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Chow IH, Miller T, Pang MY. Predictive factors for home discharge after femoral fracture surgery: a prospective cohort study. Eur J Phys Rehabil Med 2023; 59:743-753. [PMID: 37750861 DOI: 10.23736/s1973-9087.23.07900-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Femoral fractures require protracted hospitalization and often preclude return to pre-fracture levels of mobility, function and prior residential status following hospital discharge. Early prediction of rehabilitation and discharge potential in patients with femoral fracture would optimize discharge planning. AIM To identify predictive factors of discharge destination during the early phase of femoral fracture rehabilitation. DESIGN Prospective cohort design. SETTING Acute and postoperative rehabilitation hospital settings. POPULATION Data from 109 participants (65 women [59.6%]) admitted for unilateral femoral fracture were included. METHODS Sociodemographic information, hip pain severity during gait (Numeric Pain Rating Scale), mobility (Elderly Mobility Scale), activities of daily living (Modified Barthel Index), cognition (Mini-Mental State Examination [MMSE]), exercise self-efficacy (Self-Efficacy for Exercise Scale), amount of physiotherapy received, and caregiver availability were assessed pre- and/or postoperatively. Discharge destination was assessed via telephone interviews 6 weeks after discharge from acute care. Receiver operating characteristic curves were used to determine optimal cut-off scores for all outcomes based on discharge destination. Outcomes demonstrating a significant area under the curve were entered as dichotomous independent variables (i.e., above or below ROC-derived cut-off values) in subsequent logistic regression analyses to determine predictors of discharge destination. RESULTS SEE Score ≥53 (odds ratio [OR]=5.975, 95% confidence interval [CI]=1.674-21.333, P=0.006), female sex (OR=3.421, 95% CI=1.187-9.861, P=0.023), ≥8 physiotherapy sessions (OR=4.633, 95% CI=1.559-13.771, P=0.006), MMSE Score ≥17 (OR=3.374, 95% CI=1.047-10.873, P=0.042), and caregiver availability (OR=3.766, 95% CI=1.133-12.520, P=0.030) were identified as significant predictors of home discharge. CONCLUSIONS Exercise self-efficacy, female sex, more physiotherapy rehabilitation training, better pre-operative cognitive function, and caregiver availability emerged as important predictors of home discharge following femoral fracture. CLINICAL REHABILITATION IMPACT These findings are highly translational and may be useful for informing clinical guidelines and policy decisions regarding rehabilitation potential and discharge pathway selection during early hospitalization following femoral fracture surgery.
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Affiliation(s)
- Intonia H Chow
- Department of Physiotherapy, Queen Elizabeth Hospital, Kowloon, Hong Kong
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Tiev Miller
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia (UBC), Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, Canada
| | - Marco Y Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong -
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2
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Onggo J, Nambiar M, McDougall C, Hau R, Babazadeh S. Comparing outcomes of total hip arthroplasty versus hemiarthroplasty in neck of femur fracture patients: an Australian registry study. Eur J Trauma Emerg Surg 2023; 49:2147-2153. [PMID: 37355483 PMCID: PMC10520181 DOI: 10.1007/s00068-023-02305-w] [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: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To determine discharge outcomes of displaced subcapital NOF patients who were from home, with intact pre-operative cognition, ASA 1 or 2 and independent walkers treated with either THA or hemiarthroplasty. METHODS A retrospective registry study was performed using data from the Australia and New Zealand Hip Fracture Registry (ANZHFR). Institutional ethics approval was obtained prior to commencement. Hip fracture registry records between 1st January 2016 and 31st January 2020 were reviewed. RESULTS A total of 930 patients with complete records were identified and included. There were 602 THA and 328 hemiarthroplasty patients. Using multivariate analysis, pre-operative factors associated with THA include younger age (OR = 0.90 for every year older, p < 0.001), females (p = 0.043), private admissions (OR = 1.62, p = 0.028) and receiving pre-operative geriatric assessment (OR = 1.89, p = 0.002). Delay to theatre due to not being fit for surgery was associated with not receiving THA (OR = 0.21, p < 0.001). THA resulted in a shorter total hospital length of stay (MD = 7.24, p < 0.001), higher likelihood of being discharged home (OR = 1.88, p < 0.001) and lower likelihood of being discharged to a residential aged care facility (OR = 0.32, p = 0.019). CONCLUSION Displaced subcapital NOF patients who were admitted from home, had intact pre-operative cognition, ASA 1 or 2, independent walkers and had THAs, had shorter total hospital length of stay, were more likely to be discharged home directly and less likely to end up in residential aged care facilities compared to those undergoing hemiarthroplasty.
