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Barceló M, Casademont J, Mascaró J, Gich I, Torres OH. Should patients with exceptional longevity be treated for osteoporosis after a hip fracture? Age Ageing 2024; 53:afae118. [PMID: 38899445 DOI: 10.1093/ageing/afae118] [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: 03/05/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND There are no studies focusing on treatment for osteoporosis in patients with exceptional longevity after suffering a hip fracture. OBJECTIVE To assess the advisability of initiating treatment for osteoporosis after a hip fracture according to the incidence of new fragility fractures after discharge, risk factors for mortality and long-term survival. DESIGN Retrospective review. SETTING A tertiary university hospital serving a population of ~425 000 inhabitants in Barcelona. SUBJECTS All patients >95 years old admitted with a fragility hip fracture between December 2009 and September 2015 who survived admission were analysed until the present time. METHODS Pre-fracture ambulation ability and new fragility fractures after discharge were recorded. Risk factors for 1-year and all post-discharge mortality were calculated with multivariate Cox regression. Kaplan-Meier survival curve analyses were performed. RESULTS One hundred and seventy-five patients were included. Median survival time was 1.32 years [95% confidence interval (CI) 1.065-1.834], with a maximum of 9.2 years. Male sex [hazard ratio (HR) 2.488, 95% CI 1.420-4.358] and worse previous ability to ambulate (HR 2.291, 95% CI 1.417-3.703) were predictors of mortality. After discharge and up to death or the present time, 10 (5.7%) patients had a new fragility fracture, half of them during the first 6 months. CONCLUSIONS Few new fragility fractures occurred after discharge and half of these took place in the first 6 months. The decision to start treatment of osteoporosis should be individualised, bearing in mind that women and patients with better previous ambulation ability will have a better chance of survival.
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Affiliation(s)
- Montserrat Barceló
- Internal Medicine Department, Geriatric Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Casademont
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Mascaró
- Internal Medicine Department, Geriatric Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ignasi Gich
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Clinical Epidemiology and Public Health, HSCSP Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Olga Herminia Torres
- Internal Medicine Department, Geriatric Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Boukebous B, Biau D, Gao F. AtoG: A simple score to predict complications and death after hip fractures, in line with the comprehensive geriatric assessment. Orthop Traumatol Surg Res 2024; 110:103827. [PMID: 38280714 DOI: 10.1016/j.otsr.2024.103827] [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: 07/19/2023] [Revised: 11/07/2023] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Proximal Femur Fractures (PFFs) are a significant public health issue and occur in the context of global frailty and aging. Recent literature identifies new patient-related prognostic factors that focus on socioeconomic environment, patient well-being, or nutrition status. Specific scores have been developed, but in most cases, they fail to be in line with the comprehensive geriatric assessment, or do not assess the newly identified prognostic factors, contain multitude collinearities, or are too complex to be used in the daily practice. Hypothesis A comprehensive score with equal representation of the patient's dimensions does at least as good as the Charlson score (CCI), to predict complications and mortality. OBJECTIVE To develop a new comprehensive prognostic score, predicting inpatient complications and mortality up to 5-year after PFF. MATERIAL AND METHODS The patients treated surgically for PFF on a native hip, between 2005 and 2017 were selected from a French national database. The variables were the gender, age, the type of treatment (osteosynthesis or arthroplasty), and the CCI. The outcomes were the medical and surgical complications as inpatient and the mortality (up to 5-year). Variables were grouped into dimensions with similar clinical significance, using a Principal Component Analysis, for instance, bedsores and malnutrition. The dimensions were tested for 90-day mortality and complications, in regressions models. Two scores were derived from the coefficients: SCOREpond (strict ponderation), and SCORE (with loose ponderation: 1 point/risk factors, -1 point/protective factors). Calibration, discrimination (ROC curves with Area Under Curves AUC), and cross-validation were assessed for SCOREpond, SCORE, and CCI. RESULTS Analyses were performed on 7756 fractures. The factorial analysis identified seven dimensions: age; brain-related conditions (including dementia): 1738/7756; severe chronic conditions (for instance, organ failures) 914/7756; undernutrition: 764/7756; environment, including social issues or housing difficulties: 659/7756; associated trauma: 814/7756; and gender. The seven dimensions were selected for the prognostic score named AtoG (ABCDEFG, standing for Age, Brain, Comorbidities, unDernutrition, Environment, other Fractures, Gender). The median survival rate was 50.8 months 95% CI [49-53]. Anaemia and urologic complications were the most prevalent medical complications (1674/7756, 21%, and 1109/7756, 14.2%). A total of 149/7756 patients (1.9%) developed a mechanical inpatient complication (fractures or dislocations), with a slightly higher risk for arthroplasties. The AUCs were 0.69, 0.68, and 0.67 for AtoGpond, AtoG, and CCI, respectively, for 90-day mortality, and 0.64, 0.63, and 0.56 for complications. Compared to patients with AtoG=0, Hazard Ratios for 90-day mortality were 2.3 95% CI [1.7-2.9], 4.2 95% CI [3.1-5.4], 6 95% CI [4.5-8.1], 8.3 95% CI [6.5-12.9], and 13.7 95% CI [8-24], from AtoG=1 to AtoG≥5, respectively (p<10-4); the 90-day survival decreased by 5%/point, roughly. The sur-risk of mortality associated with AtoG was up to 5-year: HR=1.51 (95% CI [1.46-1.55], p<10-4). Compared to AtoG=0, from AtoG=1 to AtoG≥5, the pooled Odd Ratios were 1.14 95% CI [1.06-1.2], 1.53 95% CI [1.4-1.7], 2.17 95% CI [1.9-2.4], 2.9 95% CI [2.4-3.4], and 4.9 95% CI [3.3-7.4] for any complication (p<10-4). CONCLUSION AtoG is a multidimensional score in line with the concept of comprehensive geriatric assessment. It had good discrimination and performance in predicting 90-day mortality and complications. Performances were as good as CCI for 90-day mortality, and better than it for the complications. LEVEL OF PROOF IV; retrospective cohort study.
