
- Department of Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Magid G Abdo
- Burrell College of Osteopathic Medicine, Las Cruces, NM
| | | | - Brock Knapp
- Department of Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Gene Shaffer
- Department of Orthopedic Surgery, Einstein Healthcare Network, Philadelphia, PA
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12
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Cha YH, Song SY, Park KS, Yoo JI. Relationship between pressure ulcer risk and sarcopenia in patients with hip fractures. J Wound Care 2022; 31:532-536. [PMID: 35678788 DOI: 10.12968/jowc.2022.31.6.532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Pressure ulcer (PU) is a frequent complication of hip fractures. PUs can develop at any time after a hip fracture but most appear within 2-4 days after surgery. The purpose of this study was to investigate the association between hip fractures due to sarcopenia and the risk of PUs in patients with hip fracture. METHOD Between March 2017 and March 2019, patients aged ≥65 years of age with hip fractures were included in this retrospective cohort study. PU risk assessment according to the Braden Scale was performed within the first few hours after arrival at hospital. Skeletal muscle mass index (SMI) and hand grip strength were evaluated for a diagnosis of sarcopenia. RESULTS Of the 289 patients admitted to the study institution, 180 patients were finally enrolled in the study (129 females; 51 males). In male patients, as SMI increased, so too did the Braden Scale score, which was statistically significant (p=0.02). However, there was no statistically significant difference between SMIs and Braden Scale scores in female patients (p=0.304). In male patients, there was no statistically significant difference between hand grip strength and Braden Scale score (p=0.251). However, in female patients, as hand grip strength increased, so too did the Braden Scale score; this was also statistically significant (p=0.041). CONCLUSION In this study, decreased muscle mass and muscle weakness in patients with hip fractures were associated with increased PU risk as measured by Braden Scale scores in both males and females.
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Affiliation(s)
- Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Sang-Youn Song
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ki-Soo Park
- Department of Preventive Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jun-Ii Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea
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13
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What do hip fracture patients die from? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:751-757. [PMID: 35377075 DOI: 10.1007/s00590-022-03250-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/09/2022] [Indexed: 12/25/2022]
Abstract
Hip fractures in the elderly are associated with an increased mortality rate, even if they are operated within the recommended time window. However, the causes of mortality vary considerably depending on the postoperative period and the patients' comorbidities. In the 30-day postoperative period, the most common causes of death are acute processes such as bacterial and aspiration pneumonia followed by myocardial infarction, cancer, gastrointestinal hemorrhage, stroke, pulmonary embolism, and acute renal failure. In the 6-month and 1-year postoperative period, chronic processes appear to be the most important causes of death, as well as decompensation of patients' chronic diseases. To enhance the literature, we performed this literature review to summarize and discuss the causes of mortality of elderly hip fracture patients depending on the postoperative period that they occur, and possibly to address the question what do hip fracture patients die from? Our aim was to perform an interesting and concise paper that the curious reader will find interesting and informative.
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Red Blood Cell Transfusion and Postoperative Delirium in Hip Fracture Surgery Patients: A Retrospective Observational Cohort Study. Anesthesiol Res Pract 2021; 2021:8593257. [PMID: 34853589 PMCID: PMC8629661 DOI: 10.1155/2021/8593257] [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: 07/23/2021] [Revised: 10/05/2021] [Accepted: 11/06/2021] [Indexed: 01/28/2023] Open
Abstract
Background Patients having hip fracture surgery are at high risk for postoperative delirium. Red blood cell (RBC) transfusion may increase postoperative delirium risk by causing neuroinflammation. We hypothesized that RBC transfusion would be associated with postoperative delirium in patients having hip fracture surgery. Methods An observational cohort study was performed using the United States National Surgical Quality Improvement Program (NSQIP) participant use files for hip fracture from 2016 to 2018. Propensity score analysis and inverse probability of treatment weighting (IPTW) were used to reduce bias from confounding. An IPTW adjusted odds ratio for developing postoperative delirium was calculated for patients who received RBC transfusion during surgery or in the 72 hours after. Results There were 20,838 patients who had eligible current procedural terminology (CPT) codes for primary hip fracture surgery and complete study data. After employing strict exclusions to balance covariates and reduce bias, 3,715 patients remained in the IPTW cohort. Of these, 626 patients (16.9%) received RBC transfusion and 665 patients (17.9%) developed postoperative delirium. IPTW adjustment led to good covariate balance between patients who received RBC transfusion and those who did not. Patients who received RBC transfusion had significantly higher odds of postoperative delirium, IPTW adjusted odds ratio = 1.21, 95% CI = 1.03 to 1.43, and P = 0.02. Discharge location also differed significantly between patients who received RBC transfusion and those who did not (P < 0.001) with in-hospital mortality or referral to hospice occurring in 1.6% of patients who received RBC transfusion and 1.3% of patients who were not transfused. Conclusion RBC transfusion is associated with increased odds of postoperative delirium after hip fracture surgery and may be associated with worse clinical outcome.
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Thomas S, Harris N, Dobransky J, Grammatopoulos G, Gartke K, Liew A, Papp S. Urinary catheter use in patients with hip fracture: Are current guidelines appropriate? A retrospective review. Can J Surg 2021; 64:E630-E635. [PMID: 34824151 PMCID: PMC8628842 DOI: 10.1503/cjs.014620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Guidelines for urinary catheterization in patients with hip fracture recommend limiting catheter use and using intermittent catheterization preferentially to avoid complications such as urinary tract infection (UTI) and postoperative urinary retention (POUR). We aimed to compare current practices to clinical guidelines, describe the incidence of POUR and UTI, and determine factors that increase the risk of these complications. Methods: We retrospectively reviewed the charts of patients with hip fracture who presented to a single large tertiary care centre in southeastern Ontario between November 2015 and October 2017. Data collected included comorbidities, catheter use and length of stay. We compared catheter use to guidelines, and investigated the incidence of and risk factors for POUR and UTI. Results: We reviewed the charts of 583 patients, of whom 450 (77.2%) were treated with a catheter, primarily indwelling (416 [92.4%]). Postoperative urinary retention developed in 98 patients (16.8%); however, it did not affect length of stay (p = 0.2). Patients with indwelling catheters for more than 24 hours after surgery had a higher incidence of POUR than those who had their catheter removed before 24 hours (65/330 [19.7%] v. 10/98 [10.2%]) (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.06–4.38). A UTI developed postoperatively in 62 patients (10.6%). Catheter use was associated with a 6.6-fold increased risk of UTI (OR 6.6, 95% CI 2.03–21.4). Patients with indwelling catheters did not have a significantly higher incidence of UTI than those with intermittent catheterization (57/416 [13.7%] v. 2/34 [5.9%]) (p = 0.2). Patients who developed a UTI had significantly longer catheter use than patients who did not (p < 0.002). Conclusion: Indwelling catheters were used frequently, which suggests low compliance with clinical guidelines. Longer duration of catheter use led to higher rates of UTI and POUR. Further investigation of the reasons for the common use of indwelling rather than intermittent catheterization is needed.
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Affiliation(s)
- Sruthi Thomas
- From the Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - Nicole Harris
- From the Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - Johanna Dobransky
- From the Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - George Grammatopoulos
- From the Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - Kathleen Gartke
- From the Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - Allan Liew
- From the Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - Steven Papp
- From the Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont.
