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Ko YS, Kang SY, Lee HJ, Kim HS, Yoo JJ. Trends in Hospital Stay, Complication Rate, and Mortality in Hip Fracture Patients: A Two-Decade Comparison at a National Tertiary Referral Center. J Clin Med 2024; 13:3666. [PMID: 38999232 PMCID: PMC11242650 DOI: 10.3390/jcm13133666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Since the turn of the century, the age-adjusted incidence of proximal femoral fractures has caused a plateau or fall. However, it was anticipated that the number of patients with proximal femoral fractures would rise as life expectancy rose and the population over 80 years old expanded. The aim of this study was to compare the length of hospital stay, complication rate, and mortality in patients with proximal femoral fractures between two different time periods: 20 years ago and the present. Methods: We conducted a retrospective review of medical records of patients aged 65 years and above who underwent surgery for proximal femoral fractures between January 2000 and December 2001 and between January 2020 and December 2021. We collected information on age, gender, fracture type, length of hospital stay, and complication rate. Dates of death were obtained from the Ministry of the Interior and Safety. Results: We included 136 patients who were operated on between 2000 and 2001 and 134 patients between 2020 and 2021. The average age increased significantly from 71.6 years to 79.0 years (p < 0.001). The length of hospital stay decreased dramatically from 15.1 days to 6.0 days (p < 0.001). There was no statistically significant difference in delirium, urinary tract infection, or pneumonia. No difference was found in 30-day or 1-year mortality between the two groups. Conclusions: The complication rate and mortality between the two time periods appeared comparable, although the length of hospital stay decreased substantially. Therefore, we recommend considering expedited discharge from the acute care hospital for elderly hip fracture patients while implementing an individualized approach for better outcomes.
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Affiliation(s)
- Young-Seung Ko
- Department of Orthopedic Surgery, Hallym University Dong-Tan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Sang Yoon Kang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Han Jin Lee
- Department of Orthopedic Surgery, Hanil General Hospital, Seoul 01450, Republic of Korea
| | - Hong Seok Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Fakler JKM, Pieroh P, Höch A, Roth A, Kleber C, Löffler M, Heyde CE, Zeynalova S. Predictors of long-term mortality in older patients with hip fractures managed by hemiarthroplasty: a 10-year study based on a population registry in Saxony, Germany. Patient Saf Surg 2024; 18:15. [PMID: 38689330 PMCID: PMC11061946 DOI: 10.1186/s13037-024-00398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Mortality of patients with a femoral neck fracture is high, especially within the first year after surgery, but also remains elevated thereafter. The aim of this study was to identify factors potentially associated with long-term mortality in patients homogeneously treated with hemiarthroplasty for femoral neck fracture. METHODS This retrospective cohort study was performed at a single level 1 national trauma center at the university hospital of Leipzig (Saxony, Germany). The study time-window was January 1, 2010 to December 31, 2020. Primary outcome measure was mortality depending on individual patient-related characteristics and perioperative risk factors. Inclusion criteria was a low-energy femoral neck fracture (Garden I-IV) in geriatric patients 60 years of age or older that were primarily treated with bipolar hemiarthroplasty. Date of death or actual residence of patients alive was obtained from the population register of the eastern German state of Saxony, Germany. The outcome was tested using the log-rank test and plotted using Kaplan-Meier curves. Unadjusted and adjusted for other risk factors such as sex and age, hazard ratios were calculated using Cox proportional hazards models and presented with 95% confidence intervals (CI). RESULTS The 458 included patients had a median age of 83 (IQR 77-89) years, 346 (75%) were female and 113 (25%) male patients. Mortality rates after 30 days, 1, 5 and 10 years were 13%, 25%, 60% and 80%, respectively. Multivariate regression analysis revealed age (HR = 1.1; p < 0.001), male gender (HR = 1.6; p < 0.001), ASA-Score 3-4 vs. 1-2 (HR = 1.3; p < 0.001), dementia (HR = 1.9; p < 0.001) and a history of malignancy (HR = 1.6; p = 0.002) as independent predictors for a higher long-term mortality risk. Perioperative factors such as preoperative waiting time, early surgical complications, or experience of the surgeon were not associated with a higher overall mortality. CONCLUSIONS In the present study based on data from the population registry from Saxony, Germany the 10-year mortality of older patients above 60 years of age managed with hemiarthroplasty for femoral neck fracture was 80%. Independent risk factors for increased long-term mortality were higher patient age, male gender, severe comorbidity, a history of cancer and in particular dementia. Perioperative factors did not affect long-term mortality.
