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Gvozdenović N, Šarac I, Ćorić A, Karan S, Nikolić S, Ždrale I, Milešević J. Impact of Vitamin D Status and Nutrition on the Occurrence of Long Bone Fractures Due to Falls in Elderly Subjects in the Vojvodina Region of Serbia. Nutrients 2024; 16:2702. [PMID: 39203838 PMCID: PMC11356805 DOI: 10.3390/nu16162702] [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: 07/22/2024] [Revised: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
Bone fractures are a significant public health issue among elderly subjects. This study examines the impact of diet and vitamin D status on the risk of long bone fractures due to falls in elderly subjects in Vojvodina, Serbia. Conducted at the University Clinical Center of Vojvodina in autumn/winter 2022-2023, the study included 210 subjects >65 years: 105 (F: 80/M: 15) with long bone fractures due to falls and 105 (F: 80/M: 15) controls. Groups were similar regarding age and BMI. Dietary intakes (by two 24-h recalls) and serum vitamin D levels were analyzed. The fracture group had a significantly lower median daily vitamin D intake (1.4 μg/day vs. 5.8 μg/day), intake of calcium, energy, proteins, fats, fibers, dairy products, eggs, fish, edible fats/oils, and a higher intake of sweets (p < 0.001 for all). Serum vitamin D levels were significantly lower in the fracture group (40.0 nmol/L vs. 76.0 nmol/L, p < 0.001). Logistic regression identified serum vitamin D as the most important protective factor against fractures, and ROC curve analysis indicated that serum vitamin D levels > 50.5 nmol/L decreased fracture risk. Nutritional improvements (increased intake of vitamin D and protein sources such as fish, eggs, and dairy), increased sun exposure, and routine vitamin D supplementation during winter are advised.
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Affiliation(s)
- Nemanja Gvozdenović
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Ivana Šarac
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11129 Belgrade, Serbia;
| | - Andrijana Ćorić
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
| | - Saša Karan
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Stanislava Nikolić
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
- Center of Laboratory Medicine, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Isidora Ždrale
- Faculty of Medicine, University of Novi Sad, 21137 Novi Sad, Serbia; (N.G.); (A.Ć.); (S.K.); (S.N.); (I.Ž.)
| | - Jelena Milešević
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11129 Belgrade, Serbia;
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Barthold D, Li J, Basu A. Patient Out-of-Pocket Costs for Type 2 Diabetes Medications When Aging Into Medicare. JAMA Netw Open 2024; 7:e2420724. [PMID: 38980673 PMCID: PMC11234236 DOI: 10.1001/jamanetworkopen.2024.20724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/06/2024] [Indexed: 07/10/2024] Open
Abstract
Importance For people with type 2 diabetes (T2D), out-of-pocket medication costs may influence medication choice, adherence, and overall diabetes management and progression. Little is known about how these costs change as insured people enter Medicare at age 65 years, when coinsurance in the coverage gap and catastrophic phases of Part D coverage can be increased greatly by use of insulin and newer, branded medications (eg, dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 agonists, and sodium-glucose cotransporter 2 inhibitors). Objective To identify whether reaching age 65 years is associated with T2D medication out-of-pocket costs and utilization. Design, Setting, and Participants This retrospective cohort study (2012-2020) featuring 7 years of follow-up used prescription drug claims data from the TriNetX Diamond Network. Participants included people in the US with diagnosed T2D, and claims for T2D medications were observed both before and after age 65 years. Data analysis was performed from October 2022 to September 2023. Exposure Reaching age 65 years, according to participants' year of birth. Main Outcomes and Measures The primary outcome was patient out-of-pocket costs for T2D drugs per quarter (inflation adjusted to 2020 dollars). Utilization, measured as binary utilization of specific classes, and the number of claims for mutually exclusive classes and combinations of classes were also examined. All outcomes were examined using regression discontinuity design. Results In claims data for 129 997 individuals with T2D diagnosed at ages 58 to 72 years (mean [SD] age, 65.50 [2.95] years; 801 235 female [50.9%]), reaching age 65 years was associated with an increase of $23.04 (95% CI, $19.86-$26.22) in mean quarterly out-of-pocket costs for T2D drugs, and an increase of $56.36 (95% CI, $51.48-$61.23) at the 95th percentile of spending, after utilization adjustment. Utilization decreased by 5.3% at age 65 years, from 3.40 claims per quarter (95% CI, 3.38-3.42 claims per quarter) to 3.22 claims per quarter (95% CI, 3.21-3.24 claims per quarter), but a shift in composition of utilization, including increased insulin use, was associated with additional increases in patient costs. Conclusions and Relevance In this cohort study of individuals with T2D, the increase in spending upon reaching age 65 years (when most people enroll in Medicare) was associated with patient coinsurance in the coverage gap and catastrophic coverage phases of Medicare Part D. The increased patient cost burden at age 65 years and a modest reduction in overall T2D drug utilization suggest that as people with T2D age into Medicare, there is potentially an increase in nonadherence and diabetes complications.