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Ji Y, Li X, Wang Y, Cheng L, Tian H, Li N, Wang J. Partial pressure of oxygen level at admission as a predictor of postoperative pneumonia after hip fracture surgery in a geriatric population: a retrospective cohort study. BMJ Open 2021; 11:e048272. [PMID: 34706948 PMCID: PMC8552163 DOI: 10.1136/bmjopen-2020-048272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To identify whether the partial pressure of oxygen in arterial blood (PaO2) level at admission is an independent risk factor as a prognostic biomarker to predict postoperative pneumonia (POP) in the geriatric population who have undergone hip fracture surgical repair at our hospital. DESIGN A retrospective cohort study. SETTING This is a retrospective chart review of POP after hip fracture surgery in China. PARTICIPANTS In training cohort, patients aged ≥65 years who had hip fracture surgery between 1 January 2018 and 30 November 2019. In the validation cohort, a series of patients who underwent hip fracture surgery between 1 January 2020 and 28 February 2020. INTERVENTIONS Receiver operating characteristic (ROC) analysis was used to obtain the area under the ROC curve (AUC) and cut-off values of PaO2 to predict POP. A binomial logistic regression model was used to identify potential risk factors for POP by analysing demographic distribution factors, laboratory results, preoperative comorbidities and surgical factors. Then the regression model was validated using an independent cohort. RESULTS In the training cohort, ROC curves were generated to compare the predictive performance of PaO2 for the occurrence of POP, and the area under the receiver operating characteristic curve (AUC) was 0.653 (95% CI 0.577 to 0.729, p<0.0001), with sensitivity and specificity values of 60.0% and 63.8%, respectively. The cut-off value of the PaO2 for POP was 72.5 mm Hg. Binary logistic regression analysis revealed that hypoxaemia (PaO2 <72.5 mm Hg) at hospital admission (OR=3.000, 95% CI 1.629 to 5.528; p<0.0001) was independent risk factors associated with POP after hip fracture surgery. In the validation cohort, PaO2 had a predictive effect for POP (AUC 0.71, 95% CI 0.541 to 0.891). CONCLUSIONS The current study revealed that the PaO2 level at hospital admission is a simple and widely available biomarker predictor of POP after hip fracture surgery in elderly patients.
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Affiliation(s)
- Yahong Ji
- Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaoli Li
- Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yakang Wang
- Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Li Cheng
- Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hua Tian
- Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Na Li
- Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Junning Wang
- Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Amin RM, Puvanesarajah V, Chaudhry YP, Best MJ, Rao SS, Frank SM, Hasenboehler EA. Reducing unnecessary crossmatching for hip fracture patients by accounting for preoperative hemoglobin concentration. World J Orthop 2021; 12:292-300. [PMID: 34055586 PMCID: PMC8152439 DOI: 10.5312/wjo.v12.i5.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/18/2021] [Accepted: 04/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources. Most protocols recommend type and cross of 2 red blood cell (RBC) units for patients undergoing surgery for treatment of hip fracture. Preoperative hemoglobin has been identified as the strongest predictor of inpatient transfusion, but current maximum surgical blood order schedules do not consider preoperative hemoglobin values to determine the number of RBC units to prepare prior to surgery.
AIM To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion (C:T) ratio in hip fracture surgery patients.
METHODS In 2015 a patient blood management (PBM) program was implemented at our institution mandating a single unit-per-occurrence transfusion policy and a restrictive transfusion threshold of < 7 g/dL hemoglobin in asymptomatic patients and < 8 g/dL in those with refractory symptomatic anemia or history of coronary artery disease. We identified all hip fracture patients between 2013 and 2017 and compared the preoperative hemoglobin which would predict a 2:1 C:T ratio in the pre PBM and post PBM cohorts. Prediction profiling and sensitivity analysis were performed with statistical significance set at P < 0.05.
RESULTS Four hundred and ninety-eight patients who underwent hip fracture surgery between 2013 and 2017 were identified, 291 in the post PBM cohort. Transfusion requirements in the post PBM cohort were lower (51% vs 33%, P < 0.0001) than in the pre PBM cohort. The mean RBC units transfused per patient was 1.15 in the pre PBM cohort, compared to 0.66 in the post PBM cohort (P < 0.001). The 2:1 C:T ratio (inpatient transfusion probability of 50%) was predicted by a preoperative hemoglobin of 12.3 g/dL [area under the curve (AUC) 0.78 (95% confidence interval (CI), 0.72-0.83), Sensitivity 0.66] in the pre PBM cohort and 10.7 g/dL [AUC 0.78 (95%CI, 0.73-0.83), Sensitivity 0.88] in the post PBM cohort. A 50% probability of requiring > 1 RBC unit was predicted by 11.2g/dL [AUC 0.80 (95%CI, 0.74-0.85), Sensitivity 0.87] in the pre PBM cohort and 8.7g/dL [AUC 0.78 (95%CI, 0.73-0.83), Sensitivity 0.84] in the post-PBM cohort.
CONCLUSION The hip fracture maximum surgical blood order schedule should consider preoperative hemoglobin in determining the number of units to type and cross prior to surgery.
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Affiliation(s)
- Raj M Amin
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA 94305, United States
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
| | - Yash P Chaudhry
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19122, United States
| | - Matthew J Best
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MD 02114, United States
| | - Sandesh S Rao
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
| | - Steven M Frank
- Department of Anesthesiology, Critical Care Medicine, Baltimore, MD 21205, United States
| | - Erik A Hasenboehler
- Department of Orthopaedics, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
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Preoperative Platelet and International Normalized Ratio Thresholds and Risk of Complications After Primary Hip Fracture Surgery. J Am Acad Orthop Surg 2021; 29:e396-e403. [PMID: 32796366 DOI: 10.5435/jaaos-d-19-00793] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 07/14/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A paucity of data exists on safe platelet and international normalized ratio (INR) thresholds for hip fracture surgery. Recent work has called into question the safety of preoperative INRs < 1.5 for total knee arthroplasty, and optimal platelet thresholds are unknown. The purpose of this study was to identify the risk of 30-day postoperative morbidity and mortality in patients with thrombocytopenia or elevated INRs undergoing hip fracture surgery. METHODS The National Surgical Quality Improvement Program database was queried for patients undergoing surgical treatment of a native hip fracture from 2012 to 2017 (N = 86,850). Patient demographic, laboratory, and complication data were collected. Patients with preoperative platelet counts or INRs within one day of surgery were included for analysis. Preoperative platelet counts and INRs were divided into four groups (<50 k/μL, ≥50 k to 100 k/μL, ≥100 k to 150 k/μL, ≥150 k/μL, and ≤1.0, >1.0 to 1.5, >1.5 to 2.0, and >2.0, respectively). Multivariable logistic regressions were used to assess the independent association between platelet count and INR on bleeding complications requiring transfusion, wound complications, reoperations, readmissions, and deaths. RESULTS A total of 72,306 and 56,027 patients were included for analysis of preoperative platelet and INR levels, respectively. In reference to platelet levels ≥150 k/μL, a notably increased risk of bleeding events was observed for patients with platelet counts ≥100 k to 150 k/μL (odds ratio [OR] 1.21, 95% confidence interval 1.15 to 1.27), ≥50 to 100 k/μL (OR 1.85, 1.69 to 2.03), and <50 k/μL (OR 1.60, 1.25 to 2.04). Decreasing platelet counts were associated with a stepwise increased risk of mortality from OR 1.12 (1.02 to 1.22) for platelet counts ≥100 k to 150 k/μL to OR 1.63 (1.41 to 1.90) and OR 1.59 (1.06 to 2.39) for platelet counts ≥50 k to 100 k/μL and <50 k/μL, respectively. Elevated INR was associated with an increased risk of reoperations, readmissions, and death (P < 0.001 for all), with largest effect sizes observed starting at INRs >1.5. DISCUSSION The results of this study suggest that preoperative platelet thresholds of <100,000/μL and INR thresholds of 1.5 serve as an important risk factor for complications after hip fracture surgery. Future work is warranted to determine whether preoperative platelet transfusions and/or INR reversal will improve outcomes for these patients. LEVEL OF EVIDENCE Prognostic Level III.
