1
|
Bauman ZM, Cemaj S, Patel N, Raposo-Hadley A, Saxton K, Evans CH, Waibel B, Cantrell E. "Peas in a Pod": Clustering minorly injured trauma patients together during their hospitalization results in decreased hospital costs and fewer inpatient complications. Am J Surg 2022; 224:106-110. [PMID: 35354532 DOI: 10.1016/j.amjsurg.2022.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/22/2021] [Accepted: 03/22/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Trauma patient care is complex. Clustering these patients within the hospital seems intuitive. This study's purpose was to explore the benefits of trauma patient clustering, hypothesizing these patients will have decreased costs and better outcomes. METHODS This was an analysis of all adult (18-99 years) trauma patients admitted from 1/2017-1/2019 without an intensive care unit stay. Patients were grouped into those admitted to the trauma unit (TU) versus non-trauma units (NTU). Outcomes evaluated between groups were baseline demographics, direct costs, complication rates (using our TQIP registry), and discharge location. T-test, median test, and chi squared test were used. Linear regression was performed. Significance was set at p < 0.05. RESULTS 1481 patients (684 TU and 797 NTU) were analyzed. TU patients were younger. Injury Severity Score, mortality, and hospital length of stay were similar between groups. Direct hospital costs were decreased for TU patients ($4941(±$4740) versus $5639(±$4897), p = 0.006). Fewer TU patients experienced inpatient complications (7.8% versus 13.5%, p < 0.001). More TU patients were discharged to home (78.9% versus 73.8%, p = 0.02). Linear regression analysis demonstrated admission to NTUs predicted a direct cost increase of $766.35 (p < 0.001). CONCLUSIONS Clustering minorly injured trauma patients on a dedicated unit resulted in reduced costs, decreased complications, and higher likelihood for discharge to home.
Collapse
Affiliation(s)
- Zachary M Bauman
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Sophie Cemaj
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Neesha Patel
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Ashley Raposo-Hadley
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Karen Saxton
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Charity H Evans
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Brett Waibel
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Emily Cantrell
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| |
Collapse
|
2
|
Fujimoto Y, Setoguchi T, Ishidou Y, Taniguchi N. Low geriatric nutritional risk index is a risk factor for death within 1 year following hip fracture. J Orthop Surg (Hong Kong) 2022; 30:10225536221103360. [PMID: 35578747 DOI: 10.1177/10225536221103360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Hip fracture is common in older patients and is associated with high mortality and functional impairment. The Geriatric Nutritional Risk Index (GNRI) evaluates the risk of malnutrition-related complications, and the Barthel Index (BI) evaluates older patients' functional status. The study aim was to determine the risk factors for both death and decreased BI within 1 year after hip fracture. METHODS We retrospectively reviewed the records of 108 patients who were treated for hip fractures in 10 public or private hospitals from February to July 2007. Participating facilities comprised eight public or private hospitals with 200-499 beds, and two private or orthopedic hospitals with 20-199 beds. We evaluated several risk factors for death and lower BI within 1 year after hip fracture. RESULTS The mortality rate within 1 year postoperatively for patients who survived inpatient stay was 6.5% (7/108). The proportion of patients with decreased postoperative BI was 43.6% (44/101). Binomial logistic regression analysis showed that several factors, including low GNRI (odds ratio [OR]: 0.80; 95% confidence interval [CI: 0.68-0.93]), were risk factors for death within 1 year. Postoperative delirium (OR: 8.84 [1.52-51.6]), postinjury dementia (OR: 34.8 [3.01-402]), preinjury BI (OR: 1.05 [1.02-1.08]), and preinjury dementia (OR: 6.22 [1.73-22.4]) were risk factors for decreased postoperative BI. CONCLUSIONS Our findings indicated that lower GNRI was a risk factor for death within 1 year of hip surgery and that delirium and dementia were among the risk factors for decreased BI 1 year after hip fracture.
Collapse
Affiliation(s)
- Yusuke Fujimoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan.,Department of Medical Joint Materials, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| | - Takao Setoguchi
- Department of Orthopaedic Surgery, Japanese Red Cross Kagoshima Hospital, Kagoshima, Japan
| | - Yasuhiro Ishidou
- Department of Medical Joint Materials, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| | - Noboru Taniguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| |
Collapse
|
3
|
Malhotra R, Huq SS, Chong M, Murphy D, Daruwalla ZJ. Outcomes in Nonagenarians with Hip Fractures Treated Conservatively and Surgically. Malays Orthop J 2021; 15:21-28. [PMID: 34966491 PMCID: PMC8667238 DOI: 10.5704/moj.2111.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/14/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction We aimed to assess the clinical outcomes in nonagenarians following a hip fracture. We also further investigated the factors that influence these outcomes, such as method of treatment (operative versus conservative), co-morbidities, and pre-morbid function. Materials and methods We studied 65 nonagenarians that were identifiable from our hospital hip fracture database. We reviewed various parameters of these patients admitted after sustaining a hip fracture (neck of femur or intertrochanteric) and investigated how these parameters affected patient outcomes. The main outcomes studied were: inpatient morbidity, and mortality at one year. Results Inpatient morbidity was more likely in patients with an ASA grade of 3 to 5. Urinary tract infection was the most common medical complication. The 1-year mortality was 15.4% and was significantly influenced by advancing age. Surgically managed patients had a 1-year mortality rate (14.3%) slightly less than non-operative patients (17.4%). Post injury mobility was significantly better in those who received operative treatment with 63% of surgical cases regaining ambulatory status versus 7% of conservatively managed patients. Conclusions We presented the outcomes of hip fractures in an extreme age group in the population. In nonagenarians with hip fractures surgery was associated with a 1-year mortality rate of 14.3% which is comparable to the general hip fracture population and less than the mortality rate of conservatively managed patients (17.4%). The primary advantage of surgery would be that two-thirds of patients return to ambulatory status. This information is useful to counsel patients and their families especially since the elderly are often more fearful of surgical intervention.
