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Rudy MD, Grant PJ. The Patient with Hip Fracture. Med Clin North Am 2024; 108:1155-1169. [PMID: 39341619 DOI: 10.1016/j.mcna.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Hip fractures are a frequent cause of hospitalization in the elderly population and can lead to significant morbidity and mortality. As the population continues to age, the incidence of hip fractures is expected to increase. The internist/hospitalist plays a critical role in the care of this population as many patients have multiple medical comorbidities. Management of the fragility hip fracture patient requires knowledge of several perioperative topics including preoperative risk assessment, risk reduction strategies, the optimal timing of surgical repair, venous thromboembolism prevention, and postoperative care considerations such as early mobilization with physical therapy, and osteoporosis treatment.
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Affiliation(s)
- Michael D Rudy
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Paul J Grant
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Boulet J, Belzile EL, Dion N, Morency C, Bérubé M, Tremblay A, Pelet S. Palliative care is a viable option for frail elderly patients with neurocognitive disorders admitted for hip fractures. BMC Musculoskelet Disord 2024; 25:635. [PMID: 39127682 DOI: 10.1186/s12891-024-07739-w] [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: 11/02/2023] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
IMPORTANCE Most patients presenting with a hip fracture regardless of their comorbidities are surgically treated. A growing body of research states that a certain type of elderly patient could benefit more from a palliative approach. OBJECTIVE Identify the patient who would benefit most from a palliative care approach instead of a surgery. DESIGN Exploratory-matched retrospective cohort study between 2015 and 2021. SETTING Single Level 1 Trauma Center. PARTICIPANTS There were 2240 hip fracture patients admitted to our institution between 2015 and 2021. Patients over 65 years old with intertrochanteric or femoral neck fractures could be included. A total of 129 patients opted for palliative care (Palliative Group = PG). This cohort was compared to a matched cohort (for age, sex and fracture type) who underwent surgery but died within three months of the procedure (Surgery Deceased Group = SDG) and another matched cohort who survived more than three months (Surgery Alive Group = SAG) following surgery. MAIN OUTCOMES AND MEASURES Medical charts were reviewed for patient demographics, autonomy level, level of care, neurocognitive disorders (NCD), fracture type, in-hospital data and outpatient death within three months of admission. Analysis was performed through univariate and multivariate models with SAS OnDemand for Academics (alpha 0.05). RESULTS Patients in the PG (n = 129) were 88.2 ± 7.2 years old, 71.3% were females, and 61.2% had a femoral neck fracture. Patients in the SDG (n = 95) and SAG (n = 107) were well matched. The PG differed from the SDG (n = 95) and SAG (n = 107) regarding NCD (85.3% vs. 57.9% vs. 36.4%, p < 0.01) and the presence of Behavioral and psychological symptoms of dementia (BPSD) (19.4% vs. 5.3% vs. 3.7%, p < 0.01). There were more known heart failure (24.2% vs. 16.3%, p < 0.01) and Chronic Obstructive Pulmonary Disease (COPD) in the SDG group than in the PG group (26.6 vs. 14.7%, p = 0.02). Patients in the SAG have a significant lower rate of NCD (OR 2,7 (95%CI 1,5-5,0)), heart failure (OR 5,7 (95%CI 1,9-16,4)) and COPD (OR 2,8 (95%CI 1,2-6,3)) than other groups. Prefracture mobility, autonomy and living situation significantly differed between the groups. Median survival was six days in PG and 17 days in SDG. All groups lost autonomy and mobility. There were more complications in the SDG group than in the PG group. The end-of-care trajectory was death or hospice for most patients in the PG and SDG groups. More than 30% of the SAG group could not return home at discharge. CONCLUSION The presence of an NCD and diminished prefracture autonomy strongly support counseling for palliative care. The high rate of complications when surgery is proposed for frail patients with multiple comorbidities suggests that the concept of palliative surgery needs to be revisited.
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Affiliation(s)
- Justine Boulet
- Department of Surgery, Division of Orthopedic Surgery, CHU de Quebec-Universite Laval, Quebec City, QC, Canada.
- Department of Surgery, Faculty of Medicine, Laval University, Quebec City, QC, Canada.
| | - Etienne L Belzile
- Department of Surgery, Division of Orthopedic Surgery, CHU de Quebec-Universite Laval, Quebec City, QC, Canada
- Department of Surgery, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Norbert Dion
- Department of Surgery, Division of Orthopedic Surgery, CHU de Quebec-Universite Laval, Quebec City, QC, Canada
- Department of Surgery, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Chantal Morency
- Palliative Care Unit, Department of Medicine, CHU de Quebec-Universite Laval, Quebec City, QC, Canada
| | - Mélanie Bérubé
- Population Health and Optimal Practices Research Unit, CHU de Quebec-Universite Laval Research Centre, Quebec City, QC, Canada
- Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | | | - Stéphane Pelet
- Department of Surgery, Division of Orthopedic Surgery, CHU de Quebec-Universite Laval, Quebec City, QC, Canada.
