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Hoffa MT, Furdock RJ, Moon TJ, Bacharach A, Heimke IM, Vallier HA. Fractures in Patients With Diabetes Mellitus: Findings From a 20-year Registry at a Single Level 1 Trauma Center. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00002. [PMID: 38768051 PMCID: PMC11068150 DOI: 10.5435/jaaosglobal-d-23-00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/02/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Diabetes mellitus (DM) is a risk factor of infection. Although DM has been associated with worse functional outcomes after acetabular fracture, literature regarding the effect of DM on surgical site infection and other early complications is lacking. METHODS A 20-year registry from a level 1 trauma center was queried to identify 134 patients with DM and 345 nondiabetic patients with acetabular fractures. RESULTS The diabetic patient population was older (57.2 versus 43.2; P < 0.001) and had higher average body mass index (33.6 versus 29.5; P < 0.001). Eighty-three patients with DM and 270 nondiabetics were treated surgically (62% versus 78%; P < 0.001). Diabetic patients who were younger (54.6 versus 61.4; P = 0.01) with fewer comorbidities (1.7 versus 2.2; P = 0.04) were more frequently managed surgically. On univariate analysis, patients with DM more commonly developed any early infection (28.4% versus 21%; P = 0.049) but were no more likely to develop surgical site infection, or other postoperative complications. Older patient age, length of stay, baseline pulmonary disease, and concurrent abdominal injury were independent predictors of postoperative infection other than surgical site infection. Diabetics that developed infection had more comorbidities (2.4 versus 1.5; P < 0.001) and higher Injury Severity Score (24.1 versus 15.8; P = 0.003), and were more frequently insulin-dependent (72.7% versus 41%; P = 0.01). DISCUSSION Independent of management strategy, diabetic patients were more likely to develop an infection after acetabular fracture. Insulin dependence was associated with postoperative infection on univariate analysis. Optimal selection of surgical candidates among patients with DM may limit postoperative infections.
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Affiliation(s)
- Matthew T. Hoffa
- From the MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Ryan J. Furdock
- From the MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Tyler J. Moon
- From the MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Abigail Bacharach
- From the MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Isabella M. Heimke
- From the MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Heather A. Vallier
- From the MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
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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.
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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
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3
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Asrian G, Suri A, Rajapakse C. Machine learning-based mortality prediction in hip fracture patients using biomarkers. J Orthop Res 2024; 42:395-403. [PMID: 37727905 DOI: 10.1002/jor.25675] [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: 02/09/2023] [Revised: 07/01/2023] [Accepted: 07/26/2023] [Indexed: 09/21/2023]
Abstract
The purpose of this retrospective study was to assess whether mortality following a hip fracture can be predicted by a machine learning model trained on basic blood and lab test data as well as basic demographic data. Additionally, the purpose was to identify the key variables most associated with 1-, 5-, and 10-year mortality and investigate their clinical significance. Input data included 3751 hip fracture patient records sourced from the Medical Information Mart for Intensive Care IV database, which provided records from in-hospital database systems at the Beth Israel Deaconess Medical Center. The 1-year mortality rate for all patients studied was 21% and for those aged 80+ was 29%. We assessed 10 different machine learning classification models, finding LightGBM to have the strongest 1-year mortality prediction performance, with accuracy of 81%, AUC of 0.79, sensitivity of 0.34, and specificity of 0.98 on the test set. The strongest-weighted features of the 1-year model included age, glucose, red blood cell distribution width, mean corpuscular hemoglobin concentration, white blood cells, urea nitrogen, prothrombin time, platelet count, calcium levels, and partial thromboplastin time. Most of these were also in the top 10 features of the LightGBM 5- and 10-year prediction models trained. Testing for these high-ranking biomarkers in new hip fracture patients can aid clinicians in assessing the likelihood of poor outcomes for hip fracture patients, and additional research can use these biomarkers to develop a mortality risk score.