Collapse
Affiliation(s)
- R Malhotra
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - S S Huq
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - M Chong
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - D Murphy
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| | - Z J Daruwalla
- Department of Orthopaedics, National University Hospital of Singapore, Singapore
| |
Collapse
|
4
|
Lee SH, Han Y, Kim SJ, Lee SJ, Ryu YJ. Impact of right ventricular systolic pressure in elderly patients admitted to intensive care unit after femur fracture surgery: A retrospective observational study. Medicine (Baltimore) 2020; 99:e22881. [PMID: 33157931 PMCID: PMC7647512 DOI: 10.1097/md.0000000000022881] [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] [Indexed: 11/25/2022] Open
Abstract
The number of femoral fractures is expected to continue to increase as the size of the older population rapidly grows. However, old age is accompanied by various comorbidities and is an important postoperative risk factor in itself, meaning that patients who undergo surgery for a femur fracture may require admission to an ICU. We investigated pulmonary complications in patients over the age of 65 admitted to the ICU after femur fracture surgery.In this single-center retrospective observational study, 289 patients over 65 years who admitted to the ICU after femur fracture surgery between June 2008 and December 2016 were investigated.Pulmonary complications occurred in 97 of these patients (33.6%) after surgery. Mean hospitalization days (34.1 ± 25.7 vs 23.1 ± 15.7, P < .001) and mean ICU length of stay (8.4 ± 16.1 vs 2.5 ± 1.1, P = .001) were significantly longer for patients with pulmonary complications than for patients without pulmonary complications after femur fracture surgery. Patients with pulmonary complications were significantly more likely to have pulmonary disease (19.6% vs 8.9%, P = .009) and exhibit sequelae on preoperative chest X-rays (9.3% vs 3.6%, P = .048) than were patients without pulmonary complications. In addition, significant differences were observed in the right ventricular systolic pressure (RVSP) measured during preoperative echocardiography (37.4 ± 10.9 mm Hg vs 40.7 ± 9.3 mm Hg for patients without and with pulmonary complications, P = .010) and in the proportion of each group that had an RVSP of >35 mm Hg, which is a marker for pulmonary hypertension (55.2% vs 76.3% for patients without and with pulmonary complications, P < .001). In multivariate analysis, an RVSP of >35 mm Hg during preoperative echocardiography was associated with pulmonary complications after femur fracture surgery (OR, 2.6; 95% CI, 1.45-4.53).In conclusion, Pulmonary complications in older patients admitted to the ICU after femur fracture surgery was associated with longer hospitalization and ICU stays. Preoperative RVSP measurement could identify those older patients with a high risk of pulmonary complications following transferal to the ICU after femur fracture surgery.
Collapse
Affiliation(s)
- Su Hwan Lee
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine
| | - Yeji Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul
| | - Soo Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul
| | - Seok Jeong Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul
| |
Collapse
|
5
|
Outcome of Spinal Surgery in Patients Older Than Age 90 Years. World Neurosurg 2019; 123:e457-e464. [DOI: 10.1016/j.wneu.2018.11.188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/21/2022]
|
6
|
Takeuchi R, Mutsuzaki H, Shimizu Y, Mataki Y, Tokeji K, Wadano Y. Factors affecting ambulatory ability in patients aged 90 years and older following proximal femoral fractures. J Rural Med 2017; 12:63-67. [PMID: 29255522 PMCID: PMC5721289 DOI: 10.2185/jrm.2928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/31/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives: To investigate the details of patients’ status on admission and
at discharge at our hospital, to compare the ambulatory group and non-ambulatory group at
discharge, and to assess the factors associated with ambulatory ability at discharge in
patients aged ≥ 90 years with proximal femoral fractures (PFFs). Patients/Materials and Methods: Twenty patients admitted to our hospital for
rehabilitation after surgery for a PFF were evaluated retrospectively. The rate of
regaining ambulatory ability, presence of dementia, body mass index, serum albumin level,
hemoglobin level, lymphocyte count, and functional independence measure (FIM) were
assessed on admission and at discharge. Relationships between patients’ ambulatory ability
and ambulatory parameters were compared between the ambulatory and non-ambulatory
groups. Results: The rate of regaining ambulatory ability was 55% at discharge. The
serum albumin level at discharge was significantly higher in the ambulatory group than
that in the non-ambulatory group. More patients had dementia on admission in the
non-ambulatory group than in the ambulatory group. On admission, scores for the cognitive
items of the FIM (“expression” and “memory”) were significantly higher in the ambulatory
group than those in the non-ambulatory group. Conclusions: The rate of ambulatory ability at discharge was 55% in those
with a PFF, who were aged ≥ 90 years. The presence of dementia on admission and serum
albumin level at discharge were factors related to ambulatory ability. It is very
important to use a general rehabilitation protocol that takes cognitive function and
nourishment into account, in addition to the physical aspect.
