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Tarrant SM, Kim RG, McDonogh JM, Clapham M, Palazzi K, Attia J, Balogh ZJ. Preadmission Statin Prescription and Inpatient Myocardial Infarction in Geriatric Hip Fracture. J Clin Med 2021; 10:jcm10112441. [PMID: 34072776 PMCID: PMC8199133 DOI: 10.3390/jcm10112441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Statins have been shown to reduce myocardial infarction (MI) in cardiac and vascular surgery. MI is common in hip fracture. This study aims to investigate whether statins decrease MI in hip fracture surgery and reduce mortality resulting from MI. Patients aged 65 years and above with a low-energy hip fracture were identified between January 2015 and December 2017. Demographics, comorbidities, predictive scores, medications and outcomes were assessed retrospectively. The primary outcome was inpatient MI. The secondary outcome was inpatient mortality resulting from MI, for which fatal and non-fatal MI were modelled. Regression analysis was conducted with propensity score weighting. Hip fracture occurred in 1166 patients, of which 391 (34%) were actively taking statins. Thirty-one (2.7%) patients were clinically diagnosed with MI. They had a higher inpatient mortality than those who did not sustain an MI (35% vs. 5.3%, p < 0.0001). No reduction was seen between statin use and the occurrence of MI (OR = 0.97, 95% CI: 0.45-2.11; p = 0.942) including Fluvastatin-equivalent dosage (OR = 1.00, 95% CI: 0.96-1.03, p = 0.207). Statins were not associated with having a non-fatal MI (OR 1.47, 95% CI: 0.58-3.71; p = 0.416) or preventing fatal MI (OR = 0.40, 95% CI: 0.08-1.93; p = 0.255). Preadmission statin use and associations with clinically diagnosed inpatient MI or survival after inpatient MI were not able to be established.
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Affiliation(s)
- Seth M. Tarrant
- Department of Traumatology, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia; (S.M.T.); (R.G.K.); (J.M.M.)
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Raymond G. Kim
- Department of Traumatology, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia; (S.M.T.); (R.G.K.); (J.M.M.)
| | - Jack M. McDonogh
- Department of Traumatology, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia; (S.M.T.); (R.G.K.); (J.M.M.)
| | - Matthew Clapham
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; (M.C.); (K.P.)
| | - Kerrin Palazzi
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; (M.C.); (K.P.)
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia;
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; (M.C.); (K.P.)
| | - Zsolt J. Balogh
- Department of Traumatology, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia; (S.M.T.); (R.G.K.); (J.M.M.)
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia;
- Correspondence:
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DI Monaco M, Castiglioni C, Bardesono F, Milano E, Massazza G. Sarcopenic obesity and function in women with subacute hip fracture: a short-term prospective study. Eur J Phys Rehabil Med 2021; 57:940-947. [PMID: 33759440 DOI: 10.23736/s1973-9087.21.06720-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The prognostic role exerted by the concurrent presence of sarcopenia and obesity after hip fracture has not been elucidated. AIM To assess the effect of sarcopenic obesity on ability to function in women with subacute hip fracture. DESIGN Short-term prospective study. SETTING Rehabilitation hospital. POPULATION Women with subacute hip fracture. METHODS At admission, grip strength, by a Jamar dynamometer, and body composition by dual-energy x-ray absorptiometry were assessed. Sarcopenia was defined according to the criteria released by the European Working Group for Sarcopenia in Older People in 2019, with both grip strength < 16kg and appendicular lean mass (aLM) < 15kg. Alternatively, aLM/(height)2 < 5.5kg/m2 was substituted for aLM < 15kg to confirm sarcopenia in the women with grip strength < 16kg. Obesity was diagnosed with fat mass exceeding 40% of total body mass. Function was assessed by the Barthel index. RESULTS We assessed 183 of 200 women. Sarcopenic women had lower Barthel index scores assessed at the end of subacute inpatient rehabilitation (U=300,0; z=-4.3; P<0.001) and lower Batrhel index effectiveness (U=310,0; z=-4.2; P<0.001) than non-sarcopenic women. Conversely, we found no significant differences in function between obese and non-obese women. The concurrent presence of sarcopenia and obesity did not worsen the functional prognosis versus the presence of isolated sarcopenia. After adjustment for Barthel index scores before rehabilitation, age, hip-fracture type and cognitive impairment, sarcopenia was significantly associated with Barthel index scores (P=0.001) and Barthel index effectiveness (P<0.001), whereas obesity was not. The results did not materially change when aLM/(height)2 < 5.5kg/m2 was substituted for aLM <15kg to confirm sarcopenia in the women whose handgrip strength was < 16kg. CONCLUSIONS The concurrent presence of obesity did not worsen the negative prognostic role of sarcopenia in the short-term recovery of ability to function after hip fracture in women. CLINICAL REHABILITATION IMPACT In women with subacute hip fracture, sarcopenia but not obesity should be assessed to contribute to the prediction of the short-term functional outcome.
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Affiliation(s)
- Marco DI Monaco
- Osteoporosis Research Center, Division of Physical and Rehabilitation Medicine, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Torino, Italy -
| | - Carlotta Castiglioni
- Osteoporosis Research Center, Division of Physical and Rehabilitation Medicine, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Torino, Italy
| | - Francesca Bardesono
- Division of Physical and Rehabilitation Medicine, Department of Surgical Sciences, University, Torino, Italy
| | - Edoardo Milano
- Osteoporosis Research Center, Division of Physical and Rehabilitation Medicine, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Torino, Italy
| | - Giuseppe Massazza
- Division of Physical and Rehabilitation Medicine, Department of Surgical Sciences, University, Torino, Italy
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da Casa C, Hierro-Estévez MA, Pérez-López R, Pablos-Hernández C, González-Ramírez A, Blanco JF. Effect of pharmacological treatment prior to admission on the outcome of older hip fracture patients. Arch Gerontol Geriatr 2020; 93:104311. [PMID: 33296815 DOI: 10.1016/j.archger.2020.104311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE We aim to relate the pharmacological treatment at admission of hip fracture patients with their prognosis. METHODS We designed a prospective study including 436 hip fracture patients. We classified all the pharmacological treatment prior to admission of each patient into 25 groups according to their active agent and indications. We followed-up patients for one year for survival, emergency department visits (EDV), and in-hospital re-admissions (RAD). Differential analysis was performed by chi-square test, U-Mann Whitney test, and logistic regression. In all cases, p ≤ 0.05 was considered statistically significant. RESULTS At 30-day follow-up, 14.9% patients noted EDV, 9.2% RAD, and 3.2% dead. Patients taking beta-blockers (p = 0.046), loop diuretics (p = 0.018) or antiparkinsonian (p = 0.009) showed an increased 30-day EDV; patients taking benzodiazepines (p = 0.014), loop diuretics (p = 0.009) or antiparkinsonian (p = 0.009), an increased 30-day RAD. At one-year follow-up, 50.7% patients noted EDV, 30.7% RAD, and 22.7% dead. Patients taking oral antidiabetics (p = 0.006) noted a greater one-year EDV; patients taking major opioids (p = 0.001), benzodiazepines (p = 0.016), cardiac agents (p = 0.046), loop diuretics (p = 0.042), beta-blockers (p = 0.018), oral anticoagulants (p = 0.013) or gastric prophylaxis (p = 0.020), greater RAD; patients taking cardiac agents (p = 0.024), loop diuretics (p = 0.006) or oral anticoagulants (p = 0.015), increased 1-year mortality rate. CONCLUSIONS The pharmacological treatment noted at admission for hip fracture patients is related to the outcome, in a dose-independent way. The pharmacological treatment could be an additional parameter that could help us to improve the decision-making process and the resource assignation of hip fracture patients. A proper medication review upon admission because of a hip fracture is warranted.
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Affiliation(s)
- Carmen da Casa
- Instituto de Investigación Biomédica de Salamanca (IBSAL). Salamanca, Spain
| | | | | | - Carmen Pablos-Hernández
- Instituto de Investigación Biomédica de Salamanca (IBSAL). Salamanca, Spain; Orthogeriatric Unit. University Hospital of Salamanca. Salamanca, Spain
| | - Alfonso González-Ramírez
- Instituto de Investigación Biomédica de Salamanca (IBSAL). Salamanca, Spain; Orthogeriatric Unit. University Hospital of Salamanca. Salamanca, Spain
| | - Juan F Blanco
- Instituto de Investigación Biomédica de Salamanca (IBSAL). Salamanca, Spain; Trauma and Orthopedics Department. University Hospital of Salamanca. Salamanca, Spain.