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Affiliation(s)
- Johannes K M Fakler
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
- Department of Orthopaedic and Trauma Surgery, Hospital of Passau, Innstr. 76, 94032, Passau, Germany.
| | - Philipp Pieroh
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Andreas Höch
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Andreas Roth
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Christian Kleber
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Markus Löffler
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstrasse 16-18, 04107, Leipzig, Germany
| | - Christoph E Heyde
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Samira Zeynalova
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstrasse 16-18, 04107, Leipzig, Germany
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Suto A, Fujii K, Nakatani T, Ogawa K, Ichihara T, Li S, Sato K, Miura K, Funayama T, Yamazaki M. Correlation between preoperative CT scan of the paraspinal, psoas, and gluteus muscles and postoperative ambulatory status in patients with femoral neck fractures. BMC Musculoskelet Disord 2024; 25:132. [PMID: 38347481 PMCID: PMC10860248 DOI: 10.1186/s12891-024-07251-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND This study aimed to investigate the relationship between femoral neck fractures and sarcopenia. METHODS This was a retrospective analysis of 92 patients with femoral neck fractures, from September 2017 to March 2020, who were classified into high ambulatory status (HG) and low ambulatory status (LG) groups. Ambulatory status was assessed before surgery, one week after surgery, at discharge, and during the final follow-up. To evaluate sarcopenia, muscle mass and fatty degeneration of the muscles were measured using preoperative CT. An axial slice of the superior end of the L5 vertebra was used to evaluate the paraspinal and psoas muscles, a slice of the superior end of the femoral head for the gluteus maximus muscle, and a slice of the inferior end of the sacroiliac joint for the gluteus medius muscle. The degeneration of the muscles was evaluated according to the Goutallier classification. RESULTS The cross-sectional area of the gluteus medius and paraspinal muscles was significantly correlated with ambulatory status before the injury, at discharge, and during the final follow-up. CONCLUSIONS Measurement of the gluteus medius and paraspinal muscles has the potential to evaluate sarcopenia and predict ambulatory status after femoral neck fractures.
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Affiliation(s)
- Akihito Suto
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Kengo Fujii
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Takushi Nakatani
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Kaishi Ogawa
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Takumi Ichihara
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Sayori Li
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Kosuke Sato
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan.
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
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Wang Z, Zhang L, Zeng X, Nie P, Wang M, Xiong Y, Xu Y. The Nomogram Model and Factors for the Postoperative Mortality of Elderly Patients with Femoral Neck Fracture Undergoing Artificial Hip Arthroplasty: A Single-Institution 6-Year Experience. Orthop Surg 2024; 16:391-400. [PMID: 38151885 PMCID: PMC10834201 DOI: 10.1111/os.13944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE Artificial hip arthroplasty (AHA) is widely accepted in elderly patients with femoral neck fractures, but it is associated with high risk of death and various postoperative complications due to old age and accompanying chronic diseases. Therefore, this study aimed to explore the risk factors for death in elderly patients with femoral neck fractures after AHA and to establish a nomogram risk prediction model, which is expected to reveal high-risk patients and improve the postoperative quality of life and survival rate of patients. METHODS Elderly patients who underwent AHA for femoral neck fractures in our hospital from September 2014 to May 2021were retrospectively analyzed. These patients were divided into a survival group and a death group according to their clinical outcomes. The following clinical data were recorded for the patients in the two groups: sex, age, underlying diseases, smoking and drinking history, preoperative nutritional risk score (NRS) and American Society of Anesthesiologists (ASA) score, as well as relevant indicators about the operation. These data were subject to univariate analysis and then logistic analysis to