Collapse
Affiliation(s)
- Ryoko Takeuchi
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences, Japan
| | - Hirotaka Mutsuzaki
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba, Japan
| | - Yuki Mataki
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences, Japan
| | - Kayo Tokeji
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences, Japan
| | - Yasuyoshi Wadano
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences, Japan
| |
Collapse
|
7
|
Tulic G, Dubljanin-Raspopovic E, Tomanovic-Vujadinovic S, Sopta J, Todorovic A, Manojlovic R. Prolonged pre-operative hospital stay as a predictive factor for early outcomes and mortality after geriatric hip fracture surgery: a single institution open prospective cohort study. INTERNATIONAL ORTHOPAEDICS 2017; 42:25-31. [PMID: 28956102 DOI: 10.1007/s00264-017-3643-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/10/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this open prospective cohort study was to determine if a prolonged pre-operative hospital stay is a true predictor of higher morbidity or mortality in geriatric patients with hip fractures. MATERIALS AND METHODS We analysed early outcome parameters, such as functional independence measure (FIM), at discharge and four months post-operatively, peri-operative nonsurgical complications, intra-hospital and one year mortality compared with prolonged pre-operative hospital stay in 308 patients from a continuous cohort of 344. RESULTS Average pre-operative stay was 8.39 ± 5.80 days. Delaying surgery for > 72 hours was independently predictive for general complications and lower motor FIM gain at four months. All findings worsen progressively after the fifth day of delay. Pre-operative period was not found to be an independent predictor of mortality. CONCLUSION In all observed outcome parameters except mortality, pre-operative delay > 72 hours was shown to be a true predictive factor.
Collapse
Affiliation(s)
- Goran Tulic
- School of Medicine, University of Belgrade, Belgrade, Serbia. .,Clinic for Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Belgrade, Serbia.
| | - Emilija Dubljanin-Raspopovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Physical Medicine and Rehabilitation, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Jelena Sopta
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Institute for Pathology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Todorovic
- Clinic for Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Radovan Manojlovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Belgrade, Serbia
| |
Collapse
|
8
|
Fansa A, Huff S, Ebraheim N. Prediction of Mortality in Nonagenarians Following the Surgical Repair of Hip Fractures. Clin Orthop Surg 2016; 8:140-5. [PMID: 27247737 PMCID: PMC4870315 DOI: 10.4055/cios.2016.8.2.140] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/06/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study is to report on the mortality of nonagenarians who underwent surgical treatment for a hip fracture, specifically in regards to preexisting comorbidities. Furthermore, we assessed the effectiveness of the Deyo score in predicting such mortality. METHODS Thirty-nine patients over the age of 90 who underwent surgical repair of a hip fracture were retrospectively analyzed. Twenty-six patients (66.7%) suffered femoral neck fractures, while the remaining 13 (33.3%) presented with trochanteric type fractures. Patient charts were examined to determine previously diagnosed patient comorbidities as well as living arrangements and mobility before and after surgery. RESULTS Deyo index scores did not demonstrate statistically significant correlations with postoperative mortality or functional outcomes. The hazard of in-hospital mortality was found to be 91% (p = 0.036) and 86% (p = 0.05) less in patients without a history of congestive heart failure (CHF) and chronic pulmonary disease (CPD), respectively. Additionally, the hazard of 90-day mortality was 88% (p = 0.01) and 81% (p = 0.024) less in patients without a history of dementia and CPD, respectively. The hazard of 1-year mortality was also found to be 75% (p = 0.01) and 80% (p = 0.01) less in patients without a history of dementia and CPD, respectively. Furthermore, dementia patients stayed in-hospital postoperatively an average of 5.3 days (p = 0.013) less than nondementia patients and only 38.5% returned to preoperative living conditions (p = 0.036). CONCLUSIONS Nonagenarians with a history of CHF and CPD have a higher risk of in-hospital mortality following the operative repair of hip fractures. CPD and dementia patients over 90 years old have higher 90-day and 1-year mortality hazards postoperatively. Dementia patients are also discharged more quickly than nondementia patients.