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Yuan Y, Tian W, Deng X, Yue R, Ge X, Wu X, Zhang P. Elderly patients with concurrent hip fracture and lower respiratory tract infection: the pathogens and prognosis over different bedridden periods. J Orthop Surg Res 2021; 16:246. [PMID: 33849586 PMCID: PMC8042877 DOI: 10.1186/s13018-021-02399-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/05/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Elderly patients who experience hip fractures often become bedridden and are at risk of developing lower respiratory tract infections. The current study was to investigate the etiology and bacterial drug resistance patterns of elderly patients with hip fractures and lower respiratory tract infections on prolonged bedridden time and to determine their prognosis. METHODS Patients diagnosed with hip fractures admitted from May 2015 to April 2017 were included. The basic characteristics including the patients' gender, age, fracture type, operation mode, bedridden duration, length of hospital stay, prognosis, past medical history, routine bloodwork, C-reactive protein (CRP), procalcitonin (PCT), blood biochemistry, blood gas analysis, glycosylated hemoglobin (HbA1C%), sputum smear, sputum culture, and anti-infection and related therapy were recorded. All patients were classified into three groups based on bed rest duration, including short-term (<1 month), mid-term (1-12 months), and long-term (> 12 months). The correlation between the bedridden time and the patients' basic characteristics, disease history, laboratory examination results, pathogen, anti-infection, and related therapy were evaluated. The risk factors related to the prognosis of the disease were investigated. RESULTS Prolonged bed rest in patients led to an increase in hospitalization time, mortality rates, and decreased serum albumin levels (P < 0.05). Sputum bacteriological culture results showed that, with bed rest prolongation, the proportion of Pseudomonas aeruginosa and fungal infections increased. Binomial logistic regression of pulmonary infection prognosis, glucocorticoid use during the anti-infective period, prolonged bedridden time, and serum albumin level showed that intravenous use of glucocorticoid during anti-infective treatment, bed rest > 1 year, and low serum albumin level were related to poor prognosis. CONCLUSION Elderly hip fracture patients with prolonged bedridden time had an increased chance of opportunistic pulmonary infection and decreased nutritional status. Glucocorticoids should be used cautiously.
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Affiliation(s)
- Yuan Yuan
- Department of Geriatrics, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Wei Tian
- Department of Geriatrics, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Xiaohui Deng
- Department of Geriatrics, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Rui Yue
- Department of Geriatrics, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Xiaozhu Ge
- Department of Geriatrics, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Xinbao Wu
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Ping Zhang
- Department of Geriatrics, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
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Leal JA, Garcia LF, Peña OR, Gomez-Gelvez A. Patients aged ninety years and older are exposed to increased risk of one-year mortality after hip fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1501-1506. [PMID: 33651223 DOI: 10.1007/s00590-021-02918-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The increase in the population over 90 years old suggests an expected surge in the number of extreme elderly patients sustaining hip fractures. OBJECTIVE The aim of this study is to identify factors associated with 1-year mortality and determine the conditions that are associated with an unfavorable survival outcome in nonagenarians. DESIGN Cross-sectional study SUBJECTS: Nonagenarian patients presenting with hip fractures between 2013 and 2018. METHODS Bivariate and multivariate analyses were performed to identify variables associated with mortality, and a survival analysis was conducted to determine whether the Charlson Comorbidity Index (CCI) is associated with mortality. RESULTS A total of 127 patients, with a mean age of 92.84 years was assessed, identifying 1-year mortality rate in 53.5% of patients. According to the bivariate analysis, requirement of postoperative vasopressor support, transfusion, decompensated heart failure and general anesthesia were associated with a higher probability of 1-year mortality after surgery. Body mass index, health status, dementia or CCI ≥ 3 were not associated with mortality. Similarly, the Kaplan-Meier survival analysis showed no difference in mortality rate of patients with CCI ≥ 3 (p = 0.282). CONCLUSION Patients older than 90 years with hip fractures have higher mortality rates per year than younger patients. Some associations were found, but more studies are needed to reach final conclusions, which could help identify higher-risk patients and be able to implement additional measures.
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Affiliation(s)
- Jaime A Leal
- Department of Orthopedics and Traumatology, Hospital Universitario de La Samaritana, Carrera 8 # 0 - 29 Sur, 110411, Bogotá, D.C., Colombia.
| | - Luisa F Garcia
- Department of Orthopedics and Traumatology, Hospital Universitario de La Samaritana, Carrera 8 # 0 - 29 Sur, 110411, Bogotá, D.C., Colombia
| | - Omar R Peña
- Department of Orthopedics and Traumatology, Hospital Universitario de La Samaritana, Carrera 8 # 0 - 29 Sur, 110411, Bogotá, D.C., Colombia
| | - Amparo Gomez-Gelvez
- Department of Orthopedics and Traumatology, Hospital Universitario de La Samaritana, Carrera 8 # 0 - 29 Sur, 110411, Bogotá, D.C., Colombia
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21
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Chang JS, Ravi B, Jenkinson RJ, Paterson JM, Huang A, Pincus D. Impact of preoperative echocardiography on surgical delays and outcomes among adults with hip fracture. Bone Joint J 2021; 103-B:271-278. [PMID: 33517719 DOI: 10.1302/0301-620x.103b2.bjj-2020-1011.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Echocardiography is commonly used in hip fracture patients to evaluate perioperative cardiac risk. However, echocardiography that delays surgical repair may be harmful. The objective of this study was to compare surgical wait times, mortality, length of stay (LOS), and healthcare costs for similar hip fracture patients evaluated with and without preoperative echocardiograms. METHODS A population-based, matched cohort study of all hip fracture patients (aged over 45 years) in Ontario, Canada between 2009 and 2014 was conducted. The primary exposure was preoperative echocardiography (occurring between hospital admission and surgery). Mortality rates, surgical wait times, postoperative LOS, and medical costs (expressed as 2013$ CAN) up to one year postoperatively were assessed after propensity-score matching. RESULTS A total of 2,354 of 42,230 (5.6%) eligible hip fracture patients received a preoperative echocardiogram during the study period. Echocardiography ordering practices varied among hospitals, ranging from 0% to 23.0% of hip fracture patients at different hospital sites. After successfully matching 2,298 (97.6%) patients, echocardiography was associated with significantly increased risks of mortality at 90 days (20.1% vs 16.8%; p = 0.004) and one year (32.9% vs 27.8%; p < 0.001), but not at 30 days (11.4% vs 9.8%; p = 0.084). Patients with echocardiography also had a mean increased delay from presentation to surgery (68.80 hours (SD 44.23) vs 39.69 hours (SD 27.09); p < 0.001), total LOS (19.49 days (SD 25.39) vs 15.94 days (SD 22.48); p < 0.001), and total healthcare costs at one year ($51,714.69 (SD 54,675.28) vs $41,861.47 (SD 50,854.12); p < 0.001). CONCLUSION Preoperative echocardiography for hip fracture patients is associated with increased postoperative mortality at 90 days and one year but not at 30 days. Preoperative echocardiography is also associated with increased surgical delay, postoperative LOS, and total healthcare costs at one year. Echocardiography should be considered an urgent test when ordered to prevent additional surgical delay. Cite this article: Bone Joint J 2021;103-B(2):271-278.