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Affiliation(s)
- James Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Mithun Nambiar
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Catherine McDougall
- Department of Orthopaedic Surgery, Metro North Hospital and Health Service, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Sina Babazadeh
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia
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3
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Stubbs TA, Doherty WJ, Chaplin A, Langford S, Reed MR, Sayer AA, Witham MD, Sorial AK. Using pre-fracture mobility to augment prediction of post-operative outcomes in hip fracture. Eur Geriatr Med 2023; 14:285-293. [PMID: 37002428 PMCID: PMC10113355 DOI: 10.1007/s41999-023-00767-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023]
Abstract
Abstract
Purpose
Pre-operative scores based on patient characteristics are commonly used to predict hip fracture outcomes. Mobility, an indicator of pre-operative function, has been neglected as a potential predictor. We assessed the ability of pre-fracture mobility to predict post-operative outcomes following hip fracture.
Methods
We analysed prospectively collected data from hip fracture surgery patients at a large-volume trauma unit. Mobility was classified into four groups. Post-operative outcomes studied were mortality and residence at 30 days, medical complications within 30- or 60-days post-operatively, and prolonged length of stay (LOS, ≥ 28 days). We performed multivariate regression analyses adjusting for age and sex to assess the discriminative ability of the Nottingham Hip Fracture Score (NHFS), with and without mobility, for predicting outcomes using the area under the receiver operating characteristic curve (AUROC).
Results
1919 patients were included, mean age 82.6 (SD 8.2); 1357 (70.7%) were women. Multivariate analysis demonstrated patients with worse mobility had a 1.7–5.5-fold higher 30-day mortality (p ≤ 0.001), and 1.9–3.2-fold higher likelihood of prolonged LOS (p ≤ 0.001). Worse mobility was associated with a 2.3–3.8-fold higher likelihood of living in a care home at 30-days post-operatively (p < 0.001) and a 1.3–2.0-fold higher likelihood of complications within 30 days (p ≤ 0.001). Addition of mobility improved NHFS discrimination for discharge location, AUROC NHFS 0.755 [0.733–0.777] to NHFS + mobility 0.808 [0.789–0.828], and LOS, AUROC NHFS 0.584 [0.557–0.611] to NHFS + mobility 0.616 [0.590–0.643].
Conclusion
Incorporating mobility assessment into risk scores may improve casemix adjustment, prognostication following hip fracture, and identify high-risk patient groups requiring enhanced post-operative care at admission.
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Affiliation(s)
- Thomas A Stubbs
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle-Upon-Tyne, NE4 5PL, UK
| | - William J Doherty
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle-Upon-Tyne, NE4 5PL, UK
| | - Andrew Chaplin
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, NE27 0QJ, UK
| | - Sarah Langford
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, NE27 0QJ, UK
| | - Mike R Reed
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, NE27 0QJ, UK
| | - Avan A Sayer
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle-Upon-Tyne, NE4 5PL, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Newcastle-Upon-Tyne, NE4 5PL, UK.
| | - Antony K Sorial
- Department of Trauma and Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, NE27 0QJ, UK.
- Institute for Cell and Molecular Biosciences, Newcastle University, International Centre for Life, Newcastle Upon Tyne, NE1 3BZ, UK.