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Abstract
BACKGROUND Hip fractures are recognized as one of the most devastating injuries impacting older adults because of the complications that follow. Mortality rates postsurgery can range from 14% to 58% within one year of fracture. We aimed to identify factors associated with increased risk of mortality within 24 months of a femoral neck fracture in patients aged ≥50 years enrolled in the FAITH and HEALTH trials. METHODS Two multivariable Cox proportional hazards regressions were used to investigate potential prognostic factors that may be associated with mortality within 90 days and 24 months of hip fracture. RESULTS Ninety-one (4.1%) and 304 (13.5%) of 2247 participants died within 90 days and 24 months of suffering a femoral neck fracture, respectively. Older age (P < 0.001), lower body mass index (P = 0.002), American Society of Anesthesiologists (ASA) class III/IV/V (P = 0.004), use of an ambulatory aid before femoral neck fracture (P < 0.001), and kidney disease (P < 0.001) were associated with a higher risk of mortality within 24 months of femoral neck fracture. Older age (P = 0.03), lower body mass index (P = 0.02), use of an ambulatory aid before femoral neck fracture (P < 0.001), and having a comorbidity (P = 0.04) were associated with a higher risk of mortality within 90 days of femoral neck fracture. CONCLUSIONS Our analysis found that factors that are indicative of a poorer health status were associated with a higher risk of mortality within 24 months of femoral neck fracture. We did not find a difference in treatment methods (internal fixation vs. joint arthroplasty) on the risk of mortality. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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The Effect of Type of Femoral Component Fixation on Mortality and Morbidity after Hip Hemiarthroplasty: A Systematic Review and Meta-Analysis. HSS J 2020; 16:222-232. [PMID: 33082721 PMCID: PMC7534891 DOI: 10.1007/s11420-020-09769-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hip hemiarthroplasty is a well-established treatment of displaced femoral neck fracture, although debate exists over whether cemented or uncemented fixation is superior. Uncemented prostheses have typically been used in younger, healthier patients and cemented prostheses in older patients with less-stable bone. Also, earlier research has suggested that bone cement has cytotoxic effects and may trigger cardiovascular and respiratory adverse events. QUESTIONS/PURPOSES The aim of this systematic review and meta-analysis was to compare morbidity and mortality rates after cemented and uncemented hemiarthroplasty for the treatment of displaced femoral neck fractures in elderly patients. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched seven medical databases for randomized clinical trials and observational studies. We compared cemented and uncemented hemiarthroplasty using the Harris Hip Score (HHS), as well as measures of postoperative pain, mortality, and complications. Data were extracted and pooled as risk ratios or standardized mean difference with their corresponding 95% confidence intervals in a meta-analysis model. RESULTS The meta-analysis included 34 studies (12 randomized trials and 22 observational studies), with a total of 42,411 patients. In the pooled estimate, cemented hemiarthroplasty was associated with less risk of postoperative pain than uncemented hemiarthroplasty. There were no significant differences between groups regarding HHS or rates of postoperative mortality, pulmonary embolism, cardiac arrest, myocardial infarction, acute cardiac arrhythmia, or deep venous thrombosis. CONCLUSIONS While we found that cemented hemiarthroplasty results in less postoperative pain than uncemented hemiarthroplasty in older patients with femoral neck fracture, the lack of significant differences in functional hip scores, mortality, and complications was surprising. Further high-level research is needed.
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Olsen F, Hård Af Segerstad M, Nellgård B, Houltz E, Ricksten SE. The role of bone cement for the development of intraoperative hypotension and hypoxia and its impact on mortality in hemiarthroplasty for femoral neck fractures. Acta Orthop 2020; 91:293-298. [PMID: 32237931 PMCID: PMC8023921 DOI: 10.1080/17453674.2020.1745510] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The bone cement implantation syndrome characterized by hypotension and/or hypoxia is a well-known complication in cemented arthroplasty. We studied the incidence of hypotension and/or hypoxia in patients undergoing cemented or uncemented hemiarthroplasty for femoral neck fractures and evaluated whether bone cement was an independent risk factor for postoperative mortality.Patients and methods - In this retrospective cohort study, 1,095 patients from 2 hospitals undergoing hemiarthroplasty with (n = 986) and without (n = 109) bone cementation were included. Pre-, intra-, and postoperative data were obtained from electronic medical records. Each patient was classified for grade of hypotension and hypoxia during and after prosthesis insertion according to Donaldson's criteria (Grade 1, 2, 3). After adjustments for confounders, the hazard ratio (HR) for the use of bone cement on 1-year mortality was assessed.Results - The incidence of hypoxia and/or hypotension was higher in the cemented (28%) compared with the uncemented group (17%) (p = 0.003). The incidence of severe hypotension/hypoxia (grade 2 or 3) was 6.9% in the cemented, but not observed in the uncemented group. The use of bone cement was an independent risk factor for 1-year mortality (HR 1.9, 95% CI 1.3-2.7), when adjusted for confounders.Interpretation - The use of bone cement in hemiarthroplasty for femoral neck fractures increases the incidence of intraoperative hypoxia and/or hypotension and is an independent risk factor for postoperative 1-year mortality. Efforts should be made to identify patients at risk for BCIS and alternative strategies for the management of these patients should be considered.
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Affiliation(s)
- Fredrik Olsen
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mathias Hård Af Segerstad
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erik Houltz
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden,Correspondence:
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7
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Jantzen C, Madsen CM, Abrahamsen B, Van Der Mark S, Duus BR, Howland J, Lauritzen JB, Jørgensen HL. Pre-fracture medication use as a predictor of 30-day mortality in hip fracture patients: an analysis of 141,201 patients. Hip Int 2020; 30:101-106. [PMID: 30821177 DOI: 10.1177/1120700019832603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the predictive value of pre-fracture medication usage on 30-day mortality following a hip fracture. METHODS Information on age, sex, fracture type, time of death and Charlson co-morbidity index (CCI) was collected from the Danish National Patient Registry on all patients above 60 years, sustaining a hip fracture during the period January 1995 to December 2013. Information on drug usage was obtained from the Danish National Prescription Database. Hazard ratios were calculated with 30-day mortality as the outcome. A univariate and 3 multivariate analyses were conducted with increasing adjustments, starting with age, sex and fracture type, adding co-morbidity and dose in the latter. RESULTS 141,201 patients were included and a total of 12 drugs/drug groups were identified for analysis. Increased mortality was evident in all analyses for antiarrhythmics, beta blockers, proton pump inhibitors, loop diuretics, opioids, acetaminophen and for psycholeptics. For ACE-inhibitors, increased mortality was found in all analyses, except after adjustment for co-morbidity and dose. For thiazide diuretics, a significantly reduced mortality was evident in all but the univariate analyses while NSAIDs and statins were associated with a significantly reduced mortality in all analyses. For calcium channel blockers, an insignificant decrease was found after adjustment for dose. Further analysis showed a dose-response relationship for all drugs except ACE-inhibitors and calcium channel blockers. CONCLUSION The study shows a correlation between pre-fracture usage of certain drugs and 30 day mortality after a hip fracture.
