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Guan L, Liu Q, Yang J, Wang L, Chen S, Yao Y, Peng Y, Chen Y, Zhou Z, Yang Y, Zhou L. Moderate to severe anemia at admission increases the risk of complications in patients over 60 years with hip fracture. BMC Geriatr 2024; 24:775. [PMID: 39304854 DOI: 10.1186/s12877-024-05335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 08/27/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Anemia frequently occurs in patients with hip fractures and represents a risk factor that can potentially be altered. To evaluate the association between admission anemia and complications in older hip fracture patients while exploring the potential impact of anemia on complications from the perspective of overall, operation and non-operation. METHODS This retrospective study enrolled in-patients over 60 years old with hip fractures from January 2020 to November 2023. At admission, anemic patients were identified as having a hemoglobin level below 12 g/dL in females and 13 g/dL in males. Anemia was further classified as mild, moderate, or severe. Data encompassing demographics, comorbidities, medications, information on fracture and surgery, and complications were collected. RESULTS A total of 462/679 patients had anemia, including 348, 105, and 9 with mild, moderate, and severe anemia, respectively. A total of 281 individuals experienced complications, including 212 and 69 with and without operation, respectively. Multivariate regression analysis identified anemia as a greater risk for acute heart failure (OR = 2.056, p = 0.037, 95% CI 1.043-4.052) than non-anemia. Moderate to severe anemia was a significant risk factor for any complication (OR = 1.584, p = 0.028, 95% CI 1.050-2.390), ≥ 2 (OR = 2.364, p = 0.001, 95% CI 1.443-3.872) or 3 (OR = 2.311, p = 0.022, 95% CI 1.131-4.720) complications, delirium (OR = 2.301, p = 0.018, 95% CI 1.156-4.579), venous thromboembolism (OR = 2.031, p = 0.042, 95% CI 1.025-4.025), and acute heart failure (OR = 2.095, p = 0.016, 95% CI 1.145-3.834), compared with mild to non-anemia. Similar results were observed in operated patients, while anemia and its severity were not associated with complications in non-operated patients. CONCLUSION Moderate to severe anemia caused complications in elderly hip fracture patients, but it was not observed in non-operated individuals. These findings would support orthopedic physicians' hierarchical management of anemic patients.
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Affiliation(s)
- Lijuan Guan
- Department of gerontology and geriatrics, Chengdu University of Traditional Chinese Medicine Affiliated Fifth People's hospital, No.56, Wanchun East Rd, Chengdu, 611137, China
- Geriatric Diseases Institute of Chengdu, Chengdu, 611137, China
| | - Qian Liu
- Department of gerontology and geriatrics, Chengdu University of Traditional Chinese Medicine Affiliated Fifth People's hospital, No.56, Wanchun East Rd, Chengdu, 611137, China
- Geriatric Diseases Institute of Chengdu, Chengdu, 611137, China
| | - Jing Yang
- Geriatric Diseases Institute of Chengdu, Chengdu, 611137, China
- Department of endocrinology, Chengdu University of Traditional Chinese Medicine Affiliated Fifth People's hospital, Chengdu, 611137, China
| | - Lingxiao Wang
- Department of gerontology and geriatrics, Chengdu University of Traditional Chinese Medicine Affiliated Fifth People's hospital, No.56, Wanchun East Rd, Chengdu, 611137, China
- Geriatric Diseases Institute of Chengdu, Chengdu, 611137, China
| | - Shanping Chen
- Department of gerontology and geriatrics, Chengdu University of Traditional Chinese Medicine Affiliated Fifth People's hospital, No.56, Wanchun East Rd, Chengdu, 611137, China
- Geriatric Diseases Institute of Chengdu, Chengdu, 611137, China
| | - Yao Yao
- Department of gerontology and geriatrics, Chengdu University of Traditional Chinese Medicine Affiliated Fifth People's hospital, No.56, Wanchun East Rd, Chengdu, 611137, China
- Geriatric Diseases Institute of Chengdu, Chengdu, 611137, China
| | - Yang Peng
- Department of gerontology and geriatrics, Chengdu University of Traditional Chinese Medicine Affiliated Fifth People's hospital, No.56, Wanchun East Rd, Chengdu, 611137, China
- Geriatric Diseases Institute of Chengdu, Chengdu, 611137, China
| | - Yingcun Chen
- Department of gerontology and geriatrics, Chengdu University of Traditional Chinese Medicine Affiliated Fifth People's hospital, No.56, Wanchun East Rd, Chengdu, 611137, China
- Geriatric Diseases Institute of Chengdu, Chengdu, 611137, China
| | - Zheng Zhou
- Geriatric Diseases Institute of Chengdu, Chengdu, 611137, China
- Department of orthopedic, Chengdu University of Traditional Chinese Medicine Affiliated Fifth People's hospital, Chengdu, 611137, China
| | - Yongxue Yang
- Department of gerontology and geriatrics, Chengdu University of Traditional Chinese Medicine Affiliated Fifth People's hospital, No.56, Wanchun East Rd, Chengdu, 611137, China.
- Geriatric Diseases Institute of Chengdu, Chengdu, 611137, China.
| | - Lihua Zhou
- Department of gerontology and geriatrics, Chengdu University of Traditional Chinese Medicine Affiliated Fifth People's hospital, No.56, Wanchun East Rd, Chengdu, 611137, China.
- Geriatric Diseases Institute of Chengdu, Chengdu, 611137, China.
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Zhou YF, Wang J, Wang XL, Song SS, Bai Y, Li JL, Luo JY, Jin QQ, Cai WC, Yuan KM, Li J. A prediction model of elderly hip fracture mortality including preoperative red cell distribution width constructed based on the random survival forest (RSF) and Cox risk ratio regression. Osteoporos Int 2024; 35:613-623. [PMID: 38062161 DOI: 10.1007/s00198-023-06988-0] [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: 06/16/2023] [Accepted: 11/20/2023] [Indexed: 03/22/2024]
Abstract
An independent correlation between pre-RDW and 1-year mortality after surgery in elderly hip fracture can be used to predict mortality in elderly hip fracture patients and has predictive significance in anemia patients. With further research, a treatment algorithm can be developed to potentially identify patients at high risk of preoperative mortality. INTRODUCTION Red blood cell distribution width (RDW) is an independent predictor of various disease states in elderly individuals, but its association with the prognosis of elderly hip fracture patients is controversial. This study aimed to evaluate the prognostic value of RDW in such patients, construct a prediction model containing RDW using random survival forest (RSF) and Cox regression analysis, and compare RDW in patients with and without anemia. METHODS We retrospectively analyzed the data of elderly patients who underwent hip fracture surgery, selected the best variables using RSF, stratified the independent variables by Cox regression analysis, constructed a 1-year mortality prediction model of elderly hip fracture with RDW, and conducted internal validation and external validation. RESULTS Two thousand one hundred six patients were included in this study. The RSF algorithm selects 12 important influencing factors, and Cox regression analysis showed that eight variables including preoperative RDW (pre-RDW) were independent risk factors for death within 1-year after hip fracture surgery in elderly patients. Stratified analysis showed that pre-RDW was still independently associated with 1-year mortality in the non-anemia group and not in the anemia group. The nomogram prediction model had high differentiation and fit, and the prediction model constructed by the total cohort of patients was also used for validation of patients in the anemia patients and obtained good clinical benefits. CONCLUSION An independent correlation between pre-RDW and 1-year mortality after surgery in elderly hip fracture can be used to predict mortality in elderly hip fracture patients and has predictive significance in anemia patients.