Collapse
Affiliation(s)
- Ashraf Fansa
- Department of Orthopedics, University of Toledo Medical Center, Toledo, OH, USA
| | - Scott Huff
- College of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Nabil Ebraheim
- Department of Orthopedics, University of Toledo Medical Center, Toledo, OH, USA
| |
Collapse
|
9
|
Ishidou Y, Koriyama C, Kakoi H, Setoguchi T, Nagano S, Hirotsu M, Yamamoto T, Yokouchi M, Komiya S. Predictive factors of mortality and deterioration in performance of activities of daily living after hip fracture surgery in Kagoshima, Japan. Geriatr Gerontol Int 2016; 17:391-401. [DOI: 10.1111/ggi.12718] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 11/07/2015] [Accepted: 11/22/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Yasuhiro Ishidou
- Department of Medical Joint Materials; Kagoshima University; Kagoshima Japan
| | - Chihaya Koriyama
- Department of Epidemiology and Preventive Medicine; Kagoshima University; Kagoshima Japan
| | - Hironori Kakoi
- Department of Orthopedic Surgery; Kagoshima University; Kagoshima Japan
| | - Takao Setoguchi
- The Near-Future Locomotor Organ Medicine Creation Course; Graduate School of Medical and Dental Sciences; Kagoshima University; Kagoshima Japan
| | - Satoshi Nagano
- Department of Orthopedic Surgery; Kagoshima University; Kagoshima Japan
| | - Masataka Hirotsu
- Department of Orthopedic Surgery; Kagoshima University; Kagoshima Japan
| | - Takuya Yamamoto
- Department of Orthopedic Surgery; Kagoshima University; Kagoshima Japan
| | - Masahiro Yokouchi
- Department of Orthopedic Surgery; Kagoshima University; Kagoshima Japan
| | - Setsuro Komiya
- Department of Orthopedic Surgery; Kagoshima University; Kagoshima Japan
| |
Collapse
|
10
|
Tajika T, Kobayashi T, Yamamoto A, Shitara H, Ichinose T, Shimoyama D, Okura C, Kanazawa S, Nagai A, Takagishi K. Relationship between grip, pinch strengths and anthropometric variables, types of pitch throwing among Japanese high school baseball pitchers. Asian J Sports Med 2015; 6:e25330. [PMID: 25883777 PMCID: PMC4393547 DOI: 10.5812/asjsm.25330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/02/2015] [Accepted: 01/06/2015] [Indexed: 11/21/2022] Open
Abstract
Background: Grip and pinch strength are crucially important attributes and standard parameters related to the functional integrity of the hand. It seems significant to investigate normative data for grip and pinch strength of baseball players to evaluate their performance and condition. Nevertheless, few reports have explained the association between grip and pinch strength and anthropometric variables and types of pitch throwing for baseball pitchers. Objectives: The aim of this study was to measure and evaluate clinical normative data for grip and tip, key, palmar pinch strength and to assess the relationship between these data and anthropometric variables and types of pitch throwing among Japanese high-school baseball pitchers. Materials and Methods: One hundred-thirty three healthy high school baseball pitchers were examined and had completed a self-administered questionnaire including items related to age, hand dominance, throwing ratio of type of pitch. A digital dynamometer was used to measure grip strength and a pinch gauge to measure tip, key and palmer pinch in both dominant and nondominant side. Body composition was measured by the multi frequency segmental body composition analyzer. Results: Grip strength and tip and palmer pinch strength in dominant side were statistically greater than them in nondominant side (P < 0.05). There were significant associations between grip strength and height (r = 0.33, P < 0.001), body mass (r = 0.50, P < 0.001), BMI (r = 0.37, P < 0.001), muscle mass of upper extremity (r = 0.56, P < 0.001), fat free mass (r = 0.57, P < 0.001), fat mass (r = 0.22, P < 0.05) in dominant side. A stepwise multiple regression analysis revealed that fat free mass and tip, palmer, key pinch strength were predictors of grip strength in dominant side. No statistical significant correlations were found between the throwing ratio of types of pitches thrown and grip strength and tip, key, palmar pinch strength. Conclusions: Our result provides normative values and evidences for grip and pinch strengths in high school baseball pitchers.
Collapse
Affiliation(s)
- Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
- Corresponding author: Tsuyoshi Tajika, Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan. Tel: +81-272208269, Fax: +81-27220-8270, E-mail:
| | - Tsutomu Kobayashi
- Department of Physical therapy, Takasaki University of Health and Welfare, Gunma, Japan
| | - Atsushi Yamamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Daisuke Shimoyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Chisa Okura
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Saeko Kanazawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Ayako Nagai
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| |
Collapse
|
11
|
Liu Y, Peng M, Lin L, Liu X, Qin Y, Hou X. Relationship between American Society of Anesthesiologists (ASA) grade and 1-year mortality in nonagenarians undergoing hip fracture surgery. Osteoporos Int 2015; 26:1029-33. [PMID: 25300530 DOI: 10.1007/s00198-014-2931-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/02/2014] [Indexed: 12/21/2022]
Abstract
UNLABELLED This study retrospectively reviewed 327 nonagenarians who underwent hip fracture surgery at six hospitals. Functional status, postoperative complications, and 1-year mortality were evaluated, and relationships between these factors and American Society of Anesthesiologists (ASA) grade were analyzed. ASA grade was significantly associated with postoperative complications and 1-year mortality. INTRODUCTION Few previous studies have reported outcomes after hip fracture in nonagenarians, and these studies did not report significant associations between ASA grade and mortality. However, most of these studies included only a small number of patients from a single hospital. This study aimed to evaluate the relationships between ASA grade and functional status, postoperative complications, and mortality rate in nonagenarians undergoing hip fracture surgery. METHODS This study included 327 nonagenarians who underwent hip fracture surgery between January 2000 and December 2012. Patients with open fractures, subtrochanteric fractures, polytrauma, and pathological fractures were excluded. The medical records and X-rays were retrospectively reviewed. The relationships between ASA grade and functional status, postoperative complications, and 1-year mortality were analyzed. RESULTS There were significant associations between the ASA grade and the rates of postoperative complications and 1-year mortality (both p < 0.05). All pairwise comparisons showed significant differences in postoperative complication rates between ASA grades (all p < 0.05). All pairwise comparisons, except for grades I vs. II and grades II vs. III, also showed significant differences in mortality rates between ASA grades (all p < 0.05). There were significant associations between the preoperative ability to manage activities of daily living and the rates of postoperative complications and 1-year mortality (both p < 0.05). CONCLUSIONS ASA grade was significantly associated with the rates of postoperative complications and 1-year mortality in nonagenarians undergoing hip fracture surgery. The preoperative functional status was also significantly associated with these outcomes.