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Affiliation(s)
- George Asrian
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abhinav Suri
- Univesity of California, Los Angeles, California, USA
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4
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Ramezani A, Babagoli M, Ghaseminejad-Raeini A, Golbakhsh M, Shafiei SH. Factors associated with postoperative quality of life in patients with intertrochanteric fracture. Ann Med Surg (Lond) 2024; 86:703-711. [PMID: 38333317 PMCID: PMC10849437 DOI: 10.1097/ms9.0000000000001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Intertrochanteric fractures, which make up the majority of hip fractures, are a common and serious injury that can greatly impact quality of life. Treatment of such fractures comprises nearly half of the costs contributed to hip fractures. Identifying the factors affecting the functional outcomes of patients after intertrochanteric fracture can help to reduce burden of disease for the patient and healthcare system. The present study investigated the factors underlying the worsening of short form-36 score (SF-36) scores for intertrochanteric fracture patients. Materials and methods This retrospective cohort study was designed based on data from our clinic. All consecutive patients with intertrochanteric fractures from November 2016 to September 2020 were reviewed. The exclusion criteria included patients having a second injury or having had previous surgery related to the hip and those with incomplete data. Baseline characteristics of patients were extracted from annotated records. The lab data were acquired from the electronic hospital system. The outcomes were SF-36 scores obtained by phone contact with patients or their families. Statistical analysis was conducted in SPSS. Results A total of 310 patients were included in the current study. The female gender, advanced age, history of diabetes, thyroid malfunction, cancer, osteoporosis, anticoagulant use and blood transfusion were identified as risk factors for lower SF-36 scores. Low levels of haemoglobin before surgery, blood urea nitrogen (BUN), BUN/Creatinine, and white blood count values correlated with lower SF-36 scores. Conclusion Numerous contextual variables affected the functional outcomes of the patients. Consideration of these factors could be helpful in reducing costs and improving the quality of life for intertrochanteric fracture patients.
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Affiliation(s)
| | | | | | | | - Seyyed Hossein Shafiei
- Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
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5
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Buunaaim ADB, Osman I, Salisu WJ, Bukari MIS, Yempabe T. Epidemiology of elderly fractures in a tertiary hospital in Northern Ghana: a 3-year retrospective descriptive review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:473-479. [PMID: 36527505 DOI: 10.1007/s00590-022-03450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The incidence of elderly fractures is closely related to the increasing proportion of the elderly population in sub-Saharan Africa, making it a relevant public health concern. Epidemiological profiles of these fractures and treatment options are necessary for resource-poor settings to optimise planning and patient care. METHODS A retrospective descriptive cross-sectional study was conducted at Tamale Teaching Hospital. Data of 69 elderly patients (60 years and above) with fractures admitted to the trauma and orthopaedic unit from January 2017 to December 2019 were collected. Simple descriptive and bivariate analysis was conducted on some variables, whereas the Chi-square was used to test for some associations for categorical data. RESULTS The mean age of the study participants was 70.3(± 8.6). Elderly males (55.1%) were three times more likely to sustain fractures than females. The primary mechanism of injury was a road traffic accident (RTA) (59.4%), followed by falls from slips (29.0%). There was a significant association between gender and mechanisms (RTA and Falls from slips) of injury (p = 0.002). The most fractured bone was the femur (50.7%). Hip fractures (33.3%) were more common among females than males and mainly among the (71-80) age group. Open fractures were more common among males than females. CONCLUSION RTAs were the most typical cause of fractures in the elderly. Contrary to other studies, males were more commonly involved in accidents than females, albeit females were the majority for hip fractures. Therefore, significant public health policies with resource allocation should address the unmet health needs of this unique age group in our growing populations in low- and middle-income countries.
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Affiliation(s)
- A D B Buunaaim
- Department of Surgery/Department Physician Assistant Studies, School of Medicine, University for Development Studies, Tamale, Ghana.
- Department of Surgery, Trauma/Orthopaedic Unit, Tamale Teaching Hospital, Tamale, Ghana.