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Affiliation(s)
- Ying-Feng Zhou
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Zhejiang, China
| | - Jiao Wang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Zhejiang, China
| | - Xin-Lin Wang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Zhejiang, China
| | - Shu-Shu Song
- Department of Anesthesiology, Wenzhou Central Hospital, Zhejiang, China
| | - Yue Bai
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Zhejiang, China
| | - Jian-Lin Li
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Zhejiang, China
| | - Jing-Yu Luo
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Zhejiang, China
| | - Qi-Qi Jin
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Zhejiang, China
| | - Wei-Cha Cai
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Zhejiang, China
| | - Kai-Ming Yuan
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Zhejiang, China.
| | - Jun Li
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Zhejiang, China.
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Lu Y, Chen W, Guo Y, Wang Y, Wang L, Zhang Y. Risk factors for short-term mortality in elderly hip fracture patients with complicated heart failure in the ICU: A MIMIC-IV database analysis using nomogram. J Orthop Surg Res 2023; 18:829. [PMID: 37924144 PMCID: PMC10625197 DOI: 10.1186/s13018-023-04258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/02/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Hip fracture is a prevalent and hazardous injury among the elderly population that often results in intensive care unit (ICU) admission due to various complications, despite advanced medical science. One common complication experienced in the ICU by elderly hip fracture patients is heart failure, which significantly impacts short-term survival rates. Currently, there is a deficit of adequate predictive models to forecast the short-term risk of death following heart failure for elderly hip fracture patients in the ICU. This study aims to identify independent risk factors for all-cause mortality within 30 days for elderly patients with hip fractures and heart failure while in the ICU in order to develop a predictive model. METHOD A total of 641 elderly patients with hip fractures combined with heart failure were recruited from the Medical Information Mart for Intensive Care IV dataset and randomized to the training and validation sets. The primary outcome was all-cause mortality within 30 days. The least absolute shrinkage and selection operator regression was used to reduce data dimensionality and select features. Multivariate logistic regression was used to build predictive models. Consistency index (C-index), receiver operating characteristic curve, and decision curve analysis (DCA) were used to measure the predictive performance of the nomogram. RESULT Our results showed that these variables including MCH, MCV, INR, monocyte percentage, neutrophils percentage, creatinine, and combined sepsis were independent factors for death within 30 days in elderly patients with hip fracture combined with heart failure in the ICU. The C-index was 0.869 (95% CI 0.823-0.916) and 0.824 (95% CI 0.749-0.900) for the training and validation sets, respectively. The results of the area under the curve and decision curve analysis (DCA) confirmed that the nomogram performed well in predicting elderly patients with hip fractures combined with heart failure in the ICU. CONCLUSION We developed a new nomogram model for predicting 30-day all-cause mortality in elderly patients with hip fractures combined with heart failure in the ICU, which could be a valid and useful clinical tool for clinicians for targeted treatment and prognosis prediction.
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Affiliation(s)
- Yining Lu
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Wei Chen
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yuhui Guo
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yujing Wang
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Ling Wang
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
| | - Yingze Zhang
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
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Barceló M, Casademont J, Mascaró J, Gich I, Torres OH. Indoor falls and number of previous falls are independent risk factors for long-term mortality after a hip fracture. Aging Clin Exp Res 2023; 35:2483-2490. [PMID: 37688755 PMCID: PMC10627886 DOI: 10.1007/s40520-023-02551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Hip fractures are almost always the result of a fall. Causes and circumstances of falls may differ between frail and vigorous patients. AIM To describe the circumstances of falls causing hip fractures, number of falls during the previous year, and their association with long-term mortality. PATIENTS AND METHODS The study is a retrospective review conducted in a tertiary university hospital serving a population of 425,000 inhabitants in Barcelona. All patients admitted with hip fractures with medical records describing the circumstances and number of previous falls were included. The number of falls in the previous 12 months was recorded, including the one causing the fracture. The circumstances of the index fall were dichotomized according to whether it was from the patient's own height or above; day or night; indoors or outdoors, due to intrinsic or extrinsic causes. Cumulative mortality was recorded for almost 5 years after hip fracture. RESULTS Indoor falls were strongly associated with shorter survival. Falling more than once in the previous year was also a risk factor for long-term mortality (hazard ratio 1.461, p < 0.001 and hazard ratio 1.035, p = 0.008 respectively). CONCLUSION Indoor falls and falling more than once in the previous year are long-term risk factors for mortality after hip fractures. It is always essential to take a careful patient history on admission to determine the number of falls and their circumstances, and special care should be taken to reduce mortality in patients at high risk.
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Affiliation(s)
- Montserrat Barceló
- Geriatric Unit, Departament de Medicina, Internal Medicine Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas Street, no. 90, 08041, Barcelona, Spain.
| | - Jordi Casademont
- Geriatric Unit, Departament de Medicina, Internal Medicine Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas Street, no. 90, 08041, Barcelona, Spain
| | - Jordi Mascaró
- Geriatric Unit, Departament de Medicina, Internal Medicine Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas Street, no. 90, 08041, Barcelona, Spain
| | - Ignasi Gich
- Department of Clinical Epidemiology and Public Health, CIBER Epidemiología Y Salud Pública (CIBERESP), HSCSP Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Olga Herminia Torres
- Geriatric Unit, Departament de Medicina, Internal Medicine Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas Street, no. 90, 08041, Barcelona, Spain
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Ohata E, Nakatani E, Kaneda H, Fujimoto Y, Tanaka K, Takagi A. Use of the Shizuoka Hip Fracture Prognostic Score (SHiPS) to Predict Long-Term Mortality in Patients With Hip Fracture in Japan: A Cohort Study Using the Shizuoka Kokuho Database. JBMR Plus 2023; 7:e10743. [PMID: 37283648 PMCID: PMC10241087 DOI: 10.1002/jbm4.10743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/21/2023] [Indexed: 06/08/2023] Open
Abstract
Hip fractures are common in patients of advanced age and are associated with excess mortality. Rapid and accurate prediction of the prognosis using information that can be easily obtained before surgery would be advantageous to clinical management. We performed a population-based retrospective cohort study using an 8.5-year Japanese claims database (April 2012-September 2020) to develop and validate a predictive model for long-term mortality after hip fracture. The study included 43,529 patients (34,499 [79.3%] women) aged ≥65 years with first-onset hip fracture. During the observation period, 43% of the patients died. Cox regression analysis identified the following prognostic predictors: sex, age, fracture site, nursing care certification, and several comorbidities (any malignancy, renal disease, congestive heart failure, chronic pulmonary disease, liver disease, metastatic solid tumor, and deficiency anemia). We then developed a scoring system called the Shizuoka Hip Fracture Prognostic Score (SHiPS); this system was established by scoring based on each hazard ratio and classifying the degree of mortality risk into four categories based on decision tree analysis. The area under the receiver operating characteristic (ROC) curve (AUC) (95% confidence interval [CI]) of 1-year, 3-year, and 5-year mortality based on the SHiPS was 0.718 (95% CI, 0.706-0.729), 0.736 (95% CI, 0.728-0.745), and 0.758 (95% CI, 0.747-0.769), respectively, indicating good predictive performance of the SHiPS for as long as 5 years after fracture onset. Even when the SHiPS was individually applied to patients with or without surgery after fracture, the prediction performance by the AUC was >0.7. These results indicate that the SHiPS can predict long-term mortality using preoperative information regardless of whether surgery is performed after hip fracture.