Collapse
MESH Headings
- Activities of Daily Living
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/mortality
- China/epidemiology
- Female
- Fracture Fixation, Internal/adverse effects
- Fracture Fixation, Internal/methods
- Fracture Fixation, Internal/mortality
- Hemiarthroplasty/adverse effects
- Hemiarthroplasty/methods
- Hemiarthroplasty/mortality
- Hip Fractures/mortality
- Hip Fractures/surgery
- Humans
- Male
- Osteoporotic Fractures/mortality
- Osteoporotic Fractures/surgery
- Retrospective Studies
- Trauma Severity Indices
Collapse
Affiliation(s)
- Y Liu
- Department of Orthopedics, Third Hospital of Hebei Medical University, No. 139 Zi Qiang Road, Shijiazhuang, Hebei, 050051, China,
| | | | | | | | | | | |
Collapse
|
12
|
Hagino T, Ochiai S, Senga S, Watanabe Y, Wako M, Ando T, Haro H. Efficacy of early surgery and causes of surgical delay in patients with hip fracture. J Orthop 2015; 12:142-6. [PMID: 26236117 DOI: 10.1016/j.jor.2015.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/04/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Whether early surgery for hip fractures is effective remains controversial. The current Japanese medical system poses some constraints on conducting early surgery. We examined the usefulness of early surgery and factors that delay surgery in patients with hip fractures treated at our hospital. METHODS Among 314 patients aged ≥60 years treated for hip fractures since January 2006, 270 patients (55 men, 215 women; mean age 84.1 years; femoral neck fracture in 111, trochanteric fracture in 159) who underwent surgery were studied. They were divided into an early surgery group (surgery up to 1 day after admission) and a delayed surgery group (later than 1 day). Clinical parameters analyzed included age, gender, pre-injury residence, pre-injury ambulatory ability, admission during public holiday, fracture site, fracture type, blood tests and urinalysis at admission, chest radiography, electrocardiography, number of systemic chronic diseases, dementia, surgical modality, blood transfusion, length of hospital stay, ambulatory ability at discharge, and hospital death. After performing univariate analysis between two groups, the parameters that were identified as significant were further tested by multivariate analysis. RESULTS Among 270 patients treated for hip fracture, 112 patients (41.5%) received early surgery. Multivariate analysis identified admission during public holiday, electrocardiographic abnormalities, femoral head replacement, and length of hospital stay as significant independent factors. CONCLUSION The causes of surgical delay were admission during public holiday, electrocardiographic abnormalities, and femoral head replacement. Although length of hospital stay was shorter in patients with early surgery, there was no difference in outcome.
Collapse
Affiliation(s)
- Tetsuo Hagino
- Department of Orthopaedic Surgery, Kofu National Hospital, Kofu, Yamanashi 400-8533, Japan
| | - Satoshi Ochiai
- Department of Orthopaedic Surgery, Kofu National Hospital, Kofu, Yamanashi 400-8533, Japan
| | - Shinya Senga
- Department of Orthopaedic Surgery, Kofu National Hospital, Kofu, Yamanashi 400-8533, Japan
| | - Yoshiyuki Watanabe
- Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan
| | - Masanori Wako
- Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan
| | - Takashi Ando
- Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo-city, Yamanashi 409-3898, Japan
| |
Collapse
|
13
|
Tay YWA, Hong CC, Murphy D. Functional outcome and mortality in nonagenarians following hip fracture surgery. Arch Orthop Trauma Surg 2014; 134:765-72. [PMID: 24682524 DOI: 10.1007/s00402-014-1982-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The world's population is ageing and the elderly population itself is growing older. This population shows a high incidence of hip fractures. We performed a retrospective study, reviewing the functional status, postoperative complications and mortality rate of nonagenarians who underwent surgery for hip fracture. METHODS AND SUBJECTS 56 nonagenarian patients underwent hip fracture surgery in our institution between January 2000 and December 2010. Two of these patients had presented with hip fracture on separate occasions, giving a total of 58 hips for analysis. Patients with open fracture, subtrochanteric fracture, polytrauma and pathological fracture were excluded. The case notes, electronic records and X-rays for all those included in the study were reviewed. The main outcome measures were functional status, postoperative complications and mortality rate at 1 year. RESULTS Patients with extracapsular hip fractures were associated with higher risks of postoperative complications (60.7 %; p = 0.037), mortality (25 %; p = 0.003) and more likely to be non-ambulant at 1 year (53.6 vs 16.7 %; p = 0.003). Females were more likely to suffer postoperative complications than males (p = 0.016). 46.6 % of the patients had immediate postoperative complications and most commonly due to urological complications (29.3 %). The 1-year mortality rate was 12.1 %. A notable proportion of patients (65.5 %) remained ambulant 1 year postoperatively, although almost half of the patients (48.3 %) who could ambulate independently pre-injury required a walking aid after hip fracture surgery. CONCLUSION Nonagenarians have good surgical outcomes after hip fracture surgery with low mortality rate. They should be treated similarly as their younger counterparts in terms of decision for surgery. Potential decline in functional status and rehabilitation options should be shared with the patient and family at an early stage.