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Affiliation(s)
- Baptiste Boukebous
- Université Paris Cité, équipe ECAMO, Centre of Research in Epidemiology and Statistics (CRESS), Inserm, UMR 1153, Paris, France; Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, université Paris Cité, AP-HP, Paris, France.
| | - David Biau
- Université Paris Cité, équipe ECAMO, Centre of Research in Epidemiology and Statistics (CRESS), Inserm, UMR 1153, Paris, France; Service de chirurgie orthopédique et traumatologique, Cochin, université Paris Cité, AP-HP, Paris, France
| | - Fei Gao
- Recherche sur les Services et management en santé (RSMS) - U1309, université de Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, 35000 Rennes, France
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de Haan E, Roukema GR, van Rijckevorsel VAJIM, Kuijper TM, de Jong L. Risk Factors for 30-Days Mortality After Proximal Femoral Fracture Surgery, a Cohort Study. Clin Interv Aging 2024; 19:539-549. [PMID: 38528883 PMCID: PMC10962460 DOI: 10.2147/cia.s441280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/17/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose The primary objective of this study was to identify new risk factors and to confirm previously reported risk factors associated with 30-day mortality after hip fracture surgery. Patients and methods A prospective hip fracture database was used to obtain data. In total, 3523 patients who underwent hip fracture surgery between 2011 and 2021 were included. Univariable and multivariable logistic regression was used to screen and identify candidate risk factors. Twenty-seven baseline factors and 16 peri-operative factors were included in the univariable analysis and 28 of those factors were included in multivariable analysis. Results 8.6% of the patients who underwent hip fracture surgery died within 30 days after surgery. Prognostic factors associated with 30-day mortality after hip fracture surgery were as follows: age 90-100 years (OR = 4.7, 95% CI: 1.07-19.98, p = 0.041) and above 100 years (OR = 11.3, 95% CI: 1.28-100.26, p = 0.029), male gender (OR = 2.6, 95% CI: 1.97-3.33, p < 0.001), American Society of Anesthesiologists (ASA) 3 and ASA 4 (OR = 2.1, 95% CI: 1.44-3.14, p < 0.001), medical history of dementia (OR = 1.7, 95% CI: 1.25-2.36, p = 0.001), decreased albumin level (OR = 0.94, 95% CI: 0.92-0.97, p < 0.001), decreased glomerular filtration rate (GFR) (OR = 0.98, 95% CI: 0.98-0.99, p < 0.001), residential status of nursing home (OR = 2.1, 95% CI: 1.44-2.87, p < 0.001), higher Katz Index of Independence in Activities of Daily Living (KATZ-ADL) score (OR = 1.1, 95% CI: 1.01-1.16, p=0.018) and postoperative pneumonia (OR = 2.4, 95% CI: 1.72-3.38, p < 0.001). Conclusion A high mortality rate in patients after acute hip fracture surgery is known. Factors that are associated with an increased mortality are age above 90 years, male gender, ASA 3 and ASA 4, medical history of dementia, decreased albumin, decreased GFR, residential status of nursing home, higher KATZ-ADL score and postoperative pneumonia.
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Affiliation(s)
- Eveline de Haan
- Surgery Department, Maasstad Hospital, Rotterdam, Zuid-Holland, the Netherlands
- Surgery Department, Franciscus Hospital, Rotterdam, Zuid-Holland, the Netherlands
| | - Gert R Roukema
- Surgery Department, Maasstad Hospital, Rotterdam, Zuid-Holland, the Netherlands
| | | | | | - Louis de Jong
- Surgery Department, Maasstad Hospital, Rotterdam, Zuid-Holland, the Netherlands
| | - On behalf of Dutch Hip Fracture RegistryCollaboration
- Surgery Department, Maasstad Hospital, Rotterdam, Zuid-Holland, the Netherlands
- Surgery Department, Franciscus Hospital, Rotterdam, Zuid-Holland, the Netherlands
- Science Board, Maasstad Hospital, Rotterdam, Zuid-Holland, the Netherlands
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Sun Y, Liu Y, Zhu Y, Luo R, Luo Y, Wang S, Feng Z. Risk prediction models of mortality after hip fracture surgery in older individuals: a systematic review. Curr Med Res Opin 2024; 40:523-535. [PMID: 38323327 DOI: 10.1080/03007995.2024.2307346] [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: 07/25/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE This study aimed to critically assess existing risk prediction models for postoperative mortality in older individuals with hip fractures, with the objective of offering substantive insights for their clinical application. DESIGN A comprehensive search was conducted across prominent databases, including PubMed, Embase, Cochrane Library, SinoMed, CNKI, VIP, and Wanfang, spanning original articles in both Chinese and English up until 1 December 2023. Two researchers independently extracted pertinent research characteristics, such as predictors, model performance metrics, and modeling methodologies. Additionally, the bias risk and applicability of the incorporated risk prediction models were systematically evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST). RESULTS Within the purview of this investigation, a total of 21 studies were identified, constituting 21 original risk prediction models. The discriminatory capacity of the included risk prediction models, as denoted by the minimum and maximum areas under the subject operating characteristic curve, ranged from 0.710 to 0.964. Noteworthy predictors, recurrent across various models, included age, sex, comorbidities, and nutritional status. However, among the models assessed through the PROBAST framework, only one was deemed to exhibit a low risk of bias. Beyond this assessment, the principal limitations observed in risk prediction models pertain to deficiencies in data analysis, encompassing insufficient sample size and suboptimal handling of missing data. CONCLUSION Subsequent research endeavors should adopt more stringent experimental designs and employ advanced statistical methodologies in the construction of risk prediction models. Moreover, large-scale external validation studies are warranted to rigorously assess the generalizability and clinical utility of existing models, thereby enhancing their relevance as valuable clinical references.
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Affiliation(s)
- Ying Sun
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
| | - Yanhui Liu
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
| | - Yaning Zhu
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
| | - Ruzhen Luo
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yiwei Luo
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
| | - Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zihang Feng
- School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China
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Alito A, Fenga D, Portaro S, Leonardi G, Borzelli D, Sanzarello I, Calabrò RS, Milone D, Tisano A, Leonetti D. Early hip fracture surgery and rehabilitation. How to improve functional quality outcomes. A retrospective study. Folia Med (Plovdiv) 2023; 65:879-884. [PMID: 38351775 DOI: 10.3897/folmed.65.e99513] [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: 01/02/2023] [Accepted: 01/27/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Hip fractures are one of the major disability causes associated with a high morbidity and mortality rate. Early surgery and stable fixation could be associated with better pain control, possibly lower mortality rates, and early recovery of autonomy.
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Sun Z, Cheng K, Jin G, Jia J. Increasing serum miR-409-3p predicts the major adverse cardiac adverse events in elderly patients after hip fracture surgery. BMC Musculoskelet Disord 2023; 24:920. [PMID: 38017411 PMCID: PMC10683352 DOI: 10.1186/s12891-023-07049-7] [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: 09/15/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Major adverse cardiovascular events (MACE) are critical complications responsible for the morbidity and mortality of elderly hip fracture patients. There was an urgent need to explore an effect biomarker for predicting MACE in elderly patients receiving hip fracture surgery. OBJECTIVE This study focused on an age-related miRNA, miR-409-3p, and assessed its significance in elderly hip fracture patients. METHODS A total of 267 hip fracture patients were enrolled in this study including 104 elderly patients (age ≥ 60 years). All patients were followed up for 1 year to monitor the occurrence of MACE. The risk factors for the occurrence of MACE were evaluated by the logistic regression analysis. RESULTS Elderly age and reduced cardiac and renal function were identified as risk factors for MACE in hip fracture patients. Elderly patients also showed a high incidence of MACE. In elderly hip fracture patients, significant upregulation of miR-409-3p was observed, which was associated with patients' elderly age, higher level of revised cardiac risk index (RCRI), lower left ventricular ejection fraction (LVEF), and higher levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase-MB (CK-MB), and high sensitivity troponin I (hsTnI). Additionally, miR-409-3p was identified as an independent factor for the MACE in elderly patients received hip fracture surgery. CONCLUSION Upregulated miR-409-3p was an age-related miRNA and could predict the occurrence of MACE in elderly hip fracture patients.
