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Eardley W, Johansen A. Safety and efficacy in the management of older patients with displaced intracapsular hip fractures. Injury 2024; 55:111598. [PMID: 38776790 DOI: 10.1016/j.injury.2024.111598] [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: 01/31/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
The management of the older person with a displaced intracapsular hip fracture is one of the most significant aspects of musculoskeletal trauma. These patients require prompt, integrated pathway delivered care. The care delivered outside of the operating theatre and that performed within, are intertwined. Traditionally, surgeons have focussed predominantly only on the operative elements. In modern trauma care for older people, this focus must broaden. We provide for the first time a comprehensive overview of all elements of care for this important patient group. This brings together pathway elements from the National Hip Fracture Database Key Performance Indicators and NICE guidance alongside a synthesis of all current research output for intracapsular hip fracture.
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Affiliation(s)
- Wgp Eardley
- Surgical Clinical, Lead National Hip Fracture Database, United Kingdom.
| | - A Johansen
- Orthogeriatric Clinical, Lead National Hip Fracture Database, United Kingdom
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2
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Khatib Y, Bal G, Liu R, Ashaia W, Sorial R. A randomised controlled trial assessing the effect of tranexamic acid on post-operative blood transfusions in patient with intra-capsular hip fractures treated with hemi- or total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:3095-3102. [PMID: 38847833 DOI: 10.1007/s00402-024-05325-2] [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: 01/31/2024] [Accepted: 04/12/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Intravenous tranexamic acid (TA) has proven efficacy in reducing blood loss and incidence of transfusion of blood products in elective total joint arthroplasty. However, evidence of efficacy in the setting of intracapsular hip fractures needing hip hemiarthroplasty (HA) or total hip arthroplasty (THA) are scarce. This study aimed to assess post-operative transfusion incidence in this clinical setting. METHODS Over a five-year period 250 patients with intracapsular neck of femur fractures requiring arthroplasty were randomised to two groups. The treatment group received three-dose intravenous TA protocol and the control group received usual treatment without administration of TA. Blood loss was estimated from the change in Hb levels on day 1, 3 and 5 after surgery compared to preoperative levels. Transfusions of blood products were recorded when they were triggered by an a priori protocol. Post-operative complications were recorded during patient hospital admission. RESULTS The intervention group showed significantly lower transfusion incidence of packed red blood cells (PRBC) (6 vs. 15, p = 0.04, OR = 0.37, 95%CI OR = 0.14 to 0.99) and in the group of patients who received a blood transfusion, a trend was observed for patients who received TA to have lesser number of units of PRBC (mean = 1.3 vs. 1.6, p = 0.51). A significant difference was noted in post-operative Hb levels of day 1,3 and 5. Backward stepwise multivariable regression analysis showed the use of TA was the most significant factor for reduction in postoperative blood transfusion (p = 0.047, OR = 0.37, 95% CI OR = 0.14 to 0.99). Assessment of the strength of the correlation showed modest correlation (Pearson correlation - 0.13 p = 0.04, 95% CI correlation= -0.25 to -0.01). There was no increase in adverse events in patients who received TA. CONCLUSION The use of TA in setting of intracapsular hip fractures requiring arthroplasty reduces blood loss, the need for transfusion of blood products and may reduce surgical site complications without increasing the risk of VTE.
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Affiliation(s)
- Yasser Khatib
- Nepean Hospital, The School of Medicine Nepean, The University of Sydney, PO Box 949, Penrith, NSW, 2750, Australia.
| | - Gobind Bal
- Nepean Hospital, Derby St, Kingswood, NSW, 2747, Australia
| | - Rui Liu
- Nepean Hospital, Kingswood, NSW, Australia
| | - Wagdy Ashaia
- Nepean Hospital, Derby St, Kingswood, NSW, 2747, Australia
| | - Rami Sorial
- Nepean Hospital, The School of Medicine Nepean, The University of Sydney, PO Box 949, Penrith, NSW, 2750, Australia
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3
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Ko YS, Kang SY, Lee HJ, Kim HS, Yoo JJ. Trends in Hospital Stay, Complication Rate, and Mortality in Hip Fracture Patients: A Two-Decade Comparison at a National Tertiary Referral Center. J Clin Med 2024; 13:3666. [PMID: 38999232 PMCID: PMC11242650 DOI: 10.3390/jcm13133666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Since the turn of the century, the age-adjusted incidence of proximal femoral fractures has caused a plateau or fall. However, it was anticipated that the number of patients with proximal femoral fractures would rise as life expectancy rose and the population over 80 years old expanded. The aim of this study was to compare the length of hospital stay, complication rate, and mortality in patients with proximal femoral fractures between two different time periods: 20 years ago and the present. Methods: We conducted a retrospective review of medical records of patients aged 65 years and above who underwent surgery for proximal femoral fractures between January 2000 and December 2001 and between January 2020 and December 2021. We collected information on age, gender, fracture type, length of hospital stay, and complication rate. Dates of death were obtained from the Ministry of the Interior and Safety. Results: We included 136 patients who were operated on between 2000 and 2001 and 134 patients between 2020 and 2021. The average age increased significantly from 71.6 years to 79.0 years (p < 0.001). The length of hospital stay decreased dramatically from 15.1 days to 6.0 days (p < 0.001). There was no statistically significant difference in delirium, urinary tract infection, or pneumonia. No difference was found in 30-day or 1-year mortality between the two groups. Conclusions: The complication rate and mortality between the two time periods appeared comparable, although the length of hospital stay decreased substantially. Therefore, we recommend considering expedited discharge from the acute care hospital for elderly hip fracture patients while implementing an individualized approach for better outcomes.
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Affiliation(s)
- Young-Seung Ko
- Department of Orthopedic Surgery, Hallym University Dong-Tan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Sang Yoon Kang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Han Jin Lee
- Department of Orthopedic Surgery, Hanil General Hospital, Seoul 01450, Republic of Korea
| | - Hong Seok Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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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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Postler A, Posten C, Schubert M, Beyer F, Lützner J, Vicent O, Kleber C, Goronzy J, Kamin K. Patients risk for mortality at 90 days after proximal femur fracture - a retrospective study in a tertiary care hospital. BMC Geriatr 2024; 24:130. [PMID: 38310209 PMCID: PMC10838409 DOI: 10.1186/s12877-024-04733-8] [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: 11/05/2023] [Accepted: 01/20/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Despite improving the management of proximal femur fractures (PFF) with legal requirements of timing the surgery within 24 h, mortality rates in these patients remain still high. The objective of our study was to analyze potential cofactors which might influence the mortality rate within 90 days after surgery in PFF to avoid adverse events, loss of quality of life and high rates of mortality. METHODS In this retrospective, single-center study all patients with PFF aged 65 years and older were included. We recorded gender, age, type of fracture, surgery and anesthesia, time, comorbidities and medication as well as complications and mortality rate at 90 days. Separate logistic regression models were used to assess which parameters were associated with patients' mortality. The mortality rate was neither associated with timing, time and type of surgery nor time and type of anesthesia, but with higher age (OR 1.08 per year; 95% CI 1.034-1.128), lower BMI (OR 0.915 per kg/m2; 95% CI 0.857-0.978), higher CCI (OR 1.170 per point; 95% CI 1.018-1.345), dementia (OR 2.805; 95% CI 1.616-4.869), non-surgical complications (OR 2.276; 95% CI 1.269-4.083) and if mobilization was impossible (OR 10.493; 95% CI 3.612-30.479). RESULTS We analyzed a total of 734 patients (age ≥ 65 years) who had a PFF in 2019 and 2020 and received surgery. 129 patients (17.6%) died until 90 days at an median age of 89.7 years (range 65-101 years). CONCLUSION The proportion of patients who died until 90 days after surgery is still high. It is less extend influenced by surgical and anaesthesiologic factors than by patient-related factors like age or lower BMI. Physicians should be aware of the importance of avoiding adverse events and the importance of patients' mobilization to reduce mortality and improve patients' outcome.
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Affiliation(s)
- Anne Postler
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Charlotte Posten
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Melanie Schubert
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Oliver Vicent
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Christian Kleber
- Department of Orthopaedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Jens Goronzy
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Konrad Kamin
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Tsunemitsu A, Tsutsumi T, Inokuma S, Imanaka Y. Effects of hospitalist co-management for hip fractures. J Orthop Sci 2024; 29:278-285. [PMID: 36443140 DOI: 10.1016/j.jos.2022.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/29/2022] [Accepted: 11/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early surgery is recommended for patients with hip fractures. Average time to surgery in Japan is 3.8 days. Such delay could be caused by the burden of preoperative assessment and management of geriatric comorbidities upon orthopedic surgeons. Hospitalist co-management has potential benefits in comprehensive perioperative care that could positively affect time to surgery in patients with hip fractures. We compare clinical outcomes of patients with hip fractures managed by orthopedic surgeon-led care (conventional group) vs. those of patients with hip fractures managed by hospitalist co-management. METHODS In this single-center retrospective cohort study, time to surgery was assessed with interrupted time series analyses. Whole length of hospital stay, length of hospital stay after surgery, complications during hospitalization, 30-day readmission, initiation of osteoporosis treatment and adherence to guidelines for deep vein thrombosis prophylaxis were also evaluated with Chi-square or Fisher's exact tests. RESULTS The conventional group comprised 332 patients and the co-management group 418 patients. Interrupted time series analyses revealed an immediate reduction of time to surgery by 1.2 days (95%CI, -1.9 to -0.4, P = 0.003) with the start of co-management. Whole length of hospital stay and length of hospital stay after surgery tended to be shorter, but without statistical significance. Intermediate to severe complications and 30-day readmission were not significantly different between the groups. In the co-management group, the rate of initiation of osteoporosis treatment (46.4% vs. 6.3%, P < 0.001) and adherence rate to guidelines for deep vein thrombosis prophylaxis (99.3% vs. 88%, P < 0.001) were significantly higher than those in the conventional group. CONCLUSIONS Hospitalist co-management for elderly patients with hip fractures led to significantly shorter time to surgery than conventional orthopedic surgeon-led care, and had advantages in other clinical indicators.
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Affiliation(s)
- Ayako Tsunemitsu
- Department of General Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan; Department of Healthcare Economics and Quality Management, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto 606-8501, Japan.
| | - Takahiko Tsutsumi
- Department of General Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan; Department of Healthcare Economics and Quality Management, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto 606-8501, Japan
| | - Sakiko Inokuma
- Department of General Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto 606-8501, Japan
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Pangaud C, Pauly V, Jacquet C, Orleans V, Boyer L, Khakha R, Argenson JN, Ollivier M. Reduced mortality associated to cementless total hip arthroplasty in femoral neck fracture. Sci Rep 2023; 13:16849. [PMID: 37803077 PMCID: PMC10558430 DOI: 10.1038/s41598-023-43790-8] [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: 08/02/2022] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
Mortality related to femoral neck fractures remains a challenging health issue, with a high mortality rate at 1 year of follow-up. Three modifiable factors appear to be under control of the surgeon: the choice of the implant, the use of cement and the timing before surgery. The aim of this research project was to study the impact on mortality each of these risk factors play during the management of femoral neck fractures. A large retrospective epidemiological study was performed using a national database of the public healthcare system. The inclusion criteria were patients who underwent joint replacement surgery after femoral neck fracture during the years 2015 to 2017. All data points were available for at least 2 years after the fracture. The primary outcome was mortality within 2 years following the surgery. We evaluated the association between mortality and the type of the implant hemiarthroplasty (HA) versus total hip arthroplasty (THA), cemented versus non cemented femoral stem as well as the timing from fracture to surgical procedure. A multivariate analysis was performed including age, gender, comorbidities/autonomy scores, social category, and obesity. We identified 96,184 patients who matched the inclusion criteria between 2015 and 2017. 64,106 (66%) patients underwent HA and 32,078 (33.4%) underwent THA. After multivariate analysis including age and comorbidities, patients who underwent surgery after 72 h intra-hospital had a higher risk of mortality: Hazard Ratio (HR) = 1.119 (1.056-1.185) p = 0.0001 compared to the group who underwent surgery within 24 h. THA was found to be a protective factor HR = 0.762 (0.731-0.795) p < 0.0001. The use of cement was correlated with higher mortality rate: HR = 1.107 (1.067-1.149) p < 0.0001. Three key points are highlighted by our study in the reduction of mortality related to femoral neck fracture: the use of hemiarthroplasty a surgery performed after 48 h and the use of cement for femoral stem fixation adversely affect mortality risk.
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Affiliation(s)
- Corentin Pangaud
- Institute of Movement and Locomotion, Aix-Marseille Université et CNRS 5, Marseille, France
| | - Vanessa Pauly
- CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
- Department of Epidemiology and Health Economics, APHM, Marseille, France
- Department of Medical Information, APHM, Marseille, France
| | - Christophe Jacquet
- Institute of Movement and Locomotion, Aix-Marseille Université et CNRS 5, Marseille, France
| | - Veronica Orleans
- CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
- Department of Epidemiology and Health Economics, APHM, Marseille, France
- Department of Medical Information, APHM, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Services Research and Quality of Life Center, Faculté de Médecine, Secteur Timone, EA 3279, CEReSS -Centre D'Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
- Department of Epidemiology and Health Economics, APHM, Marseille, France
- Department of Medical Information, APHM, Marseille, France
| | - Raghbir Khakha
- Department of Trauma and Orthopaedics, Guys and St Thomas' Hospitals, Great Maze Pond, London, SE1 9RT, UK
| | - Jean Noël Argenson
- Institute of Movement and Locomotion, Aix-Marseille Université et CNRS 5, Marseille, France.