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Affiliation(s)
- Emi Ohata
- Graduate School of Public HealthShizuoka Graduate University of Public HealthShizuokaJapan
- 4DIN LtdTokyoJapan
| | - Eiji Nakatani
- Graduate School of Public HealthShizuoka Graduate University of Public HealthShizuokaJapan
| | - Hideaki Kaneda
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at KobeKobeJapan
| | - Yoh Fujimoto
- Graduate School of Public HealthShizuoka Graduate University of Public HealthShizuokaJapan
- Department of Pediatric OrthopedicsShizuoka Children's HospitalShizuokaJapan
| | - Kiyoshi Tanaka
- Department of General Internal MedicineShizuoka General HospitalShizuokaJapan
- Faculty of NutritionKobe Gakuin UniversityKobeJapan
| | - Akira Takagi
- Graduate School of Public HealthShizuoka Graduate University of Public HealthShizuokaJapan
- Department of OtolaryngologyShizuoka General HospitalShizuokaJapan
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Jiang Y, Lin X, Wang Y, Li J, Wang G, Meng Y, Li M, Li Y, Luo Y, Gao Z, Yin P, Zhang L, Lyu H, Tang P. Preoperative Anemia and Risk of In-hospital Postoperative Complications in Patients with Hip Fracture. Clin Interv Aging 2023; 18:639-653. [PMID: 37096216 PMCID: PMC10122467 DOI: 10.2147/cia.s404211] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
Purpose To evaluate the impact of preoperative anemia on postoperative complications after hip fracture surgery. Patients and Methods We conducted a retrospective study including hip fracture patients at a teaching hospital between 2005 and 2022. We defined preoperative anemia as the last hemoglobin measurement level before surgery < 130 g/L for men and < 120 g/L for women. The primary outcome was a composite of in-hospital major complications, including pneumonia, respiratory failure, gastrointestinal bleeding, urinary tract infection, incision infection, deep venous thrombosis, pulmonary embolism, angina pectoris, arrhythmia, myocardial infarction, heart failure, stroke, and death. Secondary outcomes were cardiovascular events, infection, pneumonia, and death. We used multivariate negative binomial or logistic regression to evaluate the impact of anemia and its severity, categorized as mild (90-130 g/L for men, 90-120 g/L for women) or moderate-to-severe (< 90 g/L for both) anemia on outcomes. Results Of the 3540 included patients, 1960 had preoperative anemia. 188 anemic patients experienced 324 major complications, while 63 non-anemic patients had 94 major complications. The risk of major complications was 165.3 (95% CI, 149.5-182.4) and 59.5 (95% CI, 48.9-72.3) per 1000 persons in anemic and non-anemic patients, respectively. Anemic patients were more likely to have major complications than non-anemic patients (adjusted incidence rate ratio (aIRR), 1.87; 95% CI, 1.30-2.72), which was consistent in mild (aIRR, 1.77; 95% CI, 1.22-2.59) and moderate-to-severe (aIRR, 2.97; 95% CI, 1.65-5.38) anemia. Preoperative anemia also increased the risk of cardiovascular events (aIRR, 1.96; 95% CI, 1.29-3.01), infection (aIRR, 1.68; 95% CI, 1.01-2.86), pneumonia (adjusted odds ratio (aOR), 1.91; 95% CI, 1.06-3.57), and death (aOR, 3.17; 95% CI, 1.06-11.89). Conclusion Our findings suggest that even mild preoperative anemia is associated with major postoperative complications in hip fracture patients. This finding highlights considering preoperative anemia as a risk factor in surgical decision-making for high-risk patients.
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Affiliation(s)
- Yu Jiang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Xisheng Lin
- Department of Rehabilitation, the Second Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Yilin Wang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Jia Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, People’s Republic of China
| | - Guoqi Wang
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Yutong Meng
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ming Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, People’s Republic of China
| | - Yi Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, People’s Republic of China
| | - Yan Luo
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, People’s Republic of China
| | - Zefu Gao
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Pengbin Yin
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, People’s Republic of China
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, People’s Republic of China
| | - Houchen Lyu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, People’s Republic of China
- Correspondence: Houchen Lyu; Peifu Tang, Department of Orthopedics, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People’s Republic of China, Tel +86-13501149301, Email ;
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, People’s Republic of China
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Cho MR, Cho YJ, Song SK. Factors affecting the need of postoperative blood transfusion in elderly patients with intertrochanteric hip fracture. Sci Prog 2022; 105:368504221134429. [PMID: 36320187 PMCID: PMC10450466 DOI: 10.1177/00368504221134429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION We investigated the risk factors that increased the frequency of blood transfusions in elderly patients with intertrochanteric hip fractures to determine blood transfusion risk before surgery and to take selective precautionary measures in the group at high risk for transfusion to ensure safe surgery. MATERIALS AND METHODS We retrospectively reviewed the electronic medical records of 203 patients who underwent surgical fixation of intertrochanteric hip fractures from January 2015 to December 2020. We hypothesized that patient sex, age, body mass index, preoperative hemoglobin, preoperative platelet count, glomerular filtration rate (GFR), preoperative albumin level, American Society of Anesthesiologist score, intraoperative blood loss, duration of surgery, method of anesthesia, and time from injury to surgery would affect the need for blood transfusion. Student's t-test, Chi-squared test, and the one-way analysis of variance test were used to determine whether differences between variables in the transfusion and non-transfusion groups were significant. RESULTS Unstable fractures (P = 0.002), general anesthesia (P = 0.028), lower preoperative hemoglobin levels (P < 0.001), and lower GFRs (P < 0.001) were identified as related to blood transfusions in univariate analysis. In multivariate logistic analysis, the need for allogeneic blood transfusion in unstable fractures was approximately 2.949 times higher than in stable fractures (P = 0.009). The risk in general anesthesia patients was about 2.953 times higher than in spinal anesthesia patients (P = 0.007). In addition, the need for allogeneic blood transfusion increased by about 1.293 times as preoperative hemoglobin levels decreased by 1 g/dL (P = 0.017) and increased by about 1.017 times as the GFR decreased by 1 mL/min/1.7m2 (P = 0.006). CONCLUSION Low preoperative hemoglobin levels, low GFRs, general anesthesia, and unstable fractures in elderly patients with intertrochanteric hip fractures increased the risk of blood transfusion.