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4
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Fukuda K, Amari T, Yoshino K, Izumiya H, Yamaguchi K. Influence of patients' walking ability at one-week post-proximal femur fracture surgery on the choice of discharge destination in Japan. J Phys Ther Sci 2022; 34:791-796. [PMID: 36507077 PMCID: PMC9711972 DOI: 10.1589/jpts.34.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/14/2022] [Indexed: 12/02/2022] Open
Abstract
[Purpose] With the innovation of healthcare delivery systems, a need for early determination of patients' discharge outcomes arises after proximal femur fracture surgery, to reduce the burden on healthcare infrastructure. Several studies have examined the extent of walking ability early in the postoperative period to predict the outcome destination. In this study, as an additional validation of these studies, we examined the effect of walking ability on the hospital discharge prognosis of patients in the first week after proximal femur fracture surgery in Japan. [Participants and Methods] Medical records of 228 patients with proximal femur fractures, aged ≥75 years old, admitted between April 2015 and March 2019, were retrospectively analyzed. The objective variable was discharge destination. The main evaluation factor was walking ability one-week post-surgery. [Results] Good walking ability and the company of a relative living together one week post-surgery were significant determining factors of discharge destination. [Conclusion] The ability to walk and the presence of a co-resident one week after surgery increased the likelihood of proximal femur fracture patients to be discharged directly to home. Our findings may help rehabilitation professionals make better decisions regarding discharge destination.
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Affiliation(s)
- Kyosuke Fukuda
- Department of Rehabilitation, Ageo Central General
Hospital: 1-10-10 Kashiwaza, Ageo, Saitama 362-8588, Japan,Corresponding author. Kyosuke Fukuda (E-mail: )
| | - Takashi Amari
- Department of Physical Therapy, Health Science University,
Japan
| | - Kohei Yoshino
- Department of Rehabilitation, Ageo Central General
Hospital: 1-10-10 Kashiwaza, Ageo, Saitama 362-8588, Japan
| | - Hikaru Izumiya
- Department of Rehabilitation, Ageo Central General
Hospital: 1-10-10 Kashiwaza, Ageo, Saitama 362-8588, Japan
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5
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Hawley S, Inman D, Gregson CL, Whitehouse M, Johansen A, Judge A. Predictors of returning home after hip fracture: a prospective cohort study using the UK National Hip Fracture Database (NHFD). Age Ageing 2022; 51:6618063. [PMID: 35930719 DOI: 10.1093/ageing/afac131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION our objective was to describe trends in returning home after hospitalisation for hip fracture and identify predictive factors of this important patient-focussed outcome. METHODS a cohort of hip fracture patients from England and Wales (2018-2019) resident in their own home pre-admission were analysed to identify patient and service factors associated with returning home after hospital discharge, and with living in their own home at 120 days. Geographical variation was also analysed. RESULTS analysis of returning home at discharge included 87,797 patients; 57,104 (65%) were discharged home. Patient factors associated with lower likelihood of discharge home included cognitive impairment (odds ratio (OR) 0.60 [95% CI: 0.57, 0.62]), malnutrition (OR 0.81 [0.76, 0.86]), being at risk of malnutrition (OR 0.81 [0.78, 0.85]) and experiencing delay to surgery due to reversal of anti-coagulant medication (OR 0.84 [0.77, 0.92]). Corresponding service factors included surgery delay due to hospital logistical reasons (OR 0.91 [0.87, 0.95]) and early morning admission between 4:00 and 7:59 am (OR 0.83 [0.78, 0.89]). Nerve block prior to arrival at the operating theatre was associated with higher likelihood of discharge home (OR 1.07 [1.03, 1.11]). Most of these associations were stronger when analysing the outcome 'living in their own home at 120 days', in which two out of 11 geographic regions were found to have significantly more patients returning home. CONCLUSION we identify numerous modifiable factors associated with short-term and medium-term return to own home after hip fracture, in addition to significant geographical variation. These findings should support improvements to care and inform future research.