| | - I Osman
- Department of Surgery, Trauma/Orthopaedic Unit, Tamale Teaching Hospital, Tamale, Ghana
| | - W J Salisu
- Department of Nursing, Tamale Teaching Hospital, Tamale, Ghana
| | - M I S Bukari
- Department of Surgery/Department Physician Assistant Studies, School of Medicine, University for Development Studies, Tamale, Ghana
| | - T Yempabe
- Department of Surgery, Trauma/Orthopaedic Unit, Tamale Teaching Hospital, Tamale, Ghana
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Kang MJ, Kim BR, Lee SY, Beom J, Choi JH, Lim JY. Factors predictive of functional outcomes and quality of life in patients with fragility hip fracture: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e32909. [PMID: 36800622 PMCID: PMC9936013 DOI: 10.1097/md.0000000000032909] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
To determine the predictors of functional outcomes and quality of life (QoL) of patients who were surgically treated for fragility hip fracture. This was a retrospective cohort study performed in the 3 tertiary rehabilitation facilities. A total of 165 patients who had undergone surgery for fragility hip fracture were followed up to 6 months postoperatively. The factors expected to be related to the functional outcomes and QoL at 6 months post-surgery were as follows: baseline demographics, fracture site, operation type, fall characteristics including fall location and fall direction, comorbidities, and initial functional status. The following were comorbidities: hypertension, diabetes mellitus, dementia, cerebrovascular accident, and osteoporosis. Functional outcome and QoL measures were represented using the Koval grade, functional ambulatory category (FAC), Berg balance scale, 4-m walking speed test, the Korean version of Mini-Mental State Examination, EuroQol 5-dimension (EQ-5D) questionnaire, the Korean version of Modified Barthel Index, and the Korean version of instrumental activities of daily living (K-IADL). For all tests, each patient was assessed immediately after transfer and at 6 months post-surgery. Multivariable regression analyses adjusting for factors mentioned above were as follows. Old age led to a significantly less favorable outcome on FAC and K-IADL at 6 months. Intertrochanteric fracture had a significantly positive impact on Koval at 6 months compared to femur neck and intertrochanteric fractures. Total hip replacement arthroplasty and bipolar hemiarthroplasty had a significantly positive impact on EQ-5D and FAC at 6 months respectively compared to other operation types. Fall characteristics didn't reveal any significant impact on functional outcomes and QoL. Patients with hypertension and diabetes mellitus had a significantly negative outcome on EQ-5D and K-IADL respectively. Among initial assessments of function and QoL, initial 4-m walking speed test, Korean version of Mini-Mental State Examination, K-IADL, and Korean version of Modified Barthel Index were independent predictors of function and QoL at 6 months. This study confirmed that age, fracture site, operation type, comorbidities, and initial physical and cognitive function significantly influenced recovery of function and QoL at 6 months in patients with fragility hip fractures.
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Affiliation(s)
- Mun Jeong Kang
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic Korea
- * Correspondence: Bo Ryun Kim, Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea (e-mail: )
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jun Hwan Choi
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
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Tang Y, Kang L, Guo M, Fan L. Intertrochanteric Fracture Surgery Patients with Diabetes Mellitus are Prone to Suffer Perioperative Neurological and Endocrine/Metabolic Complications: A Propensity-Score Matched Analysis. Ther Clin Risk Manag 2022; 18:775-783. [PMID: 35967194 PMCID: PMC9365324 DOI: 10.2147/tcrm.s366846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background In older adults, the recovery after hip fracture surgery is not always to be well expected due to high risks of adverse outcomes including perioperative complications and mortality. We aimed to evaluate the intertrochanteric fracture (IF) patients with diabetes mellitus (DM) and receiving surgical fixation with intramedullary nail on the perioperative complications, total hospital costs (THC), length of hospital stay (LOS), and mortality. Methods In this retrospective cohort study, among 487 consecutive intertrochanteric fracture patients with age over 65 years and treated surgically by using intramedullary nail between Jan. 2015 and Mar. 2020, 353 patients were included, including 81 with DM and 272 without DM. After using propensity-score matched (PSM) analysis, 80 patients remained in each group. The perioperative complications, 30-day, 90-day, 1-year, and 2-year survival rates, THC, and LOS were observed and compared between two groups. Overall survival was compared by Kaplan–Meier method. Results No significant between-group differences were found in 30-day, 90-day, 1-year, and 2-year mortality rates, THC, LOS, and other perioperative complications after PSM and McNemar’s tests (all p>0.05), except for neurological complications (p<0.004) and endocrine/metabolic complications (p<0.001). At a mean follow-up time of 36.2 months, there were no statistically significant differences between the groups based on the Kaplan–Meier survival curve (p=0.171, log-rank). Conclusion IF surgery patients with DM are more prone to suffer perioperative neurological and endocrine/metabolic complications and they should be managed individually while being aware of these risks henceforth. Further high evidence clinical trials are needed to expand in DM patients with IF.