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Affiliation(s)
- Christopher Jantzen
- Department of Orthopaedic Surgery, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Christian M Madsen
- Department of Orthopaedic Surgery, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Bo Abrahamsen
- Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark and Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Susanne Van Der Mark
- Department of Orthopaedic Surgery, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Benn R Duus
- Department of Orthopaedic Surgery, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Jonathan Howland
- Department of Emergency Medicine, Boston University School of Medicine, MA, USA
| | - Jes B Lauritzen
- Department of Orthopaedic Surgery, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Henrik L Jørgensen
- Department of Clinical Biochemistry, Bispebjerg Hospital, University of Copenhagen, Denmark
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Modig K, Erdefelt A, Mellner C, Cederholm T, Talbäck M, Hedström M. "Obesity Paradox" Holds True for Patients with Hip Fracture: A Registry-Based Cohort Study. J Bone Joint Surg Am 2019; 101:888-895. [PMID: 31094980 DOI: 10.2106/jbjs.18.01249] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hip fractures are associated with high mortality and reduced quality of life. Studies have reported a high body mass index (BMI) as being positively associated with survival when linked to old age and some chronic diseases. This phenomenon is called the "obesity paradox." The association between BMI and survival after hip fracture has not been thoroughly studied in large samples, nor has to what extent the association is altered by comorbidities, sex, and age. The objective of this study was to investigate the association of BMI with survival after hip fracture and with the probability of returning to living at home after hip fracture. METHODS This cohort study was based on data from a prospectively maintained national registry of patients with hip fracture. A total of 17,756 patients ≥65 years of age who were treated for hip fracture during the period of 2013 to 2016, and followed until the end of 2017, were included. BMI was clinically assessed at hospital admission, comorbidity was measured with the American Society of Anesthesiologists (ASA) score, and the date of death was retrieved from a national database. Self-reported data on living arrangements were assessed on admission and 4 months after fracture. Multivariable regression models were used to estimate the associations. RESULTS Despite ASA scores being similar among all BMI groups, obese patients had the highest 1-year survival and patients with a BMI of <22 kg/m had the lowest. Adjustment for potential confounders strengthened the associations. For the chance of returning to living at home, no advantage was seen for obese patients, but patients with a BMI of <22 kg/m had clearly worse odds compared with patients who were of normal weight, overweight, or obese. CONCLUSIONS The obesity paradox appears to be true for hip fracture patients aged 65 and older. Attention should be given to patients with malnutrition and underweight status rather than to those with overweight status or obesity when developing the orthogeriatric care. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Carl Mellner
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Tommy Cederholm
- Karolinska University Hospital, Stockholm, Sweden.,Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.,Department of Geriatrics, Uppsala University Hospital, Uppsala, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Hedström
- Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Ruzbarsky JJ, Gausden EB, Goldwyn EM, Lowenwirt IP, Kotlyar V. The Fascia Iliaca Block as the Primary Intraoperative Anesthesia for Hip Fracture Surgery: A Preliminary Study. HSS J 2018; 14:77-82. [PMID: 29398999 PMCID: PMC5786593 DOI: 10.1007/s11420-017-9582-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/26/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early surgical intervention for hip fractures in the elderly has proven efficacious. However, surgical delays commonly occur in this patient population due to comorbid conditions that put these patients at a high risk for hypotension-related complications of general or neuraxial anesthesia or anticoagulants that delay the safe use of neuraxial anesthesia. QUESTIONS/PURPOSES The questions/purposes of this study are (1) to investigate if a fascia iliaca block in conjunction with light to moderate sedation could provide adequate analgesia throughout open surgery for intertrochanteric hip fractures (AO/OTA 31-1) without requiring conversion to general anesthesia with airway support and (2) to assess its perioperative complication profile. METHODS A retrospective chart review was conducted to identify patients with intertrochanteric hip fractures who underwent anesthesia with a fascia iliaca block over a 1.5-year period. RESULTS In the six patients identified, there were no intraoperative conversions to general anesthesia requiring airway support. Additionally, there were no intraoperative complications, no mortalities within 30 days, 2 patients on anticoagulation who required a blood transfusion, and a single patient who developed a postoperative hospital-acquired pneumonia that resolved with an antibiotic course. CONCLUSIONS In this series of patients, we demonstrate that a fascia iliaca block can reliably be utilized as the primary anesthetic for patients undergoing surgical fixation of intertrochanteric hip fractures, with an acceptable perioperative complication profile. Although concomitant sedation was provided with the block, this anesthesia strategy has the potential to reduce preoperative delays and minimize the overall burden of sedative and anesthetic medications in a geriatric population. These initial findings may serve as a basis for future, higher-quality prospective and comparative studies.
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Affiliation(s)
| | | | - Elan M. Goldwyn
- New York Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355 USA
| | | | - Vitaly Kotlyar
- New York Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355 USA
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10
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Postoperative Myocardial Injury and Inflammation Is Not Blunted by a Trial of Atorvastatin in Orthopedic Surgery Patients. HSS J 2018; 14:67-76. [PMID: 29398998 PMCID: PMC5786589 DOI: 10.1007/s11420-017-9577-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Orthopedic patients are at risk for adverse postoperative cardiovascular outcomes. QUESTIONS/PURPOSES This pilot randomized controlled trial (RCT) of atorvastatin vs. placebo in orthopedic surgery patients was performed in order to assess: (1) the prevalence of perioperative myocardial injury; (2) the effect of atorvastatin on perioperative inflammation; and (3) the feasibility of performing a large RCT of statin therapy in orthopedic patients. METHODS Hip fracture (hip Fx) and total hip and knee replacement (THR and TKR) patients were randomized 1:1 to atorvastatin 40 mg daily vs. placebo, starting preoperatively and continuing until postoperative day (POD) 45. High-sensitivity cardiac troponin I (hs-cTnI), high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) were measured preoperatively and on POD 2. Patients were monitored for adverse events until POD 90. RESULTS Five hundred fifty-six patients were screened, 22 were recruited (4 hip Fx, 11 THR, 7 TKR), and 2 withdrew. Most (80%) had detectable hs-cTnI (> 1.1 pg/mL) preoperatively. Twenty percent had a perioperative rise in hs-cTnI (≥ 10 pg/mL), which was not blunted by atorvastatin. Hs-CRP rose in 19/20 patients, and IL-6 rose in all patients. However, atorvastatin did not blunt the rise in these inflammatory biomarkers. On POD 2, IL-6 and hs-cTnI levels correlated (ρ = 0.59, p = 0.02). Recruitment was limited by the high prevalence of statin use in the screened population and a high prevalence of exclusions among hip fracture patients. CONCLUSION Perioperative myocardial injury and inflammation are common in orthopedic patients and do not appear to be reduced in those randomized to atorvastatin. TRIAL REGISTRATION NCT02197065.
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11
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Ernst G, Watne LO, Frihagen F, Wyller TB, Dominik A, Rostrup M. Decreases in heart rate variability are associated with postoperative complications in hip fracture patients. PLoS One 2017; 12:e0180423. [PMID: 28742855 PMCID: PMC5526500 DOI: 10.1371/journal.pone.0180423] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/15/2017] [Indexed: 11/18/2022] Open
Abstract
Background To explore relevant associations between deviations in linear and nonlinear heart rate variability (HRV) scores, and short-term morbidity and mortality in patients undergoing hip-surgery after a fracture. Methods 165 patients with hip fractures being admitted for surgery at two hospitals were included in a prospective cohort study. A short-term ECG was recorded within 24 hours of arrival. 15 patients had to be excluded due to insufficient quality of the ECG recordings. 150 patients were included in the final analysis. Linear parameters were calculated in time domain: standard deviation of NN intervals (SDNN), root mean square of successive differences (rMSSD); and frequency domain: Total Power (TP), High Frequency Power (HF), Low Frequency Power (LF), Very Low Frequency Power (VLF), and the ratio of LF/HF. Postoperative outcome was evaluated at the time of discharge. This included occurrence of pneumonia, overall infection rate, stroke, myocardial infarction, and all-cause mortality. Results Patients experiencing complications had significantly lower rMSSD (p = 0.04), and TP (p = 0.03) preoperatively. Postoperative infections were predicted by decreased VLF preoperatively (p = 0.04). There was a significant association between pneumonia and LF/HF<1 (p = 0.03). The likelihood ratio to develop pneumonia when LF/HF < 1 was 6,1. Conclusion HRV seems to reflect the general frailty of the patient with hip fracture and might be used to identify patients in need of increased surveillance or prophylactic treatment.