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
| | - Matthieu Ollivier
- Institute of Movement and Locomotion, Aix-Marseille Université et CNRS 5, Marseille, France
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Liu Z, Du Z, Lu H, Fu Z, Xu H. Delay between admission and surgery as a potential risk factor for postoperative morbidity and mortality in elderly patients with hip fractures: A retrospective study. J Orthop Sci 2023; 28:1124-1130. [PMID: 36031534 DOI: 10.1016/j.jos.2022.07.010] [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: 11/07/2021] [Revised: 07/03/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to assess the impact of delay between admission and surgery on the postoperative outcomes such as mortality and related complications in elderly patients with acute hip fractures. METHODS 840 patients aged ≥65 years from January 2009 to September 2015 were included in this retrospective study. According to the interval from admission to surgery, the patients were divided into four groups: group A (surgery within 24 h), group B (surgery within 24 h-48 h), group C (surgery within 48 h-72 h), and group D (surgery later than 72 h). Postoperative complications during hospitalization and mortality at different follow-up time points were compared. RESULTS A total of 763 cases were successfully followed up, with an average follow-up time of 30.4 ± 13.1 months. The mean age of the patients was 79.4 ± 6.8 years. The difference in gross postoperative complications among groups was statistically significant in terms of pressure sore (P = 0.02), respiratory complications (P = 0.001), and urological complications (P < 0.001). The multivariate logistic regression analysis identified 3 factors independently associated with the postoperative morbidity, including age (odds ratio [OR] = 1.040), postoperative drainage volume (OR = 1.002) and time from admission to surgery (OR = 1.108). The difference in postoperative mortality among groups was statistically significant at 1 year (P = 0.046) after operation. The multivariate logistic regression analysis identified that age, postoperative drainage volume and time from admission to surgery were independently associated with mortality at 1 year postsurgery. CONCLUSION The incidence of postoperative morbidity and mortality in elderly patients with hip fracture is usually the result of multiple factors, surgeons should pay attention to the patient's age, postoperative wound status and surgical delay time, which may significantly affect the outcome of the treatment.
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Affiliation(s)
- Zhongdi Liu
- Trauma Medicine Center, Peking University People's Hospital, China.
| | - Zhe Du
- Trauma Medicine Center, Peking University People's Hospital, China.
| | - Hao Lu
- Department of Trauma and Orthopedics, Peking University People's Hospital, China.
| | - Zhongguo Fu
- Department of Trauma and Orthopedics, Peking University People's Hospital, China.
| | - Hailin Xu
- Department of Trauma and Orthopedics, Peking University People's Hospital, China.
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Ahmed M, Tirimanna R, Ahmed U, Hussein S, Syed H, Malik-Tabassum K, Edmondson M. A comparison of internal fixation and hemiarthroplasty in the management of un- or minimally displaced hip fractures in patients over 60 years old. Injury 2023; 54:1180-1185. [PMID: 36529551 DOI: 10.1016/j.injury.2022.11.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The incidence of hip fractures in the elderly is increasing. Minimally displaced and undisplaced hip fractures can be treated with either internal fixation or hemiarthroplasty. OBJECTIVES To identify the revision rate of internal fixation and hemiarthroplasty in patients 60 years or older with Garden I or II hip fractures and to identify risk factors associated with each method. METHOD A retrospective analysis was conducted from 2 Major Trauma Centres and 9 Trauma Units between 01/01/2015 and 31/12/2020. Patients managed conservatively, treated with a total hip replacement and missing data were excluded from the study. RESULTS 1273 patients were included of which 26.2% (n = 334) had cannulated hip fixation (CHF), 19.4% (n = 247) had a dynamic hip screw (DHS) and 54.7% (n = 692) had a hemiarthroplasty. 66 patients in total (5.2%) required revision surgery. The revision rates for CHF, DHS and hemiarthroplasty were 14.4%, 4%, 1.2% (p<0.001) respectively. Failed fixation was the most common reason for revision with the incidence increasing by 7-fold in the CHF group [45.8% (n = 23) vs. 33.3% (n = 3) in DHS; p<0.01]. The risk factors identified for CHF revision were age >80 (p<0.05), female gender (p<0.05) and smoking (p<0.05). The average length of hospital stay was decreased when using CHF compared to DHS and hemiarthroplasty (12.6 days vs 14.9 days vs 18.1 days respectively, p<0.001) and the 1 year mortality rate for CHF, DHS and hemiarthroplasty was 2.5%, 2% and 9% respectively. CONCLUSIONS Fixation methods for Garden I and II hip fractures in elderly patients are associated with a higher revision rate than hemiarthroplasty. CHF has the highest revision rate at 14.4% followed by DHS and hemiarthroplasty. Female patients, patients over the age of 80 and patients with poor bone quality are considered high risk for fixation failure with CHF. Hemiarthroplasty is a suitable alternative with lowest revision rates. When considering an internal fixation method, DHS is more robust than a screw construct.
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Affiliation(s)
- Maryam Ahmed
- University Hospitals Sussex, Brighton BN2 5BE, United Kingdom.
| | | | - Umar Ahmed
- Eastbourne District General Hospital, Eastbourne BN21 2UD, United Kingdom
| | | | - Habib Syed
- University Hospitals Sussex, Brighton BN2 5BE, United Kingdom
| | | | - Mark Edmondson
- University Hospitals Sussex, Brighton BN2 5BE, United Kingdom
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10
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Jäger M, Portegys E, Busch A, Wegner A. [Femoral neck fractures]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:332-346. [PMID: 36867225 DOI: 10.1007/s00132-023-04364-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
Femoral neck fractures (FNF) are the most frequent fractures in the older population and are also of high socioeconomic importance due to the high risk of mortality. The diagnostics are based on the clinical examination and imaging procedures. The classification systems used in the routine clinical practice are oriented towards the prognosis and are therefore a valuable aid in making decisions for the selection of the treatment procedure. Early surgery is decisive for the success of treatment. Older patients (> 60 years) with arthritically damaged hips and a high degree of fracture dislocation benefit from prompt hip replacement (bipolar systems, total hip arthroplasty, dual mobility systems). In contrast, joint-preserving surgery by osteosynthesis is indicated in younger patients with a low degree of dislocation. This article summarizes the clinically relevant aspects of FNF and gives an overview of current treatment strategies with inclusion of the scientific literature.
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Affiliation(s)
- M Jäger
- Lehrstuhl für Orthopädie und Unfallchirurgie, University of Duisburg-Essen, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland.
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim a. d. Ruhr, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland.
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus-Stift, Hülsmannstr. 17, 45355, Essen, Deutschland.
| | - E Portegys
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim a. d. Ruhr, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland
| | - A Busch
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Katholisches Klinikum Essen Philippus-Stift, Hülsmannstr. 17, 45355, Essen, Deutschland
| | - A Wegner
- Lehrstuhl für Orthopädie und Unfallchirurgie, University of Duisburg-Essen, Kaiserstr. 50, 45468, Mülheim a. d. R., Deutschland
- Klinik für Unfallchirurgie, Orthopädie, Handchirurgie, Klinikum Wolfsburg, Sauerbruchstr. 7, 38440, Wolfsburg, Deutschland
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11
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van Rijckevorsel VAJIM, de Jong L, Verhofstad MHJ, Roukema GR. Influence of time to surgery on clinical outcomes in elderly hip fracture patients : an assessment of surgical postponement due to non-medical reasons. Bone Joint J 2022; 104-B:1369-1378. [PMID: 36453044 PMCID: PMC9680196 DOI: 10.1302/0301-620x.104b12.bjj-2022-0172.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
AIMS Factors associated with high mortality rates in geriatric hip fracture patients are frequently unmodifiable. Time to surgery, however, might be a modifiable factor of interest to optimize clinical outcomes after hip fracture surgery. This study aims to determine the influence of postponement of surgery due to non-medical reasons on clinical outcomes in acute hip fracture surgery. METHODS This observational cohort study enrolled consecutively admitted patients with a proximal femoral fracture, for which surgery was performed between 1 January 2018 and 11 January 2021 in two level II trauma teaching hospitals. Patients with medical indications to postpone surgery were excluded. A total of 1,803 patients were included, of whom 1,428 had surgery < 24 hours and 375 had surgery ≥ 24 hours after admission. RESULTS Prolonged total length of stay was found when surgery was performed ≥ 24 hours (median 6 days (interquartile range (IQR) 4 to 9) vs 7 days (IQR 5 to 10); p = 0.001) after admission. No differences in postoperative length of hospital stay nor in 30-day mortality rates were found. In subgroup analysis for time frames of 12 hours each, pressure sores and urinary tract infections were diagnosed more frequently when time to surgery increased. CONCLUSION Longer time to surgery due to non-medical reasons was associated with a higher incidence of postoperative pressure sores and urinary tract infections when time to surgery was more than 48 hours after admission. No association was found between time to surgery and 30-day mortality rates or postoperative length of hospital stay.Cite this article: Bone Joint J 2022;104-B(12):1369-1378.
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Affiliation(s)
| | - Louis de Jong
- Department of Surgery, Franciscus Hospital, Rotterdam, the Netherlands
| | - Michael H. J. Verhofstad
- Department of Trauma Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Gert R. Roukema
- Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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12
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Tang Y, Kang L, Guo M, Fan L. Intertrochanteric Fracture Surgery Patients with Diabetes Mellitus are Prone to Suffer Perioperative Neurological and Endocrine/Metabolic Complications: A Propensity-Score Matched Analysis. Ther Clin Risk Manag 2022; 18:775-783. [PMID: 35967194 PMCID: PMC9365324 DOI: 10.2147/tcrm.s366846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background In older adults, the recovery after hip fracture surgery is not always to be well expected due to high risks of adverse outcomes including perioperative complications and mortality. We aimed to evaluate the intertrochanteric fracture (IF) patients with diabetes mellitus (DM) and receiving surgical fixation with intramedullary nail on the perioperative complications, total hospital costs (THC), length of hospital stay (LOS), and mortality. Methods In this retrospective cohort study, among 487 consecutive intertrochanteric fracture patients with age over 65 years and treated surgically by using intramedullary nail between Jan. 2015 and Mar. 2020, 353 patients were included, including 81 with DM and 272 without DM. After using propensity-score matched (PSM) analysis, 80 patients remained in each group. The perioperative complications, 30-day, 90-day, 1-year, and 2-year survival rates, THC, and LOS were observed and compared between two groups. Overall survival was compared by Kaplan–Meier method. Results No significant between-group differences were found in 30-day, 90-day, 1-year, and 2-year mortality rates, THC, LOS, and other perioperative complications after PSM and McNemar’s tests (all p>0.05), except for neurological complications (p<0.004) and endocrine/metabolic complications (p<0.001). At a mean follow-up time of 36.2 months, there were no statistically significant differences between the groups based on the Kaplan–Meier survival curve (p=0.171, log-rank). Conclusion IF surgery patients with DM are more prone to suffer perioperative neurological and endocrine/metabolic complications and they should be managed individually while being aware of these risks henceforth. Further high evidence clinical trials are needed to expand in DM patients with IF.
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Affiliation(s)
- You Tang
- Department of Joint Surgery, Binzhou People’s Hospital, Binzhou, People’s Republic of China
- Correspondence: You Tang, Department of Joint Surgery, Binzhou People’s Hospital, Binzhou, People’s Republic of China, Email
| | - Le Kang
- Department of Hand Surgery & Microsurgery and Foot & Ankle Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, People’s Republic of China
| | - Meng Guo
- Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, People’s Republic of China
| | - Linlin Fan
- Department of Child Healthcare, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, People’s Republic of China
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13
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Levi AR, Coste M, Warshowsky E, Shah NV, Suneja N, Schwartz JM, Roudnitsky V. Cracking the Hip: Does Protocol Matter? A Retrospective Cohort Study Investigating the Effect of Protocol Implementation. Geriatr Orthop Surg Rehabil 2022; 13:21514593221076614. [PMID: 35242395 PMCID: PMC8886300 DOI: 10.1177/21514593221076614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Approximately 300 000 hip fractures occur annually in the USA in patients
>65 years old. Early intervention is key in reducing morbidity and
mortality. Our institution implemented a collaborative hip fracture
protocol, streamlining existing processes to reduce time to OR (TTO) and
hospital length of stay (LOS). Our aim was to determine if this protocol
improved these outcomes. Study Design We conducted a retrospective cohort study using our level-1 trauma center’s
trauma registry, comparing outcomes for patients >60 years old with
isolated hip fractures pre-and post-hip protocol implementation in May 2018.
Our primary outcomes were TTO and in-hospital mortality. Secondary outcomes
included LOS and postoperative complications. Univariate analysis was done
using chi-square and T-test. Results We identified 176 patients with isolated hip fractures: 69 post- and 107
pre-protocol. Comparing post- to pre-protocol, TTO decreased by 18hrs (39 vs
57h; P = .013) and patients had fewer postoperative
complications (9 vs 23%; P = .016) despite post-protocol
patients being more likely to have diabetes (42 vs 27%, P
< .05), elevated BMI (22 vs 25; P < .001), and to be
current smokers (9 vs 2%; P < .05). LOS and in-hospital
mortality also decreased (11 vs 20d; P = .312, 4.3 vs 7.5%;
P = .402). Post-protocol patients were more likely to
go to the OR within 24hrs of presentation (39 vs 16%; P
< .001) and to go straight from ED to OR (32 vs 4%; P
< .001). Conclusion TTO, LOS, and postoperative complications for isolated hip fracture patients
were lower post-protocol. Though not all statistically significant, this
trend indicates that the protocol was helpful in improving hip fracture
outcomes but may require further improvement and institution-wide
education.