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Affiliation(s)
- Zhengtao Sun
- Department of Osteoarticular Surgery, Linfen People's Hospital, No.319 Gulou West Street, Yao Du District, Linfen, 041000, China
| | - Kai Cheng
- Department of Osteoarticular Surgery, Linfen People's Hospital, No.319 Gulou West Street, Yao Du District, Linfen, 041000, China
| | - Guochao Jin
- Department of Osteoarticular Surgery, Linfen People's Hospital, No.319 Gulou West Street, Yao Du District, Linfen, 041000, China
| | - Jian Jia
- Department of Osteoarticular Surgery, Linfen People's Hospital, No.319 Gulou West Street, Yao Du District, Linfen, 041000, China.
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Correoso Castellanos S, Blay Domínguez E, Veracruz Gálvez EM, Muela Pérez B, Puertas García-Sandoval JP, Ricón Recarey FJ, Salinas Gilabert JE, Mira Viudes V, Lajara Marco F. [Translated article] Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T365-T370. [PMID: 37364723 DOI: 10.1016/j.recot.2023.06.012] [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: 10/24/2022] [Accepted: 02/08/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Pre-operative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. MATERIAL AND METHODS A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA≤II were included for analysis and divided according to their post-operative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year post-operative mortality rates; 30-day post-operative hospital readmission rate; and medical or surgical cause were recorded. RESULTS In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% versus 4.1%, p=.16) and 1-year post-operative (4.3% versus 16.3%, p=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% versus 16.3%, p=.037). CONCLUSIONS In the present study, the early discharge group obtained better results 30-day and 1-year post-operative mortality indicators, as well as readmission for medical reasons.
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Tang W, Yao W, Wang W, Lv Q, Ding W. Association between admission hyperglycemia and postoperative pneumonia in geriatric patients with hip fractures. BMC Musculoskelet Disord 2023; 24:700. [PMID: 37658378 PMCID: PMC10472715 DOI: 10.1186/s12891-023-06829-5] [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: 04/12/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Admission hyperglycemia is a common phenomenon in the early stages of injury. This study aimed to determine the relationship between admission hyperglycemia and postoperative pneumonia in geriatric patients with hip fractures. METHODS A total of 600 geriatric patients admitted to Dandong Central Hospital with hip fractures were included. Patients were divided into four groups based on quartiles of admission blood glucose levels: Q1- Q4. Multivariable logistic regression and propensity score-matched analyses were conducted to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for postoperative pneumonia. Receiver operating characteristic (ROC) curves were used to determine the cut-off value of admission hyperglycemia for predicting postoperative pneumonia. RESULTS The incidence of postoperative pneumonia was significantly higher among hyperglycemic patients than those with normal glucose levels (OR = 2.090, 95% CI: 1.135-3.846, p = 0.016). Admission hyperglycemia showed moderate predictive power, with an area under the ROC curve of 0.803. Furthermore, propensity score-matched analyses demonstrated that patients in the Q3 (OR = 4.250, 95% CI: 1.361-13.272, p = 0.013) and Q4 (OR = 4.667, 95% CI: 1.251-17.405, p = 0.022) quartiles had a significantly higher risk of postoperative pneumonia compared to patients in the Q1 quartile. CONCLUSIONS Admission hyperglycemia in elderly hip fracture patients increases the risk of postoperative pneumonia. This biomarker can aid clinical assessment and perioperative management.
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Affiliation(s)
- Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, Liaoning Province, 118002, P.R. China
| | - Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, Liaoning Province, 118002, P.R. China
| | - Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, Liaoning Province, 118002, P.R. China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, Liaoning Province, 118002, P.R. China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, Liaoning Province, 118002, P.R. China.
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Correoso Castellanos S, Blay Domínguez E, Veracruz Gálvez EM, Muela Pérez B, Puertas García-Sandoval JP, Ricón Recarey FJ, Salinas Gilabert JE, Mira Viudes V, Lajara Marco F. Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:365-370. [PMID: 36801250 DOI: 10.1016/j.recot.2023.02.002] [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: 10/24/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. MATERIAL AND METHODS A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. RESULTS In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). CONCLUSIONS In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.
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Krickl J, Ittermann T, Thannheimer A, Schmidt W, Willauschus M, Ruether J, Loose K, Gesslein M, Millrose M. The Rising Problem of Hip Fractures in Geriatric Patients-Analysis of Surgical Influences on the Outcome. J Pers Med 2023; 13:1271. [PMID: 37623521 PMCID: PMC10455730 DOI: 10.3390/jpm13081271] [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: 07/21/2023] [Revised: 08/13/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Hip fractures in geriatric patients often have a poor outcome in terms of mortality, mobility as well as independence. Different surgical influence factors are known that improve the outcome. METHODS In this observational cohort study, 281 patients of a geriatric trauma unit were analyzed prospectively. Demographic factors, as well as data regarding the trauma mechanism and perioperative treatment, were recorded. The nutritional status was also analyzed. The follow-up was set to 120 days. RESULTS The key conclusion of this study is that a high ASA classification, the use of anticoagulatory medicine and malnutrition are significantly associated with higher mortality together with worse independence (p < 0.05). There is no significant difference in outcome concerning the time to surgery within the first 24 h. CONCLUSIONS Malnutrition seems to be an important risk factor for an adverse outcome of geriatric patients and therefore warrants a focus in multidisciplinary treatment. The risk factor ASA cannot be improved during the pre-surgery phase, but requires intensified care by a multidisciplinary team specialized in orthogeriatrics.