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Affiliation(s)
- Justin S Chang
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Richard J Jenkinson
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - J Michael Paterson
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Daniel Pincus
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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22
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Cary MP, Zhuang F, Draelos RL, Pan W, Amarasekara S, Douthit BJ, Kang Y, Colón-Emeric CS. Machine Learning Algorithms to Predict Mortality and Allocate Palliative Care for Older Patients With Hip Fracture. J Am Med Dir Assoc 2021; 22:291-296. [PMID: 33132014 PMCID: PMC7867606 DOI: 10.1016/j.jamda.2020.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate a machine learning model designed to predict mortality for Medicare beneficiaries aged >65 years treated for hip fracture in Inpatient Rehabilitation Facilities (IRFs). DESIGN Retrospective design/cohort analysis of Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility-Patient Assessment Instrument data. SETTING AND PARTICIPANTS A total of 17,140 persons admitted to Medicare-certified IRFs in 2015 following hospitalization for hip fracture. MEASURES Patient characteristics include sociodemographic (age, gender, race, and social support) and clinical factors (functional status at admission, chronic conditions) and IRF length of stay. Outcomes were 30-day and 1-year all-cause mortality. We trained and evaluated 2 classification models, logistic regression and a multilayer perceptron (MLP), to predict the probability of 30-day and 1-year mortality and evaluated the calibration, discrimination, and precision of the models. RESULTS For 30-day mortality, MLP performed well [acc = 0.74, area under the receiver operating characteristic curve (AUROC) = 0.76, avg prec = 0.10, slope = 1.14] as did logistic regression (acc = 0.78, AUROC = 0.76, avg prec = 0.09, slope = 1.20). For 1-year mortality, the performances were similar for both MLP (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.96) and logistic regression (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.95). CONCLUSION AND IMPLICATIONS A scoring system based on logistic regression may be more feasible to run in current electronic medical records. But MLP models may reduce cognitive burden and increase ability to calibrate to local data, yielding clinical specificity in mortality prediction so that palliative care resources may be allocated more effectively.
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Affiliation(s)
- Michael P Cary
- School of Nursing, Duke University, Durham, NC, USA; Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.
| | - Farica Zhuang
- Department of Computer Science, Duke University, Durham, NC, USA
| | - Rachel Lea Draelos
- Department of Computer Science, Duke University, Durham, NC, USA; School of Medicine, Duke University, Durham, NC, USA
| | - Wei Pan
- School of Nursing, Duke University, Durham, NC, USA
| | | | | | - Yunah Kang
- School of Nursing, Duke University, Durham, NC, USA
| | - Cathleen S Colón-Emeric
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA; School of Medicine, Duke University, Durham, NC, USA; Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
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23
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Xie L, Hu X, Li W, Ouyang Z. A retrospective study of end-stage kidney disease patients on maintenance hemodialysis with renal osteodystrophy-associated fragility fractures. BMC Nephrol 2021; 22:23. [PMID: 33430788 PMCID: PMC7802139 DOI: 10.1186/s12882-020-02224-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/23/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nephropathy associated metabolic disorder induces high incidence of fragility fracture in end-stage renal disease (ESRD) patients. As the risk factors and prognosis of fragility fracture in ESRD patients are unclear, more research is needed. This study aimed to evaluate various risk factors for ESRD-related fragility fractures, explore factors affecting the prognosis of patients with such fractures, and provide information for prevention and treatment of renal osteopathy to improve the prognosis of patients. METHODS In this retrospective case-control study, the case notes of 521 ESRD patients who received maintenance dialysis for at least 3 months were examined. Finally, 44 patients diagnosed with fragility fractures were assigned to the fragility fracture (FF) group and 192 patients were included in the control group (CG). Demographic information, underlying diseases, nutritional, bone metabolism, and renal function parameters, along with the number and causes of any deaths, were recorded for multiple statistical analysis. RESULTS The FF group had increased incidences of essential hypertension and diabetes mellitus and higher serum calcium, corrected calcium, alkaline phosphatase, and hemoglobin levels. Immunoreactive parathyroid hormone (iPTH), total cholesterol (TC), and low density lipoprotein (LDL) levels were higher in the CG. Multivariate Cox regression analysis revealed that fragility fracture was an independent risk factor for all-cause mortality in ESRD patients (P < .001, RR: 4.877, 95% CI: 2.367-10.013). CONCLUSIONS Essential hypertension and diabetes, high serum calcium and alkaline phosphatase levels, and reduced iPTH levels were risk factors for fragility fracture in ESRD patients. Maintaining iPTH and serum TC levels may protect against fragility fractures in them. Fragility fractures may yield poor prognosis and shorter lifespan. The presence of fragility fracture was an independent predictor of all-cause death in ESRD patients.
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Affiliation(s)
- Lihua Xie
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, P.R. China
| | - Xuantao Hu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, P.R. China
| | - Wenzhao Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, P.R. China.
| | - Zhengxiao Ouyang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, P.R. China.
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Díez-Manglano J, Berges Vidal M, Martínez Barredo L, Poblador-Plou B, Gimeno-Miguel A, Martínez Heras P, Prados-Torres A. Chronic Obstructive Pulmonary Disease and Incidence of Hip Fracture: A Nested Case-Control Study in the EpiChron Cohort. Int J Chron Obstruct Pulmon Dis 2020; 15:2799-2806. [PMID: 33177817 PMCID: PMC7652231 DOI: 10.2147/copd.s270713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine whether chronic obstructive pulmonary disease (COPD) is a risk factor for hip fracture and identify other factors associated with hip fracture. Patients and Methods Observational nested case-control study was conducted in Aragon, Spain in 2010. We included COPD patients aged >40 years, in the EpiChron cohort. Each COPD patient was matched for age, sex, and number of comorbidities with a control subject without COPD. Patients with an existing diagnosis of osteoporosis and those with hip fracture before 2011 were excluded. We collected baseline demographic, comorbidity, and pharmacological treatment data. During a 5-year follow-up period, we recorded the incidence of hip fracture. A logistic regression model was constructed to identify factors associated with hip fracture. Results The study population consisted of 26,517 COPD patients and the same number of controls (median [interquartile range] age, 74 [17] years; women, 24.7%). Smoking and heart failure were more frequent in COPD patients, and obesity, hypertension, diabetes, dyslipidemia, stroke, arthritis, and visual or hearing impairment were less frequent (all p<0.001). Consumption of benzodiazepines (p=0.037), bronchodilators (p<0.001), and corticosteroids (p<0.001) was higher in the COPD group, while that of beta-blockers and thiazides was lower (both p<0.001). During follow-up, 898 (1.7%) patients experienced hip fracture, with no differences observed between COPD and control patients. Multivariate analysis revealed that independent of COPD status, age, female sex, chronic liver disease, heart failure, and benzodiazepine use were independently associated with a higher risk of hip fracture, and obesity with a lower risk. In COPD patients, use of inhaled anticholinergics was independently associated with hip fracture (OR, 1.390; 95% CI 1.134-1.702; p=0.001). Conclusion COPD is not a risk factor for a hip fracture within 5 years. The association between the use of inhaled anticholinergics and risk of hip fracture warrants further study.