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Affiliation(s)
- Samuel Hawley
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dominic Inman
- Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK.,Care Quality Improvement Department, Royal College of Physicians, London, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 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
| | - Antony Johansen
- Care Quality Improvement Department, Royal College of Physicians, London, UK.,University Hospital of Wales and School of Medicine, Cardiff University, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 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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6
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Ferris H, Brent L, Sorensen J, Ahern E, Coughlan T. Discharge destination after hip fracture: findings from the Irish hip fracture database. Eur Geriatr Med 2021; 13:415-424. [PMID: 34420192 DOI: 10.1007/s41999-021-00556-7] [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] [Received: 05/04/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Although home continues to be the place from which the majority of patients are admitted, less than one third of patients are Discharged Directly Home (DDH) following hip fracture. Once ready for discharge, DDH as opposed to Discharge to an Alternative Location (DAL), i.e., community care, rehabilitation facility or long-term care, is a high priority for patients and clinicians alike. Not only is DDH integral to the quality of life of patients, it is also an essential driver of the socioeconomic cost of hip fracture care. METHODS We analysed 21,819 cases in the Irish Hip Fracture Database from 2013 to 2019. Descriptive and analytical statistics were conducted. RESULTS 29% (n = 6476) of patients were DDH during the study period. On multivariate analysis, the odds of DDH decreased as age increased (OR 0.28, p < 0.01, 95% CI 0.24-0.34). Patients who were independently mobile prior to fracture were 47% more likely to be DDH (OR 1.47, p < 0.01, 95% CI 1.29-1.68). Those mobilised early post operatively were 24% more likely to be DDH (OR 1.24, p < 0.01, 95% CI 1.06-1.45). Patients who waited > 72 h prior to surgery were 30% less likely to be DDH (OR 0.70, p < 0.01, 95% CI 0.56-0.88). CONCLUSION The authors identified patient characteristics that increased the likelihood of DDH, i.e., younger patients independently mobile prior to fracture, who received timely surgery and early post-operative mobilisation. The Irish Hip Fracture Standards (IHFS) incorporate 2 out the 3 modifiable factors identified, which reinforces the importance of the IHFS in improving patient outcomes.
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Affiliation(s)
- H Ferris
- Department of Public Health, Health Service Executive - South, Cork, Ireland.
| | - L Brent
- National Office of Clinical Audit, Dublin, Ireland
| | - J Sorensen
- Healthcare Outcomes Centre, Royal College of Surgeons, Dublin, Ireland
| | - E Ahern
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - T Coughlan
- Department of Age Related Health Care, Tallaght University Hospital, Dublin, Ireland
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7
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Kusen JQ, van der Naald N, van Overeem L, van der Vet PCR, Smeeing DPJ, Eversdijk HAJ, Verleisdonk EJMM, van der Velde D, Schuijt HJ. Is the Parker Mobility Score in the older patient with a traumatic hip fracture associated with discharge disposition after surgery? A retrospective cohort study. Eur J Trauma Emerg Surg 2021; 48:1919-1927. [PMID: 34097075 DOI: 10.1007/s00068-021-01712-1] [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] [Received: 11/28/2020] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The research questions for this study were as follows: (1) is the Parker Mobility Score (PMS) associated with discharge disposition and hospital length of stay (HLOS) of geriatric traumatic hip fracture patients? (2) Can the PMS be incorporated in a decision tree for the prediction of discharge disposition of geriatric traumatic hip fracture patients upon admittance. METHODS A dual-center retrospective cohort study was conducted at two level II trauma centers. All patients aged 70 years and older with traumatic hip fractures undergoing surgery in 2018 and 2019 were included consecutively (n = 649). A χ2 automatic interaction detection analysis was performed to determine the association of the PMS (and other variables) with discharge disposition and HLOS and predict discharge destination. RESULTS The decision tree for discharge disposition classified patients with an overall accuracy of 82.1% and a positive predictive value of 91% for discharge to a rehabilitation facility. The PMS had the second most significant effect on discharge disposition (χ2 = 22.409, p < 0.001) after age (χ2 = 79.094, p < 0.001). Regarding the tree analysis of HLOS, of all variables in the analysis, PMS had the most significant association with HLOS (F = 14.891, p < 0.001). Patients who were discharged home had a mean HLOS of 6.5 days (SD 8.0), whereas patients who were discharged to an institutional care facility had a mean HLOS of 9.7 days (SD 6.4; p < 0.001). CONCLUSION This study shows that the PMS was strongly associated with discharge disposition and HLOS. The decision tree for the discharge disposition of geriatric traumatic hip fracture patients offers a practical solution to start discharge planning upon admittance which could potentially reduce HLOS. LEVEL OF EVIDENCE Level III, diagnostic.