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Affiliation(s)
- Julian Krickl
- Department of Trauma Surgery and Sports Medicine, Garmisch-Partenkirchen Medical Centre, 82467 Garmisch-Partenkirchen, Germany; (J.K.); (A.T.); (W.S.)
| | - Till Ittermann
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University of Greifswald, 17489 Greifswald, Germany;
| | - Andreas Thannheimer
- Department of Trauma Surgery and Sports Medicine, Garmisch-Partenkirchen Medical Centre, 82467 Garmisch-Partenkirchen, Germany; (J.K.); (A.T.); (W.S.)
| | - Wolfgang Schmidt
- Department of Trauma Surgery and Sports Medicine, Garmisch-Partenkirchen Medical Centre, 82467 Garmisch-Partenkirchen, Germany; (J.K.); (A.T.); (W.S.)
| | - Maximilian Willauschus
- Department of Orthopedics and Traumatology, Paracelsus Medical University, 90471 Nuremberg, Germany; (M.W.); (J.R.); (K.L.); (M.G.)
| | - Johannes Ruether
- Department of Orthopedics and Traumatology, Paracelsus Medical University, 90471 Nuremberg, Germany; (M.W.); (J.R.); (K.L.); (M.G.)
| | - Kim Loose
- Department of Orthopedics and Traumatology, Paracelsus Medical University, 90471 Nuremberg, Germany; (M.W.); (J.R.); (K.L.); (M.G.)
| | - Markus Gesslein
- Department of Orthopedics and Traumatology, Paracelsus Medical University, 90471 Nuremberg, Germany; (M.W.); (J.R.); (K.L.); (M.G.)
| | - Michael Millrose
- Department of Trauma Surgery and Sports Medicine, Garmisch-Partenkirchen Medical Centre, 82467 Garmisch-Partenkirchen, Germany; (J.K.); (A.T.); (W.S.)
- Department of Orthopedics and Traumatology, Paracelsus Medical University, 90471 Nuremberg, Germany; (M.W.); (J.R.); (K.L.); (M.G.)
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Popp D, Nia A, Biedermann G, Schmoelz L, Silvaieh S, Tiefenboeck TM, Hajdu S, Widhalm HK. Predictive Validity of Mortality after Surgically Treated Proximal Femur Fractures Based on Four Nutrition Scores-A Retrospective Data Analysis. Nutrients 2023; 15:3357. [PMID: 37571292 PMCID: PMC10420813 DOI: 10.3390/nu15153357] [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: 06/30/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Hip fractures are becoming a growing concern due to an aging population. The high costs to the healthcare system and far-reaching consequences for those affected, including a loss of independence and increased mortality rates, make this issue important. Poor nutritional status is a common problem among geriatric patients and is associated with a worse prognosis. Nutritional screening tools can help identify high-risk patients and enable individualized care to improve survival rates. MATERIAL AND METHODS This retrospective study investigates four nutritional scores and laboratory parameters' predictive significance concerning postoperative mortality after surgical treatment of proximal femur fractures at 1, 3, 6, and 12 month/s for patients over 60 years using the chi-square test, Cox regression analysis, and receiver operating characteristics (ROC). The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines were used as part of the screening of the respective nutritional status of the patients, in particular to filter out malnutrition. RESULTS A total of 1080 patients were included in this study, whereas 8.05% suffered from malnutrition, defined as a body mass index (BMI) below 18.5 kg/m2. The Mini Nutritional Assessment (MNA) screening tool identified the highest proportion of malnourished patients at 14.54%. A total of 36.39% of patients were at risk of malnutrition according to three nutrition scores, with MNA providing the most significant proportion at 41.20%. Patients identified as malnourished had a higher mortality rate, and MNA screening was the only tool to show a significant correlation with postoperative mortality in all survey intervals. The MNA presented the best predictive significance among the screening tools, with a maximum area under the curve (AUC) of 0.7 at 12 month postoperatively. CONCLUSIONS MNA screening has a solid correlation and predictive significance regarding postoperative mortality-therefore routine implementation of this screening in orthopedic/traumatology wards is recommended. Moreover, nutritional substitution therapy can offer a relatively inexpensive and easy-to-implement measure. The Graz malnutrition screening (GMS) shows moderate predictive power and could be considered as an alternative for patients under 60 years of age. A higher albumin level is associated with improved survival probability, but cannot be indicative of nutritional status.
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Affiliation(s)
- Domenik Popp
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (D.P.); (A.N.); (G.B.); (L.S.); (T.M.T.); (S.H.)
| | - Arastoo Nia
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (D.P.); (A.N.); (G.B.); (L.S.); (T.M.T.); (S.H.)
| | - Gregor Biedermann
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (D.P.); (A.N.); (G.B.); (L.S.); (T.M.T.); (S.H.)
| | - Lukas Schmoelz
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (D.P.); (A.N.); (G.B.); (L.S.); (T.M.T.); (S.H.)
| | - Sara Silvaieh
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Thomas M. Tiefenboeck
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (D.P.); (A.N.); (G.B.); (L.S.); (T.M.T.); (S.H.)
| | - Stefan Hajdu
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (D.P.); (A.N.); (G.B.); (L.S.); (T.M.T.); (S.H.)
| | - Harald K. Widhalm
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria; (D.P.); (A.N.); (G.B.); (L.S.); (T.M.T.); (S.H.)
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12
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Feller K, Abdel-Jalil N, Blockhaus C, Kröger K, Kowall B, Stang A. Impact of oral anticoagulation on inhospital mortality of patients with hip fracture - Analysis of nationwide hospitalization data. Injury 2023:110829. [PMID: 37246114 DOI: 10.1016/j.injury.2023.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/26/2023] [Accepted: 05/13/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Oral anticoagulation (OAC) may have an impact on mortality in cases hospitalized for hip fracture (HF). We studied nationwide time trends of OAC prescriptions and compared time trends of inhospital mortality of HF cases with and without OAC in Germany DESIGN: Retrospective cohort study SETTING: Nationwide German hospitalization, Diagnosis-Related Groups Statistic PATIENTS/PARTICIPANTS: All hospital admissions for HF 60 years and older in the years 2006 through 2020. INTERVENTION Additional diagnosis with a personal history of long-term use of anticoagulants (ICD code Z92.1). MAIN OUTCOME MEASUREMENTS Inhospital mortality RESULTS: Cases hospitalized for HF 60 years and older increased by 29.5%. In 2006, 5.6% had a documented history of long-term use of OACs. This proportion rose to 20.1% in 2020. Age-standardized hospitalization mortality in HF cases without long-term use of OACs in males decreased steadily from 8.6% (95% confidence intervals 8.2 - 8.9) in 2006 to 6.6% (6.3 - 6.9) in 2020 and in females from 5.2% (5.0 - 5.3) to 3.9% (3.7 - 4.0). Mortality of HF cases with long-term use of OACs remained unchanged: males 7.0% (5.7 - 8.2) in 2006 and 7.3% (6.7 - 7.8) in 2020, females 4.8% (4.1 - 5.4) and 5.0% (4.7 - 5.3). CONCLUSION Inhospital mortality of HF cases with and without long-term OAC show different trends. In HF cases without OAC, mortality decreased from 2006 to 2020. In cases with OAC such a decrease could not be observed.