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Affiliation(s)
- Jesús Díez-Manglano
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Spain.,EpiChron Research Group, Aragon Health Sciences Institute, IIS Aragón, REDISSEC, Zaragoza, Spain
| | - María Berges Vidal
- EpiChron Research Group, Aragon Health Sciences Institute, IIS Aragón, REDISSEC, Zaragoza, Spain
| | | | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute, IIS Aragón, REDISSEC, Zaragoza, Spain
| | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute, IIS Aragón, REDISSEC, Zaragoza, Spain
| | - Pilar Martínez Heras
- Internal Medicine Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute, IIS Aragón, REDISSEC, Zaragoza, Spain
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Abstract
OBJECTIVE To determine how timing of surgery affects transfusion, major complications, and mortality in patients who sustain a geriatric hip fracture while taking dual antiplatelet therapy (DAPT; typically aspirin and clopidogrel). DESIGN Retrospective cohort study. SETTING University-affiliated Level 1 Trauma Center. PATIENTS Patients 65 years of age or older on DAPT with a geriatric hip fracture were investigated at a single institution between 2002 and 2017. Demographic and perioperative data were collected from patient records, institutional databases, and national hip fracture registry. INTERVENTION Fixation or arthroplasty. MAIN OUTCOME MEASUREMENT Transfusion, major complications, and 30-day mortality. RESULTS Of the 6724 patients sustaining a geriatric hip fracture, 122 patients were taking DAPT on admission. Timing of surgery did not influence transfused units (incidence rate ratio 1.00, 95% confidence interval: 0.87-1.15, P = 0.968) but did affect major complications (time modeled as quadratic term; odds ratios ranging from 0.20 to 7.91, ptime = 0.001, ptime*time<0.001) and 30-day mortality (odds ratio 1.32, 95% confidence interval: 1.03-1.68, P = 0.030). CONCLUSION Surgical delay does not change the need for transfusion of hip fracture patients on DAPT, but it is associated with increased probabilities of major complications and 30-day mortality. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Pei F, Zhao R, Li F, Chen X, Guo K, Zhu L. Osteonecrosis of femoral head in young patients with femoral neck fracture: a retrospective study of 250 patients followed for average of 7.5 years. J Orthop Surg Res 2020; 15:238. [PMID: 32600432 PMCID: PMC7322831 DOI: 10.1186/s13018-020-01724-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/20/2020] [Indexed: 12/20/2022] Open
Abstract
Objective To investigate the risk factors for osteonecrosis of the femoral head (ONFH) after the treatment of femoral neck fracture in patients under 60 years old. Methods A total of 250 cases of femoral neck fracture treated at 3 hospitals in Xuzhou from January 2002 to January 2016 were studied. The patients were followed up for 1~15 years, and the clinical data on femoral head necrosis after the femoral neck operation were analysed retrospectively. Risk factors were recorded, including age, gender, preoperative traction, time from injury to operation, reduction method, type of reduction, BMI, ASA classification, and quality of reduction. Logistic regression analysis was used to evaluate the independent risk factors for ONFH after treatment of femoral neck fracture. Results The duration of follow-up was 1~15 years, with an average of 7.5 years. None of the 250 patients had fracture non-union, but 40 (16%) had necrosis of the femoral head. The time to necrosis of the femoral head was 1~7 years after the operation, with an average of 3.8 years. Univariate analysis showed that the type of fracture, the quality of reduction, the removal of internal fixation, BMI and ASA classification were risk factors affecting necrosis of the femoral head in patients with femoral neck fracture, and the difference was statistically significant (P < 0.05). Multivariate analysis showed that internal fixation, fracture type (displacement), reduction quality (dissatisfaction), BMI (> 25), and ASA grade (III + IV) were independent risk factors affecting femoral head necrosis in patients with femoral neck fracture. Conclusion A variety of high-risk factors for femoral head necrosis are present after surgery with hollow compression screws for femoral neck fracture in adults. Removal of internal fixation, type of fracture, quality of reduction, BMI, and ASA classification were the most important risk factors influencing the development of femoral head necrosis. During treatment, there should be some targeted measures to reduce the incidence of necrosis of the femoral head.
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Affiliation(s)
- Fang Pei
- Department of Orthopedics, Nanjing Medical University, Nanjing, Jiangsu, P.R. China.,Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Rui Zhao
- Department of Radiology, Xuzhou Municipal Hospital Affiliated of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Fenglei Li
- Department of Orthopedics, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Xiangyang Chen
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - KaiJin Guo
- Department of Orthopedics, Nanjing Medical University, Nanjing, Jiangsu, P.R. China. .,Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
| | - Liang Zhu
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
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Kim D, Jo H, Lee Y, Kim KO. Elixhauser comorbidity measures-based risk factors associated with 30-day mortality in elderly population after femur fracture surgery: a propensity scorematched retrospective case-control study. Acute Crit Care 2020; 35:10-15. [PMID: 32131576 PMCID: PMC7056954 DOI: 10.4266/acc.2019.00745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/04/2020] [Indexed: 01/23/2023] Open
Abstract
Background: As the average life expectancy increases, anesthesiologists confront unique challenges in the perioperative care of elderly patients who have significant comorbidities. In this study, we evaluated Elixhauser comorbidity measures-based risk factors associated with 30-day mortality in patients aged 66 years and older who underwent femur fracture surgery. Methods: We used the Medical Information Mart for Intensive Care III which contains the medical records of patients admitted to the intensive care unit (ICU) at Beth Israel Deaconess Medical Center in the United States between 2001 and 2012 to identify patients admitted to the ICU after femur fracture surgery (n=209). Patients who died within 30 days of admission (case group, n=49) were propensity score-matched to patients who did not (control group, n=98). The variables for matching were age, sex, race, anemia (hemoglobin ≤10 g/dl), and malignancy. We attempted to explain mortality via nine independent factors: hypertension, uncomplicated diabetes, complicated diabetes, congestive heart failure (CHF), cardiac arrhythmias, chronic pulmonary disease, renal failure, neurological disorders other than paralysis, and peripheral vascular disease. Results: Logistic regression identified three significant risk factors: CHF, arrhythmias, and neurological disorders other than paralysis. The odds ratio (OR) for the 30-day mortality of CHF was 4.99 (95% confidence interval [CI], 2.18 to 12.06). The equivalent ORs for cardiac arrhythmias and neurological disorders other than paralysis were 2.61 (95% CI, 1.14 to 6.21) and 2.40 (95% CI, 0.95 to 6.48), respectively. Conclusions: Identifying patients with these risk factors (CHF, arrhythmias, and neurological disorders other than paralysis) will assist clinicians with perioperative planning and provide caregivers with valuable information for decision-making.
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Affiliation(s)
- Dohyung Kim
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hyunmin Jo
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Younsuk Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Kyoung Ok Kim
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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Cha YH, Ha YC, Ryu HJ, Lee YK, Park SH, Lee KJ, Koo KH. Effect of heart failure on postoperative short and long-term mortality in elderly patients with hip fracture. Injury 2020; 51:694-698. [PMID: 31948778 DOI: 10.1016/j.injury.2020.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/04/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We designed a comparative study using elderly hip fracture patients with and without heart failure (HF). The purpose of this study was to assess 1) prevalence of HF, compare 2) early and late mortality after elderly hip fracture between HF and non-HF patients and to assess 3) risk factors of mortality after hip fractures in elderly patients with HF. In addition, we also investigated 4) whether there is a difference in mortality according to the severity of left ventricular (LV) systolic dysfunction classified by LV ejection fraction (EF) in HF patients through subgroup analysis. METHODS This study included 1992 patients (1992 hips) who were diagnosed as having unilateral femoral neck or intertrochanteric fractures and who underwent surgery at two hospitals between January 2004 and June 2018. The patients were categorized into a non-HF group (1782 patients) and a HF group (210 patients; mild [119 patients] and moderate-to- severe HF subgroups [91 patients]). The cumulative crude mortality rate was calculated, and 30-day, 60-day, 3-month, 6-month, and 1-year mortality rates were compared between the non-HF and HF. Logistic regression analysis was conducted to identify independent factors associated with mortality. RESULTS Of 1992 patients, 210 (10.5%) patients were diagnosed with HF. The 30-day, 60-day, 3-month, 6-month, and 1-year postoperative cumulative mortality rates were respectively 1.6%, 3.6%, 5.1%, 8.4%, and 12.9% in the non-HF group, and 5.7%, 9.5%, 12.4%, 17.1%, and 25.2% in the HF group (p ≤ 0.001). The factors that affected 1-year mortality were sex (OR, 2.10; 95% CI, 1.62-2.72; p < 0.001) and age (OR, 1.04; 95% CI, 1.02-1.06; p < 0.001) and presence of HF (OR, 1.62; 95% CI, 1.45-1.86; p = 0.005). In subgroup analysis, the factors that affected 30-day mortality were only moderate-to-severe HF (OR, 4.01; 95% CI, 1.10-8.78; p = 0.009). CONCLUSIONS In elderly patients with hip fracture, the comparison between the HF and non-HF patients revealed that HF was an independent factor of mortality at a minimum of 1-year follow-up, and severity of LV systolic dysfunction classified by LVEF in patients with hip fracture was also a risk factor of 30-day mortality.