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Affiliation(s)
- Gernot Ernst
- Department of Anaesthesiology, Kongsberg hospital, Kongsberg, Norway
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway
- * E-mail:
| | - Leiv Otto Watne
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Frede Frihagen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Torgeir Bruun Wyller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Morten Rostrup
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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12
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Tvedt C, Sjetne IS, Helgeland J, Løwer HL, Bukholm G. Nurses' reports of staffing adequacy and surgical site infections: A cross-sectional multi-centre study. Int J Nurs Stud 2017; 75:58-64. [PMID: 28735246 DOI: 10.1016/j.ijnurstu.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 07/04/2017] [Accepted: 07/09/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is indicated that healthcare personnel's perceptions of the work environment may reflect the clinical outcomes for the patients they care for. However, the body of evidence is inconsistent when it comes to the association between work environment and surgical site infection. OBJECTIVES The aim of this study is to examine the associations between nurse-reported characteristics of the work environment and incidence of surgical site infections after total hip arthroplasty. DESIGN AND SETTINGS This is a cross-sectional multicentre study conducted in 16 Norwegian hospitals. PARTICIPANTS Clinical outcomes for 2885 patients >18years that underwent total hip arthroplasty are combined with work environment descriptions from 320 nurses. MATERIALS AND METHODS We combine data about surgical site infections from The Norwegian Surveillance System for Antibiotic Consumption and Healthcare-Associated Infections and hospital characteristics such as overall survival probability (from administrative patient data) and nurses' reports of characteristics of the work environment (from a multicentre survey among nurses in Norwegian hospitals). Stepwise mixed-effects logistic regression model was performed to examine the associations between characteristics of the work environment and surgical site infections. RESULTS The incidence of surgical site infection among 2885 patients undergoing total hip arthroplasty in 16 Norwegian hospitals was 2.6%. Older age, elective procedures and high scores for staffing adequacy were associated with risk for surgical site infection. The association between high scores for adequate staffing and low risk for surgical site infections was present for patients that were admitted for an elective procedure, but not for patients admitted for a non-elective procedure. CONCLUSION Our results show that the risk of surgical site infections after elective total hip arthroplasty was lower in hospitals where nurses assessed staffing as adequate. Our findings add to the existing literature that examines the linkage between work environment and clinical outcomes.
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Affiliation(s)
- Christine Tvedt
- Lovisenberg Diaconal University College, Lovisenberggata 15b, 0456 Oslo, Norway.
| | | | - Jon Helgeland
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
| | - Hege Line Løwer
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
| | - Geir Bukholm
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway; Norwegian University of Life Sciences, PO Box 5003, 1432 Ås, Norway
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Vosoughi AR, Emami MJ, Pourabbas B, Mahdaviazad H. Factors increasing mortality of the elderly following hip fracture surgery: role of body mass index, age, and smoking. Musculoskelet Surg 2016; 101:25-29. [PMID: 27766497 DOI: 10.1007/s12306-016-0432-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 10/09/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Hip fracture is one of the most common public health problems with a significant financial burden on the patient and on the healthcare system. This study was conducted to assess the 3-month and 1-year mortality rates of patients with operated hip fractures and to determine the influence of predictors of mortality. METHODS In this prospective cross-sectional study, all admitted patients aged more than 50 years with hip fracture at Chamran Hospital from January 2008 to August 2013 were enrolled. The characteristic data obtained included demographic information, body mass index (BMI), smoking, any previous history of osteoporotic fracture, and comorbidities. In addition, the mechanism of fracture, fracture type, and treatment method were recorded. A follow-up with the patients was conducted at 3 months and 1 year through a telephonic interview to ask about possible mortalities. Statistical analyses were performed using SPSS software version 17.0 for Windows. RESULTS A total of 1015 patients aged 50 years and older with hip fracture underwent surgery. Only 724 patients (71.3 %) completed the survey and the 1-year follow-up interview. The mean age was 75.7 ± 10.6 years. Overall, the 3-month and 1-year mortality rates were 14.5 and 22.4 %, respectively. Multivariate logistic regression analysis recognized age (OR 1.08; 95 % CI 1.05, 1.11, p < 0.001), BMI (OR 0.88; 95 % CI 0.82, 0.96, p = 0.003), and smoking (OR 1.76; 95 % CI 1.05, 2.96, p = 0.03) as major independent risk factors for mortality. CONCLUSION It is clear that modifiable factors like quitting the habit of smoking and gaining more energy with better nutrition could reduce the mortality rate if hip fracture occurs in the elderly.
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Affiliation(s)
- A R Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M J Emami
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - B Pourabbas
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H Mahdaviazad
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Berggren M, Stenvall M, Englund U, Olofsson B, Gustafson Y. Co-morbidities, complications and causes of death among people with femoral neck fracture - a three-year follow-up study. BMC Geriatr 2016; 16:120. [PMID: 27260196 PMCID: PMC4893237 DOI: 10.1186/s12877-016-0291-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/23/2016] [Indexed: 01/20/2023] Open
Abstract
Background The poor outcome after a hip fracture is not fully understood. The aim of the study was to describe the prevalence of co-morbidities, complications and causes of death and to investigate factors that are able to predict mortality in old people with femoral neck fracture. Methods Data was obtained from a randomized, controlled trial with a 3-year follow-up at Umeå University Hospital, Sweden, which included 199 consecutive patients with femoral neck fracture, aged ≥70 years. The participants were assessed during hospitalization and in their homes 4, 12 and 36 months after surgery. Medical records and death certificates were analysed. Results Multivariate analysis revealed that cancer, dependence in P-ADL (Personal Activities of Daily Living), cardiovascular disease, dementia at baseline or pulmonary emboli or cardiac failure during hospitalization were all independent predictors of 3-year mortality. Seventy-nine out of 199 participants (40 %) died within 3 years. Cardiovascular events (24 %), dementia (23 %), hip-fracture (19 %) and cancer (13 %) were the most common primary causes of death. In total, 136 participants suffered at least one urinary tract infection; 114 suffered 542 falls and 37 sustained 56 new fractures, including 13 hip fractures, during follow-up. Conclusion Old people with femoral neck fracture have multiple co-morbidities and suffer numerous complications. Thus randomized intervention studies should focus on prevention of complications that might be avoidable such as infections, heart diseases, falls and fractures.
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Affiliation(s)
- Monica Berggren
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden.
| | - Michael Stenvall
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Undis Englund
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Birgitta Olofsson
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, SE-901 87, Umeå, Sweden.,Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden
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Sheehan KJ, Sobolev B, Chudyk A, Stephens T, Guy P. Patient and system factors of mortality after hip fracture: a scoping review. BMC Musculoskelet Disord 2016; 17:166. [PMID: 27079195 PMCID: PMC4832537 DOI: 10.1186/s12891-016-1018-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 04/07/2016] [Indexed: 12/03/2022] Open
Abstract
Background Several patient and health system factors were associated with the risk of death among patients with hip fracture. However, without knowledge of underlying mechanisms interventions to improve survival post hip fracture can only be designed on the basis of the found statistical associations. Methods We used the framework developed by Arksey and O’Malley and Levac et al. for synthesis of factors and mechanisms of mortality post low energy hip fracture in adults over the age of 50 years, published in English, between September 1, 2009 and October 1, 2014 and indexed in MEDLINE. Proposed mechanisms for reported associations were extracted from the discussion sections. Results We synthesized the evidence from 56 articles that reported on 35 patient and 9 system factors of mortality post hip fracture. For 21 factors we found proposed biological mechanisms for their association with mortality which included complications, comorbidity, cardiorespiratory function, immune function, bone remodeling and glycemic control. Conclusions The majority of patient and system factors of mortality post hip fracture were reported by only one or two articles and with no proposed mechanisms for their effects on mortality. Where reported, underlying mechanisms are often based on a single article and should be confirmed with further study. Therefore, one cannot be certain whether intervening on such factors may produce expected results.
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Affiliation(s)
- K J Sheehan
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - B Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - A Chudyk
- Centre for Hip Health and Mobility, Vancouver, Canada
| | - T Stephens
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - P Guy
- Centre for Hip Health and Mobility, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
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Flodin L, Laurin A, Lökk J, Cederholm T, Hedström M. Increased 1-year survival and discharge to independent living in overweight hip fracture patients: A prospective study of 843 patients. Acta Orthop 2016; 87:146-51. [PMID: 26986549 PMCID: PMC4812076 DOI: 10.3109/17453674.2015.1125282] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Hip fracture patients usually have low body mass index (BMI), and suffer further postoperative catabolism. How BMI relates to outcome in relatively healthy hip fracture patients is not well investigated. We investigated the association between BMI, survival, and independent living 1 year postoperatively. PATIENTS AND METHODS This prospective multicenter study involved 843 patients with a hip fracture (mean age 82 (SD 7) years, 73% women), without severe cognitive impairment and living independently before admission. We investigated the relationship between BMI and both 1-year mortality and ability to return to independent living. RESULTS Patients with BMI > 26 had a lower mortality rate than those with BMI < 22 and those with BMI 22-26 (6%, 16%, and 18% respectively; p = 0.006). The odds ratio (OR) for 1-year survival in the group with BMI > 26 was 2.6 (95% CI: 1.2-5.5) after adjustment for age, sex, and physical status. Patients with BMI > 26 were also more likely to return to independent living after the hip fracture (OR = 2.6, 95% CI: 1.4-5.0). Patients with BMI < 22 had similar mortality and a similar likelihood of independent living to those with BMI 22-26. INTERPRETATION In this selected group of patients with hip fracture, the overweight and obese patients (BMI > 26) had a higher survival rate at 1 year, and returned to independent living to a higher degree than those of normal (healthy) weight. The obesity paradox and the recommendations for optimal BMI need further consideration in patients with hip fracture.
