1
|
Wang W, Yao W, Tang W, Li Y, Sun H, Ding W. Risk factors for urinary tract infection in geriatric hip fracture patients: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1360058. [PMID: 38405191 PMCID: PMC10884186 DOI: 10.3389/fmed.2024.1360058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
Background Urinary tract infection (UTI) is a prevalent and consequential complication in hip fracture patients, leading to significant disability and heightened healthcare expenditures. Consequently, there is a critical need for a comprehensive systematic review to identify risk factors and establish early and effective preventive measures. Methods A comprehensive search was performed across the PubMed, Cochrane, Embase, Web of Science, and Scopus databases (up to August 31, 2023). Article screening, data extraction, and quality assessment were independently completed by two reviewers. Results Forty-four studies were eligible for inclusion, yielding an overall incidence rate of 11% (95% CI: 8%-14%). Our pooled analysis revealed 18 significant risk factors, including being female (OR = 2.23, 95% CI: 1.89-2.63), advanced age (MD = 1.35, 95% CI: 0.04-2.66), obesity (OR = 1.21, 95% CI: 1.11-1.31), catheterization (OR = 3.8, 95% CI: 2.29-6.32), blood transfusion (OR = 1.39, 95% CI: 1.21-1.58), American Society of Anesthesiologists ≥III (OR = 1.28, 95% CI: 1.18-1.40), general anesthesia (OR = 1.26, 95% CI: 1.11-1.43), intertrochanteric fracture (OR = 1.25, 95% CI: 1.01-1.54), hemiarthroplasty (OR = 1.43, 95% CI: 1.19-1.69), prolonged length of hospital stay (MD = 1.44, 95% CI: 0.66-2.23), delirium (OR = 2.66, 95% CI: 2.05-3.47), dementia (OR = 1.82, 95% CI: 1.62-2.06), Parkinson's disease (OR = 1.53, 95% CI: 1.46-1.61), diabetes (OR = 1.27, 95% CI: 1.13-1.43), hypertension (OR = 1.14, 95% CI: 1.03-1.26), congestive heart failure (OR = 1.35, 95% CI: 1.10-1.66), history of sepsis (OR = 7.13, 95% CI: 5.51-9.22), and chronic steroid use (OR = 1.29, 95% CI: 1.06-1.57). Conclusion Our study identifies numerous risk factors strongly associated with UTI, offering compelling evidence and actionable strategies for improving clinical prediction, enabling early intervention, and facilitating targeted UTI management. Systematic review registration identifier [CRD42023459600], https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=459600.
Collapse
Affiliation(s)
| | | | | | | | - Hongbo Sun
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| |
Collapse
|
2
|
Shen L, Fu T, Huang L, Sun H, Wang Y, Sun L, Lu X, Zhang J, Yang Z, Ni C. 7295 elderly hospitalized patients with catheter-associated urinary tract infection: a case-control study. BMC Infect Dis 2023; 23:825. [PMID: 38001413 PMCID: PMC10668367 DOI: 10.1186/s12879-023-08711-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Catheter-associated urinary tract infection (CAUTI) ranks second among nosocomial infections in elderly patients after lung infections. Improper treatment can lead to death. This study analysed the risk factors, pathogen distribution, clinical characteristics and outcomes of CAUTI in elderly inpatients with a large sample size to provide evidence for clinical prevention and control. METHODS Based on the HIS and LIS, a case‒control study was conducted on all hospitalized patients with indwelling urinary catheters ≥ 60 years old from January 1, 2019, to December 31, 2022, and the patients were divided into the CAUTI group and the non-CAUTI group. RESULTS CAUTI occurred in 182 of 7295 patients, and the infection rate was 3.4/per 1000 catheter days. Urine pH ≥ 6.5, moderate dependence or severe dependence in the classification of self-care ability, age ≥ 74 years, male sex, hospitalization ≥ 14 days, indwelling urinary catheter ≥ 10 days, diabetes and malnutrition were independent risk factors for CAUTI (P < 0.05). A total of 276 strains of pathogenic bacteria were detected in urine samples of 182 CAUTI patients at different times during hospitalization. The main pathogens were gram-negative bacteria (n = 132, 47.83%), followed by gram-positive bacteria (n = 91, 32.97%) and fungi (n = 53, 19.20%). Fever, abnormal procalcitonin, positive urinary nitrite and abnormal urination function were the clinical characteristics of elderly CAUTI patients (P < 0.001). Once CAUTI occurred in elderly patients, the hospitalization days were increased by 18 days, the total hospitalization cost increased by ¥18,000, and discharge all-cause mortality increased by 2.314 times (P<0.001). CONCLUSION The situation of CAUTI in the elderly is not optimistic, it is easy to have a one-person multi-pathogen infection, and the proportion of fungi infection is not low. Urine pH ≥ 6.5, moderate or severe dependence on others and malnutrition were rare risk factors for elderly CAUTI in previous studies. Our study analysed the clinical characteristics of CAUTI in the elderly through a large sample size, which provided a reliable basis for its diagnosis and identified the adverse outcome of CAUTI.
Collapse
Affiliation(s)
- Li Shen
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
- Department of Nursing, Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Ting Fu
- Department of Military Prevention Medicine, Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Luguang Huang
- Department of information, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Huiying Sun
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Yu Wang
- Neurosurgical ICU, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Lili Sun
- Neurological ICU, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Xiaoyun Lu
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Jing Zhang
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Zhaoxu Yang
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China.
| | - Chunping Ni
- Department of Nursing, Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China.
| |
Collapse
|
3
|
Yao W, Tang W, Wang W, Lv Q, Ding W. Correlation between admission hypoalbuminemia and postoperative urinary tract infections in elderly hip fracture patients. J Orthop Surg Res 2023; 18:774. [PMID: 37838687 PMCID: PMC10576304 DOI: 10.1186/s13018-023-04274-7] [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: 08/17/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023] Open
Abstract
PURPOSE This study aimed to evaluate the correlation between hypoalbuminemia upon admission and the incidence of postoperative urinary tract infections (UTIs) in elderly patients with hip fractures. METHODS A retrospective analysis was performed on the medical records of elderly patients who underwent surgical treatment for hip fractures at a level I trauma center from 2013 to 2023. Serum albumin levels were measured upon admission, and hypoalbuminemia was defined as a total albumin level < 35 g/L. Multivariable logistic regression and propensity score matching analysis were utilized to control and reduce potential confounding factors, aiming to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CI) for UTIs to determine the strength of the association. RESULTS This observational cohort study included 1279 patients, among whom 298 (23.3%) developed UTIs. Patients with albumin levels < 35 g/L had significantly greater odds of developing UTIs compared to those with albumin levels ≥ 35 g/L (OR 1.86, 95% CI 1.28-2.70). Further analysis, dividing albumin levels into quartiles, demonstrated that patients in the Q2 group (38.0-40.9 g/L; OR 1.38, 95% CI 0.88-2.17), Q3 group (35.0-37.9 g/L; OR 1.69, 95% CI 1.06-2.71), and Q4 group (15.3-34.9 g/L; OR 2.67, 95% CI 1.61-4.43) had notably higher odds of developing UTIs compared to those in the Q1 group (41.0-52.0 g/L). CONCLUSIONS The presence of hypoalbuminemia upon admission in elderly patients undergoing hip fracture surgery is strongly correlated with the occurrence of postoperative UTIs. Furthermore, this association exhibits a clear dose-response relationship.