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Affiliation(s)
- Douglas Barthold
- The Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle
| | - Jing Li
- The Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle
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Nathe K, Bakaes Y, Giakas AM, Kung J, Gauthier C, Grabowski G, Smoker B, Boguski J, Toole W, Elliott M, Van Eck CF, Bowman E, Townsend C, Jackson JB. Open Ankle Fractures in Older Individuals: A Multi-center Study. J Foot Ankle Surg 2024:S1067-2516(24)00136-4. [PMID: 38909963 DOI: 10.1053/j.jfas.2024.06.001] [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: 09/28/2023] [Revised: 05/06/2024] [Accepted: 06/08/2024] [Indexed: 06/25/2024]
Abstract
The purpose of this study is to identify demographics, etiology, comorbidities, treatment, complications, and outcomes for older patients with open ankle fractures. Patients ≥60 years old who sustained an open ankle fracture between January 1, 2004 and March 31, 2014 at 6 Level 1 trauma centers were retrospectively reviewed. Univariate analysis using chi-squared or Student's t test was performed to identify associations between preoperative variables and 2 postoperative outcomes of interest: amputation and 1-year mortality. Multivariate analysis was performed using stepwise logistical regression to identify independent predictors of postoperative amputation and 1-year mortality. Of the 162 total patients, the most common mechanism of injury was a ground-level fall (51.9%). The most common fracture types were bimalleolar fractures (52.5%) followed by trimalleolar fractures (26.5%), with 41.5% of the fractures classified as Gustilo Anderson Classification Type 2 and 38.6% classified as Type 3A. The average number of surgeries required per patient was 2.1. Complications included: 15.4% superficial infection rate, 9.9% deep infection rate, and 9.3% amputation rate. The 1-year mortality rate was 13.6% and the overall mortality rate was 25.9%. Male gender and fracture type were found to be independent predictors for amputation after surgery (p = .009, .005, respectively). Older age and having diabetes were independent predictors for 1-year mortality after surgery (p = .021, .005 respectively). Overall, open ankle fractures in older individuals were associated with high rates of amputation and mortality.
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Affiliation(s)
- Kristen Nathe
- Prisma Health Midlands Department of Orthopaedic Surgery, Columbia, SC
| | - Yianni Bakaes
- University of South Carolina School of Medicine Columbia, Columbia, SC.
| | - Alec M Giakas
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Justin Kung
- Prisma Health Midlands Department of Orthopaedic Surgery, Columbia, SC
| | - Chase Gauthier
- Prisma Health Midlands Department of Orthopaedic Surgery, Columbia, SC
| | - Gregory Grabowski
- Prisma Health Midlands Department of Orthopaedic Surgery, Columbia, SC
| | - Brice Smoker
- University of South Carolina School of Medicine Columbia, Columbia, SC
| | | | - William Toole
- University of Florida College of Medicine, Jacksonville, FL
| | - Mark Elliott
- University of Florida College of Medicine, Jacksonville, FL
| | | | - Erik Bowman
- University of Nebraska Medical Center, Omaha, NE
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Seong H, Resnick B, Holmes S, Galik E, Breman RB, Fortinsky RH, Zhu S. Exploring Factors Associated With Resilience and Physical Activity in Older Men and Women Post-Hip Fracture. J Appl Gerontol 2024; 43:627-637. [PMID: 38105620 DOI: 10.1177/07334648231221640] [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] [Indexed: 12/19/2023] Open
Abstract
This study aimed to test a model of factors associated with resilience and physical activity post-hip fracture and compare model fit between men and women. We used data from the seventh Baltimore Hip Study that included 339 participants. Model testing indicated that health status (men: β = .237, p = .002; women: β = .265, p = <.001), depression (men: β = -.245, p = .001; women: β = -.241, p = <.001), and optimism (men: β = .320, p = <.001; women: β = .282, p = <.001) were associated with resilience in men and women, but resilience was only associated with physical activity in men (β = .203, p = .038) and not in women. Social interaction was related to physical activity only among women (β = .206, p = .044). This study provides support for the relationship between resilience and physical activity at least among men.