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Affiliation(s)
- Amelia R Levi
- Department of Surgery, SUNY Downstate Health & Sciences University, Kings County NYC Health & Hospitals, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Marine Coste
- Department of Surgery, SUNY Downstate Health & Sciences University, Kings County NYC Health & Hospitals, Brooklyn, NY, USA
| | - Ethan Warshowsky
- Department of Surgery, SUNY Downstate Health & Sciences University, Kings County NYC Health & Hospitals, Brooklyn, NY, USA
| | - Neil V Shah
- Department of Orthopaedic Surgery, SUNY Downstate Health & Sciences University, Kings County NYC Health and Hospitals, Brooklyn, NY, USA
| | - Nishant Suneja
- Department of Orthopaedic Surgery, Kings County NYC Health and Hospitals, Brooklyn, NY, USA
| | - Jeffrey M Schwartz
- Department of Orthopaedic Surgery, Kings County NYC Health and Hospitals, Brooklyn, NY, USA
| | - Valery Roudnitsky
- Department of Surgery, SUNY Downstate Health & Sciences University, Kings County NYC Health & Hospitals, Brooklyn, NY, USA
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14
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Murphy JR, Loh J, Smith NC, Stone NC. Association of length of hospital stay with delay to surgical fixation of hip fracture. Can J Surg 2022; 65:E188-E192. [PMID: 35292524 PMCID: PMC8929431 DOI: 10.1503/cjs.017520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Previous research has shown increases in length of stay (LOS), morbidity and mortality when the standard for surgical fixation of hip fracture of 48 hours is not met. However, few investigators have analyzed LOS as a primary outcome, and most used time of diagnosis as opposed to time of fracture as the reference point. We examined the effect of time to surgical fixation of hip fracture, measured from time of fracture, on length of hospital stay; the secondary outcome was average 1-year mortality. Methods: We conducted a retrospective cohort study of patients presenting to 1 of 2 tertiary care centres in St. John’s, Newfoundland and Labrador, Canada, with a hip fracture from Jan. 1, 2014, to Dec. 31, 2018. We analyzed 3 groups based on timing of surgical fixation after fracture: less than 24 hours (group 1), 24–48 hours (group 2) and more than 48 hours (group 3). We assessed statistical significance using 1-way analysis of variance. Results: Of the 692 patients included in the study, 212 (30.6%) were in group 1, 360 (52.0%) in group 2 and 120 (17.3%) in group 3. A delay to surgical fixation exceeding 48 hours was associated with a significantly longer LOS, by an average of 2.9 and 2.8 days compared to groups 1 and 2, respectively (p = 0.04); there was no significant difference in LOS between groups 1 and 2. A significant difference in average 1-year mortality was observed between groups 1 (11%) and 3 (26%) (p = 0.004), and groups 2 (13%) and 3 (p = 0.009). Conclusion: Surgical fixation beyond 48 hours after hip fracture resulted in significantly increased LOS and 1-year mortality. Further research should be conducted to evaluate reasons for delays to surgery and the effects of these delays on time to surgical fixation as measured from time of fracture.
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Affiliation(s)
- Justin R Murphy
- From the Discipline of Orthopaedic Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Nfld.
| | - Jeremy Loh
- From the Discipline of Orthopaedic Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Nfld
| | - Nicholas C Smith
- From the Discipline of Orthopaedic Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Nfld
| | - N Craig Stone
- From the Discipline of Orthopaedic Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Nfld
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15
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Marley MA, Lambers A, Marley I, Welthy L, Seymour H. The Tyranny of Distance: How Hospital Transfer Affects Time to Surgery for Hip Fracture Patients. Cureus 2022; 14:e22662. [PMID: 35371764 PMCID: PMC8964482 DOI: 10.7759/cureus.22662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction In Western Australia, vast distances between hospitals can limit a patient’s access to timely surgical intervention. The aim was to examine the effect of patient location on outcomes. Methods Hip fracture data from all operative cases at the major Western Australian hospitals between 2015 and 2019 was retrospectively reviewed. A total of 5691 patients were separated into three groups based on hospital of first presentation - directly to the operative hospital (metropolitan), a hospital less than 2.5 hours by road from the operative centre (outer-metropolitan), or requiring transfer by air (rural). Impact of location on time to surgery, length of stay and 30-day and 120-day mortality was analysed. Results The mean time to surgery was 26.7 hours for metropolitan patients, 37.0 hours for outer-metropolitan, and 42.6 hours for rural patients. Outer-metropolitan patients were less likely to reach surgery within 48 hours than metropolitan patients (80.2% vs 91.5%, p<0.001), with even lower rates for rural patients (66.8%, p<0.001). Acute length of stay was longer for rural patients compared to outer-metropolitan (7.2 vs 5.8 days) and metropolitan patients (5.5 days) (p<0.001). There was no significant difference in 30-day or 120-day mortality for outer-metropolitan or rural patients compared to metropolitan patients despite requiring transfer. However, when considered as a whole group there was an increased 120-day mortality with increased time to surgery. Overall mortality was 8.7% at 30 days and 17.3% at 120 days. Conclusion Patients presenting outside the metropolitan area with a hip fracture have a longer time to surgery and longer length of stay. Delay for outer-metropolitan patients is disproportionately longer than transit time alone and may provide opportunities for improvement.
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Sugand K, Aframian A, Park C, Sarraf KM. Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative. BMJ Open 2022; 12:e054919. [PMID: 35042707 PMCID: PMC8771810 DOI: 10.1136/bmjopen-2021-054919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE This is the first British multicentre study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during its peak. DESIGN A longitudinal, multicentre, retrospective, observational, cohort study was conducted during the peak 6 weeks of the first wave from 17 March 2020 compared with the same period in 2019. SETTING Hospitals from six major urban cities were recruited around the UK, including London. PARTICIPANTS A total of 4840 clinical encounters were initially recorded. 4668 clinical encounters were analysed post-exclusion. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes included the number of acute trauma referrals and those undergoing operative intervention, mortality rates and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia used. RESULTS During the COVID-19 period, there was a 34% reduction in acute orthopaedic trauma referrals compared with 2019 (1792 down to 1183 referrals), and a 29.5% reduction in surgical interventions (993 down to 700 operations). The mortality rate was more than doubled for both risk and odds ratios during the COVID-19 period for all referrals (1.3% vs 3.8%, p=0.0005) and for those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-19-related complications (vs non-COVID-19 causes) had greater odds by a factor of at least 20 times. For the operative cohort during COVID-19, there was an increase in odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters, as well as doubled odds of a consultant acting as the primary surgeon. CONCLUSION Although there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in odds during the peak of the pandemic compared with the same time interval 1 year ago.
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Affiliation(s)
- Kapil Sugand
- MSk Lab, Imperial College London, London, UK
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Arash Aframian
- MSk Lab, Imperial College London, London, UK
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Chang Park
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Khaled M Sarraf
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
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17
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Literature review on the management of simultaneous bilateral extracapsular hip fractures in the elderly. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sura-Amonrattana U, Tharmviboonsri T, Unnanuntana A, Tantigate D, Srinonprasert V. Evaluation of the implementation of multidisciplinary fast-track program for acute geriatric hip fractures at a University Hospital in resource-limited settings. BMC Geriatr 2021; 21:548. [PMID: 34641804 PMCID: PMC8513216 DOI: 10.1186/s12877-021-02509-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background Hip fractures are common among frail, older people and associated with multiple adverse outcomes, including death. Timely and appropriate care by a multidisciplinary team may improve outcomes. Implementing a team to jointly deliver the service in resource-limited settings is challenging, particularly on the effectiveness of patient outcomes. Methods A retrospective cohort study to compare outcomes of hip fracture patients aged 65 or older admitted at Siriraj hospital before and after implementation of the Fast-track program for Acute Geriatric Hip Fractures. The primary outcome was the incidence of medical complications. The secondary outcomes were time to surgery, factors related to the occurrence of various complications, in-hospital mortality, and mortality at month 3, month 6 and month 12 after the operation. Results Three hundred two patients were enrolled from the Siriraj hospital’s database from October 2016 to October 2018; 151 patients in each group with a mean age of 80 years were analyzed. Clinical parameters were similar between groups except the Fast-track group comprising more patients with dementia (37.1% VS 23.8%, p < 0.012). In the Fast-track group, there was a significantly higher proportion of patients underwent surgery within 72-h (80.3% VS 44.7%, p < 0.001) and the length of stay was significantly shorter (11 days (8–17) VS 13 days (9–18), p = 0.017). There was no significant difference in medical complications. Stratified analysis by dementia status showed a trend in delirium reduction in both patients with dementia and without dementia groups, and a pressure injury reduction among patients with dementia after the program was implemented but without statistical significance. There was no significant difference in mortality. Conclusions The implementation of a multidisciplinary team for hip fracture patients is feasible in resource-limited setting. In the Fast-track program, time to surgery was reduced and the length of stay was shortened. Other outcome benefits were not shown, which may be due to incomplete uptake of all involved disciplines.
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Affiliation(s)
- Unchana Sura-Amonrattana
- Department of Medicine, Division of Geriatric Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Theerawoot Tharmviboonsri
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Aasis Unnanuntana
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Direk Tantigate
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varalak Srinonprasert
- Department of Medicine, Division of Geriatric Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Trevisan C, Gallinari G, Carbone A, Klumpp R. Efficiently stratifying mid-term death risk in femoral fractures in the elderly: introducing the ASAgeCoGeCC Score. Osteoporos Int 2021; 32:2023-2031. [PMID: 33811493 DOI: 10.1007/s00198-021-05932-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/17/2021] [Indexed: 12/25/2022]
Abstract
UNLABELLED We evaluated mortality in a cohort of hip fracture patients and implemented a risk prediction score named ASAgeCoGeCC with excellent discrimination. It allowed to separate patients in 3 different risk groups with distinct mortality rates. Recognition of the heterogeneity of patients with femoral fractures may have relevant implications for their management. INTRODUCTION Usage of risk prediction models to estimate postoperative mortality risk for hip fracture patients represents a useful tool to give insight in the prognosis and assist in clinical decision-making. The aim of this study was to identify a predictive model able to determine the possible presence of distinct subgroups of hip fracture patients by risk classes in the mid-term. METHODS Three hundred twenty-three hip fracture patients were evaluated, and mortality rates at 30 days, 1, 2, and 4 years were calculated. A multivariate logistic regression analysis using mortality 4 years after fracture as a dependent variable found ASA score, age, cognitive status, gender, and Charlson Comorbidities Index (CCI) as significant risk factors. Using these items, a score named ASAgeCoGeCC was implemented and compared with CCI and Nottingham Hip Fracture Score (NHFS) by a receiver operating characteristic (ROC) curve. RESULTS The area under the ROC curve for ASAgeCoGeCC was always greater than that of CCI and NHFS and ranged between 0.804 and 0.820 suggesting an excellent discrimination. The ASAgeCoGeCC logistic model showed also a good calibration. Patients were divided in 3 groups: a low risk group, an intermediate risk group with an odds ratio for 4-year mortality of 5.6 (95% CI 2.9-10.6), and a high risk group with an odds ratio 21.6 (95% CI 10.6-44). CONCLUSION The ASAgeCoGeCC Score is a predictive tool for mortality after hip fracture with good calibration and excellent discrimination properties. It is the first scoring system stratifying hip fracture patients' mortality at 4 years from fracture.
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Affiliation(s)
- C Trevisan
- UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST-Bergamo Est, Via Paderno 21, 24065, Seriate, BG, Italia.
| | - G Gallinari
- UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST-Bergamo Est, Via Paderno 21, 24065, Seriate, BG, Italia
| | - A Carbone
- UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST-Bergamo Est, Via Paderno 21, 24065, Seriate, BG, Italia
| | - R Klumpp
- UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST-Bergamo Est, Via Paderno 21, 24065, Seriate, BG, Italia
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Kjaervik C, Gjertsen JE, Engeseter LB, Stensland E, Dybvik E, Soereide O. Waiting time for hip fracture surgery: hospital variation, causes, and effects on postoperative mortality : data on 37,708 operations reported to the Norwegian Hip fracture Register from 2014 to 2018. Bone Jt Open 2021; 2:710-720. [PMID: 34472378 PMCID: PMC8479844 DOI: 10.1302/2633-1462.29.bjo-2021-0079.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aims This study aimed to describe preoperative waiting times for surgery in hip fracture patients in Norway, and analyze factors affecting waiting time and potential negative consequences of prolonged waiting time. Methods Overall, 37,708 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked with data in the Norwegian Patient Registry. Hospitals treating hip fractures were characterized according to their hip fracture care. Waiting time (hours from admission to start of surgery), surgery within regular working hours, and surgery on the day of or on the day after admission, i.e. ‘expedited surgery’ were estimated. Results Mean waiting time was 22.6 hours (SD 20.7); 36,652 patients (97.2%) waited less than three days (< 72 hours), and 27,527 of the patients (73%) were operated within regular working hours (08:00 to 16:00). Expedited surgery was given to 31,675 of patients (84%), and of these, 19,985 (53%) were treated during regular working hours. Patients classified as American Society of Anesthesiologists (ASA) classes 4 and 5 were more likely to have surgery within regular working hours (odds ratio (OR) 1.59; p < 0.001), and less likely to receive expedited surgery than ASA 1 patients (OR 0.29; p < 0.001). Low-volume hospitals treated a larger proportion of patients during regular working hours than high volume hospitals (OR 1.26; p < 0.001). High-volume hospitals had less expedited surgery and significantly longer waiting times than low and intermediate-low volume hospitals. Higher ASA classes and Charlson Comorbidity Index increased waiting time. Patients not receiving expedited surgery had higher 30-day and one-year mortality rates (OR 1.19; p < 0.001) and OR 1.13; p < 0.001), respectively. Conclusion There is inequality in waiting time for hip fracture treatment in Norway. Variations in waiting time from admission to hip fracture surgery depended on both patient and hospital factors. Not receiving expedited surgery was associated with increased 30-day and one-year mortality rates. Cite this article: Bone Jt Open 2021;2(9):710–720.
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Affiliation(s)
- Cato Kjaervik
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway.,Department of Surgery, Nordland Hospital Trust, Vesteraalen Hospital, Stokmarknes, Norway
| | - Jan-Erik Gjertsen
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Møllendalsbakken, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Lars B Engeseter
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Møllendalsbakken, Bergen, Norway
| | - Eva Stensland
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway.,Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Sykehusveien, Tromsø, Norway
| | - Eva Dybvik
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Møllendalsbakken, Bergen, Norway
| | - Odd Soereide
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Sykehusveien, Tromsø, Norway
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Bolder SB, Spaans EA, Van den Hout JA, Wagenmakers R, Koenraadt KL. Acute femoral fracture does not compromise the outcome of total hip arthroplasty : 5 year results from a single center cohort study in 2,782 patients. Acta Orthop Belg 2021. [DOI: 10.52628/87.2.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
National arthroplasty registries reveal a higher risk of revision for periprosthetic fracture and dislocation after total hip arthroplasty (THA) in patients with a femoral neck fracture compared to those with osteoarthritis (OA). Since these registries may con- tain confounding factors, we conducted a single center cohort study comparing survival and reason for failure between THA for an acute femoral neck fracture and OA using the same hip prosthesis after a minimum follow-up of 2 years.