Collapse
Affiliation(s)
- Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, People's Republic of China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China.
| |
Collapse
|
4
|
Shi H, Gao Y, Zhao W, Wang H, Wu X, Wang F, Yang X, Li J. Development of a prediction model for postoperative complications and economic burden analysis in older patients with hip fractures. Heliyon 2023; 9:e20342. [PMID: 37780772 PMCID: PMC10539933 DOI: 10.1016/j.heliyon.2023.e20342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023] Open
Abstract
Purpose The high rates of disability and mortality due to postoperative complications of hip fractures in the elderly, especially the oldest-old individuals, have become an increasingly serious global public health concern. This study aimed to establish a nomogram prediction model and analyze the economic burden to guide clinical decision-making and improve patient prognosis. Methods Data of 514 patients aged over 80 years with hip fractures who received surgical treatment were retrospectively collected, and the patients were divided into training and validation cohorts. Independent risk factors for postoperative complications were identified based on logistic regression analysis, and a nomogram was constructed. The model was evaluated for its discrimination and consistency using receiver operating characteristic (ROC) curves and calibration curves, and for its clinical benefit using decision curve analysis (DCA). The economic burden was analyzed using propensity score matching (PSM). Results The American Society of Anesthesiologists (ASA) classification ≥Ⅲ, anemia, male sex, diabetes mellitus, and the number of comorbidities were found to be independent risk factors for postoperative complications in oldest-old patients with hip fracture (all P < 0.05). The areas under the curve (AUC) of the nomogram prediction model for the training and validation cohorts were 0.743 and 0.767, respectively, indicating reliable discrimination. The calibration curves and DCA showed that the model has good consistency and high benefits. The direct economic burden of postoperative complications for the patients was US$1045.10. Conclusions The nomogram model can accurately quantify the risk of postoperative complications among oldest-old patients with hip fractures and guide clinical professionals to implement early and targeted preventive treatment for high-risk patients.
Collapse
Affiliation(s)
- Haoning Shi
- School of Nursing, Weifang Medical University, Weifang 261053, Shandong Province, PR China
| | - Ying Gao
- School of Nursing, Weifang Medical University, Weifang 261053, Shandong Province, PR China
- Linyi People's Hospital, Linyi 276034, Shandong Province, PR China
| | - Wanying Zhao
- School of Public Health, Weifang Medical University, Weifang 261053, Shandong Province, PR China
| | - Hongyu Wang
- School of Public Health, Weifang Medical University, Weifang 261053, Shandong Province, PR China
| | - Xueqian Wu
- School of Public Health, Weifang Medical University, Weifang 261053, Shandong Province, PR China
| | - Fei Wang
- School of Public Health, Weifang Medical University, Weifang 261053, Shandong Province, PR China
| | - Xiao Yang
- School of Nursing, Weifang Medical University, Weifang 261053, Shandong Province, PR China
| | - Jing Li
- School of Public Health, Weifang Medical University, Weifang 261053, Shandong Province, PR China
| |
Collapse
|
5
|
Yao W, Tang W, Wang W, Lv Q, Ding W. The relationship between admission hyperglycaemia and urinary tract infections in geriatric patients with hip fractures. INTERNATIONAL ORTHOPAEDICS 2023; 47:2591-2600. [PMID: 37436524 DOI: 10.1007/s00264-023-05882-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE This study investigated the association of admission hyperglycaemia with catheter-associated urinary tract infections (CAUTIs) and catheter-unassociated urinary tract infections (CUUTIs) in elderly patients with hip fractures. METHODS In an observational cohort study of elderly patients with hip fractures, glucose values were collected within 24 h of admission. Urinary tract infections were classified as CAUTIs and CUUTIs. Multivariate logistic regression analysis and propensity score matching obtained adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for urinary tract infections. Subgroup analyses were further explored to investigate the relationship between admission hyperglycemia and urinary tract infections. RESULTS The study included 1279 elderly patients with hip fractures, 298 (23.3%) of whom had urinary tract infections upon hospitalization (including 182 CAUTIs and 116 CUUTIs). Propensity score matching indicated that patients with glucose levels exceeding 10.00 mmol/L had significantly higher odds of developing CAUTIs (OR 3.10, 95% CI 1.65-5.82) than those with glucose levels between 4.00-6.09 mmol/L. It is worth noting that patients with blood glucose levels greater than 10.00 mmol/L have a higher susceptibility for CUUTIs (OR 4.42, 95% CI 2.09-9.33) than CAUTIs. The subgroup analyses observed significant interactions between diabetes and CAUTIs (p for interaction = 0.01) and between bedridden time and CUUTIs (p for interaction = 0.04). CONCLUSIONS Elderly hip fracture patients with admission hyperglycaemia have an independent association with CAUTIs and CUUTIs. The association is stronger with CUUTIs and necessitates clinician intervention if blood glucose levels at admission exceed 10 mmol/L.
Collapse
Affiliation(s)
- Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, 118002, Dandong, Liaoning Province, China
| | - Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, 118002, Dandong, Liaoning Province, China
| | - Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, 118002, Dandong, Liaoning Province, China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, 118002, Dandong, Liaoning Province, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, 118002, Dandong, Liaoning Province, China.
| |
Collapse
|
6
|
Frödin M, Ahlstrom L, Gillespie BM, Rogmark C, Nellgård B, Wikström E, Erichsen Andersson A. Effectiveness of implementing a preventive urinary catheter care bundle in hip fracture patients. J Infect Prev 2022; 23:41-48. [PMID: 35340925 PMCID: PMC8941588 DOI: 10.1177/17571774211060417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background Urinary catheter (UC)–associated infections are one of the most common
preventable healthcare-associated infections (HAIs) and they frequently
occur in older, frail populations. Aim The study aim was to describe the incidence of UC-associated infection in
elderly patients undergoing hip fracture surgery after implementing a
preventive care bundle. Methods A longitudinal prospective study using a before-and-after design. The bundle
was theory driven and involved the co-creation of a standard operational
procedure, education and practical training sessions. Prospectively
collected registry data were analysed. Univariable statistics and
multivariable logistic regressions were used for analyses. Results 2,408 patients with an acute hip fracture were included into the study. There
was an overall reduction in UC catheter associated-associated urinary tract
infections, from 18.5% (n = 75/406) over time to 4.2%
(n = 27/647). When adjusting for all identified
confounders, patients in phase 4 were 74% less likely to contract an
UC-associated infection (OR, 0.26; 95% CI, 0.15–0.45, p
< 0.0001). Discussion Bundled interventions can reduce UC-associated infections substantially, even
in elderly frail patients. Partnership and co-creation as implementation
strategies appear to be promising in the fight against HAI.