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Affiliation(s)
- Myung-Rae Cho
- Daegu Catholic University Medical Center, Daegu, Korea
| | - Young-Jae Cho
- Daegu Catholic University Medical Center, Daegu, Korea
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Duque-Sánchez JD, Toro LÁ, González-Gómez FI, Botero-Baena SM, Duque G, Gómez F. One-year mortality after hip fracture surgery: urban-rural differences in the Colombian Andes. Arch Osteoporos 2022; 17:111. [PMID: 35945469 PMCID: PMC9363373 DOI: 10.1007/s11657-022-01150-5] [Citation(s) in RCA: 1] [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: 04/17/2022] [Accepted: 07/11/2022] [Indexed: 02/03/2023]
Abstract
To determine urban-rural differences influencing mortality in patients with hip fracture in Colombian Andes Mountains over a 1-year period. PURPOSE To identify the urban-rural differences of sociodemographic variables, fracture-related characteristics, and preoperative and postoperative clinical factors associated with 1-year mortality in patients over 60 years old who underwent hip fracture surgery in the Andes Mountains. METHODS A total of 126 patients with a fragility hip fracture during 2019-2020 were admitted to a tertiary care hospital. They were evaluated preoperatively and followed up until discharge. Those who survived were contacted by telephone at 1, 3, and 12 months. Univariate, bivariate, and Kaplan-Meier analyses with survival curves were performed. Relative risk was calculated with a 95% confidence interval. RESULTS A total of 32.5% of the patients died within 1 year after surgery, with a significant difference between those who resided in rural areas (43.1%) and those who resided in urban areas (23.5%) (RR 1.70; 95% CI, 1.03 to 2.80, p = 0.036). In the multivariate analysis, anemia (hemoglobin level ≤ 9.0 g/dL during hospitalization) (RR 6.61; 95% CI, 1.49-29.37, p = 0.003), a blood transfusion requirement (RR 1.47; 95% CI, 1.07 to 2.01, p = 0.015), the type of fracture (subtrochanteric fracture (RR = 4.9, 95% CI = 1.418-16.943, p = 0.005)), and postoperative acute decompensation of chronic disease (RR 1.60; 95% CI, 1.01 to 2.53, p = 0.043) were found to be independent predictive factors of 1-year mortality after surgery. CONCLUSIONS There was a difference in 1-year mortality between patients from rural and urban areas. More studies must be conducted to determine whether rurality behaves as an independent risk factor or is related to other variables, such as the burden of comorbidities and in-hospital complications.
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Affiliation(s)
| | - Luis-Ángel Toro
- Research Group On Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
| | - Fernando-Iván González-Gómez
- Research Group On Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
| | | | - Gustavo Duque
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
| | - Fernando Gómez
- Research Group On Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia.
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9
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Relationship between Preoperative Hemoglobin and Hospital Stays in Patients Receiving Prime Total Knee Arthroplasty. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:3627688. [PMID: 35875776 PMCID: PMC9307341 DOI: 10.1155/2022/3627688] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/05/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022]
Abstract
Previous evidence has shown that preoperative hemoglobin is related to poor prognosis after primary total knee arthroplasty. Reviewing cohort research was conducted at the third-level academic medical center in Singapore and involved 2,676 patients. Population statistics, complications, preoperative hemoglobin (Hb) levels, length of hospital stay (LOS), and readmission information of thirty days were obtained. Anemia was defined based on the World Health Organization (WHO). LOS extension was with the definition as no less than six days with >1/75 LOS corresponding to the data. According to the study requirements, we finally collected 2273 patients. We plotted the relationship between hemoglobin levels and length of stay. We analyzed 2273 patients, with 140 cases of Hb ≤ 11.0 g/dL, 831 cases of Hb 11.0–12.9 g/dL, and the other 1320 cases of Hb ≥ 13.0 g/dL. The mean age of patients with prolonged LOS (68.4 ± 8.2 years) was higher than that of patients with familiar LOS (65.9 ± 8.0 years). In addition, patients with extended LOS had higher ASA-PS values, a history of cerebrovascular accidents (CVA), diabetes mellitus (DM), and ischemic heart disease (IHD) (P < 0.001), repeated surgery within 30 days, HB, and operative time (min) (P < 0.01). Variables independently related to increased risk of extended LOS included general anesthesia (GA) (adjusted OR (aOR) 1.4, P=0.005, P=0.005), CVA (aOR 3.0, P < 0.001), DM (aOR 1.4, P=0.032), and HB < 11 g/dL. Variables increased LOS included HB ≥ 13 g/dL (aOR 0.4, P < 0.001) and Hb 11.0–12.9 g/dL (aOR 0.5, P=0.001). Hb was 14 g/dL, and LOS decreased by at least 0.24 days for each 1 g increase in preoperative Hb before the inflection point (95%CI 0.12 to 0.36, P=0.0001). Anemia is familiar in patients receiving elective total knee arthroplasty (TKA) in Singapore. Thus, this study describes that the preoperative hemoglobin was associated with length of stay. We found that on the left where HB was 14, length of stay decreased with increased hemoglobin values. We recommend preoperative correction of anemia to determine the diagnosis.
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10
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Lu X, Wang Z, Chong F, Wang Y, Wu S, Du Q, Gou W, Peng K, Xiong Y. A New Nomogram Model for Predicting 1-Year All-Cause Mortality After Hip Arthroplasty in Nonagenarians With Hip Fractures: A 20-Year Period Retrospective Cohort Study. Front Surg 2022; 9:926745. [PMID: 35836611 PMCID: PMC9273933 DOI: 10.3389/fsurg.2022.926745] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundChina has become an ageing society and as it continues to age, it will face an increasing number of hip fractures in nonagenarians. However, few preoperative assessment tools to determine the postoperative mortality risk in nonagenarians with hip fracture were available. The aim of this study was to identify all-cause mortality risk factors after hip arthroplasty in nonagenarians with hip fractures and to establish a new nomogram model to optimize the individualized hip arthroplasty in nonagenarians with hip fractures.MethodsWe retrospectively studied 246 consecutive nonagenarians diagnosed with hip fracture from August 2002 to February 2021 at our center. During the follow-up, 203 nonagenarians with a median age of 91.9 years treated with hip arthroplasty were included, of which 136 were females and 67 were males, and 43 nonagenarians were excluded (40 underwent internal fixation and 3 were lost to follow-up). The full cohort was randomly divided into training (50%) and validation (50%) sets. The potential predictive factors for 1-year all-cause mortality after hip arthroplasty were assessed by univariate and multivariate COX proportional hazards regression on the training set, and then, a new nomogram model was established and evaluated by concordance index (C-index) and calibration curves.ResultsAfter analyzing 44 perioperative variables including demographic characteristics, vital signs, surgical data, laboratory tests, we identified that age-adjusted Charlson Comorbidity Index (aCCI) (p = 0.042), American Society of Anesthesiologists (ASA) classification (p = 0.007), Urea (p = 0.028), serum Ca2+ (p = 0.011), postoperative hemoglobin (p = 0.024) were significant predictors for 1-year all-cause mortality after hip arthroplasty in the training set. The nomogram showed a robust discrimination, with a C-index of 0.71 (95%CIs, 0.68–0.78). The calibration curves for 1-year all-cause mortality showed optimal agreement between the probability as predicted by the nomogram and the actual probability in training and validation sets.ConclusionA novel nomogram model integrating 5 independent predictive variables were established and validated. It can effectively predict 1-year all-cause mortality after hip arthroplasty in nonagenarians with hip fracture and lead to a more optimized and rational therapeutic choice.