Collapse
Affiliation(s)
- You Wei Adriel Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | | |
Collapse
|
14
|
Menzies IB, Mendelson DA, Kates SL, Friedman SM. Prevention and clinical management of hip fractures in patients with dementia. Geriatr Orthop Surg Rehabil 2013; 1:63-72. [PMID: 23569664 DOI: 10.1177/2151458510389465] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hip fractures and dementia increase exponentially with age, and patients who are afflicted by both conditions suffer significant morbidity and mortality. The aging of our population heightens the need to recognize the interaction of these conditions in order to improve our efforts to prevent hip fractures, provide acute care that improves outcomes, and provide secondary prevention and rehabilitation that returns patients to their previous level of functioning. Identification and treatment of vitamin D deficiency and osteoporosis and assessment and interventions to reduce falls in patients with dementia can significantly impact the incidence of first and subsequent hip fractures. Acute management of hip fractures that focuses on comanagement by orthopedic surgeons and geriatricians and uses protocol-driven geriatric-focused care has been shown to decrease mortality, length of hospitalization, readmission rates, and complications including delirium. Patients with mild-to-moderate dementia benefit from intensive geriatric rehabilitation to avoid nursing home placement. Recognizing the need to optimize primary and secondary prevention of hip fractures in patients with dementia and educating providers and families will lead to improved quality of life for patients affected by dementia and hip fractures.
Collapse
Affiliation(s)
- Isaura B Menzies
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | | | | |
Collapse
|
15
|
Abstract
BACKGROUND Hip fracture is a common yet serious injury sustained by the elderly patient and represents one of the major healthcare challenges today. The aim of this study was to better define the unique characteristics of treating nonagenarian peritrochanteric hip fractures and their subsequent complications during hospital stay. METHODS Seven hundred twenty-two patients underwent surgery for isolated fracture around the femoral neck. These patients were divided into one of three age groups: A, <50 years; B, 51-89 years; and C, >90 years. We performed a retrospective chart review to compare these groups in terms of patient characteristics, comorbidities, postoperative complications, fracture type, type of surgery performed, and mortality rate. RESULTS There was no difference in time to surgery between groups. Comorbidities were similar in groups B and C but were higher than group A. Nonagenarians received a significantly greater percentage of hemiarthroplasties compared with those aged 51 years to 89 years. Cardiac complications were significantly higher in group C. In patients with sustained cardiac complications, the odds ratio for mortality was 15.88. CONCLUSIONS Our results suggest that groups B and C were not significantly different pre- or intraoperatively. Nevertheless, there is an increase in cardiac complications and mortality in nonagenarians postoperatively. Nonagenarians should undergo similar treatment in the operating room compared with less elderly patients with the caveat that older patients, especially those with cardiac disease, may be more at risk for complication. The surgeon must evaluate the elderly patient with a hip fracture on a case-by-case basis, while ignoring chronological age. LEVEL OF EVIDENCE III, prognostic study.
Collapse
|
16
|
Outcomes in nonagenarians after hemiarthroplasty for femoral neck fracture. A prospective matched cohort study. Hip Int 2012; 22:113-8. [PMID: 22383320 DOI: 10.5301/hip.2012.9080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2011] [Indexed: 02/07/2023]
Abstract
A prospective cohort of 33 nonagenarians with hemiartroplasty for femoral neck fracture was matched with 33 patients aged between 70 and 89, using preoperative and postoperative data, and the following were studied; epidemiological data, physical dependence, and SF-12 and WOMAC questionnaires. The mortality rate at one year was 24.2%, influenced by the presence of 3 or more comorbidities, dementia, and previous dependence. The perioperative period was the most vulnerable time, and in some cases delaying surgery should be considered to stabilise the patient's medical condition in very elderly patients. Mortality and functional outcomes were worse than in younger patients, but the surgical complication rate was similar. Prognostic factors for a decline in quality of life were dementia and previous dependence.
Collapse
|
17
|
Kadowaki M, Kono M, Nishiguchi K, Kakimaru H, Uchio Y. Mortality in patients with hip fracture aged over 90 years: A report from a progressively aging island. Arch Gerontol Geriatr 2012; 54:e113-7. [DOI: 10.1016/j.archger.2011.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 10/04/2011] [Accepted: 10/07/2011] [Indexed: 12/21/2022]
|
18
|
Prognostic prediction in patients with hip fracture: risk factors predicting difficulties with discharge to own home. J Orthop Traumatol 2011; 12:77-80. [PMID: 21541772 PMCID: PMC3102807 DOI: 10.1007/s10195-011-0138-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Accepted: 04/18/2011] [Indexed: 11/17/2022] Open
Abstract
Background Little is known about risk factors that may prevent hip fracture patients from being discharged to home. The present study was developed to investigate possible prognostic factors. Materials and methods We studied 345 patients with hip fracture treated at our hospital since 1997, who were living at home before the injury. There were 84 males and 261 females. Mean age at injury was 81.6 years. Fracture type was femoral neck fracture in 152 patients and trochanteric fracture in 193. Patients were divided into those who were discharged to home (home discharge group) and those who were discharged to rehabilitation facilities or died in hospital (non-home discharge group). Gender, age at admission, fracture type, and other factors were investigated. Multivariate analysis was conducted on these variables for the home discharge and non-home discharge groups. Results There were 202 patients (58.6%) in the home discharge group and 143 patients (41.4%) in the non-home discharge group. The factors significantly associated with not achieving the goal of discharge to home were age 85 years or above [odds ratio (OR) = 1.79, P = 0.0204], chronic systemic diseases (OR = 1.77, p = 0.0225), dementia (OR = 3.17, P < 0.0001), and walking disability before injury (OR = 5.70, P = 0.0328). Conclusions In elderly patients with hip fracture, the risk factors that predict difficulties with discharge to home include age at admission, concomitant chronic systemic diseases and dementia, and walking disability before injury.