- Department of Surgery, Faculty of Medicine, Laval University, Quebec City, QC, Canada.
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Tremblay A, Pelet S, Belzile É, Boulet J, Morency C, Dion N, Gagnon MA, Gauthier L, Khalfi A, Bérubé M. Strategies to improve end-of-life decision-making and palliative care following hip fracture in frail older adults: a scoping review. Age Ageing 2024; 53:afae134. [PMID: 38970548 PMCID: PMC11227115 DOI: 10.1093/ageing/afae134] [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: 09/28/2023] [Revised: 04/10/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Although surgery is the gold standard following a hip fracture, the potential for rehabilitation and survival rates are low in frail older patients. Some patients may derive more benefit from palliative care. The objectives of this review were to identify the available strategies to improve end-of-life decision-making and palliative care for frail patients with hip fractures and to synthetise their level of support. METHODS We conducted a scoping review of the scientific and grey literature, searching seven databases and websites of associations. We included all study designs, expert opinion articles and clinical practice guidelines (CPGs). Data were synthetised according to the Approach to Patient with Limited Life Expectancy and Hip Fracture framework. The number of research items and their level of evidence were tabulated for each of the recommended strategies. RESULTS Of the 10 591 items identified, 34 were eligible. The majority of included articles were original research studies (n = 15). Half of the articles and CPGs focused on intervention categories (55%) such as goals of care discussion and comfort care, followed by factors to consider in the end-of-life decision-making process (25%) and prognosis assessments (20%), mainly through the estimation of life expectancy. The level of evidence for these strategies remains low, given the limited number of prospective studies supporting them. CONCLUSIONS This scoping review highlighted that end-of-life care in frail older patients with a hip fracture remains understudied. The strategies identified could be prioritised for future research to improve the well-being of the target population while promoting sustainable resource management.
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Affiliation(s)
- Alexandra Tremblay
- Faculty of Nursing, Université Laval, 1050 Avenue de la Médecine, Québec City, Quebec G1V 0A6, Canada
- Population Health and Optimal Practices Research Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec City, Quebec GIV 1Z4, Canada
| | - Stéphane Pelet
- Department of Surgery, Division of Orthopedic Surgery, Hôpital de l’Enfant-Jésus, CHU de Quebec-Université Laval, 1401, 18e rue, Québec City, Quebec GIV 1Z4, Canada
- Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Québec City, Quebec G1V 0A6, Canada
| | - Étienne Belzile
- Department of Surgery, Division of Orthopedic Surgery, Hôpital de l’Enfant-Jésus, CHU de Quebec-Université Laval, 1401, 18e rue, Québec City, Quebec GIV 1Z4, Canada
- Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Québec City, Quebec G1V 0A6, Canada
| | - Justine Boulet
- Department of Surgery, Division of Orthopedic Surgery, Hôpital de l’Enfant-Jésus, CHU de Quebec-Université Laval, 1401, 18e rue, Québec City, Quebec GIV 1Z4, Canada
- Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Québec City, Quebec G1V 0A6, Canada
| | - Chantal Morency
- Palliative Care Unit, Department of Medicine, Hôpital de l’Enfant-Jésus, CHU de Quebec-Université Laval, 1401, 18e rue, Québec City, Quebec GIV 1Z4, Canada
| | - Norbert Dion
- Department of Surgery, Division of Orthopedic Surgery, Hôpital de l’Enfant-Jésus, CHU de Quebec-Université Laval, 1401, 18e rue, Québec City, Quebec GIV 1Z4, Canada
- Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Québec City, Quebec G1V 0A6, Canada
| | - Marc-Aurèle Gagnon
- Population Health and Optimal Practices Research Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec City, Quebec GIV 1Z4, Canada
| | - Lynn Gauthier
- Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Québec City, Quebec G1V 0A6, Canada
| | - Amal Khalfi
- Faculty of Nursing, Université Laval, 1050 Avenue de la Médecine, Québec City, Quebec G1V 0A6, Canada
- Population Health and Optimal Practices Research Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec City, Quebec GIV 1Z4, Canada
| | - Mélanie Bérubé
- Faculty of Nursing, Université Laval, 1050 Avenue de la Médecine, Québec City, Quebec G1V 0A6, Canada
- Population Health and Optimal Practices Research Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec City, Quebec GIV 1Z4, Canada