determine the risk factors of death. Subsequently, a nomogram risk prediction model was established and further validated with the receiver operating characteristic curve (ROC) and the Hosmer-Lemeshow test. Finally, the effects of predictive risk factors were analyzed using the Kaplan-Meier survival curve. RESULTS Follow-up was completed by 260 patients, including 206 patients in the survival group and 54 patients in the death group; the overall death rate was 20.77%, and the follow-up time, age, postoperative 1, 3 and 5-year death rates were 3.47 ± 1.93 years, 75.32 ± 9.12 years, 5.77%, 12.51%, and 25.61%, respectively. The top three causes of death in 54 patients were respiratory disease, cerebrocardiovascular disease, and digestive disease, respectively. The logistic analysis indicated that elderly patients with femoral neck fractures, the risk factors for death after AHA were age ≥ 80 years, preoperative NRS ≥ 4, HB ≤ 90 g/L, CR ≥ 110 umol/L, and ASA score ≥ 3, as well as postoperative albumin ≤ 35 g/L, the nomogram was established, and then its predictive performance was successfully validated using the ROC curve (AUC = 0.814, 95% confidence interval = 0.749-0.879) and the Hosmer-Lemeshow test (p = 0.840). Furthermore, Kaplan-Meier survival curve analysis revealed that the abovementioned six indicators were correlated with the post-AHA survival time of elderly patients with femoral neck fractures (pLog Rank < 0.05). CONCLUSION Old age, preoperatively high NRS and ASA score, anemia, poor renal function, and postoperative hypoproteinemia are the major risk factors for death in elderly patients with femoral neck fractures after AHA; they are also associated with postoperative survival. Early identification and effective interventions for optimization of modifiable risk factors are recommended to improve the postoperative quality of life and survival rates.
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Affiliation(s)
- Zewen Wang
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Lixiang Zhang
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Xiaoyan Zeng
- Department of General Surgery, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Piming Nie
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Min Wang
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Yan Xiong
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Yuan Xu
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
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Dijkstra H, Oosterhoff JHF, van de Kuit A, IJpma FFA, Schwab JH, Poolman RW, Sprague S, Bzovsky S, Bhandari M, Swiontkowski M, Schemitsch EH, Doornberg JN, Hendrickx LAM. Development of machine-learning algorithms for 90-day and one-year mortality prediction in the elderly with femoral neck fractures based on the HEALTH and FAITH trials. Bone Jt Open 2023; 4:168-181. [PMID: 37051847 PMCID: PMC10032237 DOI: 10.1302/2633-1462.43.bjo-2022-0162.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
To develop prediction models using machine-learning (ML) algorithms for 90-day and one-year mortality prediction in femoral neck fracture (FNF) patients aged 50 years or older based on the Hip fracture Evaluation with Alternatives of Total Hip arthroplasty versus Hemiarthroplasty (HEALTH) and Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trials. This study included 2,388 patients from the HEALTH and FAITH trials, with 90-day and one-year mortality proportions of 3.0% (71/2,388) and 6.4% (153/2,388), respectively. The mean age was 75.9 years (SD 10.8) and 65.9% of patients (1,574/2,388) were female. The algorithms included patient and injury characteristics. Six algorithms were developed, internally validated and evaluated across discrimination (c-statistic; discriminative ability between those with risk of mortality and those without), calibration (observed outcome compared to the predicted probability), and the Brier score (composite of discrimination and calibration). The developed algorithms distinguished between patients at high and low risk for 90-day and one-year mortality. The penalized logistic regression algorithm had the best performance metrics for both 90-day (c-statistic 0.80, calibration slope 0.95, calibration intercept -0.06, and Brier score 0.039) and one-year (c-statistic 0.76, calibration slope 0.86, calibration intercept -0.20, and Brier score 0.074) mortality prediction in the hold-out set. Using high-quality data, the ML-based prediction models accurately predicted 90-day and one-year mortality in patients aged 50 years or older with a FNF. The final models must be externally validated to assess generalizability to other populations, and prospectively evaluated in the process of shared decision-making.