We retrospectively analyzed 2782 patients who had undergone THA with an Accolade TMZF stem and a Trident cup between March 2009 and September 2014. Primary diagnosis before THA was osteoarthritis (OA group : n=2610) or acute femoral fracture (Fracture group : n=172). Patients in both groups were operated on by the same hip surgeons. Effect of diagnosis on THA survival was analyzed using Cox-regression analysis. Chi-square tests were used to illustrate the different reasons for revision between the groups.
Mean follow-up was 4.6 years (2-7.6). A total of 100 revisions were performed. The revision risk was comparable between the OA and Fracture group (HR=1.04, 95% CI :0.46-2.39). No differences were found between the OA and Fracture group with respect to the occurrence of periprosthetic fractures (0.8% vs. 0.6%, p=0.71) and revisions for dislocation (0.6% vs. 1.2%, p=0.38).
We found no difference in outcome or reason for revision between THA for OA or femoral neck frac- ture. Using an implant with a proven ODEP rating and having experienced hip surgeons carry out the procedures may be more important than the primary diagnosis.
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22
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Alberio RL, Rusconi M, Martinetti L, Monzeglio D, Grassi FA. Total Hip Arthroplasty (THA) for Femoral Neck Fractures: Comparison between Standard and Dual Mobility Implants. Geriatrics (Basel) 2021; 6:geriatrics6030070. [PMID: 34287327 PMCID: PMC8293229 DOI: 10.3390/geriatrics6030070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 11/21/2022] Open
Abstract
The purpose of this retrospective study is to compare the short-term clinical and radiological results between standard and dual mobility THA for femoral neck fractures (FNF) in older patients. The hypothesis is that the dual mobility cup (DMC) has the same outcomes but a lower dislocation rate than the standard THA. The study population included 56 patients (mean age 77.7 years, range 71–85) that underwent THA for displaced FNF. Patients were divided in two comparable groups for baseline characteristics (age, sex and comorbidities): 28 patients underwent THA with a standard cup (SC) and 28 THA with DMCs. The clinical records and radiograms were reviewed to search relevant data in their postoperative history. Two postoperative dislocations occurred in the SC group and none in the DMC group. At an average follow up of 23 months (12–40), 48 patients were available for the final evaluation. The WOMAC score for all patients averaged 6.26 (0–46) and was slightly better in the DMC group (4.94 vs. 7.58; p-value = 0.41); scores were significantly better in presence of neurological comorbidities (p-value = 0.04), in the absence of diabetes (p-value = 0.04) and in the case of psychiatric disorders (p-value = 0.02). Radiographic evaluation at one year showed signs of osteointegration in 42/48 (87.5%) acetabular components (20 DMCs, 22 SC). According to our experience, DMCs proved to be a valid option for the treatment of displaced FNF in older patients, since it allowed them to achieve short-term outcomes comparable to conventional THA, while decreasing the incidence of postoperative dislocations.
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Affiliation(s)
- Riccardo L. Alberio
- Orthopaedics and Traumatology Unit, Hospital “Maggiore della Carità”, 28100 Novara, NO, Italy; (R.L.A.); (D.M.); (F.A.G.)
| | - Mattia Rusconi
- Department of Health Sciences, University of East Piedmont, 28100 Novara, NO, Italy;
- Correspondence:
| | - Loris Martinetti
- Department of Health Sciences, University of East Piedmont, 28100 Novara, NO, Italy;
| | - Diego Monzeglio
- Orthopaedics and Traumatology Unit, Hospital “Maggiore della Carità”, 28100 Novara, NO, Italy; (R.L.A.); (D.M.); (F.A.G.)
| | - Federico A. Grassi
- Orthopaedics and Traumatology Unit, Hospital “Maggiore della Carità”, 28100 Novara, NO, Italy; (R.L.A.); (D.M.); (F.A.G.)
- Department of Health Sciences, University of East Piedmont, 28100 Novara, NO, Italy;
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23
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Welford P, Jones CS, Davies G, Kunutsor SK, Costa ML, Sayers A, Whitehouse MR. The association between surgical fixation of hip fractures within 24 hours and mortality : a systematic review and meta-analysis. Bone Joint J 2021; 103-B:1176-1186. [PMID: 34192937 DOI: 10.1302/0301-620x.103b7.bjj-2020-2582.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIMS The aim of this study was to assess the effect of time to surgical intervention from admission on mortality and morbidity for patients with hip fractures. METHODS MEDLINE and Embase were searched from inception to June 2020. Reference lists were manually assessed to identify additional papers. Primary comparative research studies that recruited patients aged over 60 years, with non-pathological primary proximal femoral fractures that were treated surgically, were included. Studies that did not include a group operated on within 24 hours or which reported time to surgery in calendar days were excluded. Two investigators extracted data on study characteristics, methods, and outcomes. The pre-defined primary outcome was 30-day mortality. Secondary outcomes were complications and mortality at other time points. Relative risks (RRs) with 95% confidence intervals (CIs) were aggregated and were grouped by study-level characteristics. RESULTS This review included 46 studies (January 1991 to June 2020), comprising 521,857 hip fractures with 64,047 postoperative deaths. No randomized controlled trials were eligible for inclusion. In a pooled analysis of 15 studies, RR of mortality at 30 days comparing time to surgery < 24 hours with > 24 hours was 0.86 (95% CI 0.82 to 0.91; I 2 = 69%; 95% CI 50% to 81%; p-value for heterogeneity < 0.001). The association was stronger in observational studies that did not adjust for confounders than in those that adjusted for multiple covariates. In a pooled analysis of six studies, the RR of mortality at 30 days comparing time to surgery < 24 hours with 24 to 36 hours was 0.87 (95% CI 0.81 to 0.93; I 2 = 65%; 95% CI 16% to 85%; p-value for heterogeneity = 0.014). CONCLUSION This meta-analysis indicates reduced mortality for patients operated within 24 hours compared with those operated on beyond 24 hours or within 24 to 36 hours. Where resources allow and there is no specific reversible contraindication to early surgery, we recommend that hip fractures should be surgically treated within 24 hours. Cite this article: Bone Joint J 2021;103-B(7):1176-1186.
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Affiliation(s)
- Paul Welford
- North Bristol NHS Trust, Westbury on Trym, UK
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Conor S Jones
- North Bristol NHS Trust, Westbury on Trym, UK
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Gareth Davies
- North Bristol NHS Trust, Westbury on Trym, UK
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Setor K Kunutsor
- Translational Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Matt L Costa
- Oxford Trauma, NDORMS, University of Oxford, Oxford, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- North Bristol NHS Trust, Westbury on Trym, UK
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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24
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Mukiibi W, Maharaj Z, Sekeitto AR, Mokete L, Pietrzak JRT. The management of displaced intracapsular femoral neck fractures at a Sub-Saharan Academic Hospital. SICOT J 2021; 7:34. [PMID: 34009118 PMCID: PMC8132601 DOI: 10.1051/sicotj/2021023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 03/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Femoral neck fractures (FNFs) remain "the unsolved fracture" and optimal management is still controversial. The outcomes of hemiarthroplasty (HA) and total hip arthroplasty (THA) in the treatment of FNFs are inconsistent. As demand for management of FNFs continues to grow globally, evaluation of the appropriateness of treatment remains essential, particularly in resource-constrained settings. METHODS We conducted a retrospective chart review of all patients presenting with isolated low energy intracapsular FNFs to an orthopaedic academic unit in Sub-Saharan Africa from January 2016 to April 2019. The decision regarding HA or THA was largely based upon the Sernbo score and ASA classification. The majority of patients with a Sernbo score of ≥15 and ASA class III or better received THA. RESULTS There were 117 patients (33 male/84 female) 72 years (33-97 years) with FNFs who underwent 56 THA and 61 HA between January 2016 and April 2019. The mean Sernbo score was 15.99 overall (range 8-20) and was 18.95 (11-20) for THA patients compared to 14.46 (8-20) for HA patients (p = 0.042). Time taken from admission to the theatre was 8-19 days (1-22) and 7-61 days (2-31) for HA and THA respectively. The average length of stay (LOS) was 16.04 days and the main reason for same-day cancellations was the lack of post ICU/High Care beds. The 30-day mortality rates were 1.78% and 4.91% for THA and HA patients, respectively (p = 0.07). The mortality rate for patients with a Sernbo score < 15 was 15.38% overall, 8.93% for THA patients, and 21.31% for HA patients, respectively (p = 0.021). CONCLUSION The 30-day mortality rate was comparable with published rates from developed countries. There were significant delays in time to theatre, high rates of same-day surgical cancellations, and increased LOS for both HA and THA. These factors play a cumulative role in inflating costs on a strained healthcare system in a developing country. A multidisciplinary approach including the care provision of a specialized geriatric unit is recommended. Retrospective Study, Level III evidence.
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Affiliation(s)
- Winifred Mukiibi
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Arthroplasty Unit, Department of Orthopaedics, Charlotte Maxeke Johannesburg Hospital, University of Witwatersrand 2000 Johannesburg South Africa
| | - Zia Maharaj
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Arthroplasty Unit, Department of Orthopaedics, Charlotte Maxeke Johannesburg Hospital, University of Witwatersrand 2000 Johannesburg South Africa
| | - Allan Roy Sekeitto
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Arthroplasty Unit, Department of Orthopaedics, Charlotte Maxeke Johannesburg Hospital, University of Witwatersrand 2000 Johannesburg South Africa
| | - Lipalo Mokete
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Arthroplasty Unit, Department of Orthopaedics, Charlotte Maxeke Johannesburg Hospital, University of Witwatersrand 2000 Johannesburg South Africa
| | - Jurek Rafal Tomasz Pietrzak
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Arthroplasty Unit, Department of Orthopaedics, Charlotte Maxeke Johannesburg Hospital, University of Witwatersrand 2000 Johannesburg South Africa
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25
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Oputa TJ, Dupley L, Bourne JT. One Hundred Twenty-Day Mortality Rates for Hip Fracture Patients with COVID-19 Infection. Clin Orthop Surg 2021; 13:135-143. [PMID: 34094003 PMCID: PMC8173233 DOI: 10.4055/cios20286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/27/2021] [Accepted: 03/01/2021] [Indexed: 12/18/2022] Open
Abstract
Background Increased 30-day mortality rates have been reported for patients with hip fractures and a concurrent diagnosis of coronavirus disease 19 (COVID-19) infection. Due to nosocomial spread of infection and the variable incubation period with the virus, follow-up past 30 days after injury is required to evaluate the true mortality amongst these patients. We aim to assess 120-day mortality rates in hip fracture patients with COVID-19 infection and compare this to hip fracture patients without COVID-19 infection presenting during the same time period. Methods This is a retrospective multicenter review of all patients aged ≥ 60 years admitted with a fractured neck of femur between March 5 and April 5, 2020, at nine U.K. trauma units. COVID-19 status, demographic data, comorbidities, and date of death (if applicable) were collected. Results Data were collected for 265 hip fracture patients. Forty-six patients (17.4%) tested positive for COVID-19 infection. There were no significant differences in age or Charlson comorbidity score between those with or without COVID-19. Those with COVID-19 infection were more likely to be male (p = 0.01). Patients with COVID-19 had a 30-day mortality of 35% versus 10% in patients without (p < 0.01). One hundred twenty-day mortality was also greater in those with COVID-19 infection at 63% compared to those without at 17% (p < 0.01). Previous history of myocardial infarction was the only independent factor that showed to increase mortality rate (p = 0.03). Subgroup analysis also revealed significantly increased mortality rates at 120 days in men (27% vs. 67%), women (14% vs. 59%), and those undergoing surgery (56% vs. 30%). Conclusions We report a significantly increased mortality rate at 30 and 120 days after injury in an already high-risk cohort of surgical patients. With nearly half of patients being diagnosed with COVID-19 at 14 days or greater following admission, this study highlights the importance of taking appropriate measures to decrease the incidence of nosocomial infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in hip fracture patients.
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Affiliation(s)
- Tobenna J Oputa
- Department of Trauma and Orthopaedics, Health Education North West, Manchester, UK
| | - Leanne Dupley
- Department of Trauma and Orthopaedics, Health Education North West, Manchester, UK
| | - James T Bourne
- Lancashire Teaching Hospitals, Royal Preston Hospital, Preston, UK
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26
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Luo W, Limb R, Aslam A, Kattimani R, Karthikappallil D, Paramasivan A, Waseem M. COVID-19 pandemic did not affect emergency theatre patient demographic and length of stay in the first phase of UK countrywide lockdown in a district general hospital. Ann R Coll Surg Engl 2021; 103:404-411. [PMID: 33955242 DOI: 10.1308/rcsann.2021.0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We aim to identify any changes in outcome for patients undergoing nonelective surgery at the start of the UK pandemic in our district general hospital. This was a single-centre retrospective cohort review of a UK district general hospital serving a population of over 250,000 people. METHODS Participants were all patients undergoing a surgical procedure in the acute theatre list between 23 March to 11 May in both 2019 and 2020. Primary outcome was 90-day postoperative mortality. Secondary outcomes include time to surgical intervention and length of inpatient stay. RESULTS A total of 132 patients (2020) versus 141 (2019) patients were included. Although overall 90-day postoperative mortality was higher in 2020 (9.8%) compared with 2019 (5.7%), this difference was not statistically significant (p=0.196). In 2020, eight patients tested positive for COVID-19 either as an inpatient or within 2 weeks of discharge, of whom five patients died. Time to surgical intervention was significantly faster for NCEPOD (National Confidential Enquiry into Patient Outcome and Death) code 3 patients in 2020 than in 2019 (p=0.027). There were no significant differences in mean length of inpatient stay. CONCLUSIONS We found that patients were appropriately prioritised using NCEPOD classification, with no statistically significant differences in 90-day postoperative mortality and length of inpatient stay compared with the 2019 period. A study on a larger scale would further elucidate the profile and outcomes of patients requiring acute surgery to generate statistical significance.