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Laane D, Kroes T, van den Berg A, de Jongh M, The R, Van der Velde D, Nijdam T. Patient and proxy perspectives in decision-making for geriatric hip fracture management in the Netherlands: a qualitative study. BMJ Open 2024; 14:e082093. [PMID: 38858152 PMCID: PMC11168140 DOI: 10.1136/bmjopen-2023-082093] [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: 11/15/2023] [Accepted: 05/09/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE The objective of this study was to explore the perspectives with the decision-making process between surgery and palliative, non-operative management of geriatric hip fracture patients and their proxies. DESIGN A qualitative interview study was performed. Patients and proxies were asked to participate in semi-structured interviews. Data were analysed using reflexive thematic analysis according to Braun and Clarke's six-step guide. SETTING AND PARTICIPANTS Hip fracture patients in the Netherlands were eligible for inclusion. For hip fracture patients with a pre-existing diagnosis of dementia and for patients who opted for palliative, non-operative management, proxies were included. RESULTS A total of 16 interviews were conducted, consisting of 4 patient interviews and 12 proxy interviews. Five themes were identified during thematic analysis: (1) underlying patient values, (2) the provision of information, (3) reasons to consider either palliative, non-operative management or surgery, (4) involvement in decision and (5) realisation of expectations. Information provided by the physician varied in terms of desired level of detail but involved discussing the advantages and disadvantages of surgery and palliative, non-operative management. Patients and proxies underscored the importance of achieving optimal quality of life, and the disparity between expected and actual treatment outcomes was unpleasant and negatively influenced the overall experience. CONCLUSIONS In-depth analysis provided a unique insight into the patient and proxy perspectives in shared decision-making for geriatric hip fracture management in the acute setting. Overall, there were differences between reported experiences and preferences of participants. This heterogeneity stresses the importance of keeping a person-centred approach during shared decision-making. Other key considerations during shared decision-making include physicians informing patients from professional experience and communicating sensitively about both treatment options and prognosis. Physicians should aim to provide realistic, sensitive and timely information to both patients and proxies during the choice between curation and palliation for their hip fracture.
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Affiliation(s)
- Duco Laane
- Department of Trauma Surgery, St Antonius Hospital Location Utrecht, Utrecht, Netherlands
| | - Thamar Kroes
- Department of Trauma Surgery, St Antonius Hospital Location Utrecht, Utrecht, Netherlands
| | - Arda van den Berg
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, Netherlands
| | - Mariska de Jongh
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, Netherlands
| | - Regina The
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, Netherlands
| | - Detlef Van der Velde
- Department of Trauma Surgery, St Antonius Hospital Location Utrecht, Utrecht, Netherlands
| | - Thomas Nijdam
- Department of Trauma Surgery, St Antonius Hospital Location Utrecht, Utrecht, Netherlands
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Paradis BE, Klein BJ, Bartlett LE, Cohn RM, Bitterman AD. Goals of Care Discussions in Orthopaedic Surgery: Geriatric Hip Fractures. J Arthroplasty 2024; 39:1144-1148. [PMID: 38462140 DOI: 10.1016/j.arth.2024.03.001] [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: 01/29/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Due to the severity of hip fracture complications in the geriatric population, including major morbidity and mortality, it is crucial to establish treatment goals and manage expectations as a patient-centered multidisciplinary team. Goals of care (GOC) are personalized treatment programs designed to align with the individual patient's values and preferences. There is a paucity of literature on the topic of GOC discussions, especially regarding orthopaedic injuries. Therefore, this narrative review aims to provide an account of GOC discussions related to geriatric hip fractures. METHODS We reviewed articles published on GOC between 1978 and 2024. The articles were identified by searching PubMed and Google Scholar. We utilized the search terms GOC discussions and hip fracture, with additional descriptors including arthroplasty and geriatric. RESULTS There were 11 articles that met the selection criteria and were published between 1978 and 2024. Five articles were published on GOC discussions in orthopaedic surgery, while the remaining 6 articles were published in non-orthopaedic fields. There was one systematic review, 2 narrative reviews, 6 observational studies, and 2 descriptive studies. Supplemental commentary from non-orthopaedic specialties and the fields of law and medical ethics was included to assist in highlighting barriers to GOC discussions and to explore potential strategies to enhance GOC discussions. CONCLUSIONS Goals of care discussions provide a framework for treatment decisions based on an individual patient's values and cultural beliefs; however, these conversations may be limited by perceived time constraints, patient health care literacy, and physicians' misconceptions of what is most important to discuss. While no clear consensus was identified regarding strategies for improving GOC discussions in geriatric patients who have hip fractures, the authors recommend standardized training programs, expedited family meetings, multidisciplinary team involvement, assistive technology such as Outcome Prioritization Tool, and the incorporation of GOC discussions into institutional hip fracture pathways.