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Affiliation(s)
- Xingchen Lu
- Department of Orthopaedics, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ziming Wang
- Department of Orthopaedics, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Feifei Chong
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yu Wang
- Department of Orthopaedics, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Siyu Wu
- Department of Orthopaedics, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Quanyin Du
- Department of Orthopaedics, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenlong Gou
- Department of Orthopaedics, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Keyun Peng
- Department of Orthopaedics, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yan Xiong
- Department of Orthopaedics, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Correspondence: Yan Xiong
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11
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Chen M, Liao L, Yan J, Lin FQ. Predictive Value of Red Blood Cell Distribution Width for 1-Year All-Cause Mortality in Critically Ill Patients with Acute Myocardial Infarction. Int J Gen Med 2022; 15:465-471. [PMID: 35046707 PMCID: PMC8760980 DOI: 10.2147/ijgm.s345109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/16/2021] [Indexed: 12/19/2022] Open
Abstract
Objective Red blood cell distribution width (RDW) on admission is a prognostic factor in cardiovascular disease. This study investigated the prognostic value of the RDW measured within 24 hours before discharge (24h dRDW) on 1-year all-cause mortality in critically ill patients with acute myocardial infarction (AMI), and compared the effect of 24h dRDW in anemia and non-anemia patients. Materials and Methods Altogether, 4088 patients with AMI were studied retrospectively. Data from the MIMIC-III database were collected and analyzed. The Kaplan–Meier method, Cox regression models, and receiver operating characteristic (ROC) analysis were used to assess the impact of 24h dRDW on all-cause mortality in AMI patients, and a stratified analysis was performed to investigate the prognostic value of 24h dRDW in anemia and non-anemia patients. Results Of the 4088 patients, there were 704 non-survivors (17.2%). The non-survivors had a higher RDW than the survivors (p<0.001). Cox regression analysis showed that 24h dRDW had a significant independent association with 1‐year all-cause mortality in critically ill patients with AMI (quintile 5 vs quintile 1, HR, 95% CI: 2.847, 2.014–4.023). The area under the ROC curve of 24h dRDW was 0.710 (95% CI, 0.689–0.730). In the stratified analysis, a significant prognostic value of 24h dRDW was found in anemia patients for 1-year all-cause mortality, but not in non-anemia patients. Conclusion Elevated 24h dRDW values are significantly associated with increased hazards of all‐cause mortality in critically ill patients with AMI. Significant prognostic value of 24h dRDW was found in AMI patients with anemia, but not in those without anemia.
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Affiliation(s)
- Min Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Lin Liao
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Jie Yan
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Fa-Quan Lin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
- Correspondence: Fa-Quan Lin Email
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12
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Sayed-Noor A, Al-Amiry B, Alwan A, Knutsson B, Barenius B. The Association of On-Admission Blood Hemoglobin, C-Reactive Protein, and Serum Creatinine With 2-Year Mortality of Patients With Femoral Neck Fractures. Geriatr Orthop Surg Rehabil 2021; 12:21514593211037758. [PMID: 34422440 PMCID: PMC8377304 DOI: 10.1177/21514593211037758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction The mortality of femoral neck fracture (FNF) is high and every effort should be made to identify and manage any possible risk factors. The aim of this study was to evaluate whether on-admission hemoglobin (Hb) level, C-reactive protein (CRP), and serum creatinine were associated with 2-year mortality after FNF. Patients and Methods In this retrospective observational cohort study, we considered for inclusion all displaced FNF patients 65 years and above treated with hemi-arthroplasty between February 2011 and May 2015. We documented the age, sex, cognitive status, and American Society of Anesthesiologists (ASA) classification. The Hb level, CRP, and serum creatinine were measured. The medical records were followed up for 2 years. We fitted different crude and adjusted Cox proportional hazards models to examine whether Hb level <100 g/L, CRP >20 mg/L, and serum creatinine >100 μmol/L were associated with the 2-year mortality, adjusted for age, sex, and ASA class. Results A total of 290 patients [208 females (72%), mean age 84 years] were included in the study. More than 50% of patients had impaired cognition and ASA class 3–4. Of the 290 patients, 38.3% (n = 111) had died within 2 years after surgery. Mortality among males was 46.3% (n = 38) while mortality among females was 35,1% (n = 73), p = 0.07. We found that on-admission Hb level <100 g/L was associated with 2-year mortality (HR = 3.3, 95% CI: 1.3–8.3, p < 0.01) while CRP >20 mg/L and serum creatinine >100 μmol/L were not associated with 2-year mortality (p = 0.89 and p = 0.31, respectively). Conclusion On-admission Hb level <100 g/L, but not CRP >20 mg/L and serum creatinine >100 μmol/L, was associated with 2-year mortality. These results can help healthcare providers identify high-risk FNF patients who probably would benefit from optimized perioperative medical management.
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Affiliation(s)
- Arkan Sayed-Noor
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Bariq Al-Amiry
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Alan Alwan
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Björn Knutsson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Björn Barenius
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
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13
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Li Y, Chen M, Lv H, Yin P, Zhang L, Tang P. A novel machine-learning algorithm for predicting mortality risk after hip fracture surgery. Injury 2021; 52:1487-1493. [PMID: 33386157 DOI: 10.1016/j.injury.2020.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/04/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although several risk stratification models have been developed to predict hip fracture mortality, efforts are still being placed in this area. Our aim is to (1) construct a risk prediction model for long-term mortality after hip fracture utilizing the RSF method and (2) to evaluate the changing effects over time of individual pre- and post-treatment variables on predicting mortality. METHODS 1330 hip fracture surgical patients were included. Forty-five admission and in-hospital variables were analyzed as potential predictors of all-cause mortality. A random survival forest (RSF) algorithm was applied in predictors identification. Cox regression models were then constructed. Sensitivity analyses and internal validation were performed to assess the performance of each model. C statistics were calculated and model calibrations were further assessed. RESULTS Our machine-learning RSF algorithm achieved a c statistic of 0.83 for 30-day prediction and 0.75 for 1-year mortality. Additionally, a COX model was also constructed by using the variables selected by RSF, c statistics were shown as 0.75 and 0.72 when applying in 2-year and 4-year mortality prediction. The presence of post-operative complications remained as the strongest risk factor for both short- and long-term mortality. Variables including fracture location, high serum creatinine, age, hypertension, anemia, ASA, hypoproteinemia, abnormal BUN, and RDW became more important as the length of follow-up increased. CONCLUSION The RSF machine-learning algorithm represents a novel approach to identify important risk factors and a risk stratification models for patients undergoing hip fracture surgery is built through this approach to identify those at high risk of long-term mortality.