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Affiliation(s)
- Jip Quirijn Kusen
- Geriatric Trauma Center, Sint Antonius Ziekenhuis Utrecht, Utrecht, The Netherlands. .,Geriatric Trauma Center, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
| | | | - Laura van Overeem
- Geriatric Trauma Center, Sint Antonius Ziekenhuis Utrecht, Utrecht, The Netherlands
| | | | | | | | | | - Detlef van der Velde
- Geriatric Trauma Center, Sint Antonius Ziekenhuis Utrecht, Utrecht, The Netherlands
| | - Henk Jan Schuijt
- Geriatric Trauma Center, Sint Antonius Ziekenhuis Utrecht, Utrecht, The Netherlands. .,Geriatric Trauma Center, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
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8
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van Dartel D, Vermeer M, Folbert EC, Arends AJ, Vollenbroek-Hutten MMR, Hegeman JH. Early Predictors for Discharge to Geriatric Rehabilitation after Hip Fracture Treatment of Older Patients. J Am Med Dir Assoc 2021; 22:2454-2460. [PMID: 33933417 DOI: 10.1016/j.jamda.2021.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate early predictors for discharge to a geriatric rehabilitation department at a skilled nursing home in older patients after hospitalization for hip fracture surgery. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Data from 21,176 patients with hip fracture aged ≥70 years, who were registered in the Dutch Hip Fracture Audit database between January 1, 2017, and December 31, 2019, were included. METHODS Patients were categorized into 3 discharge groups: home (n=7326), rehabilitation (n=11,738), and nursing home (n=2112). Age, gender, Pre-Fracture Mobility Score (PFMS), premorbid Katz index of independence in Activities of Daily Living (Katz-ADL), history of dementia, American Society of Anesthesiologists physical status classification (ASA score), type of anesthesia, fracture type, surgical treatment, and cotreatment by a geriatrician were gathered. Multinomial regression analysis was used to assess for early predictors. RESULTS Higher age, poor premorbid mobility, lower premorbid Katz-ADL, no history of dementia, ASA score 3-5, general anesthesia, intramedullary implant, and cotreatment by a geriatrician were independent predictors for discharge to geriatric rehabilitation vs discharge home. Identical predictors were found for discharge to a nursing home vs discharge home. History of dementia and premorbid Katz-ADL were distinguishing factors; a higher premorbid Katz-ADL and a history of dementia were associated with a higher risk of discharge to a nursing home vs discharge home. The multinomial regression model correctly predicted 86%, 38.6%, and 2.4% of the patients in the rehabilitation group, home group, and nursing home group, respectively. CONCLUSIONS AND IMPLICATIONS This study showed that age, PFMS, premorbid Katz-ADL, surgical treatment, ASA score, type of anesthesia, history of dementia, and cotreatment by a geriatrician were independent early predictors for discharge to geriatric rehabilitation vs discharge home in older patients after hip fracture surgery. Identical predictors were found as predictors for discharge to a nursing home vs discharge home, except for history of dementia and premorbid Katz-ADL.
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Affiliation(s)
- Dieuwke van Dartel
- Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands.
| | - Marloes Vermeer
- ZGT Academy, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Ellis C Folbert
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Arend J Arends
- Department of Geriatrics, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; ZGT Academy, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Johannes H Hegeman
- Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
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9
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Burahee AS, Barry VE, Sutcliffe RP, Mahroof S. Older patients with proximal femur fractures and SARS-CoV-2 infection - An observational study. SICOT J 2021; 7:5. [PMID: 33595434 PMCID: PMC7888253 DOI: 10.1051/sicotj/2021001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/21/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Older patients are at increased risk of severe COVID-19 infection and associated mortality. There are limited data evaluating the outcome of older patients with hip fractures treated during the COVID-19 pandemic, and it has been suggested that these patients should be treated non-operatively due to high mortality risk. The aim of this study was to report the outcomes of COVID-19 infected hip fracture patients treated at a single centre. Methods: This was a retrospective cohort study. Data were collected from February 2020 (after the first confirmed COVID-19 infected patient was reported in the Midlands region of the UK). All patients admitted to the hospital with femoral neck fractures were included. Patient demographics, comorbidity, COVID-19 status, and short-term clinical outcomes were obtained by review of electronic medical records. The outcomes of COVID-19 infected patients were compared with non-COVID-19 patients treated during the study period. Results: Twenty-nine patients were included (mean age of 80 years), of whom 14 (48%) were tested positive for COVID-19 infection in the postoperative period. Overall, 26 patients (90%) underwent surgical treatment. COVID-19 infected patients had significantly higher Charlson comorbidity scores compared to the control group (5 vs. 4; p = 0.047). Only 5 COVID-19 infected patients (36%) required supplemental oxygen therapy in the postoperative period, and no patients required respiratory or other organ support. The 30-day mortality rate in COVID-19 patients was 14% compared to 0% in the negative controls (p = 0.22). Interpretation: COVID-19 infection did not increase the mortality rate of older patients undergoing surgery for hip fractures during the pandemic. The authors recommend careful assessment of patient fitness and prompt surgical treatment. In addition, it was noted that nearly all admissions were either given large boluses of Vitamin D or were on maintenance supplementation, which may have affected the severity of the response to COVID-19 infections.