Collapse
|
19
|
Pillai A, Eranki V, Shenoy R, Hadidi M. Age related incidence and early outcomes of hip fractures: a prospective cohort study of 1177 patients. J Orthop Surg Res 2011; 6:5. [PMID: 21261942 PMCID: PMC3033339 DOI: 10.1186/1749-799x-6-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 01/24/2011] [Indexed: 11/25/2022] Open
Abstract
Introduction Associated with the increase in the aging population, there is an increase in the incidence of hip fractures worldwide. Outcome following such fractures is affected by age of the patient. This study aims to assess the incidence and early outcome of hip fractures, comparing between different age groups. Methods Data of hip fractures collected over a period of five years was analysed. Patients were divided into three groups, group A (patients under the age of 64), group B (patients between 65 and 84 years of age), and group C (patients over the age of 85). Results Of the 1177 patients included in the study, there were 90 patients in group A, 702 patients in group B and 385 patients in group C. There was a female preponderance across all age groups, and this increased as age advanced (p < 0.0001). A significantly larger number of older patients lived alone and needed aids to walk before the injury (p < 0.0001). There was no significant difference in the type of fracture across the three groups (p = 0.13). A higher proportion of the elderly with intracapsular fractures were treated by replacement arthroplasty. Older patients who had internal fixation of intracapsular fractures had a better walking ability at 4 months. The overall deterioration in mobility was greater in older patients (p < 0.0001). Mortality was higher in older patients. Conclusions Hip fractures are more common among females irrespective of age group. Older patients have a higher mortality and a greater deterioration of walking ability after such injuries. Internal fixation of intracapsular fractures have demonstrated satisfactory early outcome in the immediate period. This could be attributed to retention of native bone, better propioception and shorter operation time.
Collapse
Affiliation(s)
- Anand Pillai
- Department of Orthopaedics and Trauma, The Queen Elizabeth Hospital, South Australia, Australia
| | | | | | | |
Collapse
|
20
|
Harris IA, Yong S, McEvoy L, Thorn L. A prospective study of the effect of nursing home residency on mortality following hip fracture. ANZ J Surg 2010; 80:447-50. [DOI: 10.1111/j.1445-2197.2010.05313.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Skála-Rosenbaum J, Bartoníček J, Ríha D, Waldauf P, Džupa V. Single-centre study of hip fractures in Prague, Czech Republic, 1997-2007. INTERNATIONAL ORTHOPAEDICS 2010; 35:587-93. [PMID: 20217082 DOI: 10.1007/s00264-010-0984-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 01/08/2010] [Accepted: 02/07/2010] [Indexed: 10/19/2022]
Abstract
This study examines the epidemiological data of patients with hip fractures from 1997-2007. Adult patients treated for hip fracture between the years 1997-2007 were included in the study. Retrospective statistical assessment of continually gathered data focussed on epidemiology and demographics. The study involved 3,683 patients (2,678 women and 1,005 men). Patients older than 70 years accounted for 82% of all cases. There were 2.7 times more women; in patients younger than 60 years men significantly outnumbered women (p < 0.001). The mean patient age was 77.9 years (SD ± 12.6; women, 80.3 years; men, 71.5 years). There was a slight increase in the average age in both sexes. Trochanteric fractures accounted for 54.7% and femoral neck fractures accounted for 45.3% of fractures. The ratio of men to women was the same in femoral neck (AO-31B) and trochanteric (AO-31A) fractures. The average year-to-year increase in the number of fractures was 5.9%. For femoral neck fractures (AO-31B), there was a statistically insignificant increase in the number of fractures (p = 0.63); for intertrochanteric factures (AO-31A3) there was a statistically insignificant decrease (p = 0.65). There was an increase in the number of hip fractures resulting in a significant increase in pertrochanteric fractures (AO-31A1+2) (p < 0.001). The ratio of trochanteric to neck fractures increased from 0.99 to 1.53. Continual monitoring of patients with hip fracture offers data which allows comparisons between regions and countries. There has been a continual increase in the number of patients with hip fractures.