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Affiliation(s)
- Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea.
| | - Hyun-Jun Ryu
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Hyun Park
- Division of Cardiology, Department of Internal Medicine, Eulji University Hospital, Daejeon, South Korea
| | - Kwang Je Lee
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Bohsali F, Klimpl D, Baumgartner R, Sieber F, Eid SM. Effect of Heart Failure With Preserved Ejection Fraction on Perioperative Outcomes in Patients Undergoing Hip Fracture Surgery. J Am Acad Orthop Surg 2020; 28:e131-e138. [PMID: 31977615 DOI: 10.5435/jaaos-d-18-00731] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Heart failure is a leading cause of morbidity and mortality in hip fracture surgery. The impact of heart failure with preserved ejection fraction (HFpEF) is poorly understood in this population. We designed a study to evaluate national perioperative outcomes in hip fracture for patients with HFpEF. METHODS Patients with hip fracture undergoing total hip arthroplasty, hemiarthroplasty, or open/closed reduction with internal and external fixation from January 2005 to December 2013 were identified using the Nationwide Inpatient Sample. Inpatient outcomes during the index hospitalization were compared between patients without heart failure and with HFpEF. Heart failure with reduced ejection fraction was included as a secondary comparator. Perioperative major adverse cardiovascular and cerebrovascular events (MACCEs), defined as in-hospital all-cause death, acute myocardial infarction, and in-hospital cardiac arrest or acute ischemic stroke, were evaluated. RESULTS Among 2,020,712 hospitalizations for hip fracture surgery, perioperative MACCE occurred in 67,554 hospitalizations (3.3%), corresponding to an annual incidence of approximately 7,506 events after applying sample weights. Compared with patients without heart failure, patients with HFpEF experienced increased odds of MACCE, adjusted odds ratio [aOR], 1.69; 95% confidence interval (CI), 1.51 to 1.89. In comparison, the aOR of experiencing a MACCE event in the heart failure with reduced ejection fraction group was 1.75 (95% CI, 1.57 to 1.96). HFpEF was also associated with increased odds of acute respiratory failure (aOR, 1.71; 95% CI, 1.53 to 1.91) and acute renal failure (aOR, 1.52; 95% CI, 1.41 to 1.64). CONCLUSION HFpEF confers a significant perioperative risk of MACCE in patients undergoing hip fracture surgery.
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Affiliation(s)
- Fuad Bohsali
- From the Department of Medicine, Duke University School of Medicine, Durham, NC (Dr. Bohsali), the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (Dr. Klimpl and Dr. Eid), the Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC (Dr. Baumgartner), and the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (Dr. Sieber)
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A Restrictive Hemoglobin Transfusion Threshold of Less Than 7 g/dL Decreases Blood Utilization Without Compromising Outcomes in Patients With Hip Fractures. J Am Acad Orthop Surg 2019; 27:887-894. [PMID: 30829898 DOI: 10.5435/jaaos-d-18-00374] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION In patients with hip fracture, a transfusion threshold of hemoglobin (Hb) <8 g/dL is associated with similar or better outcomes than more liberal thresholds. Whether a more restrictive threshold of <7 g/dL Hb produces equivalent outcomes in such patients is unknown. The aim of the study was to examine whether a restrictive threshold of <7 g/dL Hb is safe in this population. METHODS In January 2015, a blood management program was implemented that uses a restrictive transfusion threshold of <7 g/dL Hb in hemodynamically stable patients and <8 g/dL in patients with symptomatic anemia or a history of coronary artery disease. We identified 498 patients treated for hip fractures from January 2013 through May 2017. We compared perioperative outcomes of 207 patients treated before with those of 291 patients treated after restrictive threshold implementation. RESULTS After restrictive threshold implementation, the proportion of patients receiving packed red blood cell (PRBC) transfusions decreased from 51% to 33% (P < 0.001); the mean number of PRBC units transfused per patient decreased by 40% (from 1.1 to 0.7; P < 0.001); inpatient cardiac morbidity decreased from 22.2% to 12.4% (P = 0.004); 30-day readmissions decreased from 14% to 8.6% (P = 0.04); and length of stay was unchanged (P = 0.06). Compared with the prerestrictive threshold cohort, the postrestrictive threshold group had lower odds of transfusion (odds ratio [OR] = 0.42; 95% confidence interval [CI], 0.29 to 0.62); transfusion of >1 unit of PRBCs (OR = 0.34; 95% CI, 0.22 to 0.52); and inpatient cardiac morbidity (OR = 0.45; 95% CI, 0.27 to 0.75). No significant differences were observed in inpatient morbidity, mortality, 30-day readmission, or 90-day survival. DISCUSSION A restrictive threshold of <7 g/dL Hb in hemodynamically stable patients with hip fractures is associated with noninferior perioperative outcomes and less blood utilization compared with a threshold of <8 g/dL. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Cha YH, Ha YC, Park HJ, Lee YK, Jung SY, Kim JY, Koo KH. Relationship of chronic obstructive pulmonary disease severity with early and late mortality in elderly patients with hip fracture. Injury 2019; 50:1529-1533. [PMID: 31147182 DOI: 10.1016/j.injury.2019.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/20/2019] [Accepted: 05/21/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We conducted a comparative study to compare patients with and without chronic obstructive pulmonary disease (COPD) and to analyze the effect of COPD severity on mortality in elderly patients with hip fractures who were diagnosed by pulmonologists. The purposes of this study were to compare early and late mortality after hip fracture between COPD and non-COPD patients and to assess risk factors of mortality after hip fractures in elderly patients with COPD. METHODS This study included 1294 patients (1294 hips) who were diagnosed as having unilateral femoral neck or intertrochanteric fractures and who underwent surgery at two hospitals between 2004 and 2017. The patients were categorized into a non-COPD group (853 patients) and a COPD group (441 patients; mild-to-moderate [354 patients] and severe-to-very severe COPD subgroups [87 patients]). The cumulative crude mortality rate was calculated, and 30-day, 60-day, 3-month, 6-month, and 1-year mortality rates were compared between the non-COPD and COPD groups. Logistic regression analysis was conducted to identify independent factors associated with mortality. RESULTS The 30-day, 60-day, 3-month, 6-month, and 1-year postoperative cumulative mortality rates were 1.3%, 2.5%, 3.5%, 6.6%, and 10.7%, respectively, in the non-COPD group, and 2.9%, 5.7%, 7.7%, 11.8%, and 16.6%, respectively, in the COPD group (p = 0.049, p = 0.004, p = 0.002, p = 0.002, and p = 0.004, respectively). The 30-day, 60-day, 3-month, 6-month, and 1-year postoperative cumulative mortality rates in the severe-to-very severe COPD group were 4.6%, 6.9%, 11.5%, 20.7%, and 26.4%, respectively. In elderly patients with hip fracture, COPD increased the risk of mortality for 1.6 times and 1.7 times at 3 months and 1 year postoperative, respectively. In subgroup analysis, severe-to-very severe COPD was associated with 1.55-fold and 1.65-fold increased postoperative mortality risk at 6 months and 1 year respectively, as compared with mild-moderate COPD. CONCLUSIONS In elderly patients with hip fracture, the comparison between the COPD and non-COPD patients revealed that COPD was an independent factor of mortality at a minimum of 1-year follow-up, and COPD severity in patients with hip fracture was also a risk factor of 6-month and 1-year mortality.