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Affiliation(s)
- Kathrin Feller
- Clinic for Plastic Surgery, HELIOS Klinik Krefeld, Germany
| | | | - Christian Blockhaus
- Clinic of Cardiology, HELIOS Klinik Krefeld, Germany; University of Witten/Herdecke, Witten- Herdecke, Germany
| | - Knut Kröger
- Clinic of Vascular Medicine, HELIOS Klinik Krefeld, Germany.
| | - Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany; Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, United States of America
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13
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Golsorkhtabaramiri M, Mckenzie J, Potter J. Predictability of Neutrophil to Lymphocyte Ratio in preoperative elderly hip fracture patients for post-operative short-term complications: a retrospective study. BMC Musculoskelet Disord 2023; 24:227. [PMID: 36966301 PMCID: PMC10039504 DOI: 10.1186/s12891-023-06211-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/31/2023] [Indexed: 03/27/2023] Open
Abstract
PURPOSE Neutrophil to Lymphocyte Ratio (NLR) is a simple biomarker of systemic inflammatory response. We investigated predictability of NLR for early adverse outcome after surgery for hip fracture in elderly population. METHODS We reviewed a total of 971 elderly patients with hip fracture who underwent emergency surgery between January 2017 and July 2020 in the Department of Orthopaedics Surgery at the Wollongong Hospital. After considering exclusion criteria, data from a total of 834 patients included in our study. Socio-demographic data, NLR in admission, updated Charlson comorbidity index (uCCI), biochemical markers, mortality rate and 15 short term post-operative complications were collected to determine predictability of NLR for post-operative complications and mortality. RESULTS After hip surgery, Hospital in-patient case fatality rate was 3.7% (31). In addition, 63.1% (511) of the patients had at least one complication or more. Logistic regression demonstrated that raised NLR (P-value < 0.001, OR 1.05) and uCCI≥4 (P-Value < 0.001, OR 1.75) are associated with post-operative complications. Moreover, decreased haemoglobin was associated with adverse effects (P-value < 0.001, OR 0.97). No association was found for any of these variables with in-patient mortality except for albumin (P-value: 0.03). In addition, despite significant association, ROC analyses showed a low predictability for each of the above variables including NLR (AUC 0.59) for post-operative complications. CONCLUSIONS Despite significant association, NLR was unable to prognosticate early adverse outcomes. However, it can be considered as a risk factor in admission for postoperative complications in combination with other risk factors and clinical context.
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Affiliation(s)
- Mohammad Golsorkhtabaramiri
- Aged Care Department, Illawarra and Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia.
| | - John Mckenzie
- Aged Care Department, Illawarra and Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Jan Potter
- Aged Care Department, Illawarra and Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
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Nijmeijer WS, Voorthuis BJ, Groothuis-Oudshoorn CGM, Würdemann FS, van der Velde D, Vollenbroek-Hutten MMR, Hegeman JH. The prediction of early mortality following hip fracture surgery in patients aged 90 years and older: the Almelo Hip Fracture Score 90 (AHFS 90). Osteoporos Int 2023; 34:867-877. [PMID: 36856794 PMCID: PMC10104941 DOI: 10.1007/s00198-023-06696-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 02/06/2023] [Indexed: 03/02/2023]
Abstract
UNLABELLED The AHFS90 was developed for the prediction of early mortality in patients ≥ 90 years undergoing hip fracture surgery. The AHFS90 has a good accuracy and in most risk categories a good calibration. In our study population, the AHFS90 yielded a maximum prediction of early mortality of 64.5%. PURPOSE Identifying hip fracture patients with a high risk of early mortality after surgery could help make treatment decisions and information about the prognosis. This study aims to develop and validate a risk score for predicting early mortality in patients ≥ 90 years undergoing hip fracture surgery (AHFS90). METHODS Patients ≥ 90 years, surgically treated for a hip fracture, were included. A selection of possible predictors for mortality was made. Missing data were subjected to multiple imputations using chained equations. Logistic regression was performed to develop the AHFS90, which was internally and externally validated. Calibration was assessed using a calibration plot and comparing observed and predicted risks. RESULTS One hundred and two of the 922 patients (11.1%) died ≤ 30 days following hip fracture surgery. The AHFS90 includes age, gender, dementia, living in a nursing home, ASA score, and hemoglobin level as predictors for early mortality. The AHFS90 had good accuracy (area under the curve 0.72 for geographic cross validation). Predicted risks correspond with observed risks of early mortality in four risk categories. In two risk categories, the AHFS90 overestimates the risk. In one risk category, no mortality was observed; therefore, no analysis was possible. The AHFS90 had a maximal prediction of early mortality of 64.5% in this study population. CONCLUSION The AHFS90 accurately predicts early mortality after hip fracture surgery in patients ≥ 90 years of age. Predicted risks correspond to observed risks in most risk categories. In our study population, the AHFS90 yielded a maximum prediction of early mortality of 64.5%.
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Affiliation(s)
- W S Nijmeijer
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands.
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands.
| | - B J Voorthuis
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - C G M Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - F S Würdemann
- Dutch Hip Fracture Audit Taskforce Indicators, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - D van der Velde
- Dutch Hip Fracture Audit Taskforce Indicators, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands
- Department of Surgery, Sint Antonius Hospital, Soestwetering 1, 3542 AZ, Utrecht, The Netherlands
| | - M M R Vollenbroek-Hutten
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - J H Hegeman
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
- Dutch Hip Fracture Audit Taskforce Indicators, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands
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15
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Shen H, He R, Zhang P, He Y, Liu Y, Wang G, Li T. Risk factors for postoperative medical morbidity and 3-month mortality in elderly patients with hip fracture following hip arthroplasty during COVID-19 pandemic. J Orthop Surg Res 2023; 18:59. [PMID: 36683026 PMCID: PMC9867902 DOI: 10.1186/s13018-023-03511-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/06/2023] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The purpose of the current study was to investigate the incidence of postoperative medical complications and 3-month mortality in patients ≥ 70 years old with hip fracture following hip arthroplasty (HA) and independent risk factors associated with postoperative medical complications and 3-month mortality during the Coronavirus Disease 2019 (COVID-19) pandemic. METHODS A multicenter retrospective study was conducted, patients ≥ 70 years old with HA for hip fracture under general anesthesia were included during COVID-19 and before COVID-19 pandemic. The outcome was defined as postoperative medical complications and 3-month mortality. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors for postoperative medical complications and 3-month mortality. RESULTS A total of 1096 patients were included during COVID-19 pandemic and 1149 were included before COVID-19 pandemic in the study. Patients ≥ 70 years with hip fracture for HA had longer fracture to operation duration (7.10 ± 3.52 vs. 5.31 ± 1.29, P < 0.001), and the incidence of postoperative medical complications (21.90% vs. 12.53%, P < 0.001) and 3-month mortality (5.20% vs. 3.22%, P = 0.025) was higher during COVID-2019 pandemic. Multivariate logistic regression analysis showed that dementia (OR 2.73; 95% CI 1.37-5.44; P = 0.004), chronic obstructive pulmonary disease (COPD) (OR 3.00; 95% CI 1.92-4.71; P < 0.001), longer fracture to operation duration (OR 1.24; 95% CI 1.19-1.30; P < 0.001) were associated with increased risk for postoperative medical complications. COPD (OR 2.10; 95% CI 1.05-4.17; P = 0.035), dementia (OR 3.00; 95% CI 1.11-7.94; P = 0.031), postoperative medical complications (OR 4.99; 95% CI 2.68-9.28; P < 0.001), longer fracture to operation duration (OR 1.11; 95% CI 1.04-1.19; P = 0.002) were associated with increased risk for 3-month mortality. CONCLUSIONS In conclusion, we found that postoperative medical morbidity and 3-month mortality in patients with hip fracture underwent HA were 21.90% and 5.20%, respectively, during the COVID-19. COPD, dementia and longer fracture to operation duration were associated with negative outcome in patients with hip fracture underwent HA during the COVID-19.