Collapse
Affiliation(s)
- Maria Frödin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linda Ahlstrom
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Brigid M. Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia
- Gold Coast University Hospital and Health Service, Southport, QLD, Australia
| | - Cecilia Rogmark
- Department of Orthopedics, Skane University Hospital, Lund University, Malmö, Sweden
- Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Sweden
| | - Annette Erichsen Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
7
|
Deng Y, Zheng Z, Cheng S, Lin Y, Wang D, Yin P, Mao Z, Tang P. The factors associated with nosocomial infection in elderly hip fracture patients: gender, age, and comorbidity. INTERNATIONAL ORTHOPAEDICS 2021; 45:3201-3209. [PMID: 34350473 DOI: 10.1007/s00264-021-05104-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/26/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This is a retrospective case-control study to ascertain the factors influencing nosocomial infection (NI) in elderly patients with hip fractures. METHODS A total of 80,174 patients (≥ 60 years) who suffered hip fractures between 2006 and 2017 were identified through a national inquiry of 94 hospitals. The patients were divided into an NI group and control group according to the occurrence or lack of occurrence of NI within 48 hours after surgery, respectively. Age, gender, hip fracture pattern, whether to operate, surgical treatments, and comorbidities were recorded as variables. RESULTS A total of 9806 elderly hip fracture patients (60 years) were included, 1977 of whom were patients diagnosed with NI. The control group consisted of randomly drawn cases from the 9806 patients from different hospitals with a rate of one NI patient: four patients without NI. Patient gender, age, and in particular the number of comorbidities were associated with occurrence of NI. Using regression models to predict infection outcomes based on the number of comorbidities had an area under the curve (AUC) of 0.714, while using the Charlson comorbidity index (CCI) yielded a smaller value of 0.694. The most common comorbidities of this elderly cohort were chronic respiratory disease, hypertension, diabetes mellitus, cerebrovascular disease, and coronary heart disease. CONCLUSIONS Older age, male gender, and greater number of comorbidities were found to be associated with the occurrence of NI. In particular, the number of comorbidities was the most accurate predictor of NI occurrence, and when used to build a regression model, it had greater predictive capability than CCI to predict NI in elderly hip fracture patients. Additionally, the common diseases of the elderly should be primarily considered when investigating the relationship between comorbidities and NI in older patients.
Collapse
Affiliation(s)
- Yuan Deng
- Department of Orthopedics, Fourth Medical Center, General Hospital of Chinese PLA, Beijing, 100000, China
| | - Zhong Zheng
- Information Center of Logistics Support Department of Central Military Commission, Beijing, 100000, China
| | - Shi Cheng
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150010, China
| | - Yuan Lin
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150010, China
| | - Duanyang Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150010, China
| | - Pengbin Yin
- Department of Orthopedics, Fourth Medical Center, General Hospital of Chinese PLA, Beijing, 100000, China
| | - Zhi Mao
- Department of Critical Care Medicine, First Medical Center, General Hospital of Chinese PLA, Beijing, 100000, China.
| | - Peifu Tang
- Department of Orthopedics, Fourth Medical Center, General Hospital of Chinese PLA, Beijing, 100000, China.
| |
Collapse
|
8
|
Wiedl A, Förch S, Fenwick A, Mayr E. Incidence, Risk-Factors and Associated Mortality of Complications in Orthogeriatric Co-Managed Inpatients. Geriatr Orthop Surg Rehabil 2021; 12:2151459321998314. [PMID: 33786204 PMCID: PMC7961710 DOI: 10.1177/2151459321998314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/05/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction: Pneumonia, thromboembolic and ischemic events, urinary tract infections (UTI), delirium and acute kidney injury (AKI) are common complications during the treatment of fragility fractures. In a 2 years-follow-up we determined the according incidence and risk factors of these and other complications in orthogeriatric inward patients, as well as the respective associated mortality. Methods: All patients treated on an orthogeriatric co-managed ward over the course of a year were included. Besides injury, therapy and geriatric assessment parameters, we evaluated the inward incidence of common complications. In a 2 years-follow-up the associated death rates were aquired. SPSS (IBM) was used to determine the importance of risk factors predisposing to the respective occurrence of a complication and accordingly determine it’s impact on the patients’ 1- and 2-years-mortality. Results: 830 orthogeriatric patients were initially assessed with a remaining follow-up cohort of 661 (79.6%). We observed very few cases of thrombosis (0.6%), pulmonary embolism (0.5%), apoplex (0.5%) and myocardial infarction (0.8%). Pneumonia was seen in 42 (5.1%), UTI in 85 (10.2%), delirium in 186 (22.4%) and AKI in 91 (11.0%) patients. Consistently ADL on admission was found to be a relevant risk factor in the development of each complication. After adjustment only AKI showed a significant increased mortality risk of 1.60 (95%CI:1.086-2.350). Discussion: In our fracture-independent assessment of complications in the orthogeriatric treatment of inward patients we’ve seen very rare cases of cardiac and thrombotic complications. Typical fragility-fracture associated common events like pneumonia, UTI, delirium and AKI were still more incidental. No complication except AKI was associated to significant increased mortality risk. Conclusions: The relevance of orthogeriatric care in prevention and outcome of inward complications seems promising, needing still more controlled studies, evaluating not just hip fracture patients but more diverse groups. Consensus is needed in the scholar evaluation of orthogeriatric complications.
Collapse
Affiliation(s)
- Andreas Wiedl
- Universitätsklinikum Augsburg, Abteilung für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Augsburg, Germany
| | - Stefan Förch
- Universitätsklinikum Augsburg, Abteilung für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Augsburg, Germany
| | - Annabel Fenwick
- Universitätsklinikum Augsburg, Abteilung für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Augsburg, Germany
| | - Edgar Mayr
- Universitätsklinikum Augsburg, Abteilung für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Augsburg, Germany
| |
Collapse
|
9
|
Rønfeldt I, Larsen LK, Pedersen PU. Urinary tract infection in patients with hip fracture. Int J Orthop Trauma Nurs 2021; 41:100851. [PMID: 33798910 DOI: 10.1016/j.ijotn.2021.100851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/11/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Urinary tract infection (UTI) is a frequent complication of hip fractures. The Danish national clinical guideline for hip fracture recommends early and systematic mobilisation after surgery and that indwelling catheters are not used perioperatively. AIMS The aim of this study was to describe the number of patients who received nursing care to prevent UTIs in accordance with the recommendations from the national Danish clinical guidelines. Specifically, the aim was to report the number of patients developing UTIs during admission, have indwelling catheters removed and being mobilised with 24 hours after surgery. METHODS This prospective study included 65 patients. Data were collected on mobilisation and catheter use with a chart designed for this study. Sterile intermittent catheterisation was used to collect urine samples on admission and at discharge. Urine samples were sent for analysis at the microbiology laboratory. The urine sample was positive for UTI if the test showed 104 CFU/ml bacteria. RESULTS A total of five patients contracted nosocomial UTI during their hospital stay (7.7%), while 29.2% of patients had a positive urine culture on admission and were treated for UTI. At discharge, 20% of the patients had a positive urine sample but no symptoms. Postoperatively, 52.3% of the patients were mobilised within 24 hours. CONCLUSION The incidence of nosocomial UTI was similar to what has been found in other studies (95% [CI], 0.03-0.17]). The percentage of patients with nosocomial UTI was 7.7%. Nursing care related to hygienic performance of catheterisation or intermittent catheterisation adhered to the Danish national clinical guidelines, and 52.3% of the patients were mobilised within 24 h after surgery, which showed low adherence to the guidelines.