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Affiliation(s)
- You Tang
- Department of Joint Surgery, Binzhou People’s Hospital, Binzhou, People’s Republic of China
- Correspondence: You Tang, Department of Joint Surgery, Binzhou People’s Hospital, Binzhou, People’s Republic of China, Email
| | - Le Kang
- Department of Hand Surgery & Microsurgery and Foot & Ankle Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, People’s Republic of China
| | - Meng Guo
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, People’s Republic of China
| | - Linlin Fan
- Department of Child Healthcare, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, People’s Republic of China
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Ashkenazi I, Morgan S, Graif N, Shaked O, Shohat N, Khoury A, Snir N, Warschawski Y. Increased postoperative glycemic variability is associated with increased mortality in diabetic patients undergoing hip arthroplasty for hip fracture. Arch Orthop Trauma Surg 2022; 143:2773-2779. [PMID: 35900587 DOI: 10.1007/s00402-022-04558-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/17/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Increased glycemic variability (GV) during hospitalization has been associated with increased rates of surgical site and periprosthetic joint infections (PJI) following elective total joint arthroplasty. Uncertainty exists surrounding GV as a predictor for complications in urgent arthroplasty cases following hip fractures. In this study, we evaluated the association between GV and postoperative complications in diabetic patients undergoing total hip arthroplasty (THA) and hemiarthroplasty (HA) for hip fractures. METHODS We analyzed data on 2421 consecutive patients who underwent THA or HA at our institution from 2011 to 2020. Patients with a known diagnosis of diabetes mellitus who had a minimum of three postoperative glucose values taken within the first week after surgery were included. GV was assessed using a coefficient of variation. Outcomes included short- and long-term mortality, reoperations, prosthetic joint infection (PJI) requiring revision and readmissions for any cause. RESULTS The final cohort consisted of 482 patients (294 females, 188 males). Higher GV was associated with an increased 90-day mortality (p = 0.017). GV was not associated with 30-day mortality (p = 0.45), readmissions of any cause at 30 or 90 days (p = 0.99, p = 0.91, respectively), reoperation of any cause (p = 0.91) or PJI requiring revision surgery (p = 0.42). CONCLUSIONS Higher GV in the postoperative period is associated with increased rates of mortality in diabetic patients following THA and HA for hip fractures. Efforts should be made to monitor and control glucose variability in the postoperative period.
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Affiliation(s)
- Itay Ashkenazi
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Samuel Morgan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Graif
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Or Shaked
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Noam Shohat
- Department of Orthopedics, Shamir Medical Center, Beer-Yaakov, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Nimrod Snir
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel.
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Chen FR, Quan T, Manzi JE, Gu A, Wei C, Tabaie S, Chodos M, Chapman CB, Pryor KO, Liu J. Evaluating the Association between Anesthesia Type and Postoperative Complications for Patients Receiving Total Ankle Arthroplasty. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:113-119. [PMID: 35821927 PMCID: PMC9210406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is performed for ankle arthritis and there has been interest investigating which anesthetic method is the best choice in order to optimize perioperative outcomes. In this study, we compared postoperative complications after TAA for patients receiving either 1) general anesthesia alone or 2) general anesthesia plus regional anesthesia. METHODS Patients undergoing primary TAA from 2007 to 2018 were identified in a national database. Patients were stratified into 2 cohorts: general anesthesia and general anesthesia combined with regional anesthesia. In this analysis, 30-day wound, cardiac, pulmonary, renal, thromboembolic, and sepsis complications, as well mortality, postoperative transfusion, urinary tract infection, extended length of stay, and reoperation were assessed. Bivariate analyses and multivariable logistical regression were performed. RESULTS Of 1,084 total patients undergoing TAA, 878 patients (81.0%) had general anesthesia and 206 (19.0%) had general anesthesia combined with regional anesthesia. Following adjustment, there were no increased risk of postoperative complications in the combined general and regional anesthesia group compared to those who only underwent general anesthesia. CONCLUSION Compared to general anesthesia alone, the addition of regional anesthesia to general anesthesia for TAA is not associated with increased risk of complications in the perioperative period. Level of Evidence: III.
