Characteristics of Elderly Hip Fracture Patients in Jordan: A Multicenter Epidemiological Study

Red blood cell distribution width is a short-term mortality predictor in middle-aged and older adults with hip fracture

OBJECTIVE

To study the relationship between red blood cell distribution width (RDW) and short-term mortality of hip fracture in middle-aged and older adults.

METHODS

A retrospective cohort of electronic medical records at a single hospital over a 2-year period between 2020 and 2021. We received the records of 233 patients aged > 50 years who suffered from hip fracture. the clinical data including patients demographics, comorbidities at the time of admission, type of surgery, blood examination, 3-months mortality, 6-months mortality and 1-year mortality. the relationship between RDW and short-term mortality of hip fracture were analyzed. the cohort was then divided into two groups based on their RDW levels at the time of admission: low (RDW < 13.6%) and high (RDW ≥ 13.6%).

RESULTS

Results the mean age was 78.03 ± 12.09 years; 64.81% were woman. At admission, 80 patients (34.33%) had high RDW levels and 153 patients (65.67%) had low RDW levels. there were no statistically significant differences between the groups with regard to sex, type of operation, duration of surgery and hospitalization length. Patients with high RDW had more comorbidities when compared to patients with low RDW levels (p < 0.05). All-cause mortality was higher for patients with high RDW levels, at 3 months (p < 0.05), 6 months (p < 0.05), and 12 months (p < 0.05).

CONCLUSION

RDW is significantly related with short-term mortality in hip fracture. The higher RDW, the higher risk of mortality.

Intra-operative blood transfusions raise the risk of postoperative delirium and impede functional recovery in elderly hip fracture patients: a propensity score-matched study

BACKGROUND

This retrospective analysis was performed to investigate the potential influence of intra-operative blood transfusion (IBT) in patients aged 65 years or older with intertrochanteric fractures (IF) who underwent intramedullary fixation.

METHODS

The outcomes of interest included the incidence of postoperative delirium (POD), pain score at discharge, length of hospital stay (LOS), functional outcomes, and mortality. The study included all surgically treated patients with IF between Jan. 2018 and Dec. 2021. Data on patient demographics, injury-related factors, surgical procedures, intraoperative details, in-hospital information, and postoperative outcomes were collected. In order to mitigate potential confounding and selection bias, the researchers employed the propensity score matching (PSM) technique using a 1:1 ratio via the caliper matching method. Following PSM, the association between IBT and outcome analyses was assessed using McNemar's Chi-square tests. Additionally, the Spearman correlations between IBT, POD and postoperative functional outcomes were computed.

RESULTS

Out of the initial 2159 consecutive patients screened, a final sample of 1681 individuals was included, consisting of 1278 in the non-IBT group and 403 in the IBT group. After PSM, each group comprised 298 participants. The disparities in POD rate and functional outcomes became significant after employing propensity score-based matching (P < 0.001 and 0.029, respectively), despite their lack of significance prior to matching. There were no notable distinctions observed in other operation-related data, LOS, and crude mortality rates at 30-day, 90-day, and 12-month intervals before and after PSM. Furthermore, incidence of POD (P = 0.006) and functional outcomes (P = 0.013) were significantly associated with IBT.

CONCLUSION

In conclusion, IBT significantly increases the incidence of POD and hinders postoperative functional recovery in elderly patients with hip fracture.

Prevalence and Risk Factors of Hip Fracture at Tertiary Hospital in Mogadishu, Somalia

Purpose

This study aims to determine the frequency of hip fractures and associated risk factors among patients receiving care at the Somalia Turkish Training and Research Hospital in Mogadishu.

Patients and Methods

A retrospective study of patients treated at the Somalia Turkish Training and Research Hospital in Mogadishu was carried out. 96 of the 108 patients who were admitted met the inclusion criteria. Analyzing the medical records of individuals diagnosed with hip fractures between January and December 2023 allowed for the collection of data on demographics, hip fracture type, and medical history and also conducted follow-ups to identify other potential contributing factors that may not be available in medical records. The main conclusions have been established using descriptive statistical analysis.

Results

About 8.67% of all fracture cases were hip fractures, Elderly people (60+) represented the largest group at 64.6%, followed by younger people (17-39) and Middle-aged people (40-59) at 15.6%, and children (3-16) at 4.2%. Females comprised 56.3% of cases, while males made up 43.8%. Most patients (78.1%) had low physical activity. Falls were the primary cause of fractures (83.3%), followed by other traumas (13.5%), and pathological fractures (7.3%). 32.3% of patients had comorbidities, 8.3% had a family history, and 22.9% had prior fractures. The most prevalent hip fractures (81.3%) were those of the femur neck, followed by subtrochanteric and intertrochanteric fractures (10.4% and 8.3%, respectively).

Conclusion

This study emphasizes the frequency of hip fractures in Mogadishu, Somalia, as well as the significance of fall prevention, age, gender, and comorbidity treatment. We suggest comprehensive risk assessments, gender-specific bone health programs, fall prevention programs, focused prevention for the elderly, and public education campaigns to reduce the burden of hip fractures and encourage healthier people in our community by putting these measures into practice.

Impact of the American Society of Anesthesiologists (ASA) classification on hip fracture surgery outcomes: insights from a retrospective analysis

BACKGROUND

The American Society of Anesthesiologists (ASA) classification is the most used system to assess patient health status before surgery, ranging from I to V levels. This study aims to explore the impact of different ASA risk classes (ASA II [mild risk] and ASA III [severe risk]) on clinical outcomes following hip fracture surgery, including all-cause mortality and postoperative complications.