Collapse
Affiliation(s)
- Ingerlise Rønfeldt
- Master of Science in Clinical Science and Technology, Aalborg University Hospital, Orthopedic Division, Clinic Farsoe, Denmark.
| | - Lis Kjær Larsen
- Master of Clinical Nursing, Aalborg University Hospital, Orthopedic Division, Clinic Hjoerring, Denmark
| | | |
Collapse
|
10
|
The incidence of severe urinary tract infection increases after hip fracture in the elderly: a nationwide cohort study. Sci Rep 2021; 11:3374. [PMID: 33564108 PMCID: PMC7873271 DOI: 10.1038/s41598-021-83091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/21/2021] [Indexed: 01/26/2023] Open
Abstract
Although urinary tract infection (UTI) is a common perioperative complication among elderly patients with hip fracture, its incidence and effects are often underestimated. This study investigated the effects of severe UTI (S-UTI) on elderly patients with hip fracture and the risk factors for this condition. In this retrospective nationwide cohort study, we searched Taiwan's National Health Insurance Research Database from 2000 to 2012 for data on patients aged ≥ 50 years with hip fracture who underwent open reduction and internal fixation or hemiarthroplasty for comparison with healthy controls (i.e. individuals without hip fracture). The study and comparison cohorts were matched for age, sex, and index year at a 1:4 ratio. The incidence and hazard ratios of age, sex, and multiple comorbidities associated with S-UTI were calculated using Cox proportional hazard regression models. Among the 5774 and 23,096 patients in the study and comparison cohorts, the overall incidence of S-UTI per 100 person-years was 8.5 and 5.3, respectively. The risk of S-UTI was cumulative over time and higher in the study cohort than in the comparison cohort, particularly in those who were older, were female, or had comorbidities of cerebrovascular accident or chronic renal failure.
Collapse
|
11
|
Pull the Foley: Improved Quality for Middle-Aged and Geriatric Trauma Patients Without Indwelling Catheters. J Healthc Qual 2020; 42:341-351. [PMID: 33149051 DOI: 10.1097/jhq.0000000000000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Urinary tract infection (UTI) complications are often attributed to the inappropriate use of urinary catheters. PURPOSE We sought to examine the effectiveness of a hospital-wide policy aimed at reducing the use of indwelling Foley catheters. METHODS We completed a retrospective review of prospectively collected data on 577 hip and femur fracture patients aged 55 years and older who were operatively treated at a Level 1 trauma center between October 2014 and March 2019. New standard-of-care guidelines restricting the use of indwelling Foley catheters were implemented starting January 2018, and we compared perioperative outcomes between cohorts. RESULTS Over a 50% absolute reduction in indwelling Foley catheter use and a near 30% relative reduction in hospital-acquired UTI were achieved. Postpolicy cohort patients without indwelling Foley catheters experienced lower odds of hospital-acquired UTI, higher odds of home discharge, as well as decreased time to surgery, shorter length of stay, and lower total inpatient cost compared with those with indwelling Foley catheters. CONCLUSIONS The policy of restricting indwelling Foley catheter placement was safe and effective. A decrease in indwelling Foley catheter use led to a decrease in the rate of hospital-acquired UTI and positively affected other perioperative outcomes.
Collapse
|
12
|
Delgado A, Cordero G-G E, Marcos S, Cordero-Ampuero J. Influence of cognitive impairment on mortality, complications and functional outcome after hip fracture: Dementia as a risk factor for sepsis and urinary infection. Injury 2020; 51 Suppl 1:S19-S24. [PMID: 32067771 DOI: 10.1016/j.injury.2020.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/08/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the relation between cognitive impairment on arrival at hospital in patients older than 65 years with a hip fracture, and their mortality, medical and surgical complications, and functional outcomes. PATIENTS AND METHODS Observational study of a single-center prospective consecutive cohort of 955 patients older than 64 years diagnosed of hip fracture from December/2012 to December/2015. Average age was 86±7.2 (65-104) years and 725 (75.9%) were female. Fractures were extracapsular in 538 cases (56.3%) and intracapsular in 417 (43.7%). Patients were controlled clinically and radiographically in outpatient clinic after 1, 3, 6, and 12 months. Data about basal cognitive status, walking ability before the fracture, medical and surgical complications, functional outcomes and mortality were collected for the year following the fracture. STATISTICAL ANALYSIS Bivariate analysis (Pearson, Fisher, Mann-Whitney, Wilcoxon) was applied to study statistically significant relations, and contingence coefficients (CC) were calculated. RESULTS Patients with cognitive impairment showed a higher overall mortality, (p = 0,000; CC=0,197) even after hospital discharge (p = 0.000; CC=0.198). Similarly, patients with dementia presented a higher rate of respiratory infections (p = 0,029; CC=0,093), urinary tract infections (p = 0,008; CC=0,108) and sepsis (p = 0,011; CC=0,105). On the contrary, we found no correlations between mental status and surgical complications, even for prosthesis dislocation (p = 0.136). Patients with dementia started from poorer functional situations (p = 0,000; CC=0,367) and ended follow-up with lower walking ability (p = 0,000; CC=0,43), but cognitive impairment did not relate statistically with a worse functional recovery (p = 0,304): that is, the proportion of patients who maintained their previous ability to walk was similar in both groups, those with altered mental status and those without it. CONCLUSIONS Cognitive impairment is a risk factor for mortality in patients with a hip fracture. It is also a risk factor for suffering respiratory and urinary tract infection and sepsis. These two late risks factors have not been published previously. Functional recovery is not conditioned by cognitive impairment, although further studies need to be developed to evaluate the actual role of cognitive impairment on postoperative progression of patients.