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Affiliation(s)
- Frank R. Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, Pennysylvania, USA
| | - Theodore Quan
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Alex Gu
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Chapman Wei
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sean Tabaie
- Department of Orthopaedic Surgery, Children’s National Health System, Washington, DC, USA
| | - Marc Chodos
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Cary B. Chapman
- Miami Orthopedics & Sports Medicine Institute, Coral Gables, Florida, USA
| | - Kane O. Pryor
- Department of Anesthesiology, New York-Presbyterian Hospital/ Weill Cornell Medical Center, New York, New York, USA
| | - Jiabin Liu
- Department of Anesthesiology, New York-Presbyterian Hospital/ Weill Cornell Medical Center, New York, New York, USA
- Department of Regional Anesthesia and Acute Pain Management, Hospital for Special Surgery, New York, New York, USA
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Shen Q, Ma Y. Impact of diabetes mellitus on risk of major complications after hip fracture: a systematic review and meta-analysis. Diabetol Metab Syndr 2022; 14:51. [PMID: 35414035 PMCID: PMC9003957 DOI: 10.1186/s13098-022-00821-0] [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: 02/04/2022] [Accepted: 03/29/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The impact of diabetes mellitus (DM) on adverse outcomes in hip fracture patients is unclear. Furthermore, no review has synthesized evidence on this subject. Therefore, the current study was designed to answer the following research question: Does DM increase the risk of mortality and major systemic complications in patients with hip fractures? METHODS PubMed, Embase, and Google Scholar were searched from 1st January 2000 to 1st August 2021 for studies comparing DM and non-DM patients with hip fractures. Outcomes of interest were pooled using risk ratios (RR). The study was registered on PROSPERO (CRD42021268525). RESULTS Sixteen studies were included. Meta-analysis revealed a statistically significant increased risk of mortality in diabetics as compared to non-diabetics after 1 year (RR: 1.24 95% CI 1.08, 1.43 I2 = 62% p = 0.003). Pooled analysis of eight studies reporting adjusted mortality outcomes also demonstrated similar results (RR: 1.17 95% CI 1.09, 1.25 I2 = 74% p < 0.0001). We noted a statistically significant increase in the risk of cardiac complications (RR: 1.44 95% CI 1.17, 1.78 I2 = 19% p = 0.0005) and risk of renal failure in diabetics as compared to non-diabetics (RR: 1.32 95% CI 1.04, 1.68 I2 = 0% p = 0.02); but no difference in the risk of cerebrovascular (RR: 1.45 95% CI 0.74, 2.85 I2 = 47% p = 0.28), pulmonary (RR: 0.94 95% CI 0.73, 1.23 I2 = 8% p = 0.67) and thromboembolic complications (RR: 0.81 95% CI 0.56, 1.17 I2 = 28% p = 0.26). CONCLUSION Our results indicate that diabetics have an increased risk of mortality as compared to non-diabetics. Scarce data indicates that the risk of cardiac complications and renal failure are increased in patients with DM but there is no difference in the risk of cerebrovascular, pulmonary, or thromboembolic complications. Further studies are needed to strengthen the current conclusions.
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Affiliation(s)
- Qiu Shen
- Department of Orthopaedics, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Yunping Ma
- Department of Orthopaedics, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China.
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Dimet-Wiley A, Golovko G, Watowich SJ. One-Year Postfracture Mortality Rate in Older Adults With Hip Fractures Relative to Other Lower Extremity Fractures: Retrospective Cohort Study. JMIR Aging 2022; 5:e32683. [PMID: 35293865 PMCID: PMC8968577 DOI: 10.2196/32683] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/03/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hip fracture in older adults is tied to increased mortality risk. Deconvolution of the mortality risk specific to hip fracture from that of various other fracture types has not been performed in recent hip fracture studies but is critical to determining current unmet needs for therapeutic intervention. OBJECTIVE This study examined whether hip fracture increases the 1-year postfracture mortality rate relative to several other fracture types and determined whether dementia or type 2 diabetes (T2D) exacerbates postfracture mortality risk. METHODS TriNetX Diamond Network data were used to identify patients with a single event of fracture of the hip, the upper humerus, or several regions near and distal to the hip occurring from 60 to 89 years of age from 2010 to 2019. Propensity score matching, Kaplan-Meier, and hazard ratio analyses were performed for all fracture groupings relative to hip fracture. One-year postfracture mortality rates in elderly populations with dementia or T2D were established. RESULTS One-year mortality rates following hip fracture consistently exceeded all other lower extremity fracture groupings as well as the upper humerus. Survival probabilities were significantly lower in the hip fracture groups, even after propensity score matching was performed on cohorts for a variety of broad categories of characteristics. Dementia in younger elderly cohorts acted synergistically with hip fracture to exacerbate the 1-year mortality risk. T2D did not exacerbate the 1-year mortality risk beyond mere additive effects. CONCLUSIONS Elderly patients with hip fracture have a significantly decreased survival probability. Greatly increased 1-year mortality rates following hip fracture may arise from differences in bone quality, bone density, trauma, concomitant fractures, postfracture treatments or diagnoses, restoration of prefracture mobility, or a combination thereof. The synergistic effect of dementia may suggest detrimental mechanistic or behavioral combinations for these 2 comorbidities. Renewed efforts should focus on modulating the mechanisms behind this heightened mortality risk, with particular attention to mobility and comorbid dementia.