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Affiliation(s)
- Brienne E Paradis
- University of New England College of Osteopathic Medicine, Biddeford, Maine
| | - Brandon J Klein
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
| | - Lucas E Bartlett
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
| | - Randy M Cohn
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
| | - Adam D Bitterman
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
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Nijdam TMP, Laane DWPM, Schiepers TEE, Smeeing DPJ, Kempen DHR, Willems HC, van der Velde D. The goals of care in acute setting for geriatric patients in case of a hip fracture. Eur J Trauma Emerg Surg 2023; 49:1835-1844. [PMID: 36933048 PMCID: PMC10449659 DOI: 10.1007/s00068-023-02258-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/04/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE For geriatric hip fracture patients, the decision between surgery and palliative, non-operative management is made through shared decision making (SDM). For this conversation, a physician must be familiar with the patient's goals of care (GOC). These are predominantly unknown for hip fracture patients and challenging to assess in acute setting. The objective was to explore these GOC of geriatric patients in case of a hip fracture. METHODS An expert panel gathered possible outcomes after a hip fracture, which were transformed into statements where participants indicated their relative importance on a 100-point scoring scale during interviews. These GOC were ranked using medians and deemed important if the median score was 90 or above. Patients were aged 70 years or older with a hip contusion due to similarities with the hip fracture population. Three cohorts based on frailty criteria and the diagnosis of dementia were made. RESULTS Preserving cognitive function, being with family and being with partner scored in all groups among the most important GOC. Both non-frail and frail geriatric patients scored return to pre-fracture mobility and maintaining independence among the most important GOC, where proxies of patients with a diagnosis of dementia scored not experiencing pain as the most important GOC. CONCLUSION All groups scored preserving cognitive function, being with family and being with partner among the most important GOC. The most important GOC should be discussed when a patient is presented with a hip fracture. Since patients preferences vary, a patient-centered assessment of the GOC remains essential.
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Affiliation(s)
| | | | | | | | | | - Hanna Cunera Willems
- Department of Internal Medicine and Geriatrics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Nijmeijer WS, Voorthuis BJ, Groothuis-Oudshoorn CGM, Würdemann FS, van der Velde D, Vollenbroek-Hutten MMR, Hegeman JH. The prediction of early mortality following hip fracture surgery in patients aged 90 years and older: the Almelo Hip Fracture Score 90 (AHFS 90). Osteoporos Int 2023; 34:867-877. [PMID: 36856794 PMCID: PMC10104941 DOI: 10.1007/s00198-023-06696-9] [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: 05/10/2022] [Accepted: 02/06/2023] [Indexed: 03/02/2023]
Abstract
The AHFS90 was developed for the prediction of early mortality in patients ≥ 90 years undergoing hip fracture surgery. The AHFS90 has a good accuracy and in most risk categories a good calibration. In our study population, the AHFS90 yielded a maximum prediction of early mortality of 64.5%. PURPOSE Identifying hip fracture patients with a high risk of early mortality after surgery could help make treatment decisions and information about the prognosis. This study aims to develop and validate a risk score for predicting early mortality in patients ≥ 90 years undergoing hip fracture surgery (AHFS90). METHODS Patients ≥ 90 years, surgically treated for a hip fracture, were included. A selection of possible predictors for mortality was made. Missing data were subjected to multiple imputations using chained equations. Logistic regression was performed to develop the AHFS90, which was internally and externally validated. Calibration was assessed using a calibration plot and comparing observed and predicted risks. RESULTS One hundred and two of the 922 patients (11.1%) died ≤ 30 days following hip fracture surgery. The AHFS90 includes age, gender, dementia, living in a nursing home, ASA score, and hemoglobin level as predictors for early mortality. The AHFS90 had good accuracy (area under the curve 0.72 for geographic cross validation). Predicted risks correspond with observed risks of early mortality in four risk categories. In two risk categories, the AHFS90 overestimates the risk. In one risk category, no mortality was observed; therefore, no analysis was possible. The AHFS90 had a maximal prediction of early mortality of 64.5% in this study population. CONCLUSION The AHFS90 accurately predicts early mortality after hip fracture surgery in patients ≥ 90 years of age. Predicted risks correspond to observed risks in most risk categories. In our study population, the AHFS90 yielded a maximum prediction of early mortality of 64.5%.