Collapse
Affiliation(s)
- A Delgado
- Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain
| | - E Cordero G-G
- Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain
| | - S Marcos
- Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain
| | - J Cordero-Ampuero
- Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain.
| |
Collapse
|
13
|
Velez M, Palacios-Barahona U, Paredes-Laverde M, Ramos-Castaneda JA. Factors associated with mortality due to trochanteric fracture. A cross-sectional study. Orthop Traumatol Surg Res 2020; 106:135-139. [PMID: 31926842 DOI: 10.1016/j.otsr.2019.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/12/2019] [Accepted: 06/11/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore factors associated with mortality in patients with trochanteric fracture. METHODS A cross-sectional study was performed in patients with trochanteric fracture treated at Clinica Las Vegas, in Medellín, Colombia, during the period going from January 2008 to December 2015. Information was collected on demographic, clinical variables, surgical complications and mortality. Telephone follow-up was performed up to 6months postoperatively. An exploratory analysis to identify possible factors associated with mortality was conducted. The Chi2 test was used; the strength of the association was assessed through odds ratio (OR) and its respective confidence interval (CI) of 95%. RESULTS A total of 275 patients diagnosed with trochanteric fracture were included; 16.0% of patients died within 6months following surgery. We found a higher risk of death in patients with surgery after 48hours OR 2.3 (95% CI: 1.0-5.1); acute renal failure featuring OR: 3.4 (95% CI: 1.3-8.8); patients who received blood transfusions in the intraoperative featuring OR: 4.4 (95% CI: 1.7-11.8); with urinary tract infection in the postoperative 7.1 (2.1-24.5); and patients with surgical site infection featuring OR: 5.6 (95% CI: 1.1-28.5). CONCLUSIONS Trochanteric fracture mortality is associated with acute renal failure, blood transfusion, urinary tract infection and patients with surgical site infection.
Collapse
Affiliation(s)
| | | | - Marcela Paredes-Laverde
- Grupo de Investigación Navarra Medicina, Facultad de Ciencias de la Salud, Fundación Universitaria Navarra - UNINAVARRA, Calle 10 No. 6-41, Neiva, Colombia
| | - Jorge A Ramos-Castaneda
- CINA Research Center, School of Health Sciences, Fundación Universitaria Navarra - UNINAVARRA, Neiva, Colombia; Grupo de Epidemiología y Salud Pública Surcolombiana, Universidad Surcolombiana, Neiva, Colombia.
| |
Collapse
|
14
|
Tian W, Wu J, Tong T, Zhang L, Zhou A, Hu N, Huang W, Zhou B. Diabetes and Risk of Post-Fragility Hip Fracture Outcomes in Elderly Patients. Int J Endocrinol 2020; 2020:8146196. [PMID: 32351563 PMCID: PMC7178518 DOI: 10.1155/2020/8146196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 02/25/2020] [Accepted: 03/17/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To explore the effect of diabetes on short-term (30 days after fracture) and 1-year outcomes for fragility hip fracture patients. METHODS We conducted a retrospective cohort study involving 161 diabetic hip fracture patients (older than 60 years) and 483 nondiabetic hip fracture patients. Patients were followed up on day 30 and 1 year after fracture. The short-term outcome was complications that occurred within 30 days after hip fracture and length of stay. The 1-year outcomes were postfracture functional outcomes and reduced activity level and mortality rate within 1 year after fracture. The clinical characteristics and outcomes of patients were analyzed. RESULTS Compared with nondiabetic patients, diabetic patients had a longer length of awaiting surgery (6.0 vs. 5.0 days, P=0.031) and a longer length of total hospital stay (17 vs. 15 days, P < 0.001). Furthermore, compared with nondiabetic patients, diabetic patients have higher costs (P=0.011), in addition to being more prone to developing urinary tract infections (6.2% vs. 1.7%, P=0.002) and deep vein thrombosis (4.3% vs. 1.4%, P=0.029) complications. However, at one-year follow-up, no differences in recovery of function and mortality were observed between the two groups. CONCLUSIONS Diabetic patients are at an increased risk of urinary tract infections and deep vein thrombosis complications but have similar recovery of function and 1-year mortality compared to nondiabetic patients.
Collapse
Affiliation(s)
- Wenqing Tian
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jueli Wu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Tao Tong
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lu Zhang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Aiguo Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ning Hu
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wei Huang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Bo Zhou
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| |
Collapse
|
15
|
Kwak DK, Oh CY, Lim JS, Lee HM, Yoo JH. Would early removal of indwelling catheter effectively prevent urinary retention after hip fracture surgery in elderly patients? J Orthop Surg Res 2019; 14:315. [PMID: 31533760 PMCID: PMC6751611 DOI: 10.1186/s13018-019-1360-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/03/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This study aimed to investigate the incidence and risk factors of postoperative urinary retention (POUR) among elderly patients who underwent hip fracture surgery and to evaluate the effect of indwelling catheterization on the occurrence of POUR. MATERIALS AND METHODS From January 2012 to January 2015, consecutive patients aged over 70 years who underwent hip fracture surgery were enrolled in this study. All patients underwent indwelling catheterization due to voiding difficulty upon admission. Demographic data, perioperative variables, and postoperative duration of patient-controlled analgesia and indwelling catheterization, postoperative complications, and mortality were collected. The incidence of POUR was investigated, and the risk factors related to POUR were analyzed using a logistic regression analysis. The cutoff value for the timing of catheter removal was determined using receiver operating characteristic (ROC) curve analysis. RESULTS POUR developed in 68 patients (31.8%) of the 214 patients. Of these, 24 (35.3%) were male. The indwelling catheter was left in place for an average of 3.4 days (range, 0-7 days) postoperatively. A significant difference was noted in gender and duration of indwelling catheterization between patients with POUR and without. The cutoff value for the timing of catheter removal as determined by ROC curve analysis was 3.5 postoperative day with 51.4% sensitivity and 71.5% specificity. Multiple logistic regression revealed that the duration of the indwelling catheter [odds ratios (OR), 0.31; p = 0.016)] and male gender (OR, 2.22; p = 0.014) were independent risk factors related to the occurrence of POUR. CONCLUSIONS The significant risk factors of POUR among elderly patients undergoing hip fracture surgery were early indwelling catheter removal and male gender. Therefore, early removal of indwelling catheter in elderly patients following hip fracture surgery may increase the risk of POUR, especially in male patients.
Collapse
Affiliation(s)
- Dae-Kyung Kwak
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 896 Pyeongchon-Dong, Dongan-gu, Anyang, 431-070, South Korea
| | - Chul-Young Oh
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 896 Pyeongchon-Dong, Dongan-gu, Anyang, 431-070, South Korea.,Department of Urology, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, South Korea
| | - Jeong-Seop Lim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 896 Pyeongchon-Dong, Dongan-gu, Anyang, 431-070, South Korea
| | - Hyung-Min Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 896 Pyeongchon-Dong, Dongan-gu, Anyang, 431-070, South Korea
| | - Je-Hyun Yoo
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, 896 Pyeongchon-Dong, Dongan-gu, Anyang, 431-070, South Korea.