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Affiliation(s)
- Huarui Shen
- grid.488387.8Department of Joint Surgery, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000 China
| | - Rui He
- grid.440164.30000 0004 1757 8829Department of Orthopedics, The Second People’s Hospital of Chengdu, Chengdu, 610021 People’s Republic of China
| | - Peng Zhang
- Department of Joint Surgery, Sichuan Province Orthopedic Hospital, Chengdu, 610045 People’s Republic of China
| | - Yue He
- Sichuan Provincial Ba-Yi Rehabilitation Center (Si Chuan Provincial Rehabilitation Hospital), Chengdu City, 631000 Sichuan Province People’s Republic of China
| | - Yingqi Liu
- Department of Spine Surgery, Chongqing Orthopedics Hospital of Traditional Chinese Medical, Chongqing, 400000 People’s Republic of China
| | - Guoyou Wang
- grid.488387.8Department of Joint Surgery, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000 China
| | - Ting Li
- grid.410578.f0000 0001 1114 4286School of Pharmacy, Southwest Medical University, Luzhou, 646000 People’s Republic of China
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Cintean R, Eickhoff A, Nussbaum K, Gebhard F, Schuetze K. No Excess Mortality in Geriatric Patients With Femoral Neck Fractures Due to Shorter Intensive Care Caused by COVID-19. Cureus 2022; 14:e29986. [PMID: 36381761 PMCID: PMC9636867 DOI: 10.7759/cureus.29986] [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: 10/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background Since March 2020, increasing numbers of hospitalized patients with coronavirus disease-2019 (COVID-19) infections have been registered. The first and the second waves necessitated the extensive restructuring of hospital infrastructure with prioritization of intensive care capacity. Elective surgeries in all surgical disciplines were postponed to preserve intensive care capacity for COVID-19 patients. However, emergency care for trauma patients had to be maintained. Especially, geriatric patients with hip fractures often require intensive care. This study sought to investigate the possible excess mortality of geriatric patients with femoral neck fractures due to shorter intensive care unit stays because of COVID-19. Material and methods All patients over the age of 70 between March 2019 and February 2020 who underwent surgical treatment for femoral neck fractures were included. This cohort (group 1) was compared with all patients over 70 who received surgical treatment for hip fractures during the period of the pandemic between March 2020 and February 2021 with attention to potential excess mortality due to low intensive care capacity (group 2). Demographic data, American Society of Anesthesiologists (ASA) score, surgical modality, ICU stay, complications, and mortality were analyzed and compared. Results A total of 356 patients with 178 in each cohort with a mean age of 82.7 in group 1 and 84.8 in group 2 (p<0.05) were included. No significant difference was seen in sex and ASA scores. During the pandemic, patients with hip fractures had a significantly shorter stay in ICU (0.4 ± 0.9 vs 1.2 ± 2.8 days; p<0.05), shorter time to surgery (29.9 ± 8.2 vs 16.8 ± 5.3 h; p<0.05) and operations were significantly more often performed out-of-hour (4 pm-12 am 47.8% vs 56.7%; 12 am-8 am 7.9% vs 13.5%, p<0.05). Interestingly, mortality was lower during the pandemic, but the difference did not reach significance (6.7% vs 12.4%, p=0.102). Conclusion During the pandemic, ICU capacity was reserved for COVID patients. Due to a change in the law of the Joint Federal Committee with effect from January 1, 2021, all patients with proximal femur fractures had to be operated on within the first 24 hours, which is why a significantly shorter time to surgery was observed during the pandemic period. As a consequence, a lower mortality rate was observed, although no significance could be reached.
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17
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Holleyman RJ, Khan SK, Charlett A, Inman DS, Johansen A, Brown C, Barnard S, Fox S, Baker PN, Deehan D, Burton P, Gregson CL. The impact of COVID-19 on mortality after hip fracture : a population cohort study from England. Bone Joint J 2022; 104-B:1156-1167. [PMID: 36177635 DOI: 10.1302/0301-620x.104b10.bjj-2022-0082.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Hip fracture commonly affects the frailest patients, of whom many are care-dependent, with a disproportionate risk of contracting COVID-19. We examined the impact of COVID-19 infection on hip fracture mortality in England. METHODS We conducted a cohort study of patients with hip fracture recorded in the National Hip Fracture Database between 1 February 2019 and 31 October 2020 in England. Data were linked to Hospital Episode Statistics to quantify patient characteristics and comorbidities, Office for National Statistics mortality data, and Public Health England's SARS-CoV-2 testing results. Multivariable Cox regression examined determinants of 90-day mortality. Excess mortality attributable to COVID-19 was quantified using Quasi-Poisson models. RESULTS Analysis of 102,900 hip fractures (42,630 occurring during the pandemic) revealed that among those with COVID-19 infection at presentation (n = 1,120) there was a doubling of 90-day mortality; hazard ratio (HR) 2.09 (95% confidence interval (CI) 1.89 to 2.31), while the HR for infections arising between eight and 30 days after presentation (n = 1,644) the figure was greater at 2.51 (95% CI 2.31 to 2.73). Malnutrition (1.45 (95% CI 1.19 to 1.77)) and nonoperative treatment (2.94 (95% CI 2.18 to 3.95)) were the only modifiable risk factors for death in COVID-19-positive patients. Patients who had tested positive for COVID-19 more than two weeks prior to hip fracture initially had better survival compared to those who contracted COVID-19 around the time of their hip fracture; however, survival rapidly declined and by 365 days the combination of hip fracture and COVID-19 infection was associated with a 50% mortality rate. Between 1 January and 30 June 2020, 1,273 (99.7% CI 1,077 to 1,465) excess deaths occurred within 90 days of hip fracture, representing an excess mortality of 23% (99.7% CI 20% to 26%), with most deaths occurring within 30 days. CONCLUSION COVID-19 infection more than doubles the rate of early hip fracture mortality. Those contracting infection between 8 and 30 days after initial presentation are at even higher mortality risk, signalling the potential for targeted interventions during this period to improve survival.Cite this article: Bone Joint J 2022;104-B(10):1156-1167.