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Affiliation(s)
- W. S. Nijmeijer
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - B. J. Voorthuis
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - C. G. M. Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - F. S. Würdemann
- Dutch Hip Fracture Audit Taskforce Indicators, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - D. van der Velde
- Dutch Hip Fracture Audit Taskforce Indicators, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
- Department of Surgery, Sint Antonius Hospital, Soestwetering 1, 3542 AZ Utrecht, The Netherlands
| | - M. M. R. Vollenbroek-Hutten
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - J. H. Hegeman
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
- Dutch Hip Fracture Audit Taskforce Indicators, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
| | - on behalf of the Dutch Hip Fracture Audit Taskforce Indicators Group
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
- Dutch Hip Fracture Audit Taskforce Indicators, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Surgery, Sint Antonius Hospital, Soestwetering 1, 3542 AZ Utrecht, The Netherlands
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Lee A, Xi IL, Ahn J, Bernstein J. Median survival following geriatric hip fracture among 17,868 males from the Veterans Health Administration. Front Surg 2023; 10:1090680. [PMID: 37035567 PMCID: PMC10073485 DOI: 10.3389/fsurg.2023.1090680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Background The expected value of treatments for geriatric femoral neck fracture is influenced by the predicted duration of survival after injury. Specifically, total hip arthroplasty is more suited for patients likely to live long enough to reap its longer-term benefits. For predicting short- and medium-term survival, there are many tools available, but for longer-term survival prognosis the current literature is insufficient. Our hypothesis is that patient age at the time of injury correlates with median life expectancy and survival rates, and these values can anchor a prediction regarding a given patient's life expectancy. We therefore sought to determine median and fractional survival rates at 30 days, and 1, 2, 5 and 10 years after surgery for a large cohort of elderly patients with hip fracture as a function of age. Methods 17,868 male patients, 65-89 years of age, treated surgically for hip fracture within the Veterans Affairs system were assessed. From this set, 10,000 patients were randomly selected, and their ages at surgery and death (if any) were recorded at least 10 years post-operatively. Median and fractional survival rates were recorded at 1 month and 1, 2, 5, and 10 years. The mathematical relationship between age and median survival was determined. All findings from the 10,000-patient cohort were compared to corresponding values of the remaining 7,868 patients, to assess the predictive power of the initial observations. Results The median survival rate for the entire cohort was 2.2 years, with 90.4% of the group surviving at 30 days. The percentage of the cohort surviving at 1, 2, 5 and 10 years after treatment was 64.5%, 52.3%, 27.1% and 8.9% respectively. Median survival was approximately (13 - (0.13 × age-at-time-of-surgery) years for patients of all ages. Conclusions Median survival after geriatric hip fracture can be accurately predicted by the patient's age at the time of injury. Median survival and fractional survival at key milestones can help estimate life-expectancy and thereby help guide treatment.
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Affiliation(s)
- Alexander Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Ianto Lin Xi
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, United States
- Department of Veterans Affairs Medical Center, Lieutenant Colonel Charles S. Kettles Veterans Affairs Medical Center, Ann Arbor, MI, United States
| | - Joseph Bernstein
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
- Department of Veterans Affairs Medical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
- Correspondence: Joseph Bernstein
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Predictors of Hospice Discharge After Surgical Fixation of Hip Fractures. J Am Acad Orthop Surg 2023; 31:e35-e43. [PMID: 36394941 DOI: 10.5435/jaaos-d-21-01015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 08/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Each year, over 300,000 people older than 65 years are hospitalized for hip fractures. Given the notable morbidity and mortality faced by elderly patients in the postinjury period, recommendations have been put forth for integrating palliative and, when needed, hospice care to improve patients' quality of life. Our objective was to (1) understand the proportion of patients discharged to hospice after hip fracture surgery and their 30-day mortality rates and (2) identify the independent predictors of discharge to hospice. METHODS We retrospectively queried the American College of Surgeons National Surgical Quality Improvement Program for all hip fracture surgeries between the years of 2016 and 2018. Included cases were stratified into two cohorts: cases involving a discharge to hospice and nonhospice discharge. Variables assessed included patient demographics, comorbidities, perioperative characteristics, and postoperative outcomes. Differences between hospice and nonhospice patients were compared using chi-squared analysis or the Fisher exact test for categorical variables and Student t -tests for continuous variables. A binary logistic regression model was used to assess independent predictors of hospice discharge with 30-day mortality. RESULTS Overall, 31,531 surgically treated hip fractures were identified, of which only 281 (0.9%) involved a discharge to hospice. Patients discharged to hospice had a 67% 30-day mortality rate in comparison with 5.6% of patients not discharged to hospice ( P < 0.001). Disseminated cancer, dependent functional status, >10% weight loss over 6 months preoperatively, and preoperative cognitive deficit were the strongest predictors of hospice discharge with 30-day mortality after hip fracture surgery. CONCLUSIONS Current hospice utilization in hip fracture patients remains low, but 30-day mortality in these patients is high. An awareness of the associations between patient characteristics and discharge to hospice with 30-day mortality is important for surgeons to consider when discussing postoperative expectations and outcomes with these patients. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Nijdam TMP, Laane DWPM, Spierings JF, Schuijt HJ, Smeeing DPJ, van der Velde D. Proxy-reported experiences of palliative, non-operative management of geriatric patients after a hip fracture: a qualitative study. BMJ Open 2022; 12:e063007. [PMID: 35948383 PMCID: PMC9379475 DOI: 10.1136/bmjopen-2022-063007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/18/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The objective of this study was to explore the experiences from the period after the choice was made for palliative, non-operative management for geriatric patients with a hip fracture, to the most important factors in the process, as reported by a proxy. DESIGN Semistructured interviews were conducted between 1 August 2020 and 1 April 2021 to investigate by-proxy reported patient experiences of non-operative management after hip fracture. Interviews followed a topic guide, recorded and transcribed per word. Thematic analysis was used to identify themes in the data. SETTING AND PARTICIPANTS Patients were retrospectively identified from the electronic patient record. Relatives (proxies) of the patients who underwent palliative, non-operative management were contacted and were asked to participate in a semistructured interview and were named participants. The participants were proxies of the patients since patients were expected to be deceased during the timing of the interview. RESULTS A total of 26 patients were considered eligible for inclusion in this study. The median age of the patients was 88 years (IQR 83-94). The 90-day mortality rate was 92.3%, with a median palliative care period of 11 days (IQR 4-26). A total of 19 participants were subjected to the interview. After thematic analysis, four recurring themes were identified: (1) the decision-making process, (2) pain experience, (3) patient-relative interaction and (4) the active dying. CONCLUSIONS With the introduction of shared decision-making in an acute setting for geriatric patients with hip fracture, proxies reported palliative, non-operative management as an acceptable and adequate option for patients with high risk of adverse outcomes after surgery. The emerged themes in palliative care for patients with hip fracture show great similarity with severe end-stage disease palliative care, with pain identified as the most important factor influencing comfort of the patient and their environment after hip fracture. Future research should focus on further improving targeted analgesia for these patients focusing on acute pain caused by the fracture.
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Affiliation(s)
| | | | - Jelle Friso Spierings
- Department of Surgery, St Antonius Ziekenhuis Locatie Utrecht, Utrecht, The Netherlands
| | - Henk Jan Schuijt
- Department of Surgery, St Antonius Ziekenhuis Locatie Utrecht, Utrecht, The Netherlands
| | | | - Detlef van der Velde
- Department of Surgery, St Antonius Ziekenhuis Locatie Utrecht, Utrecht, The Netherlands
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11
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Bernstein J, Lee A, Xi IL, Ahn J. Estimating Median Survival Following Hip Fracture Among Geriatric Females: (100 – Patient Age) ÷ 4. Cureus 2022; 14:e26299. [PMID: 35911335 PMCID: PMC9312923 DOI: 10.7759/cureus.26299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/05/2022] Open
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12
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Holub A, Jornet-Gibert M, Ruppenkamp J, Holy CE, Daccach J, Torner P, Caba-Doussoux P, Muñoz Vives JM. Risk of Mortality for Proximal Femoral Fracture in Patients With and Without COVID-19. A Retrospective Cohort Study. Geriatr Orthop Surg Rehabil 2022; 13:21514593221138656. [DOI: 10.1177/21514593221138656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background SARS-CoV-2 (COVID-19) has resulted in a widespread loss of lives, morbidity, and major disruptions to the healthcare system. Hip fractures are an emergent condition which require early intervention to reduce increased risk of mortality and morbidity. Infection of SARS-CoV-2 may contribute to increased mortality due to the role of infection and immune response. This study investigated the impact of COVID-19 infection (defined by clinical symptoms) on mortality following proximal femoral fracture (PFF) repair procedures. Methods This study was a retrospective cohort study. Data from the Premier Healthcare Database® was extracted for patients presenting for PFF during 2019 for control, and February 2020-September 2020 to represent a COVID time-period. Results A total of N = 73 953 subjects were enrolled for the 2019 period, and a total of N = 34 842 subjects were enrolled for the COVID period. For the 2019 period, subjects who had a PFF procedure and who had flu/COVID-like illness had 2.47 (CI:2.11, 2.88) times the odds of mortality compared to those who did not have flu/COVID-like illness. Subjects who had a PFF procedure and who had flu/COVID-like illness during the COVID period had 2.85 times (CI:2.36, 3.42) the odds of mortality compared to those who did not have flu/COVID-like illness. For the COVID period, within subjects who did not have a PFF procedure, those with flu/COVID-like illness had increased odds of mortality compared to those who did not have flu/COVID-like illness (OR:2.26, CI:1.57, 3.21). Conclusions Hip fractures present high risk for mortality and morbidity, where timely intervention is critical to improved outcomes. Presence of infection such as flu/COVID-like illness may influence mortality in patients undergoing hip fracture repair procedures. Consideration of infection status as a comorbidity is important to proper management and achieving optimal outcomes.