METHODS

A retrospective analysis from 2019 to 2021 across three Jordanian centers was conducted. The study included patients aged 65 and above who underwent hip fracture repair surgeries. Preoperative measures, intraoperative management protocols, and postoperative care were collected. Clinical data were extracted from electronic medical records, including demographics, fracture type, intraoperative data, and postoperative outcomes.

RESULTS

The analysis included 1033 patients, with 501 (48.5%) in the mild anesthetic risk group (ASA I-II) and 532 (51.5%) in the severe anesthetic risk group (ASA III-V). The mean age was 73 years, with a higher prevalence of males in the severe risk group. Patients in the severe risk group had more comorbidities, higher ICU admissions (15.23% vs. 6.18%), longer hospital stays (median 7 vs. 6 days), and higher rates of postoperative thromboembolic complications (3.39% vs. 1.39%) compared to the mild risk group. Additionally, the severe risk group showed higher mortality rates both in-hospital mortality (3.38% vs. 1.39%) and all-cause mortality (16.92% vs. 10.36%). Multivariate analysis identified higher ASA score as independent risk factors for increased all-cause mortality (HR = 1.64 95%CI 1.51-2.34) and thromboembolic complications (OR = 2.85 95%CI 1.16-7). Length of hospital stay was significantly associated with higher ASA score (OR = 1.04 95%CI 0.96-1.11).

CONCLUSION

The study underscores the significant impact of anesthetic risk on the outcomes of hip fracture surgeries. Patients with higher ASA scores associated with severe systemic diseases may have at increased risk of adverse outcomes.

Postoperative pneumonia after femoral fracture surgery: an in-depth retrospective analysis

BACKGROUND

Femoral fractures significantly contribute to disability, predominantly in the elderly. Despite this, data on postoperative pneumonia following femoral fracture surgeries remains sparse. Our study sought to explore the incidence and impact of postoperative pneumonia on outcomes following such surgeries.

METHODS

A retrospective study analyzed femoral fracture patients hospitalized from 2016 to 2022. We scrutinized postoperative outcomes, including pneumonia, hospital stay duration, intensive care unit (ICU) admissions, and in-hospital mortality. We established stringent diagnostic criteria for postoperative pneumonia, incorporating both clinical signs and radiological evidence, excluding patients with prior infections or those discharged within 24 h post-surgery. Statistical analyses involved Chi-square and t-tests, linear regression, and logestic regression using SPSS.

RESULTS

Out of 636 patients, 10.8% were diagnosed with postoperative pneumonia. The average age was 79.55 ± 8.57 years, with a male prevalence of 47.8%. Common comorbidities were hypertension (78.3%), diabetes (60.9%), and cardiovascular diseases (40.6%). Surgical interventions were categorized as intramedullary nailing (40.6%), partial hip replacement (37.7%), and dynamic hip screw (21.7%). Postoperative pneumonia was associated with older age (AOR = 1.053, 95% CI 1.020 to 1.087, p = 0.002), ICU admission (AOR = 2.283, 95% CI 1.256 to 4.148, p = 0.007), and longer length of hospital stay (AOR = 1.079, 95% CI 1.030 to 1.130, p = 0.001). The presence of pneumonia was associated with a 2.621-day increase in hospitalization after adjusting for other variables (p < 0.001, 95% CI: 1.454 to 3.789).

CONCLUSION

This study accentuates the clinical significance of postoperative pneumonia in femoral fracture patients, with a noted incidence of 10.8%. A notable association with older age, prolonged hospital stays, and ICU admissions was observed, underscoring the necessity of addressing this complication to improve patient outcomes and healthcare resource allocation.

Clinical Characteristics of Spinal versus General Anaesthesia in Older Patients Undergoing Hip Fracture Repair Surgery in Jordan: A Multicentre Study

BACKGROUND

The primary aim of this study was to examine the clinical characteristics and outcomes of older patients who underwent hip fracture repair surgery. The secondary aims were to assess the predictors of the choice of spinal or general anaesthesia and to explore the risk factors for all-cause mortality.

METHODS

This three-tertiary centres study was conducted at a tertiary care centre in Jordan. Clinical data include previous fracture history; medication details; comorbidities; surgical approach; and postoperative pain management.

RESULTS

Overall, 1084 patients who underwent hip fracture repair were included in this study. The mean age of patients was 78 years, and 55.2% were women. Twenty-four were treated with bisphosphonates before the fracture, whereas 30 were in steroid therapy. Overall, 61.8% of patients underwent spinal anaesthesia, whereas 38.2% underwent general anaesthesia. Spinal anaesthesia group had a lower prevalence of cardiovascular accidents (16.3% vs. 22.3%, p = 0.014) and Alzheimer's (3.4% vs. 1.4%, p = 0.049) than the general anaesthesia group. In the spinal anaesthesia group, postoperative opioid administration (p = 0.025) and postoperative blood transfusion (p = 0.011) occurred more frequently than general anaesthesia group. In hospital, 30-day and all-cause mortality were comparable between both groups. Diabetes mellitus (HR = 2.6; 95%CI = 1.5-4.4; p = 0.001); cemented hip hemiarthroplasty (HR = 2.4; 95%CI = 1.1-5.1; p = 0.025); deep venous thrombosis/pulmonary embolism (HR = 5.0; 95%CI = 1.2-12.9; p = 0.001); and readmission within 1 month from surgery (HR = 3.6; 95%CI = 2.0-6.3; p < 0.001) were all significant predictors of mortality.

CONCLUSIONS

This study provides insights into the outcomes and factors associated with different anaesthesia types in hip fracture repair surgery. The anaesthesia type does not affect all-cause mortality in patients undergoing hip fracture repair.