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Affiliation(s)
- Richard J Holleyman
- Public Health England, London, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sameer K Khan
- Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | | | - Dominic S Inman
- Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | | | | | | | | | - Paul N Baker
- James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
- York Medical School, University of York, York, UK
- Teeside University, Middlesbrough, UK
| | | | - Paul Burton
- Public Health England, London, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Royal United Hospital NHS Foundation Trust, Bath, UK
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Chae D, Kim NY, Kim HJ, Kim TL, Kang SJ, Kim SY. A risk scoring system integrating postoperative factors for predicting early mortality after major non-cardiac surgery. Clin Transl Sci 2022; 15:2230-2240. [PMID: 35731952 PMCID: PMC9468553 DOI: 10.1111/cts.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 01/25/2023] Open
Abstract
We aimed to develop a risk scoring system for 1-week and 1-month mortality after major non-cardiac surgery, and assess the impact of postoperative factors on 1-week and 1-month mortality using machine learning algorithms. We retrospectively reviewed the medical records of 21,510 patients who were transfused with red blood cells during non-cardiac surgery and collected pre-, intra-, and postoperative features. We derived two patient cohorts to predict 1-week and 1-month mortality and randomly split each of them into training and test cohorts at a ratio of 8:2. All the modeling steps were carried out solely based on the training cohorts, whereas the test cohorts were reserved for the evaluation of predictive performance. Incorporation of postoperative information demonstrated no significant benefit in predicting 1-week mortality but led to substantial improvement in predicting 1-month mortality. Risk scores predicting 1-week and 1-month mortality were associated with area under receiver operating characteristic curves of 84.58% and 90.66%, respectively. Brain surgery, amount of intraoperative red blood cell transfusion, preoperative platelet count, preoperative serum albumin, and American Society of Anesthesiologists physical status were included in the risk score predicting 1-week mortality. Postoperative day (POD) 5 (neutrophil count × mean platelet volume) to (lymphocyte count × platelet count) ratio, preoperative and POD 5 serum albumin, and occurrence of acute kidney injury were included in the risk score predicting 1-month mortality. Our scoring system advocates the importance of postoperative complete blood count differential and serum albumin to better predict mortality beyond the first week post-surgery.
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Affiliation(s)
- Dongwoo Chae
- Department of PharmacologyYonsei University College of MedicineSeoulKorea
| | - Na Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulKorea
| | - Hyun Joo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulKorea
| | - Tae Lim Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulKorea
| | - Su Jeong Kang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulKorea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulKorea
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Nordström P, Bergman J, Ballin M, Nordström A. Trends in Hip Fracture Incidence, Length of Hospital Stay, and 30-Day Mortality in Sweden from 1998-2017: A Nationwide Cohort Study. Calcif Tissue Int 2022; 111:21-28. [PMID: 35166892 PMCID: PMC9232476 DOI: 10.1007/s00223-022-00954-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/25/2022] [Indexed: 01/01/2023]
Abstract
In this nationwide cohort study, we investigated trends in hip fracture incidence, hospital length of stay (LOS), and 30-day mortality after admission in Sweden. The cohort included all individuals in Sweden aged ≥ 50 years with a first hip fracture diagnosis during 1998-2017 (N = 313,761). The outcomes were hip fracture incidence and 30-day mortality. The results showed that the incidence of hip fracture decreased from 79.2 to 46.7/10,000 population in women and from 35.7 to 26.5/10,000 population in men. In contrast, 30-day mortality increased from 4.3% to 6.2% in women (P < 0.001) and from 8.4% to 11.1% in men (P < 0.001). Strong risk factors (P < 1 × 10-25 for all) for 30-day mortality were older age, male sex, and shorter LOS. From 1998 to 2017, LOS decreased by on average 4 days and was shorter in both male and female aged ≥ 90 years compared to those aged 80-89 (P < 0.001 for comparisons). In conclusion, despite population aging, hip fracture incidence in Sweden has decreased over the last 20 years. However, short-term mortality has increased, which to some extent may partly be explained by the fact that LOS has decreased without being adapted to important risk factors.
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Affiliation(s)
- Peter Nordström
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden.
| | - Jonathan Bergman
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden
| | - Marcel Ballin
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Anna Nordström
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
- School of Sport Sciences, UiT the Arctic University of Norway, Tromsø, Norway
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Balta O, Altınayak H, Balta MG, Astan S, Uçar C, Kurnaz R, Çağatay Zengin E, Burtaç Eren M. Can C-reactive protein-based biomarkers be used as predictive of 30-day mortality in elderly hip fractures?A retrospective study. ULUS TRAVMA ACIL CER 2022; 28:849-856. [PMID: 35652864 PMCID: PMC10443014 DOI: 10.14744/tjtes.2022.12454] [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: 12/16/2021] [Accepted: 04/02/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND C-reactive protein-to-lymphocyte ratio (CLR), C-reactive protein/albumin (CRP/ALB), and CRP are prognostic factors for outcome and survival in oncology and digestive surgery. CLR has not been studied for the prediction of mortality in hip fracture. The aim of this study is to investigate whether there is an association between pre-operative CLR, CRP/ALB, and CRP levels in patients with hip fracture and patient survival. METHODS The medical reports of the patients who underwent surgery with a diagnosis of hip fracture in our hospital between January 2016 and December 2019 were retrospectively reviewed. The patients were divided into two groups (Group E: Those who died within 1 month and Group S: Those who died after the 1st month or those who survived). A total of 19 parameters, namely, included ' blood parameters including hemoglobin, C-reactive protein, albumin, lymphocytes, neutrophils, monocytes, platelets, PLR, NLR, LMR, CLR CRP/ALB ratios, gender, American Society of Anesthesiologists, Charlson Comorbidity Index, delirium, infections, repeated surgeries, and type of anesthesia were evaluated preoperatively and on the post-operative 2nd and 5th days and 1 month. RESULTS A total of 165 patients with the mean age of 83.09±8.52 years who met the inclusion criteria were studied. The pre-op-erative means of CRP, neutrophil count, CLR ratio, and CRP/ALB ratio were statistically significantly higher in Group E than in Group S (p=0.016, p=0.023, p=0.035, and p=0.044, respectively). The univariate regression analysis showed that age, pre-operative Hb level, CRP, and CRP/ALB ratio were significant predictors of the 1-month mortality (ß=-0.335, p=0.049; ß=0.411, p=0.028; ß=3.632, p=0.007; and ß=-3.280, p=0.008; respectively). When we performed the ROC curve analysis, the CRP/ALB ratio had the highest AUC, with the highest sensitivity and specificity. The cutoff value of CRP/ALB ratio was found to be 12.42. CONCLUSION We found that the pre-operative CRP/ALB ratio is an important parameter for predicting the first 30-day mortality in elderly patients with intertrochanteric femur fractures. For this reason, we recommend that CRP and albumin be checked in prepa-ration for routine pre-operative anesthesia.