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Affiliation(s)
- Hidde Dijkstra
- Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Geriatric Medicine, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands
| | - Jacobien H F Oosterhoff
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Engineering Systems and Services, Faculty Technology Policy Management, Delft University of Technology, Delt, Netherlands
| | - Anouk van de Kuit
- Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Orthopaedic Surgery, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands
| | - Sheila Sprague
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Sofia Bzovsky
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Marc Swiontkowski
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Job N Doornberg
- Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Laurent A M Hendrickx
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Ohki Y, Ikeda Y, Kunisawa S, Imanaka Y. Regional medical inter-institutional cooperation in medical provider network constructed using patient claims data from Japan. PLoS One 2022; 17:e0266211. [PMID: 36001543 PMCID: PMC9401144 DOI: 10.1371/journal.pone.0266211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/29/2022] [Indexed: 11/19/2022] Open
Abstract
The aging world population requires a sustainable and high-quality healthcare system. To examine the efficiency of medical cooperation, medical provider and physician networks were constructed using patient claims data. Previous studies have shown that these networks contain information on medical cooperation. However, the usage patterns of multiple medical providers in a series of medical services have not been considered. In addition, these studies used only general network features to represent medical cooperation, but their expressive ability was low. To overcome these limitations, we analyzed the medical provider network to examine its overall contribution to the quality of healthcare provided by cooperation between medical providers in a series of medical services. This study focused on: i) the method of feature extraction from the network, ii) incorporation of the usage pattern of medical providers, and iii) expressive ability of the statistical model. Femoral neck fractures were selected as the target disease. To build the medical provider networks, we analyzed the patient claims data from a single prefecture in Japan between January 1, 2014 and December 31, 2019. We considered four types of models. Models 1 and 2 use node strength and linear regression, with Model 2 also incorporating patient age as an input. Models 3 and 4 use feature representation by node2vec with linear regression and regression tree ensemble, a machine learning method. The results showed that medical providers with higher levels of cooperation reduce the duration of hospital stay. The overall contribution of the medical cooperation to the duration of hospital stay extracted from the medical provider network using node2vec is approximately 20%, which is approximately 20 times higher than the model using strength.
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Affiliation(s)
- Yu Ohki
- Graduate School of Advanced Integrated Studies in Human Survivability, Kyoto University, Kyoto, Japan
- * E-mail: (YO); (YI)
| | - Yuichi Ikeda
- Graduate School of Advanced Integrated Studies in Human Survivability, Kyoto University, Kyoto, Japan
- * E-mail: (YO); (YI)
| | | | - Yuichi Imanaka
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
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EHNE J, TSAGOZIS P, LIND A, WEDIN R, HEDSTRÖM M. The obesity paradox and mortality after pathological hip fractures: a Swedish registry study. Acta Orthop 2022; 93:185-189. [PMID: 34984479 PMCID: PMC8788673 DOI: 10.2340/17453674.2021.1020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Obesity as measured by BMI has been associated with increased survival in various diseases, a phenomenon known as the "obesity paradox." It is unknown whether obesity is associated with survival after pathological fractures. We investigated the association between BMI and survival after surgery for pathological hip fracture, to improve survival prognostication, and lay grounds for further interventional nutritional studies. Patients and methods - We analyzed prospectively collected data from Swedish nationwide registry "RIKSHÖFT." The study cohort included 1,000 patients operated for a pathological hip fracture between 2014 and 2019. BMI registered on admission was available in 449 patients. Overall patient survival was measured according to the Kaplan-Meier method. Multivariable regression was used to evaluate association with other potential factors that influence patient survival. Results - Overweight and obesity were associated with an increased postoperative survival in male patients with surgically treated pathological hip fractures. Multivariable analysis considering potential confounders confirmed this finding. The association was not that strong in women and did not reach statistical significance. Interpretation - BMI, a commonly available clinical parameter, is a good predictor of overall survival for patients operated on for pathological hip fracture. Incorporation of BMI in existent survival prognostication algorithms should be considered. Treatment of malnutrition in this frail group of patients is worth studying.