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Affiliation(s)
| | | | | | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala
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Krogseth M, Watne LO, Juliebø V, Skovlund E, Engedal K, Frihagen F, Wyller TB. Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients. Arch Gerontol Geriatr 2015; 64:38-44. [PMID: 26952375 DOI: 10.1016/j.archger.2015.12.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 12/08/2015] [Accepted: 12/11/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Delirium is a risk factor for dementia in cognitively intact patients. Whether an episode of delirium accelerates cognitive decline in patients with known dementia, is less explored. METHODS This is a prospective follow-up study of 287 hip fracture patients with pre-fracture cognitive impairment. During the hospitalization, the patients were screened daily for delirium using the Confusion Assessment Method. Pre-fracture cognitive impairment was defined as a score of 3.44 or higher on the pre-fracture Informant Questionnaire on Cognitive Decline in the Elderly Short Form (IQCODE-SF). At follow-up after 4-6 months, the caregivers rated cognitive changes emerging after the fracture using the IQCODE-SF, and the patients were tested with the Mini Mental State Examination (MMSE). A sub-group of the patients had a pre-fracture MMSE score which was used to calculate the yearly decline on the MMSE in patients with and without delirium. RESULTS 201 of the 287 patients developed delirium in the acute phase. In linear regression analysis, delirium was a significant and independent predictor of a more prominent cognitive decline at follow-up measured by the IQCODE-SF questionnaire (p=0.002). Among patients having a pre-fracture MMSE score, the patients developing delirium had a median (IQR) yearly decline of 2.4 points (1.1-3.9), compared to 1.0 points (0-1.9) in the group without delirium (p=0.001, Mann-Whitney test). CONCLUSIONS Hip fracture patients with pre-fracture dementia run a higher risk of developing delirium. Delirium superimposed on dementia is a significant predictor of an accelerated further cognitive decline.
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Affiliation(s)
- Maria Krogseth
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Old Age Psychiatry Research Network, Telemark Hospital Trust and Vestfold Hospital Trust, 3710 Skien, Norway.
| | - Leiv Otto Watne
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Vibeke Juliebø
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Norway; Department of Cardiology, Rikshospitalet, Oslo University Hospital, Norway
| | - Eva Skovlund
- Department of Public Health and General Practice, NTNU, Trondheim, Norway; Norwegian Institute of Public Health, Oslo, Norway
| | - Knut Engedal
- Institute of Clinical Medicine, University of Oslo, Norway; Norwegian Centre for Ageing and Health, Oslo University Hospital, Norway
| | - Frede Frihagen
- Department of Orthopaedic Surgery, Oslo University Hospital, Norway
| | - Torgeir Bruun Wyller
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
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Tinning CG, Cochrane LA, Singer BR. Analysis of hyponatraemia associated post-operative mortality in 3897 hip fracture patients. Injury 2015; 46:1328-32. [PMID: 25936638 DOI: 10.1016/j.injury.2015.03.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 03/30/2015] [Indexed: 02/02/2023]
Abstract
Hyponatraemia is common in hospitalised patients. In recent years the relationship between hyponatraemia and bone metabolism, falls and fractures has become more established. This study evaluates the prevalence of hyponatraemia (plasma sodium<135mmol/l) in 3897 patients undergoing operative treatment for hip fracture and the relationship between hyponatraemia and mortality in these patients. Hyponatraemia was an independent risk factor for increased post-operative mortality on multivariate analysis. Median age at admission was 83 years. Hyponatraemia was present in 19.1% of patients with hip fracture on admission, 29.5% of patients in the first 24h post-operatively and 20% of patients at discharge. There was a significant association between hyponatraemia and time from admission to surgery indicating that patients admitted with hyponatraemia waited longer. The median follow-up time was 863 (range 0-4352) days. There were 2460 deaths (63.1% of the original 3897 patients) prior to the censor date. A total of 1144 patients (29.4% of the original 3897 patients) died within 12 months of discharge. Median time to death for patients with and without hyponatraemia on admission was 34 months (SE 1.7 months) and 41 months (SE 2.5 months) respectively (p=0.003). Median time to death for patients with and without hyponatraemia within 24h post-operatively was 35 months (SE 2.5 months) and 42 months (SE 1.7 months) respectively (p=0.004). Following elimination of other independent variables associated with increased mortality, hyponatraemia on admission was associated with an increased risk of death (adjusted HR 1.15, p=0.005). Post-operative hyponatraemia was also associated with an increased risk of death (adjusted HR 1.15, p=0.006). Trends suggested that hyponatraemia within 48h of discharge was associated with an increased risk of death (adjusted HR 1.15, p=0.636). Hyponatraemia is common in elderly patients with hip fractures both at initial presentation and during admission. In this vulnerable patient group, hyponatraemia may delay time to definitive surgery and is a potentially reversible cause of increased post-operative mortality. Every effort should be made to identify and correct hyponatraemia in hip fracture patients.
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Affiliation(s)
- Craig G Tinning
- Department of Orthopaedic and Trauma Surgery, Ninewells Hospital, Dundee, UK.
| | - Lynda A Cochrane
- Division of Population Health Sciences, University of Dundee, The Mackenzie Building, Kirsty Semple Way, Dundee, UK
| | - Brian R Singer
- Department of Orthopaedic and Trauma Surgery, Perth Royal Infirmary, Taymount Terrace, Perth, UK
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Gregersen M, Borris LC, Damsgaard EM. Postoperative blood transfusion strategy in frail, anemic elderly patients with hip fracture: the TRIFE randomized controlled trial. Acta Orthop 2015; 86:363-72. [PMID: 25586270 PMCID: PMC4443456 DOI: 10.3109/17453674.2015.1006980] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Hip fracture (HF) in frail elderly patients is associated with poor physical recovery and death. There is often postoperative blood loss and the hemoglobin (Hb) threshold for red blood cell (RBC) transfusions in these patients is unknown. We investigated whether RBC transfusion strategies were associated with the degree of physical recovery or with reduced mortality after HF surgery. PATIENTS AND METHODS We enrolled 284 consecutive post-surgical HF patients (aged ≥ 65 years) with Hb levels < 11.3 g/dL (7 mmol/L) who had been admitted from nursing homes or sheltered housing. Allocation was stratified by residence. The patients were randomly assigned to either restrictive (Hb < 9.7 g/dL; < 6 mmol/L) or liberal (Hb < 11.3 g/dL; < 7 mmol/L) RBC transfusions given within the first 30 days postoperatively. Follow-up was at 90 days. RESULTS No statistically significant differences were found in repeated measures of daily living activities or in 90-day mortality rate between the restrictive group (where 27% died) and the liberal group (where 21% died). Per-protocol 30-day mortality was higher with the restrictive strategy (hazard ratio (HR) = 2.4, 95% CI: 1.1-5.2; p = 0.03). The 90-day mortality rate was higher for nursing home residents in the restrictive transfusion group (36%) than for those in the liberal group (20%) (HR = 2.0, 95% CI: 1.1-3.6; p = 0.01). INTERPRETATION According to our Hb thresholds, recovery from physical disabilities in frail elderly hip fracture patients was similar after a restrictive RBC transfusion strategy and after a liberal strategy. Implementation of a liberal RBC transfusion strategy in nursing home residents has the potential to increase survival.
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Affiliation(s)
| | - Lars C Borris
- Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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Jou HJ, Siao RY, Tsai YS, Chen YT, Li CY, Chen CC. Postdischarge rehospitalization and in-hospital mortality among Taiwanese women with hip fracture. Taiwan J Obstet Gynecol 2015; 53:43-7. [PMID: 24767645 DOI: 10.1016/j.tjog.2012.04.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To explore the factors concerning postdischarge rehospitalization and in-hospital mortality among Taiwanese women older than 50 years with hip fracture. MATERIALS AND METHODS The National Health Insurance database from 2000 to 2006 was used to identity relevant cases. Women inpatients aged over 50 years with new-onset hip fracture in 2003 were identified. We analyzed the factors affecting postdischarge rehospitalization and in-hospital mortality. RESULTS In 2003, there were 9467 new-onset hip fracture inpatients claimed among Taiwanese women aged over 50 years. The 3-year cumulative rates of rehospitalization after discharge and in-hospital mortality rate were 11.01% (1043) and 7.10% (672), respectively. The factors determined to be related to rehospitalization were patient age, hospital level, length of stay of the initial hospitalization due to hip fracture, and Charlson comorbidity index (CCI) score. The factors determined to be related to in-hospital mortality were age, urbanization level of region where patients were insured, hospital level, length of stay of the initial hospitalization due to hip fracture, and CCI score. CONCLUSION Characteristics of women aged over 50 years with hip fracture remain an important issue based on high rehospitalization and in-hospital mortality rates. We have identified related risk factors that may be helpful in treating hip fracture among this population segment.