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Affiliation(s)
- W Luo
- Macclesfield District General Hospital, UK
| | - R Limb
- Macclesfield District General Hospital, UK
| | - A Aslam
- University of Cambridge School of Clinical Medicine, UK
| | | | | | - A Paramasivan
- Countess of Chester Hospital NHS Foundation Trust, UK
| | - M Waseem
- Macclesfield District General Hospital, UK
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27
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Blanco JF, da Casa C, Pablos-Hernández C, González-Ramírez A, Julián-Enríquez JM, Díaz-Álvarez A. 30-day mortality after hip fracture surgery: Influence of postoperative factors. PLoS One 2021; 16:e0246963. [PMID: 33592047 PMCID: PMC7886122 DOI: 10.1371/journal.pone.0246963] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/28/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose The 30-day mortality rate after hip fracture surgery has been considered as an indirect indicator of the quality of care. The aim of this work is to analyse preoperative and postoperative factors potentially related to early 30-day mortality in patients over 65 undergoing hip fracture surgery. Methods Prospective cohort study including all consecutive primary hip fracture patients over 65 admitted to Trauma and Orthopaedics department from January 1, 2018 to December 31, 2019. Bed-ridden, non- surgically treated patients, and high energy trauma or tumoral aetiology fractures were excluded. A total of 943 patients were eligible (attrition rate: 2.1%). Follow-up included 30-days after discharge. We noted the 30-day mortality after hip fracture surgery, analysing 130 potentially related variables including biodemographic, fracture-related, preoperative, and postoperative clinical factors. Qualitative variables were assessed by χ2, and quantitative variables by non-parametric tests. Odds ratio determined by binary logistic regression. We selected preventable candidate variables for multivariate risk assessment by logistic regression. Results A total of 923 patients were enrolled (mean age 86.22±6.8, 72.9% women). The 30-day mortality rate was 6.0%. We noted significant increased mortality on men (OR = 2.381[1.371–4.136], p = 0.002), ageing patients (ORyear = 1.073[1.025–1.122], p = 0.002), and longer time to surgery (ORday = 1.183[1.039–1146], p<0.001), on other 20 preoperative clinical variables, like lymphopenia (lymphocyte count <103/μl, OR = 1.842[1.063–3.191], p = 0.029), hypoalbuminemia (≤3.5g/dl, OR = 2.474[1.316–4.643], p = 0.005), and oral anticoagulant intake (OR = 2.499[1.415–4.415], p = 0.002), and on 25 postoperative clinical variables, like arrhythmia (OR = 13.937[6.263–31.017], p<0.001), respiratory insufficiency (OR = 7.002[3.947–12.419], p<0.001), hyperkalaemia (OR = 10.378[3.909–27.555], p<0.001), nutritional supply requirement (OR = 3.576[1.894–6.752], p = 0.021), or early arthroplasty dislocation (OR = 6.557[1.206–35.640], p = 0.029). We developed a predictive model for early mortality after hip fracture surgery based on postoperative factors with 96.0% sensitivity and 60.7% specificity (AUC = 0.863). Conclusion We revealed that not only preoperative, but also postoperative factors have a great impact after hip fracture surgery. The influence of post-operative factors on 30-day mortality has a logical basis, albeit so far they have not been identified or quantified before. Our results provide an advantageous picture of the 30-day mortality after hip fracture surgery.
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Affiliation(s)
- Juan F. Blanco
- Trauma and Orthopaedics Department, University Hospital of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Carmen da Casa
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- * E-mail:
| | - Carmen Pablos-Hernández
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Orthogeriatric Unit, University Hospital of Salamanca, Salamanca, Spain
| | - Alfonso González-Ramírez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Orthogeriatric Unit, University Hospital of Salamanca, Salamanca, Spain
| | - José Miguel Julián-Enríquez
- Trauma and Orthopaedics Department, University Hospital of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Agustín Díaz-Álvarez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Anaesthesiology Department, University Hospital of Salamanca, Salamanca, Spain
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28
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Sekeitto AR, Sikhauli N, van der Jagt DR, Mokete L, Pietrzak JR. The management of displaced femoral neck fractures: a narrative review. EFORT Open Rev 2021; 6:139-144. [PMID: 33828857 PMCID: PMC8022011 DOI: 10.1302/2058-5241.6.200036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This article serves to review the existing clinical guidelines, and highlight the most recent medical and surgical recommendations, for the management of displaced femoral neck fractures (FNFs). It stresses the need for multi-disciplinary intervention to potentially improve mortality rates, limit adverse events and prevent further economic liability.Globally, the incidence of FNFs continues to rise as the general population ages and becomes more active. The annual number of FNFs is expected to exceed six million by 2050. The increased burden of FNFs exacerbates the demand on all services associated with treating these injuries.The management of FNFs may serve as an indicator of the quality of care of the geriatric population. However, despite escalating health costs, a significant 30-day and one-year mortality rate, increased rate of peri-operative adverse events and sub-optimal functional clinical outcomes, continued controversy exists over optimal patient care.Much debate exists over the type of surgery, implant selection and peri-operative clinical care and rehabilitation. FNF care models, systematized clinical pathways, formal geriatrics consultation and specialized wards within an established interdisciplinary care framework may improve outcomes, mitigate adverse events and limit unnecessary costs. Cite this article: EFORT Open Rev 2021;6:139-144. DOI: 10.1302/2058-5241.6.200036.
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Affiliation(s)
- Allan Roy Sekeitto
- Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nkhodiseni Sikhauli
- Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Dick Ronald van der Jagt
- Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Lipalo Mokete
- Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Jurek R.T. Pietrzak
- Arthroplasty Unit, Division of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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29
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Kristan A, Omahen S, Tosounidis TH, Cimerman M. When does hip fracture surgery delay affects the length of hospital stay? Eur J Trauma Emerg Surg 2021; 48:701-708. [PMID: 33388817 DOI: 10.1007/s00068-020-01565-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/21/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To define factors influencing length of hospital stay (LOS) besides surgery delay. METHODS We retrospectively analyzed 634 patients operated for hip fractures in 1-year period. Investigated characteristics were age, gender, American Society of Anesthesiologists score (ASA), time to surgery (first 48 h was considered early), type of surgery, anticoagulant therapy and non-routine pre-operative tests. Univariate and multivariable analysis were performed. p values < 0.05 were considered statistically significant. RESULTS Median LOS was 12 days. Patients operated within 48 h had a LOS of 10 days, while patients operated after 48 h had 4 days longer LOS (p < 0.01). In multiple regression analyses, it was predicted that patients operated after 48 h with every 10 h delay to surgery had 7.3 h longer hospitalizations. All other factors did not influence the LOS. In early operation group, patients with hip arthroplasty had 3.3 days longer hospitalization compared to patients with osteosynthesis, every higher ASA score was associated with 1.4 days longer hospitalization, patients on anticoagulant therapy had 2.6 days longer LOS but surgery delay had no influence on LOS. Preinjury residence at a nursing home was associated with 4.4 days shorter hospitalizations compared to preinjury residence at home in both time frames. CONCLUSIONS In patients operated in first 48 h longer LOS is associated with ASA, anticoagulant therapy and operation type but not with delay to surgery. If patients are operated after 48 h, surgery delay is the only factor increasing LOS.
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Affiliation(s)
- Anže Kristan
- Department of Traumatology, University Medical Center Ljubljana, 1000, Ljubljana, Slovenia.
| | - Sabastjan Omahen
- Department of Traumatology, University Medical Center Ljubljana, 1000, Ljubljana, Slovenia
| | | | - Matej Cimerman
- Department of Traumatology, University Medical Center Ljubljana, 1000, Ljubljana, Slovenia
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30
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Abstract
It is unusual, if not unique, for three major research papers concerned with the management of the fractured neck of femur (FNOF) to be published in a short period of time, each describing large prospective randomized clinical trials. These studies were conducted in up to 17 countries worldwide, involving up to 80 surgical centers and include large numbers of patients (up to 2,900) with FNOF. Each article investigated common clinical dilemmas; the first paper comparing total hip arthroplasty versus hemiarthroplasty for FNOF, the second as to whether ‘fast track’ care offers improved clinical outcomes and the third, compares sliding hip with multiple cancellous hip screws. Each paper has been deemed of sufficient quality and importance to warrant publication in The Lancet or the New England Journal of Medicine. Although ‘premier’ journals, they only occationally contain orthopaedic studies and thus may not be routinely read by the busy orthopaedic/surgical clinician of any grade. It is therefore our intention with this present article to accurately summarize and combine the results of all three papers, presenting, in our opinion, the most important clinically relevant facts. Cite this article: Bone Joint Open 2020;1-6:198–202.
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Affiliation(s)
- Peter M Lewis
- Prince Charles Hospital and Royal Glamorgan Hospital , Cwm Taf Morgannwg University Health Board, South Wales, UK
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31
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Shi BY, Hannan CV, Jang JM, Ali I, Srikumaran U. Association Between Delays in Radiography and Surgery With Hip Fracture Outcomes in Elderly Patients. Orthopedics 2020; 43:e609-e615. [PMID: 32841359 DOI: 10.3928/01477447-20200812-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/05/2019] [Indexed: 02/03/2023]
Abstract
Appropriate waiting time for hip fracture surgery is disputed. The American Academy of Orthopaedic Surgeons recommends surgery within 48 hours of presentation, although evidence suggests that earlier surgery (within 24 hours) reduces the risks of complications and death. The authors asked: (1) Do patients who receive earlier radiographic evaluation of hip fracture undergo surgery earlier? and (2) Is "surgery delay" (time from presentation to surgery) associated with postoperative opioid use, duration of hospital stay, and 30-day and 1-year mortality rates? The authors identified 511 adults 60 years or older who were admitted to their emergency department with hip fractures from 2015 through 2017. Patients were divided into 6 cohorts according to length of surgery delay and 3 cohorts according to length of radiography delay (time from presentation to first hip radiograph). The authors found that medium radiography delay (>2 to 4 hours) was associated with an additional 11 hours of surgery delay compared with short radiography delay (≤2 hours; P=.026). Longer surgery delay (>12 hours) was associated with use of 9.6 more morphine equivalents (95% confidence interval, 0.7 to 8.6) during the first 24 hours postoperatively compared with shorter surgery delay (≤12 hours). Surgery delay of greater than 36 hours was an independent risk factor for longer hospital stay (odds ratio, 2.8; 95% confidence interval, 1.7 to 4.8). Thirty-day and 1-year mortality rates were significantly higher among patients who experienced a surgery delay of greater than 36 hours compared with those who experienced a surgery delay of 36 hours or less. [Orthopedics. 2020;43(6):e609-e615.].
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Collin C, Bimou C, Mabit C, Tchalla A, Charissoux JL, Marcheix PS. Orthogeriatric assessment of patients over 75 years of age with a proximal femur fracture: Predictors of 6-month mortality. Orthop Traumatol Surg Res 2020; 106:1441-1447. [PMID: 33060014 DOI: 10.1016/j.otsr.2020.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Proximal femur fractures are common and dangerous in older adults, given the high short-term mortality rate. While surgical treatment is vital, medical orthogeriatric care may reduce the 6-month mortality rate; however, this has not been determined on a broad scale in France. This led us to conduct a retrospective study to answer the following questions: (1) Does delayed surgical treatment impact the 6-month mortality rate? (2) Are there correctable medical factors that impact the 6-month mortality? HYPOTHESIS Delayed surgical treatment is not an isolated risk factor for higher 6-month mortality after proximal femur fracture. METHODS We included all patients 75 years or older who had suffered a proximal femur fracture requiring surgical treatment. This allowed us to analyze the medical records of 476 patients retrospectively. We documented their comorbidities and pre-, intra- and postoperative characteristics. A univariate then multivariate analysis was done to identify risk factors for mortality at 6 months. RESULTS In the univariate analysis, time to surgery of more than 48hours increased the risk of dying at 6 months by 1.5 fold (Odds ratio (OR)=1.57/95% CI: 1-2.48/p=0.04). However, this risk factor was not significant in the multivariate analysis since it is not an independent risk factor. In the multivariate analysis, anticoagulants (OR=2/95% CI: 1.13-3.50/p=0.02), dementia (OR=2.2/95% CI: 1.32-3.59/p=0.002), peripheral artery disease (OR=2.9/95% CI: 1.10-7.70/p=0.03), 2-point drop in hemoglobin count from preoperative to postoperative (OR=1.9/95% CI: 1.05-3.12/p=0.04), male sex (OR=1.82/95% CI: 1.05-3.12/p=0.04), age above 85 years (OR=5.26/95% CI: 1.49-5.26/p=0.002) and Charlson comorbidity index≥7 (OR=2.13/95% CI: 1.29-3.52/p=0.003) were statistically associated with mortality at 6 months. DISCUSSION/CONCLUSION Our study found that the patients most at risk for dying within 6 months of a hip fracture were males, older than 85 and have associated medical conditions (Charlson index≥7). Prior anticoagulant treatment increases the time to surgery in our study and therefore increases the risk of these patients dying within 6 months. Treatment of these at-risk patients should ensure that their underlying medical conditions are not made worse, while providing treatment within 48hours. Patients taking anticoagulants must be monitored carefully to ensure surgical treatment is not delayed. LEVEL OF EVIDENCE IV, retrospective study without control group.
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Affiliation(s)
- Camille Collin
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - Charlotte Bimou
- EA 6310 HAVAE handicap activité vieillissement autonomie environnement, université de Limoges, 33, rue François-Mitterrand, 87032 Limoges, France
| | - Christian Mabit
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - Achille Tchalla
- Service de médecine gériatrique, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - Jean-Louis Charissoux
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - Pierre-Sylvain Marcheix
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France.
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Abstract
OBJECTIVES The study aimed to understand through qualitative research what patients considered material in their decision to consent to an acute surgical intervention. PARTICIPANTS, SETTING AND INTERVENTION The patients selected aged between 18 and 90, having been admitted to a major trauma centre to undergo an acute surgical intervention within 14 days of injury, where English was their first language. Data saturation point was reached after 21 patients had been recruited. Data collection and analysis were conducted simultaneously, through interviews undertaken immediately prior to surgery. The data were coded using NVIVO V.12 software. RESULTS The key theme that originated from the data analysis was patients were unable to identify any individual risk that would modify their decision-making process around giving consent. The patient's previous experience and the experience of others around them were a further theme. Patients sensed that there were no non-operative options for their injuries. CONCLUSION This is the first study investigating what patient considered a material risk in the consent process. Patients in this study did attribute significance to past experiences of friends and family as material, prompting us to suggest that the surgeon asks about these experiences as part of the consent process. Concern about functional recovery was important to patients but insufficient to stop them from consenting to surgery, thus could not be classified as material risk.