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Affiliation(s)
- Ashley Holub
- Epidemiology & Real-World Data Sciences, Johnson & Johnson MedTech, New Brunswick, NJ, USA
| | - Montsant Jornet-Gibert
- Department of Orthopaedic Surgery and Traumatology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Jill Ruppenkamp
- Epidemiology & Real-World Data Sciences, Johnson & Johnson MedTech, New Brunswick, NJ, USA
| | - Chantal E. Holy
- Epidemiology & Real-World Data Sciences, Johnson & Johnson MedTech, New Brunswick, NJ, USA
| | - Juan Daccach
- Medical Safety, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, NJ, USA
| | - Pere Torner
- Department of Orthopaedic Surgery and Traumatology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Pedro Caba-Doussoux
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Josep Maria Muñoz Vives
- Department of Orthopaedic Surgery and Traumatology, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain
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13
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Chiang MH, Lee HJ, Kuo YJ, Chien PC, Chang WC, Wu Y, Chen YP. Predictors of In-Hospital Mortality in Older Adults Undergoing Hip Fracture Surgery: A Case-Control Study. Geriatr Orthop Surg Rehabil 2021; 12:21514593211044644. [PMID: 34631200 PMCID: PMC8495513 DOI: 10.1177/21514593211044644] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/19/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Although surgery has been proven to improve the long-term survival of older adults with hip fracture, in-hospital mortality directly resulting from repair of hip fracture is undesirable. This study aimed to identify potential prognostic factors that predict in-hospital mortality risk in elderly patients following hip fracture surgery. Materials and Methods: This case–control study comprehensively collected data from older adults with hip fracture admitted to a single medical centre. Age was selected as the cross-matching factor. Univariate and binary multivariate logistic regression models were used to estimate the odds ratios with 95% confidence intervals. A receiver operating characteristic curve was constructed to quantify the discrimination power of the model. Results: Among a total of 841 older adults who received hip fracture surgery, 17 died during hospitalisation, yielding a 2.0% in-hospital mortality rate. Using a binary multivariate logistic regression model to perform a comparison with 51 age-matched patients in survival groups, the model revealed that estimated glomerular filtration rate (eGFR) and malignant cancer history were the only 2 factors significantly correlated with in-hospital mortality. The prognostic values for the eGFR and malignant cancer history were acceptable, with areas under the curve of .76 and .67, respectively. Conclusion: The prevalence of in-hospital mortality following hip fracture is low. After adjustment for age, eGFR and malignant cancer history were identified as factors significantly correlated with in-hospital mortality. The findings of this study could assist in the early screening and detection of patients with high in-hospital mortality risks.
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Affiliation(s)
- Ming-Hsiu Chiang
- Department of General Medicine, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| | - Huan-Ju Lee
- Department of Orthopedics, Taipei Medical University Shuan Ho Hospital, New Taipei City, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pei-Chun Chien
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chun Chang
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yueh Wu
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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14
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Whitehead PB, Gamaluddin S, DeWitt S, Stewart C, Kim KY. Caring for Patients With Dementia at End of Life. Am J Hosp Palliat Care 2021; 39:716-724. [PMID: 34519251 DOI: 10.1177/10499091211046247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Care of the dementia patient continues to be challenging. It is a terminal condition that many times goes undiagnosed leading to improper evidence-based interventions. Healthcare professionals (HCPs) should initiate goals of care conversations early with patients and their families in order to align treatment preferences. Early integration of palliative medicine is an important intervention that can lead to better manage symptoms and lessen the strain on loved ones. Additionally, early enrollment into hospice should be encouraged with loved ones to promote quality of life as defined by the patient.
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Affiliation(s)
- Phyllis B Whitehead
- Carilion Roanoke Memorial Hospital Palliative Care Service, Roanoke, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | | | - Sarah DeWitt
- Carilion Roanoke Memorial Hospital Palliative Care Service, Roanoke, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Christi Stewart
- Carilion Roanoke Memorial Hospital Palliative Care Service, Roanoke, VA, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Carilion Center for Healthy Aging, Roanoke, VA, USA
| | - Kye Y Kim
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Carilion Center for Healthy Aging, Roanoke, VA, USA
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15
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Morioka N, Moriwaki M, Tomio J, Fushimi K, Ogata Y. Dementia and patient outcomes after hip surgery in older patients: A retrospective observational study using nationwide administrative data in Japan. PLoS One 2021; 16:e0249364. [PMID: 33886588 PMCID: PMC8061936 DOI: 10.1371/journal.pone.0249364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 03/17/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To investigate whether dementia is associated with incidence of adverse events and longer hospital stays in older adults who underwent hip surgery, after adjusting for individual social and nursing care environment. DESIGN AND SETTING Retrospective observational study using the linked data between the Japanese Diagnosis Procedure Combination database and the reports of the medical functions of hospital beds database in Japan (April 2016-March 2017). PARTICIPANTS A total of 48,797 individuals aged 65 and older who underwent hip surgery and were discharged during the study period. METHODS Outcomes included in-hospital death, in-hospital pneumonia, in-hospital fracture, and longer hospital stay. We performed two-level, multilevel models adjusting for individual and hospital characteristics. RESULTS Among all participants, 20,638 individuals (42.3%) had dementia. The incidence of adverse events for those with and without dementia included in-hospital death: 2.11% and 1.11%, in-hospital pneumonia: 0.15% and 0.07%, and in-hospital fracture: 3.76% and 3.05%, respectively. The median (inter quartile range) length of hospital stay for those with and without dementia were 26 (19-39) and 25 (19-37) days, respectively. Overall, the odds ratios (95% confidence interval (CI)) of dementia for in-hospital death, in-hospital pneumonia, and in-hospital fracture were 1.12 (0.95-1.33), 0.95 (0.51-1.80), and 1.08 (0.92-1.25), respectively. Dementia was not associated with the length of hospital stay (% change) (-0.7%, 95% CI -1.6-0.3%). Admission from home, discharge to home, and lower nurse staffing were associated with prolonged hospital stays. CONCLUSIONS Although adverse events are more likely to occur in older adults with dementia than in those without dementia after hip surgery, we found no evidence of an association between dementia and adverse events or the length of hospital stay after adjusting for individual social and nursing care environment.