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Affiliation(s)
- Yi Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Ming Chen
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Houchen Lv
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Pengbin Yin
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China.
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China.
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China.
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14
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Goyal T, Dhingra M, Yadav A, Choudhury A. One-year mortality rates and factors affecting mortality after surgery for fracture neck of femur in the elderly. J Midlife Health 2021; 12:276-280. [PMID: 35264833 PMCID: PMC8849149 DOI: 10.4103/jmh.jmh_208_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022] Open
Abstract
Context: Fractures around hip in elderly are associated with significant morbidity and mortality. Aim: This sudy aims to investigate 1-year mortality rates and risk factors associated with this mortality. Effect of delay in surgery on mortality rates will also be studied. Our null-hypothesis was that there is no association between common comorbid conditions or delay in surgery on 1-year mortality rates. Study Settings and Design: Patients 60-years and above who underwent operative treatment for fracture of neck of femur between January 2018 and February 2019 were included in this retrospective study. Materials and Methods: Demographic and clinical data were collected from hospital information system and inpatient case records. Patients were followed up with quality of life (QoL) assessment with short form-12 (SF-12) at 1 year. Mortality during this period was also evaluated. Statistical Analysis: Continuous factors were expressed as means, standard deviations. Different risk factors between the patients alive and dead were studied using Fisher's exact test. Results: Nineteen out of 95 patients died at the end of 1 year. Smoking, hypertension, diabetes, low hemoglobin, raised total leukocyte count, low serum albumin, delay in surgery (>1 week), higher American Society of Anesthesiologist grade, and postoperative blood transfusion were significantly associated with higher mortality rates. Mean SF-12 QoL scores at 1 year was 35.6 ± 6.3. Conclusion: Hip fractures in elderly are associated with higher mortality rates. Results of this study indicate that patients at a higher risk of mortality may be identified and help in preoperative optimization with the aim to reduce mortality. However, these findings need to be verified by further studies with a relatively larger sample size and longer follow-up period.
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15
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Ryan G, Nowak L, Melo L, Ward S, Atrey A, Schemitsch EH, Nauth A, Khoshbin A. Anemia at Presentation Predicts Acute Mortality and Need for Readmission Following Geriatric Hip Fracture. JB JS Open Access 2020; 5:JBJSOA-D-20-00048. [PMID: 33299961 PMCID: PMC7722583 DOI: 10.2106/jbjs.oa.20.00048] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There is a paucity of research regarding the relationship between anemia and postoperative morbidity and mortality among geriatric patients presenting with hip fracture. The objective of this study was to determine the effect of anemia at presentation on 30-day morbidity and mortality among geriatric patients with hip fracture.
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Affiliation(s)
- Gareth Ryan
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Nowak
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Luana Melo
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Ward
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amit Atrey
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Emil H Schemitsch
- Division of Orthopaedic Surgery, Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Aaron Nauth
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amir Khoshbin
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Chen R, Li L, Xiang Z, Li H, Hou XL. Association of iron supplementation with risk of transfusion, hospital length of stay, and mortality in geriatric patients undergoing hip fracture surgeries: a meta-analysis. Eur Geriatr Med 2020; 12:5-15. [PMID: 32691389 DOI: 10.1007/s41999-020-00366-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/13/2020] [Indexed: 02/08/2023]
Abstract
AIMS To assess the efficacy and safety of iron supplementation for perioperative anemia in geriatric patients with hip fracture. METHODS A systematic search was conducted for studies published using PubMed, EMBASE and Cochrane Library Databases that compared iron supplementation with placebo in patients undergoing hip fracture surgery. The outcomes were blood transfusion rate and volume, length of stay, infection and mortality (last follow-up). Sub-group and sensitivity analyses were performed in cases of substantial heterogeneity. RESULTS The meta-analysis (6 studies: 1201 patients) indicated that iron supplements were not associated with reducing blood transfusion rate (OR 0.92, 95% CI 0.60-1.41; P = 0.69), but high heterogeneity (I2 = 61%) was detected and a significant association was found in sensitivity analysis of four studies (n = 637; OR 0.68, 95% CI 0.49-0.95; P = 0.02). A significant reduction was detected in transfusion volume (two studies: n = 234; MD - 0.45 units/patient, 95% CI - 0.74 to - 0.16; P = 0.002), hospital stay (five studies: n = 998; MD - 1.42, 95% CI - 2.18 to - 0.67; P = 0.0002) and caused no increased risk of mortality (five studies: n = 937; OR 0.94, 95% CI 0.65-1.36; P = 0.76) and infection (four studies: n = 701; OR 0.58, 95% CI 0.38-0.90; P = 0.01). Sub-group analyses of four studies showed that the preoperative intravenous use of iron at 200-300 mg (two studies) may be the beneficial option for hip fractures patients. CONCLUSIONS Iron supplementation, especially preoperative intravenous use of 200-300 mg iron, is safe and associated with reducing transfusion requirement and hospital stay. Unfortunately, data were too limited to draw a definite conclusion. Further evaluation is required before recommending iron supplementation for older patients with hip fracture surgeries.
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Affiliation(s)
- Ran Chen
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610000, China.,Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Lang Li
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610000, China.,Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, 610041, Sichuan, China
| | - Zhou Xiang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610000, China
| | - Hong Li
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Xiao-Ling Hou
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610000, China.
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17
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Zhou XD, Zhang Y, Jiang LF, Zhang JJ, Zhou D, Wu LD, Huang Y, Xu NW. Efficacy and Safety of Tranexamic Acid in Intertrochanteric Fractures: A Single-Blind Randomized Controlled Trial. Orthop Surg 2019; 11:635-642. [PMID: 31419080 PMCID: PMC6712408 DOI: 10.1111/os.12511] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 07/04/2019] [Accepted: 07/10/2019] [Indexed: 12/31/2022] Open
Abstract
Objective To investigate the efficacy and safety of tranexamic acid (TXA) in the reduction of bleeding and the need for transfusion in elderly intertrochanteric fracture patients. Methods A total of 100 patients with intertrochanteric fractures undergoing surgery were enrolled and randomly allocated to the TXA group in which patients (75.10 ± 8.27 years old) were treated with 1 g of TXA, or the control group (77.82 ± 6.42 years old) treated with a placebo. Surgery was performed by two senior orthopaedic surgeons from two institutions. The proximal femoral nail antirotation (PFNA) was conducted using the standard procedure. Three outcome measures, including blood loss, transfusion, and complications, were recorded. Blood loss and transfusion were investigated to assess TXA's effectiveness, while complications were investigated to assess TXA's safety. Statistical indicators for blood loss included total, intraoperative, postoperative, and hidden blood loss volumes, calculated by hemoglobin levels, hematocrit levels, and drainage volume. The number and amount of blood transfusions were recorded. Complications associated with surgery, including deep vein thrombosis, pulmonary embolism, wound hematoma, wound infection, cardiovascular and cerebrovascular accidents, and respiratory infections, were also recorded. Results All patients were followed up for 1 month after surgery. There were no significant differences in demographic and clinical characteristics between the two groups. The TXA group suffered significantly less total blood loss (563.37 ± 197.51 vs 819.25 ± 273.96 mL, 95% CI: −349.49 to −162.27, P < 0.01), intraoperative blood loss (140.3 ± 80.64 vs 230.5 ± 130.56 mL, 95% CI −132.74 to −47.66, P < 0.01), and hidden blood loss (410.42 ± 178.23 vs 571.19 ± 218.13 mL, 95% CI: −238.85 to −82.69, P < 0.01) than the control group. However, postoperative total blood loss was not significantly different (97.5 ± 20.93 vs 94.7 ± 35.78 mL; P = 0.63). A total of 5 patients from the TXA group and 27 from the control group received packed RBC for postoperative transfusion, but the mean number of transfusion units was not significantly different between groups. Complications including deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic cerebral infarction, hematoma, and infection were observed in both groups, but no significant differences were found. Conclusions In intertrochanteric fracture surgery performed using PFNA, intravenous administration of TXA significantly reduced the risk of intraoperative, total and hidden blood loss, in addition to the need for allogeneic transfusion, without increasing the rate of complications.