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Affiliation(s)
- Andrea Dimet-Wiley
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, United States
| | - George Golovko
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, United States
| | - Stanley J Watowich
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, United States
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12
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Long A, Xie Z, Wang X, Zhang Y, Han D. The impact of perioperative glucose variability on outcomes after hip fracture. Medicine (Baltimore) 2022; 101:e28728. [PMID: 35089246 PMCID: PMC8797594 DOI: 10.1097/md.0000000000028728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/11/2022] [Indexed: 01/05/2023] Open
Abstract
Diabetes is considered an independent risk factor for hip fracture. In the present study, we evaluated whether perioperative glucose variability (GV) was a significant predictor of the outcomes of patients with diabetes after hip fracture.We analyzed the characteristics and outcomes of all patients with hip fractures admitted to our hospital between September 2008 and December 2012. Patients with diabetes were grouped into tertiles for GV, and multivariate survival analysis included age, sex, fracture type, mean fasting plasma glucose, and GV.Among the 1099 patients included in this study, 239 (21.7%) had diabetes. Patients with diabetes were more likely to develop infectious complications (5.4% vs 2.8%, P = .045), and experience mortality postoperatively (1 month: 5.5% vs 2.7%, P = .052; 12 months: 15.1% vs 8.7%, P = .006). The postoperative mortality rate was increased across the GV tertiles, and GV was an independent predictor of 1- and 12-month mortality after surgery.Patients with diabetes had poor prognoses after hip fracture. Perioperative GV is an independent predictor of mortality in patients with diabetes. Therefore, GV might be considered a valid additional parameter to consider in the management of these patients.
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Affiliation(s)
- Anhua Long
- Department of Orthopaedics, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R. China
| | - Zongyan Xie
- Department of Clinical Pharmacology, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R. China
| | - Xuefei Wang
- Department of Orthopaedics, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R. China
| | - Yakui Zhang
- Department of Orthopaedics, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R. China
| | - Dacheng Han
- Department of Orthopaedics, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R. China
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13
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Koh FH, Loh CH, Tan WJ, Ho LML, Yen D, Chua JMW, Kok SSX, Sivarajah SS, Chew MH, Foo FJ. Structured presurgery prehabilitation for aged patients undergoing elective surgery significantly improves surgical outcomes and reduces cost: A nonrandomized sequential comparative prospective cohort study. Nutr Clin Pract 2021; 37:645-653. [PMID: 34861063 PMCID: PMC9299996 DOI: 10.1002/ncp.10787] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background With increasing global life expectancy, the number of major surgeries performed on aged adults invariably increases. This study aimed to examine the effectiveness of a structured prehabilitative program for aged colorectal cancer patients in improving short‐term surgical outcomes. Methods A prospective philanthropically sponsored Programme for Enhanced Elderly Recovery at Sengkang General Hospital (PEERS) was initiated in February 2017 for patients ≥70‐years‐old who were due to undergo elective colectomies. These patients were put through a 2‐ to 4‐week‐long program before surgery, which included geriatric assessment, nutrition supplementation, and resistance training. They were compared with patients from a similar age group before PEERS was introduced (non‐PEERS). Results Fifty‐eight patients, with a median age of 78.5 (70–93) years, were recruited from a single institution to undergo PEERS. Baseline characteristics between the groups were similar. There was no significant improvement of anthropometric and functional characteristics before and after PEERS. Duration of hospitalization was shorter in the PEERS group (9 vs 11 days, P = 0.01). Both groups had similar 30‐days’ morbidity rates (8.6% vs 17.4%, P = 0.26). The PEERS group had significant improvement in their median EuroQol‐5 Dimension score (0.70 presurgery to 0.80 6‐months’ postsurgery, P = 0.01). After multivariate analysis, the average duration of hospitalization in the PEERS group was 6.8 days shorter (P = 0.018; CI, 1.2–12.4) after adjusting for modality of surgery and complications. This represented a cost saving of USD$11,838.80. Conclusion A standardized prehabilitation program for aged adults reduced the duration of hospitalization, improved the quality of life after surgery, and reduced costs.