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Affiliation(s)
- Hei-Jen Jou
- Department of Obstetrics and Gynecology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Ruo-Yan Siao
- Department of Healthcare Development, Taiwan Adventist Hospital, Taipei, Taiwan
| | - You-Shih Tsai
- Department of Orthopedics, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Yi-Tui Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine National Cheng Kung University, Tainan, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Prieto-Alhambra D, Premaor MO, Avilés FF, Castro AS, Javaid MK, Nogués X, Arden NK, Cooper C, Compston JE, Diez-Perez A. Relationship between mortality and BMI after fracture: a population-based study of men and women aged ≥40 years. J Bone Miner Res 2014; 29:1737-44. [PMID: 24615695 DOI: 10.1002/jbmr.2209] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 01/24/2014] [Accepted: 02/18/2014] [Indexed: 12/22/2022]
Abstract
Fractures in obese older individuals contribute significantly to the overall burden on primary health care, but data on their impact on mortality are lacking. We studied the association between obesity and mortality following hip and nonhip clinical fractures in a retrospective, population-based cohort study. The Sistema d'Informació pel Desenvolupament de la Investigació en Atenció Primària (SIDIAP(Q) ) database contains primary care computerized medical records of a representative sample of >2.1 million people (35% of the population) in Catalonia (Spain), linked to hospital admissions data. We included in this analysis anyone aged 40 years and older suffering a hip or nonhip clinical fracture in 2007 to 2009 in the SIDIAP(Q) database. The main exposure was the most recent body mass index (BMI) measured before fracture, categorized as underweight (<18.5 kg/m2), normal (18.5 to <25 kg/m2 ), overweight (25 to <30 kg/m2), and obese (≥30 kg/m2). Furthermore, the study outcome was all-cause mortality in 2007 to 2009 as provided to SIDIAP(Q) by the National Office of Statistics. Time to death after fracture was modeled using Cox regression. Multivariate models were adjusted for age, gender, smoking, alcohol intake, oral glucocorticoid use, and Charlson comorbidity index. Within the study period, 6988 and 29,372 subjects with a hip or nonhip clinical fracture were identified and followed for a median (interquartile range) of 1.17 (0.53-2.02) and 1.36 (0.65-2.15) years, respectively. Compared to subjects of normal weight, adjusted hazard ratios (HRs) for mortality in overweight and obese subjects were 0.74 (95% CI, 0.62-0.88; p = 0.001) and 0.74 (95% CI, 0.60-0.91; p = 0.004) after hip and 0.50 (95% CI, 0.32-0.77; p = 0.002), 0.56 (95% CI, 0.36-0.87; p = 0.010) after nonhip fracture. In conclusion, the highest mortality was observed in individuals with low BMI, but compared to subjects of normal weight, obese and overweight individuals survived longer following fracture. The latter observation is consistent with data reported in other chronic conditions, but the reasons for reduced mortality in obese and overweight subjects when compared to those of normal weight require further research.
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Affiliation(s)
- Daniel Prieto-Alhambra
- Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL), Informació pel Desenvolupament de la Investigació en Atenció Primària (IDIAP) Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Unitat de Recerca en Fisiopatologia Òssia i Articular (URFOA), Institut Municipal d'Investigacions Mèdiques, Parc de Salut Mar, Barcelona, Spain; Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Primary Care Department, Institut Català de la Salut, Barcelona, Spain; Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto Carlos III, Barcelona, Spain
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Nursing care for the elderly with hip fracture in an acute care hospital. Wien Med Wochenschr 2013; 163:468-75. [DOI: 10.1007/s10354-013-0247-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/13/2013] [Indexed: 11/25/2022]
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Systemic inflammatory responses and lung injury following hip fracture surgery increases susceptibility to infection in aged rats. Mediators Inflamm 2013; 2013:536435. [PMID: 24163505 PMCID: PMC3791802 DOI: 10.1155/2013/536435] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 12/19/2022] Open
Abstract
Pulmonary infections frequently occur following hip fracture surgery in aged patients. However, the underlying reasons are not fully understood. The present study investigates the systemic inflammatory response and pulmonary conditions following hip fracture surgery as a means of identifying risk factors for lung infections using an aged rodent model. Aged, male Sprague-Dawley rats (8 animals per group) underwent a sham procedure or hip fracture plus femoral intramedullary pinning. Animals were sacrificed 1, 3, and 7 days after the injury. Markers of systemic inflammation and pulmonary injury were analyzed. Both sham-operated and injured/surgical group animals underwent intratracheal inoculation with Pseudomonas aeruginosa 1, 3, and 7 days after surgery. P. aeruginosa counts in blood and bronchoalveolar lavage (BAL) fluid and survival rates were recorded. Serum TNF-α, IL-6, IL-1β, and IL-10 levels and markers of pulmonary injury were significantly increased at 1 and 3 days following hip fracture and surgery. Animals challenged with P. aeruginosa at 1 and 3 days after injury had a significantly decreased survival rate and more P. aeruginosa recovered from blood and BAL fluid. This study shows that hip fracture and surgery in aged rats induced a systemic inflammatory response and lung injury associated with increased susceptibility to infection during the acute phase after injury and surgery.
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Sylliaas H, Wyller TB, Bergland A. Progressive Strength Training Based upon the Principle of Overloading for a 86-Year-Old Hip Fracture Patient. A Case Report. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2013. [DOI: 10.3109/02703181.2013.809399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Alagiakrishnan K, Patel K, Desai RV, Ahmed MB, Fonarow GC, Forman DE, White M, Aban IB, Love TE, Aronow WS, Allman RM, Anker SD, Ahmed A. Orthostatic hypotension and incident heart failure in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2013; 69:223-30. [PMID: 23846416 DOI: 10.1093/gerona/glt086] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To examine the association of orthostatic hypotension with incident heart failure (HF) in older adults. METHODS Of the 5,273 community-dwelling adults aged 65 years and older free of baseline prevalent HF in the Cardiovascular Health Study, 937 (18%) had orthostatic hypotension, defined as ≥20 mmHg drop in systolic or ≥10 mmHg drop in diastolic blood pressure from supine to standing position at 3 minutes. Of the 937, 184 (20%) had symptoms of dizziness upon standing and were considered to have symptomatic orthostatic hypotension. Propensity scores for orthostatic hypotension were estimated for each of the 5,273 participants and were used to assemble a cohort of 3,510 participants (883 participants with and 2,627 participants without orthostatic hypotension) who were balanced on 40 baseline characteristics. Cox regression models were used to estimate the association of orthostatic hypotension with centrally adjudicated incident HF and other outcomes during 13 years of follow-up. RESULTS Participants (n = 3,510) had a mean (±standard deviation) age of 74 (±6) years, 58% were women, and 15% nonwhite. Incident HF occurred in 25% and 21% of matched participants with and without orthostatic hypotension, respectively (hazard ratio, 1.24; 95% confidence interval, 1.06-1.45; p = .007). Among matched participants, hazard ratios for incident HF associated with symptomatic (n = 173) and asymptomatic (n = 710) orthostatic hypotension were 1.57 (95% confidence interval, 1.16-2.11; p = .003) and 1.17 (95% confidence interval, 0.99-1.39; p = .069), respectively. CONCLUSIONS Community-dwelling older adults with orthostatic hypotension have higher independent risk of developing new-onset HF, which appeared to be more pronounced in those with symptomatic orthostatic hypotension.
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Affiliation(s)
- Kannayiram Alagiakrishnan
- University of Alabama at Birmingham, 1720 2nd Avenue South, CH-19, Suite 219, Birmingham, AL 35294-2041, USA.