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Affiliation(s)
- Xin-Die Zhou
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yi Zhang
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Li-Feng Jiang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun-Jie Zhang
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Dong Zhou
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Li-Dong Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yong Huang
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Nan-Wei Xu
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
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Ong AW, Muller A, Sigal A, Fernandez F. Anemia at Discharge in Elderly Trauma Patients is Not Associated with Six-Month Mortality. Am Surg 2019. [DOI: 10.1177/000313481908500727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Few studies have evaluated outcomes in geriatric trauma patients discharged with anemia. Our hypothesis was that anemia at discharge was not associated with six-month mortality. A 22-month retrospective study of trauma patients ≥ 65 years was conducted from 2015 to 2016. The end point was six-month mortality. The degree of anemia at admission (admission hemoglobin [AHb]) and discharge (discharge hemoglobin [DHb]) was categorized as follows based on hemoglobin (Hb) (g/dL): I (>10), II (>9 and ≤10), III (>8 and ≤9), and IV (≤8). Univariate analysis and multivariate analysis were performed to determine the association of AHb and DHb with the end point. Nine hundred forty-nine patients were analyzed (median age, 82 years). Six-month mortality was 11 per cent. Mortality was associated with AHb by univariate analysis (I:10% [84/831]; II: 13% [9/67]; III: 22% [7/32]; and IV: 26% [5/19]) ( P = 0.003). DHb was not associated with mortality (I:11% [65/613]; II: 12% [21/183]; III: 10% [12/116]; and IV: 18% [7/39]) ( P = 0.37). Logistic regression found that AHb category IV, age, and chronic kidney disease were independently associated with the end point. In geriatric patients, the severity of anemia at admission and not at discharge predicted six-month mortality. Discharging patients with an Hb of ≤8 g/dL was not adversely associated with mortality.
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Affiliation(s)
- Adrian W. Ong
- Department of Surgery, Section of Trauma and Acute Care Surgery, and the
| | - Alison Muller
- Department of Surgery, Section of Trauma and Acute Care Surgery, and the
| | - Adam Sigal
- Department of Emergency Medicine, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Forrest Fernandez
- Department of Surgery, Section of Trauma and Acute Care Surgery, and the
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Zhou XD, Li J, Fan GM, Huang Y, Xu NW. Efficacy and safety of tranexamic acid in elderly patients with intertrochanteric fracture: An updated meta-analysis. World J Clin Cases 2019; 7:1302-1314. [PMID: 31236394 PMCID: PMC6580343 DOI: 10.12998/wjcc.v7.i11.1302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/15/2019] [Accepted: 03/16/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intertrochanteric fracture (ITF) is a common type of injury, and nearly 30% of ITF patients die in the first 12 mo, especially the elderly with limited activity. Tranexamic acid (TXA) has been widely used in reducing traumatic and surgical bleeding, however, the paucity of studies regarding its use in orthopedic trauma surgery has limited its integration into this field, which may benefit most from TXA. The safety of TXA in this group has not achieved a consensus.
AIM This meta-analysis was designed to investigate the efficacy and safety of TXA in elderly ITF patients undergoing surgery.
METHODS Databases, including Medline and PubMed, were searched for randomized controlled trials (RCTs) that were published before October 2018 and that addressed the efficacy and safety of TXA in patients who underwent ITF surgery. The Consolidated Standards of Reporting Trials 2010 Statement Checklist was used to assess the methodological quality of each study. Trials without and with heterogeneity were compared by fixed-effects analysis and random-effects analysis, respectively. For each study, odds ratio (OR) and 95%CI and mean differences and 95%CI were calculated for dichotomous and continuous outcomes, respectively. The Power and Sample Size Program software was used to calculate power and sample size. Stability of the results was assessed via sensitivity analysis.
RESULTS A total of 836 patients from eight RCTs were subjected to meta-analysis. TXA treatment compared with the control group significantly reduced postoperative blood loss (95%CI, -20.83 to -7.93 mL, P < 0.0001), hidden blood loss (95%CI, -213.67 to -64.43 mL, P = 0.0003), and total blood loss (95%CI, -332.49 to -23.18 mL, P = 0.02) by weighted mean differences of -14.38, -139.05, and -177.83 mL, respectively. However, no significant difference was observed between groups for analysis of intraoperative blood loss. The meta-analysis also proved that the usage of TXA in ITFs may not significantly increase the incidence of deep venous thrombosis. Allogeneic blood transfusion data showed that significantly fewer patients in the TXA group (42%) required transfusion than the control group (95%CI, 0.36 to 0.69; P < 0.0001).
CONCLUSION In ITF surgery, intravenous administration of TXA reduces the risk of hidden blood loss and the need for allogeneic transfusion, without increasing thrombotic risk.
