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Tian C, Zhu H, Shi L, Chen X, Xie T, Rui Y. Is There a "Black Friday" for Geriatric Hip Fracture Surgery? Orthop Surg 2023; 15:1304-1311. [PMID: 37052064 PMCID: PMC10157697 DOI: 10.1111/os.13741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES Reports show an increase in the short-term mortality rates of hip fracture patients admitted on weekends. However, there are few studies on whether there is a similar effect in Friday admissions of geriatric hip fracture patients. The aim of this study was to evaluate the effects of Friday admission on mortality and clinical outcomes in elderly patients with hip fractures. METHODS A retrospective cohort study was performed at a single orthopaedic trauma centre and included all patients who underwent hip fracture surgery between January 2018 and December 2021. Patient characteristics, including age, sex, BMI, fracture type, time of admission, ASA grade, comorbidities, and laboratory examinations, were collected. Data pertaining to surgery and hospitalization were extracted from the electronic medical record system and tabulated. The corresponding follow-up was performed. The Shapiro-Wilk test was applied to evaluate the distributions of all continuous variables for normality. The overall data were analyzed by Student's t test or the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables, as appropriate. Univariate and multivariate analyses were used to further test for the independent influencing factors of prolonged time to surgery. RESULTS A total of 596 patients were included, and 83 patients (13.9%) were admitted on Friday. There was no evidence supporting that Friday admission had an effect on mortality and outcomes, including length of stay, total hospital costs and postoperative complications. However, the patients admitted on Friday had delayed surgery. Then, patients were regrouped into two groups according to whether surgery was delayed, and 317 patients (53.2%) underwent delayed surgery. The multivariate analysis showed that younger age (p = 0.014), Friday admission (p < 0.001), ASA classification III-IV (p = 0.019), femoral neck fracture (p = 0.002), time from injury to admission more than 24 h (p = 0.025), and diabetes (p = 0.023) were risk factors for delayed surgery. CONCLUSIONS Mortality and adverse outcome rates for elderly hip fracture patients admitted on Friday were similar to those admitted at other time periods. However, Friday admission was identified as one of the risk factors for delayed surgery.
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Affiliation(s)
- Chuwei Tian
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, 210009, PR China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, Nanjing, 210009, PR China
- School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, 210009, PR China
| | - Huanyi Zhu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, 210009, PR China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, Nanjing, 210009, PR China
- School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, 210009, PR China
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, 210009, PR China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, Nanjing, 210009, PR China
- School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, 210009, PR China
| | - Xiangxu Chen
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, 210009, PR China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, Nanjing, 210009, PR China
- School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, 210009, PR China
| | - Tian Xie
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, 210009, PR China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, Nanjing, 210009, PR China
- School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, 210009, PR China
| | - Yunfeng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO.87 Ding Jia Qiao, Nanjing, 210009, PR China
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, Nanjing, 210009, PR China
- School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, 210009, PR China
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Zhang L, Xia J. N6-Methyladenosine Methylation of mRNA in Cell Senescence. Cell Mol Neurobiol 2023; 43:27-36. [PMID: 34767142 DOI: 10.1007/s10571-021-01168-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/03/2021] [Indexed: 01/07/2023]
Abstract
Cell senescence is the growth arrest caused by the accumulation of irreparable cell damage, which is involved in physiological and pathological processes and regulated by the post-transcriptional level. This regulation is performed by transcriptional regulators and driven by aging-related small RNAs, long non-coding RNAs, and RNA-binding proteins. N6-methyladenosine (m6A) is the most common chemical modification in eukaryotic mRNA, which can enhance or reduce the binding of transcriptional regulators. Increasing studies have confirmed the crucial role of m6A in controlling mRNA in various physiological processes. Remarkably, recent reports have indicated that abnormal methylation of m6A-related RNA may affect cell senescence. In this review, we clarified the association between m6A modification and cell senescence and analyzed the limitations of the current research.