| |
Collapse
|
16
|
Mørch SS, Tantholdt-Hansen S, Pedersen NE, Duus CL, Petersen JA, Andersen CØ, Jarløv JO, Meyhoff CS. The association between pre-operative sepsis and 30-day mortality in hip fracture patients-A cohort study. Acta Anaesthesiol Scand 2018; 62:1209-1214. [PMID: 29797710 DOI: 10.1111/aas.13160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/16/2018] [Accepted: 04/30/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Post-operative sepsis considerably increases mortality, but the extent of pre-operative sepsis in hip fracture patients and its consequences are sparsely elucidated. The aim of this study was to assess the association between pre-operative sepsis and 30-day mortality after hip fracture surgery. METHODS We conducted a retrospective analysis of data collected among 1894 patients who underwent hip fracture surgery in the Capital Region of Denmark in 2014 (NCT03201679). Data on vital signs, cultures and laboratory data were obtained. Sepsis was defined as a positive culture of any kind and presence of systemic inflammatory response syndrome within 24 hours and was assessed within 72 hours before surgery and 30 days post-operatively. Primary outcome was 30-day mortality. Secondary outcomes included length of hospital stay and admission to intensive care unit. RESULTS A total of 144 (7.6%) of the hip fracture patients met the criteria for pre-operative sepsis. The 30-day mortality was 13.9% in patients with pre-operative sepsis as compared to 9.0% in those without (OR 1.69, 95% CI [1.00; 2.85], P = .08). Patients with pre-operative sepsis had longer hospital stays (median 10 days vs 9 days, mean difference 2.1 [SD 9.4] days, P = .03), and higher frequency of ICU admission (11.1% vs 2.7%, OR 4.15, 95% CI [2.19; 7.87], P < .0001). CONCLUSION Pre-operative sepsis in hip fracture patients was associated with an increased length of hospital stay and tended to increase mortality. Pre-operative sepsis in hip fracture patients merits more intensive surveillance and increased attention to timely treatment.
Collapse
Affiliation(s)
- S. S. Mørch
- Department of Anaesthesia and Intensive Care; Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
| | - S. Tantholdt-Hansen
- Department of Anaesthesia and Intensive Care; Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
| | - N. E. Pedersen
- Department of Anaesthesia and Intensive Care; Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
- Centre for HR, Capital Region of Denmark; Copenhagen Academy for Medical Education and Simulation; Herlev Denmark
| | - C. L. Duus
- Department of Anaesthesia and Intensive Care; Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
| | - J. A. Petersen
- Department of Day Case Surgery; Amager and Hvidovre Hospital; University of Copenhagen; Copenhagen Denmark
| | - C. Ø. Andersen
- Department of Clinical Microbiology; Amager and Hvidovre Hospital; University of Copenhagen; Copenhagen Denmark
| | - J. O. Jarløv
- Department of Clinical Microbiology; Herlev and Gentofte Hospital; University of Copenhagen; Copenhagen Denmark
| | - C. S. Meyhoff
- Department of Anaesthesia and Intensive Care; Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
| |
Collapse
|
17
|
Edelmuth SVCL, Sorio GN, Sprovieri FAA, Gali JC, Peron SF. Comorbidades, intercorrências clínicas e fatores associados à mortalidade em pacientes idosos internados por fratura de quadril. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
18
|
Comorbidities, clinical intercurrences, and factors associated with mortality in elderly patients admitted for a hip fracture. Rev Bras Ortop 2018; 53:543-551. [PMID: 30245992 PMCID: PMC6148078 DOI: 10.1016/j.rboe.2018.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/26/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To analyze comorbidities and clinical complications, and to determine the factors associated with mortality rates of elderly patients admitted with a hip fracture in a tertiary public hospital. Methods Sixty-seven medical records were reviewed in a retrospective cohort study, including patients equal to or older than 65 years admitted to this institution for hip fracture between January 2014 and December 2014. The evaluated items constituted were the following: interval of time between fracture and hospital admission, time between admission and surgical procedure, comorbidities, clinical complications, type of orthopedic procedure, surgical risk, cardiac risk, and patient outcome. Results The average patients’ age in the sample was 77.6 years, with a predominance of the female gender. Most patients (50.7%) had two or more comorbidities. The main clinical complications during hospitalization included cognitive behavioral disorders, respiratory infection and of the urinary tract. The times between fracture and admission and between admission and surgery were more than seven days in most of cases. The mortality rate during hospitalization was 11.9%, and was directly connected to the presence of infections during hospital stay (p = 0.006), to time between admission and surgery longer than seven days (p = 0.005), to the Goldman Cardiac Risk Index class III (p = 0.008), and to age equal to or greater than 85 years (p = 0.031). Conclusion Patients with hip fractures generally present comorbidities, are susceptible to clinical complications, and have an 11.9% mortality rate.
Collapse
|
19
|
Frenkel Rutenberg T, Daglan E, Heller S, Velkes S. A comparison of treatment setting for elderly patients with hip fracture, is the geriatric ward superior to conventional orthopedic hospitalization? Injury 2017; 48:1584-1588. [PMID: 28465007 DOI: 10.1016/j.injury.2017.04.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hip fractures in the elderly are a major cause of morbidity and mortality. The treatment settings of these patients may change their outcomes. The aim of this study is to compare the outcomes of patients with displaced femoral neck fractures who were admitted to the orthopedic vs. geriatric wards. PATIENTS AND METHODS A retrospective study was conducted on 217 consecutive older patients with 219 displaced femoral neck fractures admitted either to the orthopedic or the geriatric ward between Jan. 2013 and Jun. 2015. Information regarding demographic, medical history, surgical management, hospitalization, and one year readmissions and mortality data was retrieved from electronic charts. RESULTS 102 hemiarthroplasty patients were admitted to the orthopedic ward and 117 to the geriatric ward. Patients' characteristics, including age, living arrangements, mobility status and the Charlson Comorbidity Index were similar between groups. Patients from the orthopedic ward had shorter hospitalization time (9±5.1 vs. 10.8±6.7days, p=0.022) and presented a lower in-hospital complication rates (0.6±0.96 vs. 1±1.9, p=0.022), namely fewer events of urinary retentions, urinary tract infections and pneumonias (8.8% vs. 23.9%, p=0.004, 3.9% vs. 14.5%, p=0.010 and 2.9% vs. 12.2%, p=0.034, respectfully). Readmission rates were similar. Neither in hospital nor one year mortality rates differed between groups. CONCLUSIONS Our study found that geriatric care was not superior to orthopedic directed management in the treatment of elderly patients with hip fractures in terms of in-hospital complications, and hospitalization times.