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Affiliation(s)
- Abdus S Burahee
- Department of Orthopaedic Surgery, Royal Wolverhampton NHS Trust, WV8 1DN Wolverhampton, UK
| | - Veronica E Barry
- Department of Orthopaedic Surgery, Royal Wolverhampton NHS Trust, WV8 1DN Wolverhampton, UK
| | | | - Sabreena Mahroof
- Department of Orthopaedic Surgery, Royal Wolverhampton NHS Trust, WV8 1DN Wolverhampton, UK
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10
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Muto Y, Higuchi R, Yoshihisa A, Hagiya K, Saji M, Takamisawa I, Tobaru T, Iguchi N, Takanashi S, Takayama M, Takeishi Y, Isobe M. Prevalence, Predictors, and Mid-Term Outcomes of Non-Home Discharge After Transcatheter Aortic Valve Implantation. Circ Rep 2020; 2:617-624. [PMID: 33693185 PMCID: PMC7933692 DOI: 10.1253/circrep.cr-20-0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has been widely used as a valued alternative to surgical aortic valve replacement. In cardiovascular surgeries, discharge disposition has been widely investigated. We examined the prevalence and predictors of non-home discharge after TAVI, and the prognosis based on discharge destination. Methods and Results: We retrospectively analyzed 732 consecutive patients undergoing TAVI, and divided them into 2 groups: the home group (discharged directly home; n=678 [92.6%]) and the non-home group (n=54 [7.4%]). From baseline and procedural characteristics, peripheral artery disease (PAD; odds ratio [OR] 2.73; 95% confidence interval [CI] 1.25-5.97; P=0.012), previous stroke (OR 2.57; 95% CI 1.03-6.45; P=0.045), albumin level (OR 0.16 per 1-g/dL increase; 95% CI 0.07-0.39; P<0.001), and procedural stroke (OR 31.6; 95% CI 10.9-91.7; P<0.001) were independently associated with non-home discharge. In Kaplan-Meier analysis, the non-home group had worse survival than the home group (log-rank, P=0.001). In multivariate analysis, male sex, atrial fibrillation or atrial flutter, and low albumin concentrations were associated with all-cause mortality, but non-home discharge was not (P=0.18). Conclusions: Non-home discharge was recorded for 7.4% of patients undergoing TAVI, and was associated with PAD, nutritional status, and previous and procedural stroke. Non-home discharge reflects worse baseline characteristics, and may be a marker of mid-term outcome after TAVI.