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Affiliation(s)
- Anthony Howard
- Leeds Orthopaedic Trauma Sciences, LGI, University of Leeds, Leeds, UK
- Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - Jonathan Webster
- Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, Leeds, UK
| | - Naomi Quinton
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | - Peter V Giannoudis
- Leeds Orthopaedic Trauma Sciences, LGI, University of Leeds, Leeds, UK
- Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
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Hansen S, Liu S, D'Souza R, Miller R. Time to surgery for fractured neck of femur in the Waikato District Health Board: Comparison between rural and metropolitan hospitals between 2017 and 2019. Aust J Rural Health 2020; 28:506-508. [PMID: 33006407 DOI: 10.1111/ajr.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/23/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Sara Hansen
- University of Auckland, Auckland, New Zealand
| | - Sarah Liu
- University of Auckland, Auckland, New Zealand
| | | | - Rory Miller
- Rural Section, Department of General Practice and Rural Health, University of Otago, Whangamata, New Zealand.,Rural Doctor Thames Hospital, Waikato District Health Board, Thames, New Zealand
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Greve K, Modig K, Talbäck M, Bartha E, Hedström M. No association between waiting time to surgery and mortality for healthier patients with hip fracture: a nationwide Swedish cohort of 59,675 patients. Acta Orthop 2020; 91:396-400. [PMID: 32326789 PMCID: PMC8023952 DOI: 10.1080/17453674.2020.1754645] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Waiting time to surgery for patients with hip fractures and its potential association with mortality has been frequently studied with the hypothesis that longer waiting time is associated with adverse outcomes. However, despite numerous studies, there is no consensus regarding which time frames are appropriate, and whether some patients are more vulnerable to waiting than others. We explored the association between waiting time to surgery and short-term mortality and whether sex, age, surgical method, and comorbidity (ASA) modified this association.Patients and methods - This is a nationwide cohort study of 59,675 patients undergoing hip fracture surgery between January 1, 2013 and December 31, 2017 with a 4-month follow-up of mortality. Data were extracted from the Swedish Registry for Hip Fracture Patients and Treatment (RIKSHÖFT) and mortality was obtained from Statistics Sweden.Results - Unadjusted analyses revealed an association between waiting more than 24 hours for surgery and increased mortality, primarily for women. However, when stratifying for ASA grade, an association persisted only among patients with ASA 3 and 4. Furthermore, the absolute differences in mortality risk between those waiting less or longer than 24 hours were small. Age, fracture type, and surgical method did not modify the association between waiting time and mortality.Interpretation - This study suggests that there may be a need for new guidelines, which take into account the heterogeneity of the patient population.
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Affiliation(s)
- Katarina Greve
- Institution of Clinical Sciences, Intervention and Technology (CLINTEC) Karolinska Institutet, Stockholm
- Perioperative Medicine and Intensive Care, Karolinska University Hospital Huddinge, Stockholm
| | - Karin Modig
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm
| | - Mats Talbäck
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm
| | - Erzsébet Bartha
- Institution of Clinical Sciences, Intervention and Technology (CLINTEC) Karolinska Institutet, Stockholm
- Perioperative Medicine and Intensive Care, Karolinska University Hospital Huddinge, Stockholm
| | - Margareta Hedström
- Institution of Clinical Sciences, Intervention and Technology (CLINTEC) Karolinska Institutet, Stockholm
- Department of Orthopaedics, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Guo J, Wang Z, Fu M, Di J, Zha J, Liu J, Zhang G, Wang Q, Chen H, Tang P, Hou Z, Zhang Y. Super elderly patients with intertrochanteric fractures do not predict worse outcomes and higher mortality than elderly patients: a propensity score matched analysis. Aging (Albany NY) 2020; 12:13583-13593. [PMID: 32649313 PMCID: PMC7377837 DOI: 10.18632/aging.103466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/27/2020] [Indexed: 12/23/2022]
Abstract
We aimed to investigate whether super elderly patients aged over 90 years had significantly worse functional outcomes, perioperative complications, and survival rates. Among 3560 patients aged over 65 years presenting with intertrochanteric fractures and treated surgically between Jan 2014 and Jan 2019, 2242 patients were included, including 206 in super elderly group and 2036 in elderly group. After using propensity score matching to minimize the effects of possible confounding variables, 192 remained in each group. No significant difference was observed in functional outcomes, perioperative complications, or 30-day, 90-day, and 1-year mortality after propensity score matching and McNemar’s tests (p>0.05). After an average follow-up of 37 months, the Kaplan-Meier survival curve showed no significant difference between the two groups in terms of cumulative survival rate (p=0.081, log-rank). Our data demonstrated progressive increases in mortality and poor outcomes with increasing Elixhauser comorbidity scores, which represented the severity index of patients preoperatively. Our study also found that there were weak correlations between five characteristics and the patient age. These results all suggested that it is not the advanced age itself but other concomitant factors, that appear to be responsible for the adverse functional outcomes, perioperative complications, and mortality in super elderly patients.
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Affiliation(s)
- Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, P.R. China
| | - Zhiqian Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, P.R. China
| | - Mingming Fu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, P.R. China
| | - Jun Di
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, P.R. China
| | - Junpu Zha
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, P.R. China
| | - Junchuan Liu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, P.R. China
| | - Guolei Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, P.R. China
| | - Qingxian Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, P.R. China
| | - Hua Chen
- Department of Orthopaedic Surgery, Chinese PLA General Hospital, 301 Hospital, Beijing 100853, P.R. China
| | - Peifu Tang
- Department of Orthopaedic Surgery, Chinese PLA General Hospital, 301 Hospital, Beijing 100853, P.R. China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, P.R. China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, P.R. China.,Chinese Academy of Engineering, Beijing 100088, P.R. China
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Kayani B, Onochie E, Patil V, Begum F, Cuthbert R, Ferguson D, Bhamra JS, Sharma A, Bates P, Haddad FS. The effects of COVID-19 on perioperative morbidity and mortality in patients with hip fractures. Bone Joint J 2020; 102-B:1136-1145. [PMID: 32634023 DOI: 10.1302/0301-620x.102b9.bjj-2020-1127.r1] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIMS During the COVID-19 pandemic, many patients continue to require urgent surgery for hip fractures. However, the impact of COVID-19 on perioperative outcomes in these high-risk patients remains unknown. The objectives of this study were to establish the effects of COVID-19 on perioperative morbidity and mortality, and determine any risk factors for increased mortality in patients with COVID-19 undergoing hip fracture surgery. METHODS This multicentre cohort study included 340 COVID-19-negative patients versus 82 COVID-19-positive patients undergoing surgical treatment for hip fractures across nine NHS hospitals in Greater London, UK. Patients in both treatment groups were comparable for age, sex, body mass index, fracture configuration, and type of surgery performed. Predefined perioperative outcomes were recorded within a 30-day postoperative period. Univariate and multivariate analysis were used to identify risk factors associated with increased risk of mortality. RESULTS COVID-19-positive patients had increased postoperative mortality rates (30.5% (25/82) vs 10.3% (35/340) respectively, p < 0.001) compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status (hazard ratio (HR) 15.4 (95% confidence interval (CI) 4.55 to 52.2; p < 0.001) and greater than three comorbidities (HR 13.5 (95% CI 2.82 to 66.0, p < 0.001). COVID-19-positive patients had increased risk of postoperative complications (89.0% (73/82) vs 35.0% (119/340) respectively; p < 0.001), more critical care unit admissions (61.0% (50/82) vs 18.2% (62/340) respectively; p < 0.001), and increased length of hospital stay (mean 13.8 days (SD 4.6) vs 6.7 days (SD 2.5) respectively; p < 0.001), compared to COVID-19-negative patients. CONCLUSION Hip fracture surgery in COVID-19-positive patients was associated with increased length of hospital stay, more admissions to the critical care unit, higher risk of perioperative complications, and increased mortality rates compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status and multiple (greater than three) comorbidities. Cite this article: Bone Joint J 2020;102-B(9):1136-1145.
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Affiliation(s)
- Babar Kayani
- University College Hospital, London, UK.,Royal London Hospital, London, UK
| | - Elliot Onochie
- Newham University Hospital, London, UK.,Whipps Cross Hospital, London, UK
| | | | | | | | | | | | | | | | - Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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Guo Z, Zhao F, Wang Y, Wang X. Intensive Care Unit Resource Utilization After Hip Fracture Surgery in Elderly Patients: Risk Factor Identification and Risk Stratification. Orthopedics 2020; 43:e159-e165. [PMID: 32003837 DOI: 10.3928/01477447-20200129-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/14/2019] [Indexed: 02/03/2023]
Abstract
The objective of this study was to develop a risk stratification index (RSI) system to guide intensive care unit (ICU) resource use for elderly patients after hip fracture surgery. The authors' first study cohort consisted of 302 elderly patients with hip fractures who had surgical treatment at their hospital. The authors conducted multivariate logistic regression analysis to investigate relevant risk factors for ICU resource utilization postoperatively. An RSI system was developed based on the significant risk factors from regression analysis. A second study cohort consisted of 205 elderly patients, among whom the authors applied the RSI system to guide ICU resource assignment. Among the first cohort of 302 hip fracture patients, 89 were transferred to ICU postoperatively, of whom 81 were planned to be transferred to ICU and 8 were not. Multivariate stepwise regression analysis revealed that age (≥80 years), preoperative pulmonary disease, perioperative anemia (hemoglobin <8 g/dL), and perioperative lactic acid level (>2 mmol/L) were independent risk factors for postoperative ICU management. The authors then constructed a weighted RSI with these risk factors. In addition, they manually added American Society of Anesthesiologists classification (III/IV) and types of anesthesia as additional risk factors based on their clinical experience. It was determined that an RSI score greater than 4 required postoperative ICU care. The RSI system was then prospectively applied to an independent cohort of 205 elderly surgical patients with hip fractures, among whom only 40 required ICU care. More importantly, there were no later transfers from the general ward to ICU after the application of RSI. The RSI system is effective for guiding postoperative ICU transfer without compromising patient care and minimizes unexpected transfers from the general ward to the postoperative ICU. [Orthopedics. 2020;43(3):e159-e165.].
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Brink O. Hip fracture clearance: How much optimisation is necessary? Injury 2020; 51 Suppl 2:S111-S117. [PMID: 32081388 DOI: 10.1016/j.injury.2020.02.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
Patients with hip fractures are typically elderly individuals with several co-morbidities. Upon admission to the hospital, they often present with acute pain, electrolyte disturbances, anaemia, coagulopathy, and delirium. Long waiting times for surgery are associated with increased morbidity and mortality. The balance between the number of clinical tests and optimisation, which may (i.e., fewer complications and better survival) or may not (i.e., more complications and increased mortality due to unnecessary surgical delay) benefit the patient, has been a preoperative challenge. This summary will review existing clinical guidelines and relevant selected studies to evaluate the extent of preoperative optimisation needed prior to hip fracture surgery.
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Affiliation(s)
- Ole Brink
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juel-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
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López-Torres II, Sanz-Ruiz P, Montero-Fernández N, Chana F, Serra-Rexach JA, Benjumea-Carrasco A, Vaquero-Martín J. Surgical treatment of hip fracture in centenarians: Complications and independent risk factors of death. Injury 2020; 51 Suppl 1:S25-S29. [PMID: 32409187 DOI: 10.1016/j.injury.2020.03.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/03/2020] [Accepted: 03/29/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The increase in life expectancy has led to the appearance of a subgroup of hip fracture (HF) patients with special characteristics known as centenarians. The aim of the present study is to analyse the demographic characteristics, complications and mortality rate of this subgroup in order to identify the specific risk factors for mortality in these patients. METHODS Retrospective analysis of 69 patients (58 women and 11 men) aged 100 years or older admitted to a tertiary hospital for HF between 1999 and 2018. RESULTS The average age was 101.3 years (100-108, median 101). More than half (62.3%) of all patients presented with extracapsular fractures. The most common complications observed were delirium (52.3%) and urinary retention (27.7%). Haematoma (9.2%) was the most common surgical complication. Only 3 patients (7.3%) changed their place of residence after admission. In-hospital, 30-day and 1-year mortality rates were 13.8%, 21.5% and 54.2%, respectively. A high Charlson Comorbidity Index and baseline Functional Ambulation Classification (FAC) <3 were associated with a higher in-hospital mortality rate (OR = 1.95 95% CI [1.03-3.69] and OR = 5.7 95% CI [1.2-26.8]), respectively. The presence of more than 3 comorbidities and baseline FAC <3 were associated with a higher risk of 30-day mortality (OR = 6, 95% CI [1.4-24.7] and OR = 4, 95% CI [1.13-14.2]), respectively. Dementia has been associated with a higher risk of 30-day and 1-year mortality (OR = 4.6, 95% CI [1.2-16.7]) and OR = 5.11, 95% CI [1.6-21]) respectively. CONCLUSION FAC score, number of comorbidities, dementia and the Charlson Comorbidity Index have been shown to be risk factors of mortality in centenarians with HF.