Collapse
Affiliation(s)
- Tal Frenkel Rutenberg
- Orthopedic Department, Rabin Medical Center, Beilinson Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Efrat Daglan
- Orthopedic Department, Wolfson Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Snir Heller
- Orthopedic Department, Rabin Medical Center, Beilinson Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Steven Velkes
- Orthopedic Department, Rabin Medical Center, Beilinson Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
20
|
Bliemel C, Buecking B, Hack J, Aigner R, Eschbach DA, Ruchholtz S, Oberkircher L. Urinary tract infection in patients with hip fracture: An underestimated event? Geriatr Gerontol Int 2017. [PMID: 28621029 DOI: 10.1111/ggi.13077] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Urinary tract infections (UTI) represent a common perioperative complication among elderly patients with hip fracture. To determine the impact of UTI on the perioperative course of elderly patients with hip fractures, a prospective study was carried out. METHODS A total of 402 surgically-treated geriatric hip fracture patients were consecutively enrolled at a level 1 trauma center. On admission, all patients received an indwelling urinary catheter. Clinically symptomatic patients were screened more closely for UTI. Patients diagnosed with UTI were compared with asymptomatic patients. Outcomes in both patient groups were measured using in-hospital mortality, overall length of hospital stay, wound infection, functional results and mobility at discharge. Multivariate regression analysis was carried out to control for influencing factors. RESULTS A total of 97 patients (24%) sustained a UTI during in-hospital treatment. UTI were independently associated with inferior functional outcomes as assessed by the Barthel Index (β = -0.091; P = 0.031), Timed Up and Go test (β = 0.364; P = 0.001) and Tinetti test (β = -0.169; P = 0.001) at discharge. Additionally, length of hospital stay was significantly longer for patients with a UTI diagnosis (β = 0.123; P = 0.029) after controlling for all other variables. No differences were observed in the rate of wound infection (odds ratio 1.185; P = 0.898) or in-hospital mortality (P < 0.997). CONCLUSIONS Patients with UTI seem to be at risk of inferior functional outcomes. In addition to an early detection of symptomatic UTI and a targeted antibiotic therapy, perioperative care should focus on preserving functional ability to protect these patients from further loss of independence and prolonged clinical courses. Geriatr Gerontol Int 2017; 17: 2369-2376.
Collapse
Affiliation(s)
- Christopher Bliemel
- Center for Orthopedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany
| | - Benjamin Buecking
- Center for Orthopedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany
| | - Juliana Hack
- Center for Orthopedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany
| | - Rene Aigner
- Center for Orthopedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany
| | | | - Steffen Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany
| | - Ludwig Oberkircher
- Center for Orthopedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany
| |
Collapse
|
21
|
Gunnarsson AK, Gunningberg L, Larsson S, Jonsson KB. Cranberry juice concentrate does not significantly decrease the incidence of acquired bacteriuria in female hip fracture patients receiving urine catheter: a double-blind randomized trial. Clin Interv Aging 2017; 12:137-143. [PMID: 28144131 PMCID: PMC5245868 DOI: 10.2147/cia.s113597] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Urinary tract infection (UTI) is a common complication among patients with hip fractures. Receiving an indwelling urinary catheter is a risk factor for developing UTIs. Treatment of symptomatic UTIs with antibiotics is expensive and can result in the development of antimicrobial resistance. Cranberries are thought to prevent UTI. There is no previous research on this potential effect in patients with hip fracture who receive urinary catheters. Aim The aim of this study is to investigate whether intake of cranberry juice concentrate pre-operatively decreases the incidence of postoperative UTIs in hip fracture patients that received a urinary catheter. Design This study employed a randomized, placebo-controlled double-blind trial. Method Female patients, aged 60 years and older, with hip fracture (n=227) were randomized to receive cranberry or placebo capsules daily, from admission, until 5 days postoperatively. Urine cultures were obtained at admission, 5 and 14 days postoperatively. In addition, Euro Qual five Dimensions assessments were performed and patients were screened for UTI symptoms. Result In the intention-to-treat analysis, there was no difference between the groups in the proportion of patients with hospital-acquired postoperative positive urine cultures at any time point. When limiting the analysis to patients that ingested at least 80% of the prescribed capsules, 13 of 33 (39%) in the placebo group and 13 of 47 (28%) in the cranberry group (P=0.270) had a positive urine culture at 5 days postoperatively. However, this difference was not statistically significant (P=0.270). Conclusion Cranberry concentrate does not seem to effectively prevent UTIs in female patients with hip fracture and indwelling urinary catheter.
Collapse
Affiliation(s)
| | - Lena Gunningberg
- Institution of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Sune Larsson
- Institution of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Kenneth B Jonsson
- Institution of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
22
|
Sathiyakumar V, Greenberg SE, Molina CS, Thakore RV, Obremskey WT, Sethi MK. Hip fractures are risky business: an analysis of the NSQIP data. Injury 2015; 46:703-8. [PMID: 25457339 DOI: 10.1016/j.injury.2014.10.051] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/28/2014] [Accepted: 10/14/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hip fractures are one of the most common types of orthopaedic injury with high rates of morbidity. Currently, no study has compared risk factors and adverse events following the different types of hip fracture surgeries. The purpose of this paper is to investigate the major and minor adverse events and risk factors for complication development associated with five common surgeries for the treatment of hip fractures using the NSQIP database. METHODS Using the ACS-NSQIP database, complications for five forms of hip surgeries were selected and categorized into major and minor adverse events. Demographics and clinical variables were collected and an unadjusted bivariate logistic regression analyses was performed to determine significant risk factors for adverse events. Five multivariate regressions were run for each surgery as well as a combined regression analysis. RESULTS A total of 9640 patients undergoing surgery for hip fracture were identified with an adverse events rate of 25.2% (n=2433). Open reduction and internal fixation of a femoral neck fracture had the greatest percentage of all major events (16.6%) and total adverse events (27.4%), whereas partial hip hemiarthroplasty had the greatest percentage of all minor events (11.6%). Mortality was the most common major adverse event (44.9-50.6%). For minor complications, urinary tract infections were the most common minor adverse event (52.7-62.6%). Significant risk factors for development of any adverse event included age, BMI, gender, race, active smoking status, history of COPD, history of CHF, ASA score, dyspnoea, and functional status, with various combinations of these factors significantly affecting complication development for the individual surgeries. CONCLUSIONS Hip fractures are associated with significantly high numbers of adverse events. The type of surgery affects the type of complications developed and also has an effect on what risk factors significantly predict the development of a complication. Concerted efforts from orthopaedists should be made to identify higher risk patients and prevent the most common adverse events that occur postoperatively.