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Affiliation(s)
- Xin-Die Zhou
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213003, Jiangsu Province, China
| | - Jin Li
- Department of Orthopedic Surgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Guo-Ming Fan
- Department of Orthopedic Surgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Yong Huang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213003, Jiangsu Province, China
| | - Nan-Wei Xu
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213003, Jiangsu Province, China
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Belangero W, Barla JD, Rienzi Bergalli DH, Olarte Salazar CM, Fernandez DS, Mite Vivar MA, Zylberberg A, Carabelli GS, Kfuri M. Nutrition and Inflammation Influence 1-Year Mortality of Surgically Treated Elderly Intertrochanteric Fractures: A Prospective International Multicenter Case Series. Geriatr Orthop Surg Rehabil 2019; 10:2151459318816982. [PMID: 30719398 PMCID: PMC6348579 DOI: 10.1177/2151459318816982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/19/2018] [Accepted: 11/05/2018] [Indexed: 01/04/2023] Open
Abstract
Introduction: Hip fracture is a common and devastating event in older adults causing increased dependence, comorbidity, and mortality. Since new surgical techniques have not significantly improved the mortality rate, a better understanding of patient risk factors could improve the treatment algorithm and outcomes. This prospective study aimed to document the 1-year survival rate of patients with intertrochanteric fracture treated surgically in Latin America and to investigate risk factors associated with 1-year mortality. Patients and Methods: Between January 2013 and March 2015, 199 patients were prospectively enrolled. Inclusion criteria were aged 60 years or older, isolated intertrochanteric fracture (AO/OTA 31-A), and time to surgery within 10 days after injury. The follow-up period was 1 year. The association between mortality and patient demographics, comorbidity, surgical details, and preoperative laboratory parameters was assessed using log-rank tests. Results: Twenty patients died by 365 days after surgery (including 5 that died within 30 days of surgery) resulting in a 1-year survival rate of 89.8% (95% confidence interval = 84.6-93.3). The 1-year mortality was significantly associated with age (≥85 years old, P = .032), existing comorbidity (P = .002), preinjury mobility level (P = .026), mental state (Mini-Mental State Examination > 23, P = .040), low preoperative plasma albumin level (P = .007), and high preoperative blood C-reactive protein level (CRP; P = .012). At the 1-year follow-up, patients on average did not regain their preinjury hip function and mobility, although the self-assessed quality of life was equal or better than before the injury. Discussion: As a prospective study, the current patient population had clear inclusion and exclusion criteria and was relatively homogeneous. The resulting associations between 1-year postoperative mortality and preoperative hypoalbuminemia and preoperative elevated CRP level are therefore especially notable. Previously identified risk factors such as male gender and time to surgery showed no significant association with 1-year mortality—the overall favorable condition of the current population or the lack of statistical power maybe responsible for this observation. Conclusion: The current results showed that under the condition of optimal surgical treatment and low surgery-related complication, preinjury health status as indicated by the blood level of albumin and CRP has a direct and significant impact on 1-year mortality rate.
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Affiliation(s)
- William Belangero
- Department of Orthopaedics and Traumatology, Hospital das Clinicas da UNICAMP Campinas, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | - Maurício Kfuri
- Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA
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Yin P, Lv H, Li Y, Meng Y, Zhang L, Zhang L, Tang P. Hip fracture patients who experience a greater fluctuation in RDW during hospital course are at heightened risk for all-cause mortality: a prospective study with 2-year follow-up. Osteoporos Int 2018; 29:1559-1567. [PMID: 29656346 DOI: 10.1007/s00198-018-4516-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/28/2018] [Indexed: 12/24/2022]
Abstract
UNLABELLED This study aims to detect whether there remains valuable prognostic information in fluctuation of red cell distribution width (RDW) in hip fracture patients. Results show that this readily available parameter may provide a more effective strategy for assessment of mortality risk, therefore providing a reference for clinical planning and decision-making. INTRODUCTION Prognostic values have been found in the fluctuation of some hematologic parameters. The red cell distribution width (RDW) routinely reported with all complete blood cell counts (CBC) has proven to be associated with poor outcomes in various diseases. However, whether the fluctuation in RDW is predictive of long-term mortality in hip fracture patients treated with surgery remains unknown. METHODS One thousand three hundred thirty hip fracture patients who underwent surgery from January 1, 2000 to November 18, 2012 were recruited in this prospective cohort study. Fluctuation in the RDW between admission and discharge was measured, and a Kaplan-Meier (KM) analysis and multivariable Cox regression model were applied to evaluate the relationship between this fluctuation and mortality. Risk factors for a larger fluctuation were detected by using Logistic regression analyses. RESULTS In addition to the admission RDW, a high RDW level at the time of discharge was also associated with an increased risk of death, while no significant difference was found in the postoperative RDW. Fluctuation in the RDW between admission and discharge was an independent risk predictor for 2-year mortality (HR 1.45 95%CI 1.06-2.00, p = 0.022). Factors affecting the change in the RDW between admission and discharge included both the demographic characteristics of the patients and clinical interventions. CONCLUSION Hip fracture patients who experience a greater fluctuation in RDW during the hospital course are at a heightened risk for 2-year all-cause mortality.
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Affiliation(s)
- P Yin
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - H Lv
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Y Li
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Y Meng
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - L Zhang
- Department of Clinical Laboratory, Chinese PLA General Hospital, Beijing, 100853, China
| | - L Zhang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - P Tang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
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Abdullah HR, Sim YE, Hao Y, Lin GY, Liew GHC, Lamoureux EL, Tan MH. Association between preoperative anaemia with length of hospital stay among patients undergoing primary total knee arthroplasty in Singapore: a single-centre retrospective study. BMJ Open 2017; 7:e016403. [PMID: 28600378 PMCID: PMC5726141 DOI: 10.1136/bmjopen-2017-016403] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Studies in western healthcare settings suggest that preoperative anaemia is associated with poor outcomes after elective orthopaedic surgery. We investigated the prevalence of preoperative anaemia among patients with primary unilateral total knee arthroplasty (TKA) in Singapore and its association with length of hospital stay (LOS), perioperative blood transfusion and hospital readmission rates. METHODS Retrospective cohort study performed in a tertiary academic medical centre in Singapore, involving patients who underwent primary unilateral TKA between January 2013 and June 2014. Demographics, comorbidities, preoperative haemoglobin (Hb) level, LOS and 30-day readmission data were collected. Anaemia was classified according to WHO definition. Prolonged LOS was defined as more than 6 days, which corresponds to >75th centile LOS of the data. RESULTS We analysed 2394 patients. The prevalence of anaemia was 23.7%. 403 patients (16.8%) had mild anaemia and 164 patients (6.8%) had moderate to severe anaemia. Overall mean LOS was 5.4±4.8 days. Based on multivariate logistic regression, preoperative anaemia significantly increased LOS (mild anaemia, adjusted OR (aOR) 1.71, p<0.001; moderate/severe anaemia, aOR 2.29, p<0.001). Similar effects were seen when preoperative anaemia was defined by Hb level below 13 g/dL, regardless of gender. Transfusion proportionately increased prolonged LOS (1 unit: aOR 2.12, p=0.006; 2 or more units: aOR 6.71, p<0.001). Repeat operation during hospital stay, previous cerebrovascular accidents, general anaesthesia and age >70 years were associated with prolonged LOS. Our 30-day related readmission rate was 1.7% (42) cases. CONCLUSION Anaemia is common among patients undergoing elective TKA in Singapore and is independently associated with prolonged LOS and increased perioperative blood transfusion. We suggest measures to correct anaemia prior to surgery, including the use of non-gender-based Hb cut-off for establishing diagnosis.
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Affiliation(s)
| | - Yilin Eileen Sim
- Department of Anesthesiology, Singapore General Hospital, Singapore
| | - Ying Hao
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - Geng Yu Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - Mann Hong Tan
- Department of Orthopaedics, Singapore General Hospital, Singapore
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