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Affiliation(s)
- Yuuki Muto
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan.,Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan
| | - Kenichi Hagiya
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan.,Department of Cardiology, Kawasaki Saiwai Hospital Kanagawa Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute Tokyo Japan.,Department of Cardiovascular Surgery, Kawasaki Saiwai Hospital Kanagawa Japan
| | | | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University Fukushima Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
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Neck of femur fracture: who gets a total hip replacement? A review of 230 eligible patients. Eur J Trauma Emerg Surg 2020; 47:1993-1999. [PMID: 32277249 DOI: 10.1007/s00068-020-01358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate patient-specific factors that predict Total Hip Replacement (THR) in patients with fracture neck of femur (NOF), fulfilling the National Institute of Health and Care Excellence (NICE) criteria. METHODS Hip fracture database from a district general hospital and university hospital was retrospectively reviewed to identify patients fulfilling NICE criteria for THR after fracture NOF. Patient demographics, Nottingham Hip Fracture score (NHFS), complications, re-operations, revision, 30 days and one-year mortality was obtained from patient-records. Independent predictors correlating with the outcome of surgery were identified. A logistic regression analysis was used to predict the type of surgery in these patients. RESULTS A total of 230 (114 WMH and 116 MH) were identified; 133 (57.8 per-cent) received hip hemiarthroplasty (HA), and 97 (42.2 per-cent) received THR. Patients receiving THR (mean 73.5 years, 95% CI 72-74.8) were significantly younger in comparison to patients receiving HA (mean 81.7 years, 95% CI 80.5-82.8). A negative correlation is noted between NHFS and type of surgery (Pearson's correlation - 0.537, p < 0.01), implying higher NHFS decreased the likelihood of receiving THR. Regression analysis showed NHFS (p-0.001) and walking ability (p-0.001) as significant predictors for the type of surgery (Nagelkerke R2-0.472). A log-rank test showed higher estimated survival time in patients with THR in comparison to HA (p-value 0.002). CONCLUSIONS NHFS and walking ability can be used as an adjunct to the NICE criteria for selecting patients for THR after fracture NOF. Carefully selected patients treated with THR survive longer and have a better outcome in comparison to HA.
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Oba T, Makita H, Inaba Y, Yamana H, Saito T. New scoring system at admission to predict walking ability at discharge for patients with hip fracture. Orthop Traumatol Surg Res 2018; 104:1189-1192. [PMID: 30293749 DOI: 10.1016/j.otsr.2018.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/20/2018] [Accepted: 07/19/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A reliable scoring system that predicts the walking ability of hip fracture patients would be useful for clinicians. Here we developed a scoring system for hip fracture patients and evaluated its predictive ability. HYPOTHESIS We hypothesized that age, sex, presence of dementia, walking ability before the injury, fracture type, serum hemoglobin level, serum albumin level and interval in days between admission and surgery would be the predictive factors of the walking ability at discharge. MATERIAL AND METHODS Data from 409 patients who underwent hip fracture surgery were included. We analyzed factors that affected walking ability and developed a scoring system that predicts the probability of walking unaided or with a cane at discharge. RESULTS The mean age of the patients was 81.3 years. A total of 164 (40%) patients could walk unaided or with a cane at discharge. Multivariate logistic regression analysis showed that the obstructive factors for the ability to walk unaided or with a cane at discharge were older age (odds ratio [OR]=0.962, p=0.002), dementia (OR=0.126, p<0.001), use of a cane before injury (OR=0.396, p<0.001), trochanteric fracture (OR=0.571, p=0.027) and low serum albumin level (OR=4.15, p<0.001) at admission. The scoring system used the following formula: Score=5-0.04×age+albumin-2(with dementia)- 1(with use of a cane before injury)-1(with trochanteric fracture). The C-statistics for the scoring system was 0.81 (95% confidence interval, 0.77-0.85). DISCUSSION This newly developed scoring system of information at admission predicted the discharge mobility of hip fracture patients. In addition to the previously known risk factors, serum albumin level at admission was detected as a new predictor for mobility at discharge. LEVEL OF PROOF IV, retrospective study.
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Affiliation(s)
- Takayoshi Oba
- Department of Orthopaedic Surgery, Kanagawa Prefectural Ashigarakami Hospital, 866-1 Matusda-souryou, Matsuda-machi, Ashigarakami-gun, 2580003 Kanagawa, Japan.
| | - Hiroyuki Makita
- Department of Orthopaedic Surgery, Kanagawa Prefectural Ashigarakami Hospital, 866-1 Matusda-souryou, Matsuda-machi, Ashigarakami-gun, 2580003 Kanagawa, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 2360004 Kanagawa, Japan
| | - Hayato Yamana
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, 1113033 Tokyo, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 2360004 Kanagawa, Japan
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