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Affiliation(s)
- Orhan Balta
- Department of Orthopaedics and Traumatology, Gaziosmanpaşa University Faculty of Medicine Hospital, Tokat-Turkey
| | - Harun Altınayak
- Department of Orthopedics and Traumatology, Health Sciences University, Samsun Training and Research Hospital, Samsun-Turkey
| | - Mehtap Gürler Balta
- Department of Anesthesiology and Reanimation, Tokat Gaziosmanpaşa University Faculty of Medicine, Tokat-Turkey
| | - Sezer Astan
- Department of Orthopedics and Traumatology, Tokat State Hospital, Tokat-Turkey
| | - Cihan Uçar
- Department of Orthopedics and Traumatology, Trabzon Training and Research Hospital, Trabzon-Turkey
| | - Recep Kurnaz
- Department of Orthopaedics and Traumatology, Acıbadem State Hospital, Eskişehir-Turkey
| | - Eyüp Çağatay Zengin
- Department of Orthopaedics and Traumatology, Gaziosmanpaşa University Faculty of Medicine Hospital, Tokat-Turkey
| | - Mehmet Burtaç Eren
- Department of Orthopaedics and Traumatology, Gaziosmanpaşa University Faculty of Medicine Hospital, Tokat-Turkey
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Oosterhoff JHF, Savelberg ABMC, Karhade AV, Gravesteijn BY, Doornberg JN, Schwab JH, Heng M. Development and internal validation of a clinical prediction model using machine learning algorithms for 90 day and 2 year mortality in femoral neck fracture patients aged 65 years or above. Eur J Trauma Emerg Surg 2022; 48:4669-4682. [DOI: 10.1007/s00068-022-01981-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/16/2022] [Indexed: 12/01/2022]
Abstract
Abstract
Purpose
Preoperative prediction of mortality in femoral neck fracture patients aged 65 years or above may be valuable in the treatment decision-making. A preoperative clinical prediction model can aid surgeons and patients in the shared decision-making process, and optimize care for elderly femoral neck fracture patients. This study aimed to develop and internally validate a clinical prediction model using machine learning (ML) algorithms for 90 day and 2 year mortality in femoral neck fracture patients aged 65 years or above.
Methods
A retrospective cohort study at two trauma level I centers and three (non-level I) community hospitals was conducted to identify patients undergoing surgical fixation for a femoral neck fracture. Five different ML algorithms were developed and internally validated and assessed by discrimination, calibration, Brier score and decision curve analysis.
Results
In total, 2478 patients were included with 90 day and 2 year mortality rates of 9.1% (n = 225) and 23.5% (n = 582) respectively. The models included patient characteristics, comorbidities and laboratory values. The stochastic gradient boosting algorithm had the best performance for 90 day mortality prediction, with good discrimination (c-statistic = 0.74), calibration (intercept = − 0.05, slope = 1.11) and Brier score (0.078). The elastic-net penalized logistic regression algorithm had the best performance for 2 year mortality prediction, with good discrimination (c-statistic = 0.70), calibration (intercept = − 0.03, slope = 0.89) and Brier score (0.16). The models were incorporated into a freely available web-based application, including individual patient explanations for interpretation of the model to understand the reasoning how the model made a certain prediction: https://sorg-apps.shinyapps.io/hipfracturemortality/
Conclusions
The clinical prediction models show promise in estimating mortality prediction in elderly femoral neck fracture patients. External and prospective validation of the models may improve surgeon ability when faced with the treatment decision-making.
Level of evidence
Prognostic Level II.
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22
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von Dercks N, Hepp P, Theopold J, Henkelmann R, Häckl D, Kossack N. Health Care for Inpatients with a Proximal Humeral Fracture - an Analysis of Health Insurance Data. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022. [PMID: 35235973 DOI: 10.1055/a-1716-2218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The proximal humeral fracture is one of the most common fractures in the elderly. While epidemiological factors have been well studied, the influence of a proximal humeral fracture on morbidity, mortality and associated costs has not yet been adequately analysed. METHOD On a basis of 4.1 million insurance holders of the German public health insurance (GKV), patients with (study population, SP) and without (comparison group, VG) a proximal humeral fracture (pHF) were compared with regard to comorbidity, rehospitalisation, mortality, drug and aid needs as well as number of physician contacts. Study period was between 2012 and 2016. RESULTS 6068 patients of the SP met the inclusion and exclusion criteria (age 69.4 ± 14.3 years; male : female = 28.2% : 71.8%). 4781 patients (78.8%) received surgical, 1287 patients (21.2%) conservative treatment of the pHF. Rehospitalisations and visits to the general practitioner occurred more frequently in the SP vs. VG (p < 0.01). Contacts with specialists after pHF varied according to specialty, as did newly occurring diseases. Typical specialities for preventive examinations were significantly less common (gynaecology p < 0.01, pathology p < 0.01, dermatology p < 0.01). According to pHF, the costs of SP for drugs (2490.76 ± 1395.51 € vs. 2167.86 ± 1314.43 €; p = 0.04), medical therapies (867.01 ± 238.67 € vs. 393.26 ± 217.55 €; p < 0.01) and aids (821.02 ± 415.73 € vs. 513.52 ± 368.76 €; p < 0.01) were significantly above the VG. The two-year survival after pHF is lower in the SP than in the VG (p < 0.01). DISCUSSION The results show increased morbidity and mortality as well as medical costs after a proximal humeral fracture. Preventive examinations and treatments are rarer. In the future, care concepts for patients with proximal humeral fractures should not only be optimised with regard to functional scores and reduced complication rates, but also with regard to quality of life and preservation of general health.
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Affiliation(s)
| | - Pierre Hepp
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Jan Theopold
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Ralf Henkelmann
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
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Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study. BMJ Open 2021; 11:e050830. [PMID: 34848515 PMCID: PMC8634634 DOI: 10.1136/bmjopen-2021-050830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/27/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis. SETTING Prospective, international, multicentre, observational cohort study. PARTICIPANTS Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative). PRIMARY OUTCOME 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality. RESULTS This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787). CONCLUSIONS Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups. TRIAL REGISTRATION NUMBER NCT04323644.
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