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Affiliation(s)
| | - Pablo Sanz-Ruiz
- Hospital General Universitario Gregorio Marañón. C/ Doctor Esquerdo 46, 28007 Madrid, Spain; Universidad Complutense de Madrid. Av. Séneca 2, 28040 Madrid, Spain
| | | | - Francisco Chana
- Hospital General Universitario Gregorio Marañón. C/ Doctor Esquerdo 46, 28007 Madrid, Spain; Universidad Complutense de Madrid. Av. Séneca 2, 28040 Madrid, Spain
| | - Jose Antonio Serra-Rexach
- Hospital General Universitario Gregorio Marañón. C/ Doctor Esquerdo 46, 28007 Madrid, Spain; Universidad Complutense de Madrid. Av. Séneca 2, 28040 Madrid, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES). Avenida de Monforte de Lemos, 3-5. Pabellón 11, 28029 Madrid, Spain.
| | | | - Javier Vaquero-Martín
- Hospital General Universitario Gregorio Marañón. C/ Doctor Esquerdo 46, 28007 Madrid, Spain; Universidad Complutense de Madrid. Av. Séneca 2, 28040 Madrid, Spain
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Guo J, Dong W, Yin Y, Zhang R, Hou Z, Zhang Y. The Effect of Configuration of Rhombic Cannulated Screws on Internal Fixation of Femoral Neck Fractures. Orthopedics 2020; 43:e72-e78. [PMID: 31841607 DOI: 10.3928/01477447-20191212-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/08/2019] [Indexed: 02/03/2023]
Abstract
Femoral neck fractures are commonly encountered clinical problems, especially in patients with osteoporosis, and have high morbidity and mortality. Internal fixation of femoral neck fractures using 3 cannulated screws placed in an inverse triangle configuration is commonly performed. Recently, the use of 4 cannulated screws in a rhombic configuration has been proposed. The aim of this study was to investigate the outcomes of femoral neck fractures treated using either an inverse triangle or rhombic configuration to determine which had a better clinical prognosis. A total of 138 consecutive patients without any previous hip surgery who had femoral neck fractures treated with cannulated compression screws in either an inverse triangle or rhombic configuration were reviewed. Patients' demographic and radiological data were collected from the authors' institutional database. The authors found that the rhombic configuration did not have a better result in decreasing complications, such as femoral neck shortening or screw exit, or in Harris Hip Scores and other clinical prognoses compared with the inverse triangle configuration. In addition, the technique used for applying 4 screws (especially the posterior ones) needs to be improved, so until then, using 3 screws in an inverse triangle configuration remains the gold standard for the treatment of femoral neck fractures. [Orthopedics. 2020; 43(2):e72-e78.].
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Kristiansson J, Hagberg E, Nellgård B. The influence of time-to-surgery on mortality after a hip fracture. Acta Anaesthesiol Scand 2020; 64:347-353. [PMID: 31652349 DOI: 10.1111/aas.13494] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/30/2019] [Accepted: 10/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The effect of time-to-surgery on mortality in acute hip fracture (AHF) patients has been debated and studies are inconsistent regarding from what time limit mortality starts to increase. At Sahlgrenska University Hospital/Mölndal, surgery is recommended within 24 hours leaving little time for pre-operative optimization. However, internationally the definition of early surgery varies between 24 and 48 hours and over. This retrospective study was initiated to investigate the relation between time-to-surgery and 30-day mortality. METHOD Data of AHF patients from January 2007 through December 2016 were collected. The variables analysed were: age, gender, American Society of Anesthesiologists physical status classification, surgical method (prosthesis or osteosynthesis) and time-to-surgery, along with 30-day mortality. Primary outcome was 30-day mortality related to time-to-surgery divided into groups. Secondary outcome was 30-day mortality related to time-to-surgery analysed hour-by-hour. RESULTS From 10,844 eligible patients, 9,270 patients were included into the study. Mean time-to-surgery was 19.4 hours and overall 30-day mortality was 7.6%. Adjusted Cox regression analysis revealed an increased mortality rate in patients with time-to-surgery >48 hours. In the hour-by-hour analysis, significant mortality increase was observed at 39 hours of time-to-surgery. Patients with time-to-surgery >24 hours did not have increased mortality compared to patients with time-to-surgery <24 hours. CONCLUSION In AHF patients, a time-to-surgery exceeding 39-48 hours was associated with increased mortality. Patients with surgeries performed before 39-48 hours did not have increased mortality and this time may, in some patients, be used for optimization prior surgery even if time-to-surgery exceeds 24 hours.
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Affiliation(s)
- Johan Kristiansson
- Department of Anaesthesiology and Intensive Care Sahlgrenska University Hospital
- Institution of Clinical Sciences Sahlgrenska Academy University of Gothenburg
| | - Eva Hagberg
- Department of Clinical Physiology Sahlgrenska University Hospital Mölndal Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care Sahlgrenska University Hospital
- Institution of Clinical Sciences Sahlgrenska Academy University of Gothenburg
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Borges FK, Bhandari M, Guerra-Farfan E, Patel A, Sigamani A, Umer M, Tiboni ME, Villar-Casares MDM, Tandon V, Tomas-Hernandez J, Teixidor-Serra J, Avram VRA, Winemaker M, Ramokgopa MT, Szczeklik W, Landoni G, Wang CY, Begum D, Neary JD, Adili A, Sancheti PK, Lawendy AR, Balaguer-Castro M, Ślęczka P, Jenkinson RJ, Nur AN, Wood GCA, Feibel RJ, McMahon SJ, Sigamani A, Popova E, Biccard BM, Moppett IK, Forget P, Landais P, McGillion MH, Vincent J, Balasubramanian K, Harvey V, Garcia-Sanchez Y, Pettit SM, Gauthier LP, Guyatt GH, Conen D, Garg AX, Bangdiwala SI, Belley-Cote EP, Marcucci M, Lamy A, Whitlock R, Le Manach Y, Fergusson DA, Yusuf S, Devereaux PJ, Veevaete L, le Polain de Waroux B, Lavand'homme P, Cornu O, Tribak K, Yombi JC, Touil N, Reul M, Bhutia JT, Clinckaert C, De Clippeleir D, Reul M, Patel A, Tandon V, Gauthier LP, Avram VRA, Winemaker M, de Beer J, Simpson DL, Worster A, Alvarado KA, Gregus KK, Lawrence KH, Leong DP, Joseph PG, Magloire P, Deheshi B, Bisland S, Wood TJ, Tushinski DM, Wilson DAJ, Kearon C, Le Manach Y, Adili A, Tiboni ME, Neary JD, Cowan DD, Khanna V, Zaki A, Farrell JC, MacDonald AM, Conen D, Wong SCW, Karbassi A, Wright DS, Shanthanna H, Coughlin R, Khan M, Wikkerink S, Quraishi FA, Lawendy AR, Kishta W, Schemitsch E, Carey T, Macleod MD, Sanders DW, Vasarhelyi E, Bartley D, Dresser GK, Tieszer C, Jenkinson RJ, Shadowitz S, Lee JS, Choi S, Kreder HJ, Nousiainen M, Kunz MR, Tuazon R, Shrikumar M, Ravi B, Wasserstein D, Stephen DJG, Nam D, Henry PDG, Wood GCA, Mann SM, Jaeger MT, Sivilotti MLA, Smith CA, Frank CC, Grant H, Ploeg L, Yach JD, Harrison MM, Campbell AR, Bicknell RT, Bardana DD, Feibel RJ, McIlquham K, Gallant C, Halman S, Thiruganasambandamoorth V, Ruggiero S, Hadden WJ, Chen BPJ, Coupal SA, McMahon SJ, McLean LM, Shirali HR, Haider SY, Smith CA, Watts E, Santone DJ, Koo K, Yee AJ, Oyenubi AN, Nauth A, Schemitsch EH, Daniels TR, Ward SE, Hall JA, Ahn H, Whelan DB, Atrey A, Khoshbin A, Puskas D, Droll K, Cullinan C, Payendeh J, Lefrancois T, Mozzon L, Marion T, Jacka MJ, Greene J, Menon M, Stiegelmahr R, Dillane D, Irwin M, Beaupre L, Coles CP, Trask K, MacDonald S, Trenholm JAI, Oxner W, Richardson CG, Dehghan N, Sadoughi M, Sharma A, White NJ, Olivieri L, Hunt SB, Turgeon TR, Bohm ER, Tran S, Giilck SM, Hupel T, Guy P, O'Brien PJ, Duncan AW, Crawford GA, Zhou J, Zhao Y, Liu Y, Shan L, Wu A, Muñoz JM, Chaudier P, Douplat M, Fessy MH, Piriou V, Louboutin L, David JS, Friggeri A, Beroud S, Fayet JM, Landais P, Leung FKL, Fang CX, Yee DKH, Sancheti PK, Pradhan CV, Patil AA, Puram CP, Borate MP, Kudrimoti KB, Adhye BA, Dongre HV, John B, Abraham V, Pandey RA, Rajkumar A, George PE, Sigamani A, Stephen M, Chandran N, Ashraf M, Georgekutty AM, Sulthan AS, Adinarayanan S, Sharma D, Barnawal SP, Swaminathan S, Bidkar PU, Mishra SK, Menon J, M N, K VZ, Hiremath SA, NC M, Jawali A, Gnanadurai KR, George CE, Maddipati T, KP MKP, Sharma V, Farooque K, Malhotra R, Mittal S, Sawhney C, Gupta B, Mathur P, Gamangati S, Tripathy V, Menon PH, Dhillon MS, Chouhan DK, Patil S, Narayan R, Lal P, Bilchod PN, Singh SU, Gattu UV, Dashputra RP, Rahate PV, Turiel M, De Blasio G, Accetta R, Perazzo P, Stella D, Bonadies M, Colombo C, Fozzato S, Pino F, Morelli I, Colnaghi E, Salini V, Denaro G, Beretta L, Placella G, Giardina G, Binda M, Marcato A, Guzzetti L, Piccirillo F, Cecconi M, Khor HM, Lai HY, Kumar CS, Chee KH, Loh PS, Tan KM, Singh S, Foo LL, Prakasam K, Chaw SH, Lee ML, Ngim JHL, Boon HW, Chin II, Kleinlugtenbelt YV, Landman EBM, Flikweert ER, Roerdink HW, Brokelman RB, Elskamp-Meijerman HF, Horst MR, Cobben JHMG, Umer M, Begum D, Anjum A, Hashmi PM, Ahmed T, Rashid HU, Khattak MJ, Rashid RH, Lakdawala RH, Noordin S, Juman NM, Khan RI, Riaz MM, Bokhari SS, Almas A, Wahab H, Ali A, Khan HN, Khan EK, Nur AN, Janjua KA, Orakzai SH, Khan AS, Mustafa KJ, Sohail MA, Umar M, Khan SA, Ashraf M, Khan MK, Shiraz M, Furgan A, Ślęczka P, Dąbek P, Kumoń A, Satora W, Ambroży W, Święch M, Rycombel J, Grzelak A, Gucwa J, Machala W, Ramokgopa MT, Firth GB, Karera M, Fourtounas M, Singh V, Biscardi A, Iqbal MN, Campbell RJ, Maluleke ML, Moller C, Nhlapo L, Maqungo S, Flint M, Nejthardt MB, Chetty S, Naidoo R, Guerra-Farfan E, Tomas-Hernandez J, Garcia-Sanchez Y, Garrido Clua M, Molero-Garcia V, Minguell-Monyart J, Teixidor-Serra J, Villar-Casares MDM, Selga Marsa J, Porcel-Vazquez JA, Andres-Peiro JV, Aguilar M, Mestre-Torres J, Colomina MJ, Guilabert P, Paños Gozalo ML, Abarca L, Martin N, Usua G, Martinez-Ripol P, Gonzalez Posada MA, Lalueza-Broto P, Sanchez-Raya J, Nuñez Camarena J, Fraguas-Castany A, Balaguer-Castro M, Torner P, Jornet-Gibert M, Serrano-Sanz J, Cámara-Cabrera J, Salomó-Domènech M, Yela-Verdú C, Peig-Font A, Ricol L, Carreras-Castañer A, Martínez-Sañudo L, Herranz S, Feijoo-Massó C, Sianes-Gallén M, Castillón P, Bernaus M, Quintas S, Gómez O, Salvador J, Abarca J, Estrada C, Novellas M, Torra M, Dealbert A, Macho O, Ivanov A, Valldosera E, Arroyo M, Pey B, Yuste A, Mateo L, De Caso J, Anaya R, Higa-Sansone JL, Millan A, Baños V, Herrera-Mateo S, Aguado HJ, Martinez-Municio G, León R, Santiago-Maniega S, Zabalza A, Labrador G, Guerado E, Cruz E, Cano JR, Bogallo JM, Sa-ngasoongsong P, Kulachote N, Sirisreetreerux N, Pengrung N, Chalacheewa T, Arnuntasupakul V, Yingchoncharoen T, Naratreekoon B, Kadry MA, Thayaparan S, Abdlaziz I, Aframian A, Imbuldeniya A, Bentoumi S, Omran S, Vizcaychipi MP, Correia P, Patil S, Haire K, Mayor ASE, Dillingham S, Nicholson L, Elnaggar M, John J, Nanjayan SK, Parker MJ, O'Sullivan S, Marmor MT, Matityahu A, McClellan RT, Comstock C, Ding A, Toogood P, Slobogean G, Joseph K, O'Toole R, Sciadini M, Ryan SP, Clark ME, Cassidy C, Balonov K, Bergese SD, Phieffer LS, Gonzalez Zacarias AA, Marcantonio AJ, Devereaux PJ, Bhandari M, Borges FK, Balasubramanian K, Bangdiwala SI, Harvey V, McGillion MH, Pettit SM, Vincent J, Vincent J, Harvey V, Dragic-Taylor S, Maxwell C, Molnar S, Pettit SM, Wells JR, Forget P, Borges FK, Landais P, Sigamani A, Landoni G, Wang CY, Szczeklik W, Biccard BM, Popova E, Moppett IK, Lamy A, Whitlock R, Ofori SN, Yang SS, Wang MK, Duceppe E, Spence J, Vasquez JP, Marcano-Fernández F, Conen D, Ham H, Tiboni ME, Prada C, Yung TCH, Sanz Pérez I, Neary JD, Bosch MJ, Prystajecky MR, Chowdhury C, Khan JS, Belley-Cote EP, Stella SF, Marcucci M, Heidary B, Tran A, Wawrzycka-Adamczyk K, Chen YCP, Tandon V, González-Osuna A, Patel A, Biedroń G, Wludarczyk A, Lefebvre M, Ernst JA, Staffhorst B, Woodfine JD, Alwafi EM, Mrkobrada M, Parlow S, Roberts R, McAlister F, Sackett D, Wright J. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Lancet 2020; 395:698-708. [PMID: 32050090 DOI: 10.1016/s0140-6736(20)30058-1] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. METHODS HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). FINDINGS Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4-9) in the accelerated-surgery group and 24 h (10-42) in the standard-care group (p<0·0001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0·91 (95% CI 0·72 to 1·14) and absolute risk reduction (ARR) of 1% (-1 to 3; p=0·40). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0·97 (0·83 to 1·13) and an ARR of 1% (-2 to 4; p=0·71). INTERPRETATION Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. FUNDING Canadian Institutes of Health Research.