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Affiliation(s)
- Frederick H Koh
- Colorectal Service, Department of Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Caroline H Loh
- Department of General Surgery, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Winson J Tan
- Colorectal Service, Department of Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Leonard M L Ho
- Colorectal Service, Department of Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Dulcena Yen
- Colorectal Service, Department of Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Jason M W Chua
- Institute of Molecular and Cell Biology, Agency for Science Technology and Research, Singapore, Singapore
| | - Shawn S X Kok
- Department of Radiology, Sengkang General Hospital, Singapore, Singapore
| | - Sharmini S Sivarajah
- Colorectal Service, Department of Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Min-Hoe Chew
- Colorectal Service, Department of Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Fung-Joon Foo
- Colorectal Service, Department of Surgery, Sengkang General Hospital, Singapore, Singapore
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Yoon SH, Kim BR, Lee SY, Beom J, Choi JH, Lim JY. Influence of comorbidities on functional outcomes in patients with surgically treated fragility hip fractures: a retrospective cohort study. BMC Geriatr 2021; 21:283. [PMID: 33910513 PMCID: PMC8082882 DOI: 10.1186/s12877-021-02227-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/15/2021] [Indexed: 01/01/2023] Open
Abstract
Background The incidence and number of fragility hip fractures are gradually increasing, resulting in a wide consumption of medical resources. Various factors affecting functional recovery in patients with fragility hip fractures are known, and comorbid diseases are one of them. The purpose of this study is to determine the effect of comorbidities on functional outcomes in patients surgically treated for fragility hip fractures, thereby contributing to the efficient distribution of medical resources. Methods This was a retrospective cohort study performed in the three tertiary rehabilitation facilities. A total of 211 patients (50 men and 161 women; average age 81.6 ± 6.7 years) who had undergone surgery for fragility hip fractures were followed up from immediately after transfer to the Department of Rehabilitation Medicine to 6 months postoperatively. Comorbidities referred to a summary of the following conditions: hypertension, diabetes mellitus, chronic liver disease, dementia, cerebrovascular accident, and osteoporosis. Functional outcomes included Koval’s grade, Functional Ambulatory Category (FAC), Functional Independence Measure (FIM)-locomotion, Modified Rivermead Mobility Index, Berg Balance Scale (BBS), 4-Meter Walking speed Test (4MWT), the Korean version of the Mini-Mental State Examination(K-MMSE), Geriatric Depression Scale (GDS), EuroQol Five-Dimension (EQ-5D) questionnaire, the Korean version of the Modified Barthel Index (K-MBI), the Korean version of the Instrumental Activities of Daily Living (K-IADL), and Korean version of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight scale (K-FRAIL). For all tests, each patient was assessed immediately after transfer and 6 months post-surgery. Results Multivariate linear regression analyses adjusted for age, sex, the initial variable of the functional outcomes, and comorbidities revealed that dementia had a significant negative impact on Koval’s grade and K-FRAIL 6 months postoperatively. Diabetes mellitus had a significant negative impact on the FAC, GDS, EQ-5D, K-IADL, and K-FRAIL 6 months postoperatively. Patients with osteoporosis showed a significant negative outcome of FIM-locomotion 6 months postoperatively. A cerebrovascular accident revealed a significant negative impact on the BBS 6 months postoperatively. In addition, hypertension led to significantly less favorable outcomes of the K-FRAIL 6 months postoperatively. Conclusions This study confirmed that comorbidities, particularly dementia and diabetes mellitus, significantly influence functional outcomes 6 months after fragility hip fracture surgeries.