Collapse
Affiliation(s)
- Vasanth Sathiyakumar
- The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 3723, United States.
| | - Sarah E Greenberg
- The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 3723, United States.
| | - Cesar S Molina
- The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 3723, United States.
| | - Rachel V Thakore
- The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 3723, United States.
| | - William T Obremskey
- The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 3723, United States.
| | - Manish K Sethi
- The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 3723, United States.
| |
Collapse
|
23
|
Islam N, Whitehouse M, Mehendale S, Hall M, Tierney J, O'Connell E, Blom A, Bannister G, Hinde J, Ceredig R, Bradley BA. Post-traumatic immunosuppression is reversed by anti-coagulated salvaged blood transfusion: deductions from studying immune status after knee arthroplasty. Clin Exp Immunol 2014; 177:509-20. [PMID: 24749651 DOI: 10.1111/cei.12351] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 12/28/2022] Open
Abstract
Major trauma increases vulnerability to systemic infections due to poorly defined immunosuppressive mechanisms. It confers no evolutionary advantage. Our objective was to develop better biomarkers of post-traumatic immunosuppression (PTI) and to extend our observation that PTI was reversed by anti-coagulated salvaged blood transfusion, in the knowledge that others have shown that non-anti-coagulated (fibrinolysed) salvaged blood was immunosuppressive. A prospective non-randomized cohort study of patients undergoing primary total knee arthroplasty included 25 who received salvaged blood transfusions collected post-operatively into acid-citrate-dextrose anti-coagulant (ASBT cohort), and 18 non-transfused patients (NSBT cohort). Biomarkers of sterile trauma included haematological values, damage-associated molecular patterns (DAMPs), cytokines and chemokines. Salvaged blood was analysed within 1 and 6 h after commencing collection. Biomarkers were expressed as fold-changes over preoperative values. Certain biomarkers of sterile trauma were common to all 43 patients, including supranormal levels of: interleukin (IL)-6, IL-1-receptor-antagonist, IL-8, heat shock protein-70 and calgranulin-S100-A8/9. Other proinflammatory biomarkers which were subnormal in NSBT became supranormal in ASBT patients, including IL-1β, IL-2, IL-17A, interferon (IFN)-γ, tumour necrosis factor (TNF)-α and annexin-A2. Furthermore, ASBT exhibited subnormal levels of anti-inflammatory biomarkers: IL-4, IL-5, IL-10 and IL-13. Salvaged blood analyses revealed sustained high levels of IL-9, IL-10 and certain DAMPs, including calgranulin-S100-A8/9, alpha-defensin and heat shock proteins 27, 60 and 70. Active synthesis during salvaged blood collection yielded increasingly elevated levels of annexin-A2, IL-1β, Il-1-receptor-antagonist, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IFN-γ, TNF-α, transforming growth factor (TGF)-β1, monocyte chemotactic protein-1 and macrophage inflammatory protein-1α. Elevated levels of high-mobility group-box protein-1 decreased. In conclusion, we demonstrated that anti-coagulated salvaged blood reversed PTI, and was attributed to immune stimulants generated during salvaged blood collection.
Collapse
Affiliation(s)
- N Islam
- Musculoskeletal Research Unit, 1st Floor Learning & Research Building, Southmead Hospital, University of Bristol, Bristol, United Kingdom; National Centre for Biomedical Engineering Science, National University of Ireland, Galway; Shannon Applied Biotechnology Centre, Institute of Technology Tralee, Tralee, County Kerry, Ireland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Treatment and prevention of postoperative complications in hip fracture patients: infections and delirium. Wien Med Wochenschr 2013; 163:448-54. [PMID: 23949565 DOI: 10.1007/s10354-013-0228-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 07/04/2013] [Indexed: 02/05/2023]
Abstract
The course of older patients with hip fractures is often complicated by infections and delirium. Accurate care and high suspicion for these complications are essential, since these conditions are associated with an increase in mortality, length of hospital stay and nursing home placement, poorer mobility, and functional decline. Because of immunosenescence and higher infection rates, older patients need specific care, immediate diagnosis, and treatment of infections. Numerous guidelines of various medical societies outline the management of nosocomial infections, but there is a need of an individualized treatment plan because of comorbidities and polypharmacy. Hygiene measures have first priority to reduce the rate of infections. Treatment of geriatric syndromes like malnutrition, exsiccosis, gait disorders, falls, delirium, urine incontinence, and organ insufficiency are as important as immunization against pneumococci and influenza. Advanced age, cognitive impairment, hearing loss, peripheral vascular disease, prior delirium episodes, sight disorders, and polypharmacy are established risk factors for delirium; thus, older people with several chronic diseases are prone to delirium. A multifactorial approach, comprising standardized screening, oxygen support, intravenous fluid administration and augmented nutrition, monitoring of vital signs, pain treatment, optimized medication, and modification in perioperative management, significantly reduces delirium incidence during hospitalization for hip fracture. An interdisciplinary approach between surgeons and geriatricians may warrant optimized satisfaction of patients' needs.
Collapse
|
25
|
Abstract
PURPOSE. To evaluate various postoperative complications and their risk factors in hip fracture patients. METHODS. 207 female and 87 male consecutive patients (mean age, 78.1 years) who underwent surgical (n=242) or conservative (n=52) treatment for closed fractures of the femoral neck (n=157) or peritrochanter (n=137) were prospectively studied. The types of complication and outcome were recorded. The comorbidity status of the patients was categorised based on the American Society of Anesthesiologists (ASA) classification. Complications and their associations with various risk factors and mortality were analysed. RESULTS. For all patients, the mean length of hospitalisation was 14.6 days. For the 242 patients who underwent surgical treatment after a mean of 3.6 days, 56.8% of them had at least one complication. Acute urinary retention (39.3%) and urinary tract infection (24.0%) were most common. Patients with ASA grade III or higher had 2.3 fold higher risk of developing complications than those with lower-grade comorbidity, whereas patients with delayed operation (>48 hours after presentation) had 1.8 fold higher risk of developing complications than those without delayed operation. Four patients died in hospital: 2 from myocardial infarction and 2 from upper gastrointestinal bleeding. CONCLUSION. Complications after hip fracture surgery were common. Advanced age, high ASA status, and delay in surgery were associated with higher complication rates. Operations should be performed on medically fit patients as early as possible.
Collapse
|
26
|
Hälleberg Nyman M, Gustafsson M, Langius-Eklöf A, Johansson JE, Norlin R, Hagberg L. Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysis. Int J Nurs Stud 2013; 50:1589-98. [PMID: 23768410 DOI: 10.1016/j.ijnurstu.2013.05.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 04/26/2013] [Accepted: 05/13/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hip surgery is associated with the risk of postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). At present, there is limited evidence for whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery. OBJECTIVES The aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness. DESIGN Randomised controlled trial with cost-effectiveness analysis. SETTING The study was carried out at an orthopaedic department at a Swedish University Hospital. METHODS One hundred and seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge. RESULTS Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (absolute difference 2.4%, 95% CI -6.9-11.6%) The patients in the intermittent catheterisation group were more often catheterised (p<0.001) and required more bladder scans (p<0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p<0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods. CONCLUSIONS Both indwelling and intermittent methods could be appropriate in clinical practice. Both methods have advantages and disadvantages but by not using routine indwelling catheterisation, unnecessary catheterisations might be avoided in this patient group.
Collapse
Affiliation(s)
- Maria Hälleberg Nyman
- Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
| | | | | | | | | | | |
Collapse
|
27
|
Ho CCK, Nor A'tikah T. Commentary on Nyman MH, Johansson JE, Persson K & Gustafsson M (2011) A prospective study of nosocomial urinary tract infection in hip fracture patients. Journal Clinical Nursing 20, 2531-2539. J Clin Nurs 2012; 21:597. [PMID: 22221276 DOI: 10.1111/j.1365-2702.2011.03978.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Christopher C K Ho
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | | |
Collapse
|