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Talsnes O, Vinje T, Gjertsen JE, Dahl OE, Engesæter LB, Baste V, Pripp AH, Reikerås O. Perioperative mortality in hip fracture patients treated with cemented and uncemented hemiprosthesis: a register study of 11,210 patients. INTERNATIONAL ORTHOPAEDICS 2013; 37:1135-40. [PMID: 23508867 DOI: 10.1007/s00264-013-1851-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/21/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE Adverse events associated with the use of bone cement for fixation of prostheses is a known complication. Due to inconclusive results in studies of hip fracture patients treated with cemented and uncemented hemiprostheses, this study was initiated. METHODS Our study is based on data reported to the Norwegian Hip Fracture Register on 11,210 cervical hip fractures treated with hemiprostheses (8,674 cemented and 2,536 uncemented). RESULTS Significantly increased mortality within the first day of surgery was found in the cemented group (relative risk 2.9, 95 % confidence interval 1.6-5.1, p=0.001). The finding was robust giving the same results after adjusting for independent risk factors such as age, sex, cognitive impairment and comorbidity [American Society of Anesthesiologists (ASA) score]. For the first post-operative day the number needed to harm was 116 (one death for every 116 cemented prosthesis). However, in the most comorbid group (ASA worse than 3), the number needed to harm was only 33. CONCLUSIONS We found increased mortality for the cemented hemiprosthesis the first post-operative day compared to uncemented procedures. This increased risk is closely related to patient comorbidity estimated by the patient's ASA score.
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Affiliation(s)
- Ove Talsnes
- Department of Orthopaedics, Innlandet Hospital Trust, Elverum, Norway.
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Aluoch AO, Jessee R, Habal H, Garcia-Rosell M, Shah R, Reed G, Carbone L. Heart failure as a risk factor for osteoporosis and fractures. Curr Osteoporos Rep 2012; 10:258-69. [PMID: 22915207 DOI: 10.1007/s11914-012-0115-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although heart failure (HF) and osteoporosis are common diseases, particularly in elderly populations, patients with HF have an increased risk for osteoporosis. The relationship of HF with osteoporosis is modified by gender and the severity of HF. In addition, shared risk factors, medication use, and common pathogenic mechanisms affect both HF and osteoporosis. Shared risk factors for these 2 conditions include advanced age, hypovitaminosis D, renal disease, and diabetes mellitus. Medications used to treat HF, including spironolactone, thiazide diuretics, nitric oxide donors, and aspirin, may protect against osteoporosis. In contrast, loop diuretics may make osteoporosis worse. HF and osteoporosis appear to share common pathogenic mechanisms, including activation of the renin-angiotensin-aldosterone system, increased parathyroid hormone levels, and/or oxidative/nitrosative stress. HF is a major risk factor for mortality following fractures. Thus, in HF patients, it is important to carefully assess osteoporosis and take measures to reduce the risk of osteoporotic fractures.
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Affiliation(s)
- Aloice O Aluoch
- Department of Medicine, University of TN Health Science Center, Memphis, 38163, USA
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Biochemical lung, liver and kidney markers and early death among elderly following hip fracture. Arch Orthop Trauma Surg 2012; 132:1753-8. [PMID: 22996053 DOI: 10.1007/s00402-012-1611-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Indexed: 02/09/2023]
Abstract
INTRODUCTION In the elderly, hip fracture is a common injury associated with high early mortality dominated by cardiorespiratory and thromboembolic events. Identification of risk factors that can be modified by treatment has caught attention over the last years. This study was conducted to assess biological markers on perioperative organ dysfunction and its association with early mortality within 3 months after surgery. METHOD Blood samples were collected before, during and until 4 days after surgery. Analyses on PaO(2), alanine aminotransaminase (ALAT), gamma-glutamyl transpeptidase (g-GT) and creatinine were performed and used as markers on lung, liver and kidney functions. PATIENTS Three hundred and two patients over 75 years of age with acute dislocated hip fracture were consecutively enrolled from two hospitals in Norway. RESULTS We found a positive correlation between the plasma levels of ALAT, creatinine and death, and an inverse relationship between PaO(2) and death. After controlling for confounding factors such as sex, age and comorbidity, ALAT and creatinine levels were shown to be significantly and independently related to risk for fatal outcome. CONCLUSION Our results provide data on clinically important biomarkers in patients undergoing hip fracture surgery. We suggest a stronger emphasis on monitoring and correcting these biomarkers when possible.
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Seo B, Kim B, Singh K. The comparison of resistance and balance exercise on balance and falls efficacy in older females. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2011.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012; 43:676-85. [PMID: 21683355 DOI: 10.1016/j.injury.2011.05.017] [Citation(s) in RCA: 440] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 05/16/2011] [Accepted: 05/16/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip fractures are always associated with a high postoperative mortality, the preoperative predictors for mortality have neither been well identified or summarised. This systematic review and meta-analysis was performed to identify the preoperative non-interventional predictors for mortality in hip fracture patients, especially focused on 1 year mortality. METHODS Non-interventional studies were searched in Pubmed, Embase, Cochrane central database (all to February 26th, 2011). Only prospective studies and retrospective studies with prospective collected data were included. Qualities of included studies were assessed by a standardised scale previous reported for observational studies. The effects of individual studies were combined with the study quality score using a previous reported model of best-evidence synthesis. The hazard ratios of strong evidence predictors were combined only by high quality studies. RESULTS 75 included studies with 94 publications involving 64,316 patients were included and the available observations was a heterogeneous group. The overall inpatient or 1 month mortality was 13.3%, 3-6 months was 15.8%, 1 year 24.5% and 2 years 34.5%. There were strong evidence for 12 predictors, including advanced age, male gender, nursing home or facility residence, poor preoperative walking capacity, poor activities of daily living, higher ASA grading, poor mental state, multiple comorbidities, dementia or cognitive impairment, diabetes, cancer and cardiac disease. We also identified 7 moderate evidence and 12 limited evidence mortality predictors, and only the race was identified as the conflicting evidence predictor. CONCLUSION Whilst there is no conclusive evidence of the preoperative predictors for mortality following hip fractures, special attention should be paid to the above 12 strong evidence predictors. Future researches were still needed to evaluate the effects of these predictors.
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Affiliation(s)
- Fangke Hu
- Medical College, Nankai University, 94 Weijin Road, Tianjin 300071, China
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Exposure to medicines among patients admitted for hip fracture and the case-fatality rate at 1 year: a longitudinal study. Eur J Clin Pharmacol 2012; 68:1525-31. [PMID: 22527343 DOI: 10.1007/s00228-012-1273-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 03/15/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To describe the demographic and clinical characteristics and the pre-fracture exposure to medicines of patients admitted for a hip fracture, and to explore their association with fatal outcome 1 year after the fracture. METHODS All patients ≥ 65 years old admitted for a hip fracture in a tertiary hospital in Barcelona between January 1 and December 31 2007 were included. Data on the patients' clinical characteristics before and during hospital admission and on pre-fracture exposures to medicines were collected from the clinical records. One-year mortality was checked by approaching the patients and their families and was cross-checked with the national mortality statistics database. A Cox proportional hazards analysis was carried out. RESULTS Four hundred and fifty-six patients [mean age (SD) 82.9 (7.2) years, 73.5 % female], were admitted with hip fracture during the study period. Almost 80 % of the patients (363, 79.6 %) had three or more associated conditions, and 41.7 % received pre-fracture treatment with five or more drugs. The case-fatality rate during hospital admission was 4.6 % (21 patients). One hundred and seven patients died within 1 year (23.5 %). Advanced age, male gender, two or more associated chronic conditions, cancer, severe cognitive impairment, and treatment with opiates before fracture were significantly associated with the risk of dying. An inverse association was recorded between mortality and pre-hospital exposure to medicines for osteoporosis. CONCLUSIONS One-quarter of patients admitted for hip fracture died within 1 year after the fracture. Exposure to opiates before hip fracture was associated with an increased 1-year death rate, whereas treatment with drugs for osteoporosis was associated with a decrease in death rate. These results should be confirmed in studies with detailed prospective collection of information on exposure to medicines.