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Affiliation(s)
- Jessica EHNE
- Department of Trauma and Reparative Medicine, Karolinska University Hospital, Stockholm
| | - Panagiotis TSAGOZIS
- Department of Trauma and Reparative Medicine, Karolinska University Hospital, Stockholm,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm
| | - Anja LIND
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Rikard WEDIN
- Department of Trauma and Reparative Medicine, Karolinska University Hospital, Stockholm,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm
| | - Margareta HEDSTRÖM
- Department of Trauma and Reparative Medicine, Karolinska University Hospital, Stockholm,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Kim JW, Park KS, Lee YK, Kim JW, Ha YC, Baek SH. Multiple screw fixation versus cementless bipolar hemiarthroplasty for femur neck fracture using a nationwide hip fracture registry. Sci Rep 2021; 11:21461. [PMID: 34728709 PMCID: PMC8563976 DOI: 10.1038/s41598-021-01046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
Cementless bipolar hemiarthroplasty (BHA) recently gained popularity as a treatment for femur neck fracture (FNF), but there have been few studies comparing this with multiple screw fixation (MSF) in the elderly population. The purpose of this study is to compare (1) surgery-related parameters, (2) reoperation rate as a local complication, (3) in-hospital systemic complication rate, and (4) mortality rate at 1 year after MSF and cementless BHA in patients with FNF using nationwide data. Six-hundred sixty-six hips (aged ≥ 50 years) extracted from nationwide Hip Fracture Registry were included in this study (133 MSF and 533 cementless BHA). One hundred fifty-six hips were divided into nondisplaced FNF (Group A) and 510 into displaced FNF (Group B). We evaluated (1) surgery-related parameters (anesthesia type, time to surgery, operation time, estimated blood loss and volume of postoperative transfusion), (2) the rate of and reasons for reoperation, (3) the rate and type of in-hospital systemic complications and (4) one-year mortality rate after surgery. In Group A, MSF showed shorter operation time (p = 0.004) and lower incidence of in-hospital systemic complications (p = 0.003). In Group B, cementless BHA demonstrated lower reoperation rate than MSF (p < 0.001). In both Group A and B, cementless BHA was associated with higher estimated blood loss than MSF (p < 0.001). Based on findings in our study, MSF might be a more favorable option for nondisplaced FNF, whereas cementless BHA might be a better one for displaced FNF in patients older than fifty. Nevertheless, our nationwide study also showed that numbers of cementless BHAs were being performed for nondisplaced FNF even in teaching hospitals.
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Affiliation(s)
- Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Kyung-Soon Park
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University, College of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
| | - Seung-Hoon Baek
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130, Dongdeok-ro, Jung-Gu, Daegu, 41944, Korea.
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鲁 攀, 谢 添, 代 广, 李 荥, 邹 继, 陈 辉, 芮 云. [Risk factors analysis for postoperative mortality of elderly patients with femoral neck fracture undergoing hemiarthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:217-220. [PMID: 33624477 PMCID: PMC8171678 DOI: 10.7507/1002-1892.202009122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/07/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To analyze the risk factors for postoperative mortality of the elderly patients with femoral neck fracture undergoing hemiarthroplasty. METHODS Patients who underwent hemiarthroplasty for femoral neck fractures between January 2011 and December 2015 were enrolled as object. One hundred and nine patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin level and nutritional status. Univariate analysis and Cox proportional hazard regression model were used to screen the risk factors for postoperative mortality. RESULTS The 1-year and 2-year mortalities were 6.4% (7/109) and 17.4% (19/109), respectively. Univariate analysis showed that the age, preoperative hemoglobin level and nutritional status were the influencing factors of postoperative mortality in the elderly patients with femoral neck fractures treated with hemiarthroplasty ( P<0.05). Multivariate analysis showed that the age≥80 years and malnutrition were the independent risk factors for postoperative mortality ( P<0.05). CONCLUSION To improve the clinical outcomes, perioperative risk should be comprehensively evaluated by multidisciplinary and perioperative management should be strengthened in the elderly patients with femoral neck fracture, especially those with advanced age and malnutrition, for the high postoperative mortality.
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Affiliation(s)
- 攀攀 鲁
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - 添 谢
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - 广春 代
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - 荥娟 李
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - 继红 邹
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - 辉 陈
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - 云峰 芮
- 东南大学附属中大医院创伤骨科(南京 210009)Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组(MDT)(南京 210009)Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
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