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Nilsen SM, Bjørngaard JH, Carlsen F, Anthun KS, Johnsen LG, Vatten LJ, Asheim A. Hospitals´ Discharge Tendency and Risk of Death - An Analysis of 60,000 Norwegian Hip Fracture Patients. Clin Epidemiol 2020; 12:173-182. [PMID: 32110108 PMCID: PMC7036694 DOI: 10.2147/clep.s237060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/30/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose A reduction in the length of hospital stay may threaten patient safety. This study aimed to estimate the effect of organizational pressure to discharge on 60-day mortality among hip fracture patients. Patients and Methods In this cohort study, hip fracture patients were analyzed as if they were enrolled in a sequence of trials for discharge. A hospital’s discharge tendency was defined as the proportion of patients with other acute conditions who were discharged on a given day. Because the hospital’s tendency to discharge would affect hip fracture patients in an essentially random manner, this exposure could be regarded as analogous to being randomized to treatment in a clinical trial. The study population consisted of 59,971 Norwegian patients with hip fractures, hospitalized between 2008 and 2016, aged 70 years and older. To calculate the hospital discharge tendency for a given day, we used data from all 5,013,773 other acute hospitalizations in the study period. Results The probability of discharge among hip fracture patients increased by 5.5 percentage points (95% confidence interval (CI)=5.3–5.7) per 10 percentage points increase in hospital discharges of patients with other acute conditions. The increased risk of death that could be attributed to a discharge from organizational causes was estimated to 3.7 percentage points (95% CI=1.4–6.0). The results remained stable under different time adjustments, follow-up periods, and age cut-offs. Conclusion This study showed that discharges from organizational causes may increase the risk of death among hip fracture patients.
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Affiliation(s)
- Sara Marie Nilsen
- Center for Health Care Improvement, Trondheim University Hospital, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Fredrik Carlsen
- Department of Economics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjartan Sarheim Anthun
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Lars Gunnar Johnsen
- Department of Orthopaedic Surgery, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Johan Vatten
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Asheim
- Center for Health Care Improvement, Trondheim University Hospital, Trondheim, Norway.,Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Alghanem SM, Massad IM, Almustafa MM, Al-Shwiat LH, El-Masri MK, Samarah OQ, Khalil OA, Ahmad M. Relationship between intra-operative hypotension and post-operative complications in traumatic hip surgery. Indian J Anaesth 2020; 64:18-23. [PMID: 32001904 PMCID: PMC6967359 DOI: 10.4103/ija.ija_397_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/19/2019] [Accepted: 09/03/2019] [Indexed: 12/04/2022] Open
Abstract
Background and Aims: The relationship between intra-operative hypotension and post-operative complications has been recently studied in non-cardiac surgery. Little is known about this relationship in traumatic hip surgery. Our study aimed to investigate this relationship. Methods: A retrospective study was conducted on patients who underwent surgical correction of traumatic hip fracture between 2010 and 2015. We reviewed the perioperative blood pressure readings and the episodes of intra-operative hypotension. Hypotension was defined as ≥30% decrease in the pre-induction systolic blood pressure sustained for ≥10 min. The relationship between intra-operative hypotension and post-operative complications was evaluated. Post-operative complications were defined as new events or diseases that required post-operative treatment for 48 h. Factors studied included type of anaesthesia, blood transfusion rate, pre-operative comorbidities and delay in surgery. We used the Statistical Package for Social Sciences (SPSS, IBM 25) to perform descriptive and non-parametric statistics. Results: A total of 502 patients underwent various types of traumatic hip surgery during the study period. Intra-operative hypotension developed in 91 patients (18.1%) and 42 patients (8.4%) developed post-operative complications. Significantly more patients with hypotension developed post-operative complications compared to patients with stable vitals (18.7% vs. 6.1; P < 0.001). There was no statistically significant difference in the incidence of post-operative complication in patients receiving general or spinal anaesthesia. Pre-operative comorbidities had no significant relationship with post-operative complications. Intra-operative blood transfusion was related to both intra-operative hypotension and post-operative complications. Conclusion: There was an association between intra-operative hypotension and post-operative complications in patients undergoing traumatic hip surgery.
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Affiliation(s)
- Subhi M Alghanem
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Islam M Massad
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud M Almustafa
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Luma H Al-Shwiat
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad K El-Masri
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Omar Q Samarah
- Department of Orthopedic, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Osama A Khalil
- Department of Orthopedic, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Muayyad Ahmad
- Department of Clinical Nursing, Faculty of Nursing, The University of Jordan, Amman, Jordan
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Smeets SJM, van Wunnik BPW, Poeze M, Slooter GD, Verbruggen JPAM. Cardiac overscreening hip fracture patients. Arch Orthop Trauma Surg 2020; 140:33-41. [PMID: 31471640 PMCID: PMC6942037 DOI: 10.1007/s00402-019-03270-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The aim of this study was to prospectively investigate the adherence to the American College of Cardiology (ACC) and the American Heart Association guidelines for perioperative assessment of patients with hip fracture in daily clinical practice and how this might affect outcome. METHODS This prospective cohort study from Maastricht University Medical Centre included 166 hip fracture patients within a 3-year inclusion period. The preoperative cardiac screening and adherence to the ACC/AHA guideline were analyzed. Cardiac risk was classified as low, intermediate and high risk. Secondary outcome measurements were delay to surgery, perioperative complications and in-hospital, 30-day, 1-year and 2-year mortality. RESULTS According to the ACC/AHA guideline, 87% of patients received correct preoperative cardiac screening. The most important reason for incorrect preoperative cardiac screening was overscreening (> 90%). Multivariate analysis showed that a cardiac consultation (p = 0.003) and overscreening (p = 0.02) as significant predictors for increased delay to surgery, while age, sex, previous cardiac history and preoperative mobility were not. High risk patients had in comparison with low risk patients a significantly higher relative risk ratio for in-hospital mortality (RR 6, 95% CI 2-17). Multivariate analysis showed that a previous cardiac history and increased delay to surgery were predictors for early mortality. High age and previous cardiac history were risk factors for late mortality. CONCLUSION Preoperative cardiac screening for hip fracture patients in adherence to the ACC/AHA guideline is associated with a diminished use of preoperative resources. Overscreening leads to greater delay to surgery, which poses a risk for perioperative complications and early mortality. LEVEL OF EVIDENCE II.
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Affiliation(s)
- S. J. M. Smeets
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA Almere, The Netherlands
| | - B. P. W. van Wunnik
- Department of Surgery, Beatrixziekenhuis, Banneweg 57, 4204 AA Gorinchem, The Netherlands
| | - M. Poeze
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G. D. Slooter
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - J. P. A. M. Verbruggen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Turesson E, Ivarsson K, Thorngren KG, Hommel A. The impact of care process development and comorbidity on time to surgery, mortality rate and functional outcome for hip fracture patients: a retrospective analysis over 19 years with data from the Swedish National Registry for hip fracture patients, RIKSHÖFT. BMC Musculoskelet Disord 2019; 20:616. [PMID: 31878903 PMCID: PMC6933741 DOI: 10.1186/s12891-019-3007-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
Abstract For a long time the attention given to the hip fracture patient group was minor and without any certain consideration to their frailty. To improve the care for these patients Skane University Hospital in Lund has during the past 19 years worked actively with developing the care. This paper aims to describe what impact the care process development has had on functional outcome and mortality, as well as to analyze the impact of comorbidity and fracture type. Methods Patients older than 50 years with non-pathological cervical and trochanteric hip fracture admitted between Jan 1st 1999 and Dec 31st 2017 were included and data was retrieved from the National Quality Register for hip fracture patients, RIKSHÖFT. Variables regarding patient characteristics, fracture type, operation method, lead-times and outcome were analyzed. For comparison Fischer’s exact test and Spearman’s rank correlation coefficient was used for the categorical data and Pearson correlation coefficient for the continuous. To further analyze the effect over time a linear regression model was used. Results A total of 7827 patients were included. A significant shift in the overall morbidity was seen, with an increase in patients of higher ASA grade. No correlation was seen between outcome and the care process development. The mortality rate for the group as a whole the mortality rate had decreased over time. The total length of stay had decreased significantly over time. There was no statistically significant change in mortality rate over time when relating it to time-to-surgery. Conclusions Although the patients display a higher morbidity over time, the mortality rate has not changed significantly, which might indicate an effect of the care process development. The care process development does not seem to impact on outcome as much as other factors. This study supports the possibility to create a more specific algorithm for hip fracture patients, taking specific subgroups into consideration.
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Affiliation(s)
- Emma Turesson
- Department of Orthopaedics, Skåne University Hospital, Lund, Sweden.
| | - Kjell Ivarsson
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Ami Hommel
- Department of Orthopaedics, Skåne University Hospital, Lund, Sweden
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Sobolev B, Guy P, Sheehan KJ, Kuramoto L, Sutherland JM, Levy AR, Blair JA, Bohm E, Kim JD, Harvey EJ, Morin SN, Beaupre L, Dunbar M, Jaglal S, Waddell J. Mortality effects of timing alternatives for hip fracture surgery. CMAJ 2019; 190:E923-E932. [PMID: 30087128 DOI: 10.1503/cmaj.171512] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The appropriate timing of hip fracture surgery remains a matter of debate. We sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay. METHODS We obtained discharge abstracts from the Canadian Institute for Health Information for hip fracture surgery in Canada (excluding Quebec) between 2004 and 2012. We estimated the expected population-average risks of inpatient death within 30 days if patients were surgically treated on day of admission, inpatient day 2, day 3 or after day 3. We weighted observations with the inverse propensity score of surgical timing according to confounders selected from a causal diagram. RESULTS Of 139 119 medically stable patients with hip fracture who were aged 65 years or older, 32 120 (23.1%) underwent surgery on admission day, 60 505 (43.5%) on inpatient day 2, 29 236 (21.0%) on day 3 and 17 258 (12.4%) after day 3. Cumulative 30-day in-hospital mortality was 4.9% among patients who were surgically treated on admission day, increasing to 6.9% for surgery done after day 3. We projected an additional 10.9 (95% confidence interval [CI] 6.8 to 15.1) deaths per 1000 surgeries if all surgeries were done after inpatient day 3 instead of admission day. The attributable proportion of deaths for delays beyond inpatient day 2 was 16.5% (95% CI 12.0% to 21.0%). INTERPRETATION Surgery on admission day or the following day was estimated to reduce postoperative mortality among medically stable patients with hip fracture. Hospitals should expedite operating room access for patients whose surgery has already been delayed for nonmedical reasons.
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Affiliation(s)
- Boris Sobolev
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont.
| | - Pierre Guy
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Katie Jane Sheehan
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Lisa Kuramoto
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Jason M Sutherland
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Adrian R Levy
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - James A Blair
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Eric Bohm
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Jason D Kim
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Edward J Harvey
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Suzanne N Morin
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Lauren Beaupre
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Michael Dunbar
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Susan Jaglal
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - James Waddell
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
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49
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Leer-Salvesen S, Engesæter LB, Dybvik E, Furnes O, Kristensen TB, Gjertsen JE. Does time from fracture to surgery affect mortality and intraoperative medical complications for hip fracture patients? An observational study of 73 557 patients reported to the Norwegian Hip Fracture Register. Bone Joint J 2019; 101-B:1129-1137. [PMID: 31474142 DOI: 10.1302/0301-620x.101b9.bjj-2019-0295.r1] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS The aim of this study was to investigate mortality and risk of intraoperative medical complications depending on delay to hip fracture surgery by using data from the Norwegian Hip Fracture Register (NHFR) and the Norwegian Patient Registry (NPR). PATIENTS AND METHODS A total of 83 727 hip fractures were reported to the NHFR between 2008 and 2017. Pathological fractures, unspecified type of fractures or treatment, patients less than 50 years of age, unknown delay to surgery, and delays to surgery of greater than four days were excluded. We studied total delay (fracture to surgery, n = 38 754) and hospital delay (admission to surgery, n = 73 557). Cox regression analyses were performed to calculate relative risks (RRs) adjusted for sex, age, American Society of Anesthesiologists (ASA) classification, type of surgery, and type of fracture. Odds ratio (OR) was calculated for intraoperative medical complications. We compared delays of 12 hours or less, 13 to 24 hours, 25 to 36 hours, 37 to 48 hours, and more than 48 hours. RESULTS Mortality remained unchanged when total delay was less than 48 hours. Total delay exceeding 48 hours was associated with increased three-day mortality (RR 1.69, 95% confidence interval (CI) 1.23 to 2.34; p = 0.001) and one-year mortality (RR 1.06, 95% CI 1.04 to 1.22; p = 0.003). More intraoperative medical complications were reported when hospital delay exceeded 24 hours. CONCLUSION Hospitals should operate on patients within 48 hours after fracture to reduce mortality and intraoperative complications. Cite this article: Bone Joint J 2019;101-B:1129-1137.
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Affiliation(s)
| | - Lars B Engesæter
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Eva Dybvik
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Torbjørn B Kristensen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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50
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Chang C, Yeh M, Chien W, Chung C, Li T, Lai EC. Interactions between psychiatric and physical disorders and their effects on the risks of suicide: a nested case–control study. Ann N Y Acad Sci 2019; 1462:79-91. [DOI: 10.1111/nyas.14216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/24/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Ching‐Feng Chang
- Graduate Institute of Medical SciencesNational Defense Medical Center Taipei Taiwan
- Department of RadiologyTri‐Service General Hospital Taipei Taiwan
| | - Ming‐kung Yeh
- Graduate Institute of Medical SciencesNational Defense Medical Center Taipei Taiwan
- School of Pharmacy, Graduate Institute of Medical SciencesNational Defense Medical Center Taipei Taiwan
| | - Wu‐Chien Chien
- School of Public HealthNational Defense Medical Center Taipei Taiwan
| | - Chi‐Hsiang Chung
- School of Public HealthNational Defense Medical Center Taipei Taiwan
| | - Tzu‐Ting Li
- Department of RadiologyTri‐Service General Hospital Taipei Taiwan
| | - Edward Chia‐Cheng Lai
- School of Pharmacy, College of Medicine, Institute of Clinical Pharmacy and Pharmaceutical SciencesNational Cheng Kung University Tainan Taiwan
- Department of PharmacyNational Cheng Kung University Hospital Tainan Taiwan
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