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Mosfeldt M, Pedersen OB, Riis T, Worm HO, van Mark S, Jørgensen HL, Duus BR, Lauritzen JB. Value of routine blood tests for prediction of mortality risk in hip fracture patients. Acta Orthop 2012; 83:31-5. [PMID: 22248167 PMCID: PMC3278654 DOI: 10.3109/17453674.2011.652883] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND There is a 5- to 8-fold increased risk of mortality during the first 3 months after a hip fracture. Several risk factors are known. We studied the predictive value (for mortality) of routine blood tests taken on admission. METHODS 792 hip fracture patients were included prospectively; blood tests were taken on admission. Follow-up data on mortality were obtained from the civil registration system. Patients were divided into 2 groups based on whether they had survived at least 90 days after the hip fracture. To estimate which laboratory tests could be used to predict outcome, we used receiver operation characteristic (ROC) curves. RESULTS 3-month mortality could be predicted with 69% accuracy from the level of plasma creatinine in standard admission blood tests. The mortality in patients with elevated levels of creatinine was almost 3-fold that of the patients with normal creatinine. Mortality was also associated with age, low blood hemoglobin, high plasma potassium, and low plasma albumin levels. INTERPRETATION Our findings could be of use in identifying patients who might benefit from increased attention perioperatively.
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Affiliation(s)
| | - Ole B Pedersen
- Tissue Typing Laboratory, Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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Tarazona-Santabalbina FJ, Belenguer-Varea A, Rovira-Daudi E, Salcedo-Mahiques E, Cuesta-Peredó D, Doménech-Pascual JR, Salvador-Pérez MI, Avellana-Zaragoza JA. Early interdisciplinary hospital intervention for elderly patients with hip fractures : functional outcome and mortality. Clinics (Sao Paulo) 2012; 67:547-56. [PMID: 22760891 PMCID: PMC3370304 DOI: 10.6061/clinics/2012(06)02] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/13/2012] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Hip fractures are associated with high levels of co-morbidity and mortality. Orthogeriatric units have been shown to be effective with respect to functional recovery and mortality reduction. The aim of this study is to document the natural history of early multidisciplinary intervention in elderly patients with hip fractures and to establish the prognostic factors of mortality and walking ability after discharge. METHODS This observational, retrospective study was performed in an orthogeriatric care unit on patients aged >70 years with a diagnosis of hip fracture between 2004 and 2008. This study included 1363 patients with a mean age of 82.7 + 6.4 years. RESULTS On admission to the unit, the average Barthel score of these patients was 77.2 + 27.8 points, and the average Charlson index score was 2.14 + 2.05. The mean length of stay was 8.9 + 4.26 days, and the readmission rate was 2.3%. The in-hospital mortality rate was 4.7%, and the mortality rates at one, six, and 12 months after discharge were 8.7%, 16.9%, and 25.9%, respectively. The Cox proportional hazards model estimated that male sex, Barthel scale, heart failure, and cognitive impairment were associated with an increased risk of death. With regard to functionality, 63.7% of the patients were able to walk at the time of discharge, whereas 77.4% and 80.1% were able to walk at one month and six months post-discharge, respectively. The factors associated with a worse functional recovery included cognitive impairment, performance status, age, stroke, Charlson score, and delirium during the hospital stay. CONCLUSIONS Early multidisciplinary intervention appears to be effective for the management of hip fracture. Age, male sex, baseline function, cognitive impairment and previous comorbidities are associated with a higher mortality rate and worse functional recovery.
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Bateman L, Vuppala S, Porada P, Carter W, Baijnath C, Burman K, Lee R, Hargus J. Medical management in the acute hip fracture patient: a comprehensive review for the internist. Ochsner J 2012; 12:101-110. [PMID: 22778674 PMCID: PMC3387835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Each year, more than 250,000 Americans will suffer a broken hip from a fall from no more than standing height. The National Osteoporosis Foundation estimates that more than 500,000 acute hip fractures will occur annually by the year 2040. The costs associated with this healthcare phenomenon are staggering and will continue to increase with an aging population.Hospitalists routinely comanage orthopedic patients as either consultants or as primary physicians in the hospital setting. A unique set of problems exists in this population. Among them are perioperative cardiac risk, perioperative anemia from acute blood loss, venous thromboembolism prophylaxis, and problems with the timing of surgery. It is imperative that hospitalists understand the orthopedic surgeon's point of view in managing these particular problems and become familiar with the evidence supporting or refuting treatment modalities related to these subject areas. In addition, an understanding of the anatomy and surgical options and complications related to each type of fracture allows the hospitalist to become familiar with postoperative rehabilitation needs. It cannot be overstated that addressing hip fracture prevention must be a part of every patient's perioperative care because the incidence of a repeat fracture is significant. Morbidity related to the fracture and comorbidities also need close examination.This article aims to provide a solid understanding of the issues associated with the acute hip fracture population to enhance practice and allow for the best outcome for patients.
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Affiliation(s)
- Laura Bateman
- Department of Internal Medicine and Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Srinivas Vuppala
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Patricia Porada
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - William Carter
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Charitraheen Baijnath
- Department of Internal Medicine and Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Kabeer Burman
- Department of Internal Medicine and Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Ryan Lee
- Department of Internal Medicine and Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Jodie Hargus
- Department of Internal Medicine and Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA
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Marks R. Physical activity and hip fracture disability: a review. J Aging Res 2011; 2011:741918. [PMID: 21584248 PMCID: PMC3092612 DOI: 10.4061/2011/741918] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 11/11/2010] [Accepted: 01/28/2011] [Indexed: 01/08/2023] Open
Abstract
Objective. The present paper examines pertinent literature sources published in the peer-reviewed English language between 1980 and November 1, 2010 concerning hip fractures. The aim was to highlight potential intervention points to offset the risk of incurring a hip fracture and its attendant disability. Methods. An in-depth search of the literature using the key terms: disability, epidemiology, hip fracture, prevention, and risk factors was conducted, along with data from the author's research base detailing the disability associated with selected hip fracture cases. All articles that dealt with these key topics were reviewed, and relevant data were tabulated and analyzed. Results. Hip fractures remain an important but potentially preventable public health problem. Among the many related remediable risk factors, low physical activity levels are especially important. Related determinants of suboptimal neuromuscular function also contribute significantly to hip fracture disability. Conclusion. Physical activity participation can help to reduce the prevalence and excess disability of hip fractures and should be encouraged.
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Affiliation(s)
- Ray Marks
- Department of Health and Behavior Studies, Teachers College, Columbia University, Box 114, 525W 120th Street, New York, NY 10027, USA
- Gerontological Studies and Services, Department of Health and Physical Education, York College, City University of New York, New York, NY 10016-4309, USA
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Becker DJ, Yun H, Kilgore ML, Curtis JR, Delzell E, Gary LC, Saag KG, Morrisey MA. Health services utilization after fractures: evidence from Medicare. J Gerontol A Biol Sci Med Sci 2010; 65:1012-20. [PMID: 20530242 DOI: 10.1093/gerona/glq093] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Osteoporosis-related fractures impose a large and growing societal burden, including adverse health effects and direct medical costs. Postfracture utilization of health care services represents an alternative measure of the resource costs associated with these fractures. METHODS We use a 5% random sample of Medicare claims data to construct annual cohorts (2000-2004) of beneficiaries diagnosed with incident fractures at one of seven sites--clinical vertebral, hip pelvis, femur, tibia/fibula, humerus, and distal radius/ulna. We use person-specific changes in health services utilization (eg, inpatient acute/postacute days, home health visits, physical, and occupational therapy) before/after fractures and probabilities of entry into (long-term) nursing home residency to estimate the utilization burden associated with fractures. RESULTS Relative to the prior 6-month period, rates of acute hospitalization are between 19.5 (distal radius/ulna) and 72.4 (hip) percentage points higher in the 6 months after fractures. Average acute inpatient days are 1.9 (distal radius/ulna) to 8.7 (hip) higher in the postfracture period. Fractures are associated with large increases in all forms of postacute care, including postacute hospitalizations (13.1-71.5 percentage points), postacute inpatient days (6.1-31.4), home health care hours (3.4-8.4), and hours of physical (5.2-23.6) and occupational (4.3-14.0) therapy. Among patients who were community dwelling at the time of the initial fracture, 0.9%-1.1% (2.4%-4.0%) were living in a nursing home 6 months (1 year) after the fracture. CONCLUSIONS Fractures are associated with significant increases in health services utilization relative to prefracture levels. Additional research is needed to assess the determinants and effectiveness of alternative forms of fracture care.
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Affiliation(s)
- David J Becker
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, 1665 University Blvd., RPHB 330H, Birmingham, AL 35294, USA.
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Juliebø V. Diuretika gir økt risiko for død etter hoftebrudd. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010. [DOI: 10.4045/tidsskr.09.1493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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