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Affiliation(s)
- Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea.
| | - Hyeong-Jun Park
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sun-Young Jung
- Department of Internal Medicine, Chungnam National University, Daejeon, South Korea
| | - Jae-Yeol Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Reconstruction of pelvic ring and acetabular fractures: What lies ahead? Orthop Traumatol Surg Res 2019; 105:799-800. [PMID: 31262661 DOI: 10.1016/j.otsr.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/15/2019] [Indexed: 02/02/2023]
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Ouellet JA, Ouellet GM, Romegialli AM, Hirsch M, Berardi L, Ramsey CM, Cooney LM, Walke LM. Functional Outcomes After Hip Fracture in Independent Community-Dwelling Patients. J Am Geriatr Soc 2019; 67:1386-1392. [PMID: 30964203 DOI: 10.1111/jgs.15870] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To determine predictors of new activities of daily living (ADLs) disability and worsened mobility disability and secondarily increased daily care hours received, in previously independent hip fracture patients. DESIGN Retrospective cohort study. SETTING Academic hospital with ambulatory follow-up. PARTICIPANTS Community-dwelling adults 65 years or older independent in ADLs undergoing hip fracture surgery in 2015 (n = 184). MEASUREMENTS Baseline, 3- and 6-month ADLs, mobility, and daily care hours received were ascertained by telephone survey and chart review. Comorbidities, medications, and characteristics of hospitalization were extracted from patient charts. Models for each outcome used logistic regression with a backward elimination strategy, adjusting a priori for age, sex, and race. RESULTS Predictors of new ADL disability at 3 months were dementia (odds ratio [OR] = 11.81; P = .001) and in-hospital delirium (OR = 4.20; P = .002), and at 6 months were age (OR = 1.04; P = .014), dementia (OR = 9.91; P = .001), in-hospital delirium (OR = 3.00; P = .031) and preadmission opiates (OR = 7.72; P = .003). Predictors of worsened mobility at 3 months were in-hospital delirium (OR = 4.48; P = .001) and number of medications (OR = 1.13; P = .003), and at 6 months were age (OR = 1.06; P = .001), preadmission opiates (OR = 7.23; P = .005), in-hospital delirium (OR = 3.10; P = .019), and number of medications (OR = 1.13; P = .013). Predictors of increased daily care hours received at 3 and 6 months were age (3 months: OR = 1.07; P = .014; 6 months: OR = 1.06; P = .017) and number of medications (3 months: OR = 1.13; P = .004; 6 months: OR = 1.22; P = .013). The proportion of patients with ADL disability and care hours received did not change from 3 to 6 months, yet there were significant improvements in mobility. CONCLUSION Age, dementia, in-hospital delirium, number of medications, and preadmission opiate use were predictors of poor outcomes in independent older adults following hip fracture. Further investigation is needed to identify factors associated with improved mobility measures from 3 to 6 months to ultimately optimize recovery.
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Affiliation(s)
| | - Gregory M Ouellet
- Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut
| | | | | | - Lisa Berardi
- Yale New Haven Health System, New Haven, Connecticut
| | - Christine M Ramsey
- Yale School of Medicine, Yale Center for Medical Informatics, New Haven, Connecticut.,Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Leo M Cooney
- Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut
| | - Lisa M Walke
- Division of Geriatrics, University of Pennsylvania, Philadelphia, Pennsylvania
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Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ. Comparing Complications and Costs of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fractures: A Propensity Score-Matched, Population-Based Study. J Bone Joint Surg Am 2019; 101:572-579. [PMID: 30946190 DOI: 10.2106/jbjs.18.00539] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although the prevalence of displaced femoral neck fractures in the elderly population is increasing worldwide, there remains controversy as to whether these injuries should be managed with hemiarthroplasty or total hip arthroplasty. Although total hip arthroplasties result in better function, they are more expensive and may have higher complication rates. Our objective was to compare the complication rates and health-care costs between hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the elderly population. METHODS A population-based, retrospective cohort study was performed on adults (≥60 years of age) undergoing either hemiarthroplasty or total hip arthroplasty for hip fracture between April 1, 2004, and March 31, 2014. We excluded patients who resided in long-term care facilities prior to the injury and those who were discharged to these facilities after the surgical procedure. Patients who underwent a hemiarthroplasty and those who underwent a total hip arthroplasty were matched using a propensity score encompassing patient demographic characteristics, patient comorbidities, and provider factors. After matching, we compared the rates of medical and surgical complications, as well as the perioperative and postoperative health-care costs in the year following the surgical procedure. The primary outcome was the occurrence of a medical complication (acute myocardial infarction, deep venous thrombosis, pulmonary embolism, ileus, pneumonia, renal failure) within 90 days or a surgical complication (dislocation, infection, revision surgical procedure) within 1 year. Additionally, we examined the change in health-care costs in the year following the surgical procedure, including costs associated with the index admission, relative to the year before the surgical procedure. RESULTS Among 29,121 eligible patients, 2,713 (9.3%) underwent a total hip arthroplasty. After successfully matching 2,689 patients who underwent a total hip arthroplasty with those who underwent a hemiarthroplasty, the patients who underwent a total hip arthroplasty were at an increased risk for dislocation (1.7% compared with 1.0%; p = 0.02), but were at a decreased risk for revision (0.2% compared with 1.8%; p < 0.0001), relative to patients who underwent a hemiarthroplasty. Furthermore, the overall increase in the annual health-care expenditure in the year following the surgical procedure was approximately $2,700 in Canadian dollars lower in patients who underwent a total hip arthroplasty (p < 0.001). CONCLUSIONS Among elderly patients with displaced femoral neck fractures, total hip arthroplasty was associated with lower rates of revision surgical procedures and reduced health-care costs during the index admission and in the year following the surgical procedure, relative to hemiarthroplasty. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Daniel Pincus
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Hayat Khan
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada
| | - David Wasserstein
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Richard Jenkinson
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Hans J Kreder
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Buss L, McKeever T, Nightingale J, Akyea R, Ollivere B, Moppett I, Bolton C. Hip fracture outcomes in patients with chronic obstructive pulmonary disease. Br J Anaesth 2018; 121:1377-1379. [DOI: 10.1016/j.bja.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/29/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022] Open
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Liu J, Frisch NB, Mehran N, Qatu M, Guthrie ST. Short-term Medical Complications Following Short Versus Long Cephalomedullary Nails. Orthopedics 2018; 41:e636-e642. [PMID: 30011050 DOI: 10.3928/01477447-20180711-03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 04/02/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this retrospective cohort study was to evaluate whether there is an increased rate of short-term medical complications following short vs long cephalomedullary nails for the treatment of intertrochanteric hip fractures. A total of 899 patients treated surgically with cephalomedullary nails from January 1, 2005, to September 1, 2014, were included. Patients who received short nails (n=334) were older and had a higher incidence of coronary artery disease and diabetes mellitus compared with patients who received long nails (n=565). The incidences of 30-day medical complications, including myocardial infarction, stroke, deep venous thrombosis, pulmonary embolism, blood transfusion, non-surgical site infection, surgical site infection, and mortality, were recorded. The orthopedic complications of periprosthetic fracture of the ipsilateral hip and implant failure through the latest outpatient follow-up were recorded. No significant difference was found between nails for any studied medical complication (63.5% short vs 66.0% long, P=.4393) or mortality (6.9% short vs 5.3% long, P=.3322). There was also no significant difference in the incidence of orthopedic complications (P=.70). Longer operating room time was associated with superficial surgical site infection. [Orthopedics. 2018; 41(5):e636-e642.].