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Affiliation(s)
- Lin Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China. .,Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Zhang G, Chen H, Zha J, Zhang J, Di J, Wang X, Hu X, Xu X, Guo J. Effect of General vs. Regional Anesthesia on Mortality, Complications, and Prognosis in Older Adults Undergoing Hip Fracture Surgery: A Propensity-Score-Matched Cohort Analysis. J Clin Med 2022; 12:jcm12010080. [PMID: 36614881 PMCID: PMC9821019 DOI: 10.3390/jcm12010080] [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: 10/13/2022] [Revised: 10/23/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
The choice of the type of anesthesia (TOA) used in hip fracture surgery in older adults is still controversial. The main question is not whether regional anesthesia (RA) or general anesthesia (GA) is superior, but in which patients the type of anesthesia may affect the outcome after surgery. In this retrospective analysis of surgically treated intertrochanteric fracture patients, we used propensity score matching (PSM) to investigate whether clinically relevant differences in outcomes were observed in mortality, complications, and functional outcomes between RA and GA. After screening 2934 consecutive patients, 2170 were ultimately included, including 841 in the GA group and 1329 in the RA group. After PSM, 808 remained in each group. Patients receiving GA were more prone to have a shorter duration for their operation and higher total hospital costs than patients with RA (p = 0.034 and 0.004, respectively). We also observed that the GA group has a higher rate of pulmonary complications, while the RA group has a higher rate of cardiac complications (p = 0.017 and 0.011, respectively). No significant difference was observed in mortality, functional outcomes, and other complications (all p > 0.05). The clinical innovation of this study was the potential value of GA for patients with cardiac diseases and of RA for patients with pulmonary diseases.
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Affiliation(s)
- Guolei Zhang
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang 050051, China
| | - Huihui Chen
- Department of Nephrology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Junpu Zha
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang 050051, China
| | - Jingtao Zhang
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang 050051, China
| | - Jun Di
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang 050051, China
| | - Xiaoqing Wang
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Xin Hu
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang 050051, China
| | - Xin Xu
- Department of Biochemistry and Molecular Biology, College of Basic Medicine, Hebei Medical University, Shijiazhuang 050011, China
- Key Laboratory of Neural and Vascular Biology of Ministry of Education, Shijiazhuang 050011, China
- Key Laboratory of Medical Biotechnology of Hebei Province, Hebei Medical University, Shijiazhuang 050011, China
- Correspondence: (X.X.); (J.G.)
| | - Junfei Guo
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang 050051, China
- Correspondence: (X.X.); (J.G.)
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Use of Intravenous Paracetamol Preoperatively Favors Lower Risk of Delirium and Functional Recovery in Elderly Patients with Hip Fracture: A Propensity Score-Matched Analysis. Pain Res Manag 2022; 2022:1582727. [PMID: 35463628 PMCID: PMC9020999 DOI: 10.1155/2022/1582727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/12/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022]
Abstract
We aimed to investigate whether the use of intravenous paracetamol (IVP) preoperatively in intertrochanteric fracture (IF) patients aged 65 years or over receiving intramedullary fixation had significantly benefits on the pain score at discharge, delirium incidence, length of hospital stay (LOS), functional outcomes, and mortality. A retrospective analysis of all surgically treated patients presenting with IF was conducted at a single Level I trauma center in China between Jan. 2016 and Jan. 2020. The data concerning patients' demographics, injury-related data, surgery-related data, operation-related data, in-hospital data, and postoperative outcomes were extracted. To minimize potential confounding and selection bias, the propensity score matching (PSM) method was performed via the caliper matching method by using a 1 : 1 ratio. After PSM, McNemar's chi-square tests were used to examine the association of using IVP with outcome analyses. The Spearman correlations of IVP using, pain scores, and the factors which may influence them were also computed. After screening 2963 consecutive patients, 2166 were included finally, including 1576 in the non-IVP group and 590 in the IVP group. After PSM, 531 remained in each group. The pain scores at discharge were significantly between the two groups before and after matching (all p < 0.001). The differences of delirium rate and functional outcomes became significant after propensity score-based matching (p=0.001 and 0.033, respectively), although they were not significant before matching. No significant difference was observed in other operation-related data, LOS, and crude mortality rates at 30-day, 90-day, and 12-month before and after PSM. In conclusion, this study highlights the need for preoperative IVP use to optimize pain control, postoperative functional recovery, and minimize pain-related comorbidities such as delirium in elderly patients with hip fracture.
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