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Affiliation(s)
- Noriko Morioka
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mutsuko Moriwaki
- Department of Tokyo Metropolitan Health Policy Advisement, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Tomio
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuko Ogata
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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16
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Lim JW, Ang GC. Approach to patients with hip fracture and concurrent stroke. BMJ Case Rep 2021; 14:14/2/e236064. [PMID: 33622739 PMCID: PMC7903073 DOI: 10.1136/bcr-2020-236064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 70-year-old man who presented with concomitant hip fracture and stroke. Our patient underwent surgical correction of a hip fracture despite the increased perioperative and postoperative risks associated with an acute stroke. He achieved good functional outcome after surgery and subsequent rehabilitation. There are no clear guidelines on the factors to determine whether a patient with concomitant stroke and hip fracture is a good candidate for surgical hip repair. Furthermore, there is also no consensus on the appropriate timing of surgical repair for such patients. We postulate that factors such as functional status, comorbidities, type and severity of stroke will affect the decision to proceed with surgical repair, and that there is a benefit in advocating for surgery in appropriate patients by a multidisciplinary orthogeriatric care team.
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Affiliation(s)
- Jing Wei Lim
- Geriatric Medicine, Changi General Hospital, Singapore
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17
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Cannada LK, Mears SC, Quatman C. Clinical Faceoff: When Should Patients 65 Years of Age and Older Have Surgery for Hip Fractures, and When is it a Bad Idea? Clin Orthop Relat Res 2021; 479:24-27. [PMID: 33315622 PMCID: PMC7899710 DOI: 10.1097/corr.0000000000001596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/05/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Lisa K Cannada
- L. K. Cannada, Orthopaedic Trauma Surgeon, Novant Health Orthopedics, Charlotte, NC, USA
- S. C. Mears, Professor, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- C. Quatman, Associate Professor, Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA
| | - Simon C Mears
- L. K. Cannada, Orthopaedic Trauma Surgeon, Novant Health Orthopedics, Charlotte, NC, USA
- S. C. Mears, Professor, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- C. Quatman, Associate Professor, Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA
| | - Carmen Quatman
- L. K. Cannada, Orthopaedic Trauma Surgeon, Novant Health Orthopedics, Charlotte, NC, USA
- S. C. Mears, Professor, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- C. Quatman, Associate Professor, Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA
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18
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Development and Internal Validation of a Prediction Model for In-Hospital Mortality in Geriatric Patients With a Hip Fracture. J Orthop Trauma 2020; 34:656-661. [PMID: 32502058 DOI: 10.1097/bot.0000000000001851] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop and validate a prediction model for in-hospital mortality in patients with hip fracture 85 years of age or older undergoing surgery. DESIGN A multicenter prospective cohort study. SETTING Six Dutch trauma centers, level 2 and 3. PARTICIPANTS Patients with hip fracture 85 years of age or older undergoing surgery. INTERVENTION Hip fracture surgery. MAIN OUTCOME MEASUREMENTS In-hospital mortality. RESULTS The development cohort consisted of 1014 patients. In-hospital mortality was 4%. Age, male sex, American Society of Anesthesiologists classification, and hemoglobin levels at presentation were independent predictors of in-hospital mortality. The bootstrap adjusted performance showed good discrimination with a c-statistic of 0.77. CONCLUSION Age, male sex, higher American Society of Anesthesiologists classification, and lower hemoglobin levels at presentation are robust independent predictors of in-hospital mortality in patients with geriatric hip fracture and were incorporated in a simple prediction model with good accuracy and no lack of fit. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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