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Predictive factors for thirty day mortality in geriatric patients with hip fractures: a prospective study. INTERNATIONAL ORTHOPAEDICS 2018; 43:275-281. [PMID: 30054670 DOI: 10.1007/s00264-018-4057-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/12/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE The study aims to analyze the incidence of 30-day mortality in elderly patients who underwent surgery for hip fractures and its associated factors. METHODS A prospective multicentric study was performed. All patients aged ≥ 65 years, with fragility hip fractures, consecutively admitted in two Italian hospitals were included. Patients with periprosthetic or pathological fractures were excluded. Logistic regression was used to identify patient and patient care variables that independently influenced the 30-day mortality and receiver operating characteristic (ROC) curve analysis to assess their predictive capacity on the outcome. RESULTS Of the patients, 728 met the inclusion criteria, of whom approximately 5% died within 30 days after admission. The 45.7% of the deceased patients died while hospitalized. Multivariate analysis showed that advancing age was the only independent predictor of 30-day mortality (OR = 1.084, 95% CI = 1.024-1.147), while a higher presence of informal caregivers was a protective factor (OR = 0.988, 95% CI = 0.979-0.997). The area under the ROC curve of the model was 0.723 (CI95% 0.676-0.770) for 30-day mortality in elderly hip fractures patients. CONCLUSIONS Patients with an advanced age need careful follow-up, especially within 30 days following operation for hip fracture; at the same time, the presence of informal caregivers at the patient's bedside should be promoted.
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Impact of Anesthesia on Hospital Mortality and Morbidities in Geriatric Patients Following Emergency Hip Fracture Surgery. J Orthop Trauma 2018; 32:116-123. [PMID: 29461445 DOI: 10.1097/bot.0000000000001035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the impact of anesthesia type on in-hospital mortality and morbidity for geriatric fragility hip fracture surgery. DESIGN Retrospective cohort study. SETTING Integrates health care delivery system across 38 facilities in the United States. PATIENTS/PARTICIPANTS We identified 16,695 patients 65 years of age and older who underwent emergent hip fracture repairs between 2009 and 2014 through the Kaiser Permanente hip fracture registry and excluded pathologic or bilateral fractures. INTERVENTION Hip fracture surgery with general or regional anesthesia. MAIN OUTCOMES MEASURES Data on in-hospital mortality, time to death, discharge disposition, and length of stay (LOS) were analyzed among the following anesthesia types: general anesthesia (GA), regional anesthesia (RA), and intraoperative conversions from regional to general (Cv). RESULTS Compared with RA, the hazard ratio for GA for in-hospital mortality was 1.38 and 2.23 for the Cv group; the time ratio for GA-associated time to death was 0.97 and 0.89 for the Cv group. The GA-associated time ratio for LOS before discharge was 1.01, and the hazard ratio for home discharge was 0.86, but no significance was found with the Cv group. CONCLUSIONS RA may offer advantages over GA for fragility hip fracture surgeries when possible. In-hospital mortality, time to death, increased LOS, and discharge to an institute rather than home were all adversely influenced by GA. Furthermore, the previously understudied Cv group demonstrated adverse outcomes for in-hospital mortality and time to death. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Ravi B, Pincus D, Wasserstein D, Govindarajan A, Huang A, Austin PC, Jenkinson R, Henry PDG, Paterson JM, Kreder HJ. Association of Overlapping Surgery With Increased Risk for Complications Following Hip Surgery: A Population-Based, Matched Cohort Study. JAMA Intern Med 2018; 178:75-83. [PMID: 29204597 PMCID: PMC5833499 DOI: 10.1001/jamainternmed.2017.6835] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE Overlapping surgery, also known as double-booking, refers to a controversial practice in which a single attending surgeon supervises 2 or more operations, in different operating rooms, at the same time. OBJECTIVE To determine if overlapping surgery is associated with greater risk for complications following surgical treatment for hip fracture and arthritis. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective population-based cohort study in Ontario, Canada (population, 13.6 million), for the years 2009 to 2014. There was 1 year of follow-up. This study encompassed 2 large cohorts. The "hip fracture" cohort captured all persons older than 60 years who underwent surgery for a hip fracture during the study period. The "total hip arthroplasty" (THA) cohort captured all primary elective THA recipients for arthritis during the study period. We matched overlapping and nonoverlapping hip fractures by patient age, patient sex, surgical procedure (for the hip fracture cohort), primary surgeon, and hospital. EXPOSURES Procedures were identified as overlapping if they overlapped with another surgical procedure performed by the same primary attending surgeon by more than 30 minutes. MAIN OUTCOMES AND MEASURES Complication (infection, revision, dislocation) within 1 year. RESULTS There were 38 008 hip fractures, and of those, 960 (2.5%) were overlapping (mean age of patients, 66 years [interquartile range, 57-74 years]; 503 [52.4%] were female). There were 52 869 THAs and of those, 1560 (3.0%) overlapping (mean age, 84 years [interquartile range, 77-89 years]; 1293 [82.9%] were female). After matching, overlapping hip fracture procedures had a greater risk for a complication (hazard ratio [HR], 1.85; 95% CI, 1.27-2.71; P = .001), as did overlapping THA procedures (HR, 1.79; 95% CI, 1.02-3.14; P = .04). Among overlapping hip fracture operations, increasing duration of operative overlap was associated with increasing risk for complications (adjusted odds ratio, 1.07 per 10-minute increase in overlap; P = .009). CONCLUSIONS AND RELEVANCE Overlapping surgery was relatively rare but was associated with an increased risk for surgical complications. Furthermore, increasing duration of operative overlap was associated with an increasing risk for complications. These findings support the notion that overlapping provision of surgery should be part of the informed consent process.
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Affiliation(s)
- Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, Toronto, Ontario, Canada
| | - Daniel Pincus
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Wasserstein
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, Toronto, Ontario, Canada
| | - Anand Govindarajan
- Mount Sinai Hospital, Division of General Surgery, Toronto, Ontario, Canada
| | - Anjie Huang
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Richard Jenkinson
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Patrick D G Henry
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, Toronto, Ontario, Canada
| | - J Michael Paterson
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Hans J Kreder
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Liu YY, Xue FS, Li HX. Assessing impact of body mass index on risk of acute kidney injury and mortality in elderly patients undergoing hip fracture surgery. Osteoporos Int 2017; 28:3515-3516. [PMID: 28849253 DOI: 10.1007/s00198-017-4194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 08/09/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Y-Y Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, People's Republic of China
| | - F-S Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, People's Republic of China.
| | - H-X Li
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, People's Republic of China
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