Collapse
Affiliation(s)
- Jiří Skála-Rosenbaum
- Department of Orthopedics and Traumatology, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
| | | | | | | | | |
Collapse
|
22
|
Bergeron E, Moore L, Fournier K, Gravel C, Lavoie A. Patients with isolated hip fracture must be considered for surgery irrespectively of their age, comorbidity status and provenance: a statement applicable even to nonagerians. Arch Orthop Trauma Surg 2009; 129:1549-55. [PMID: 19440727 DOI: 10.1007/s00402-009-0888-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Hip fractures are associated with high rates of adverse outcome but previous research has not lead to the identification of any subgroups for whom surgery could be contraindicated. The purpose of this study was to identify factors that could help in the decision making process. MATERIALS AND METHODS We identified 965 consecutive patients operated for an isolated hip fracture from 1 April 1996 to 31 March 2003 in a single large volume centre. We collected information on age, gender, comorbidities and place of injury (in-house, outdoors, nursing home). Outcome measures were mortality and orientation at discharge. Multiple logistic regression and recursive partitioning were used to identify factors associated with poor outcome. RESULTS Median age was 81.4 with 121 patients aged 90 and over. Seventy-six percent were female. The fall occurred at home in 59%, outdoors in 19% and at a nursing home in 22%. Death was significantly associated with the number of comorbidities, age and place of injury. Dementia (23%) was the most significant predictor of orientation to a new nursing home. Among 121 nonagerians, 89 survived and 59 returned home. Among 53 nonagerians with two or more comorbidities, 34 survived and 20 returned home. CONCLUSIONS Comorbidities, age and provenance of patients appear to be the most significant factors associated with adverse outcome. However, even among nonagerians with a heavy comorbidity burden, results do not contraindicate surgical intervention.
Collapse
Affiliation(s)
- Eric Bergeron
- Department of Surgery, Charles LeMoyne Hospital, Greenfield Park, QC, Canada.
| | | | | | | | | |
Collapse
|
23
|
Hagino T, Ochiai S, Wako M, Sato E, Maekawa S, Hamada Y. Comparison of the prognosis among different age groups in elderly patients with hip fracture. Indian J Orthop 2008; 42:29-32. [PMID: 19823651 PMCID: PMC2759581 DOI: 10.4103/0019-5413.38577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The outcome of treatment of hip fractures in different age groups in the elderly population is largely unknown. Hence, we stratified elderly patients with hip fracture into age groups and compared the prognosis in various age groups. MATERIALS AND METHODS Among 459 patients with hip fracture treated at our hospital from 1997, 430 patients aged 65 years or above at the time of injury were studied. The patients comprised 98 males and 332 females and the ages at injury ranged from 65 to 103 years (mean 83.4 years). There were 167 cases of femoral neck fracture and 263 cases of trochanteric fractures. Surgery was performed in 383 cases, while 47 cases were treated conservatively. The subjects were classified by age into young-old for those aged 65-74 years (group A, n = 55), middle-old for those aged 75-84 years (group B, n = 172), old-old for those aged 85-94 (group C, n = 180), and oldest-old for those aged 95 years or above (group D, n = 23). The functional and survival prognosis at discharge in each group was investigated. RESULTS Numbers of patients who were ambulatory at discharge among those ambulatory before injury were 43 of 49 (87.8%) in group A, 113 of 152 (74.3%) in group B, 86 of 138 (62.3%) in group C, and 5 of 14 (35.7%) in group D, showing worse recovery of walking ability as age advanced. Among those ambulatory before injury, 42 patients in group A, 139 patients in group B, 130 patients in group C, and 12 patients in group D underwent surgery and of these patients, 38 patients (90.5%) in group A, 109 patients (78.4%) in group B, 83 patients (63.8%) in group C, and 5 patients (41.7%) in group D were ambulatory at discharge. On the other hand, the numbers of patients who were ambulatory at discharge among those receiving conservative treatment were 5 of 7 (71.4%) in group A, 4 of 13 (30.8%) in group B, 3 of 8 (37.5%) in group C, and 0 of 2 (0%) in group D, showing better walking ability in surgical patients than in conservatively treated patients even in the elderly. There were two in-hospital deaths in group B, 11 in group C, and two in group D. Five of the 15 deaths were inoperable cases due to poor performance status at admission. CONCLUSION Walking ability at discharge and survival prognosis worsened as age advanced. On the other hand, since surgical cases achieved better walking ability than conservatively treated cases, efforts should be made to achieve better functional prognosis even in the old-olds, including surgery together with early ambulation and rehabilitation.
Collapse
Affiliation(s)
- Tetsuo Hagino
- Department of Orthopaedic Surgery, National Hospital Organization, Kofu National Hospital, Yamanashi, Japan.
| | | | | | | | | | | |
Collapse
|
24
|
Hagino T, Ochiai S, Wako M, Sato E, Maekawa S, Senga S, Sugiyama H, Hamada Y. A simple scoring system to predict ambulation prognosis after hip fracture in the elderly. Arch Orthop Trauma Surg 2007; 127:603-6. [PMID: 17492296 DOI: 10.1007/s00402-007-0330-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We conducted a study on elderly patients with hip fracture to examine whether it is possible to predict the ambulation status of these patients upon hospital discharge. MATERIAL AND METHODS One hundred and eighty six patients with femoral neck or trochanteric fracture, who were ambulant prior to fracture, were studied. Thirteen factors that may affect walking ability were selected and subjected to multivariate analysis. RESULTS Of 186 patients, 145 regained walking ability at discharge. Factors significantly affecting walking ability at discharge were (1) anemia, (2) dementia and (3) abnormal chest X-ray. Each patient was scored on the basis of the above factors (1 = yes, 0 = no), and the total was used as the predictive score. CONCLUSION A simple scoring system composed of these three factors was useful for the prediction of [corrected] the ambulation status upon hospital discharge.
Collapse
Affiliation(s)
- Tetsuo Hagino
- Department of Orthopaedic Surgery, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi 400-8533, Japan.
| | | | | | | | | | | | | | | |
Collapse
|