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Affiliation(s)
- Soo Hoon Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jun Hwan Choi
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
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15
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Paterni S, Okoye C, Calabrese AM, Niccolai F, Polini A, Caraccio N, Calsolaro V, Monzani F. Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture. Front Endocrinol (Lausanne) 2021; 12:770400. [PMID: 34867813 PMCID: PMC8637116 DOI: 10.3389/fendo.2021.770400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/22/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies have shown increased risk of fracture in older patients with poor or strict glycemic control (glycated hemoglobin, HbA1c, ≥ 8% or < 6-7% respectively); however, these reports did not investigate the oldest-old population. Comprehensive geriatric assessment (CGA) and a patient-centered approach have been proven to improve the quality of care in the management of Type 2 Diabetes Mellitus (T2DM) in the older patients, but data regarding T2DM in patients with fragility fractures are still lacking. AIM To investigate the prognostic role of HbA1c and frailty level in older diabetic patients admitted for hip fracture. METHODS Prospective observational cohort study conducted on diabetic geriatric patients consecutively hospitalized for hip fracture in the orthogeriatric unit of a tertiary care hospital. Preoperative comprehensive geriatric assessment (CGA) was performed. Using the Clinical Frailty Scale (CFS), diabetic patients were categorized in robust (CFS < 5) and frail (CFS ≥ 5), and further stratified according to HbA1c values [Tertile 1 (T1) HbA1c < 48 mmol/mol, Tertile 2 (T2) 48-58 mmol/mol and Tertile 3 (T3) > 58 mmol/mol). Comparisons between continuous variables were performed with analysis of non-parametric test for independent samples, while relationships between categorical variables were assessed by chi-square test. Using logistic multivariate regression, we evaluated the determinants of 1-year all-cause mortality in diabetic older patients with hip fracture. RESULTS Among the 1319 older patients (mean age 82.8 ± 7.5 years, 75.9% females) hospitalized for hip fracture, 204 (15.5%) had a previous diagnosis of T2DM. T2DM patients showed an increased proportion of multiple concurrent fractures occurred during the accidental fall or syncope (12.7% vs 11.2%, p=0.02). One-year mortality after hip fracture surgery was significantly higher in T2DM as compared to not diabetic patients (21.2% vs 12.5%, p<0.001). No significant difference in mortality was found across HbA1c tertiles; however, frail diabetic patients in the second and third HbA1c tertiles showed higher mortality risk compared to the robust counterparts (26.9% vs 5%, p=0.001 for T2 and 43.5% vs 13.3%, p=<0.05 for T3), while no difference was observed among those in T1. CONCLUSIONS Frail patients with HbA1c ≥ 48 mmol/L showed an increased mortality risk as compared to robust counterparts. CFS represents an important tool to select diabetic subjects with higher likelihood of adverse outcome.
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16
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Zhao K, Zhang J, Li J, Meng H, Zhang R, Yin Y, Zhu Y, Hou Z, Zhang Y. Treatment of Unstable Intertrochanteric Fractures with Proximal Femoral Nailing Antirotation: Traction Table or Double Reverse Traction Repositor. J INVEST SURG 2020; 34:1178-1184. [PMID: 32619121 DOI: 10.1080/08941939.2020.1786610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: The objective of this retrospective study was to compare the efficacy of the double reverse traction repositor (DRTR) and traction table with proximal femoral nailing antirotation (PFNA) in the treatment of unstable intertrochanteric fractures. Patients and Methods: Data from 66 patients (36 patients treated with the traction table and 30 patients treated with DRTR) with unstable intertrochanteric fractures were reviewed from January 2017 to June 2017. The demographics, fracture characteristics, surgical data, and prognostic parameters were collected to compare the differences between the two groups. Results: The collodiaphyseal angle (CDA) was significantly lower in the DRTR group than in the traction table group (129.37° ± 7.47 and 135.67° ± 6.95, respectively, p < 0.001). The open reduction rate was significantly lower in the DRTR group than in the traction table group (3.3% and 13.9%, respectively, p < 0.001). No significant differences were found in the demographics, fracture characteristics, other surgical data, or prognostic parameters between the two groups. Conclusions: DRTR can facilitate safe, effective, and minimally invasive treatment of unstable intertrochanteric fractures with PFNA.
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Affiliation(s)
- Kuo Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junzhe Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junyong Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongyu Meng
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ruipeng Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingchao Yin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
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