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Affiliation(s)
| | | | | | | | | | | | - Shijun Zhu
- University of Maryland, Baltimore, MD, USA
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Liu XS, Nie R, Duan AW, Yang L, Li X, Zhang LT, Guo GK, Guo QS, Zhao DC, Li Y, Zhang HH. YOLOX-SwinT algorithm improves the accuracy of AO/OTA classification of intertrochanteric fractures by orthopedic trauma surgeons. Chin J Traumatol 2024:S1008-1275(24)00051-8. [PMID: 38762418 DOI: 10.1016/j.cjtee.2024.04.002] [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: 11/10/2023] [Revised: 03/18/2024] [Accepted: 04/09/2024] [Indexed: 05/20/2024] Open
Abstract
PURPOSE Intertrochanteric fracture (ITF) classification is crucial for surgical decision-making. However, orthopedic trauma surgeons have shown lower accuracy in ITF classification than expected. The objective of this study was to utilize an artificial intelligence (AI) method to improve the accuracy of ITF classification. METHODS We trained a network called YOLOX-SwinT, which is based on the You Only Look Once X (YOLOX) object detection network with Swin Transformer (SwinT) as the backbone architecture, using 762 radiographic ITF examinations as the training set. Subsequently, we recruited 5 senior orthopedic trauma surgeons (SOTS) and 5 junior orthopedic trauma surgeons (JOTS) to classify the 85 original images in the test set, as well as the images with the prediction results of the network model in sequence. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) 20.0 (IBM Corp., Armonk, NY, USA) to compare the differences among the SOTS, JOTS, SOTS + AI, JOTS + AI, SOTS + JOTS, and SOTS + JOTS + AI groups. All images were classified according to the AO/OTA 2018 classification system by 2 experienced trauma surgeons and verified by another expert in this field. Based on the actual clinical needs, after discussion, we integrated 8 subgroups into 5 new subgroups, and the dataset was divided into training, validation, and test sets by the ratio of 8:1:1. RESULTS The mean average precision at the intersection over union (IoU) of 0.5 (mAP50) for subgroup detection reached 90.29%. The classification accuracy values of SOTS, JOTS, SOTS + AI, and JOTS + AI groups were 56.24% ± 4.02%, 35.29% ± 18.07%, 79.53% ± 7.14%, and 71.53% ± 5.22%, respectively. The paired t-test results showed that the difference between the SOTS and SOTS + AI groups was statistically significant, as well as the difference between the JOTS and JOTS + AI groups, and the SOTS + JOTS and SOTS + JOTS + AI groups. Moreover, the difference between the SOTS + JOTS and SOTS + JOTS + AI groups in each subgroup was statistically significant, with all p < 0.05. The independent samples t-test results showed that the difference between the SOTS and JOTS groups was statistically significant, while the difference between the SOTS + AI and JOTS + AI groups was not statistically significant. With the assistance of AI, the subgroup classification accuracy of both SOTS and JOTS was significantly improved, and JOTS achieved the same level as SOTS. CONCLUSION In conclusion, the YOLOX-SwinT network algorithm enhances the accuracy of AO/OTA subgroups classification of ITF by orthopedic trauma surgeons.
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Affiliation(s)
- Xue-Si Liu
- Department of Medical Engineering, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Rui Nie
- Department of Medical Engineering, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Ao-Wen Duan
- Department of Medical Engineering, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Li Yang
- Department of Medical Engineering, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Xiang Li
- Department of Information, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Le-Tian Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Guang-Kuo Guo
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Qing-Shan Guo
- Division of Trauma and War Injury, Daping Hospital, Army Medical University of PLA, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing, 400042, China
| | - Dong-Chu Zhao
- Division of Trauma and War Injury, Daping Hospital, Army Medical University of PLA, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing, 400042, China
| | - Yang Li
- Division of Trauma and War Injury, Daping Hospital, Army Medical University of PLA, State Key Laboratory of Trauma and Chemical Poisoning, Chongqing, 400042, China.
| | - He-Hua Zhang
- Department of Medical Engineering, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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Burke CA, Nitti VW, Stothers L. Melatonin and melatonin receptor agonists in the treatment of nocturia: A systematic review. Neurourol Urodyn 2024; 43:826-839. [PMID: 38456646 DOI: 10.1002/nau.25443] [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: 12/08/2023] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
AIM Causes of nocturia may extend beyond primary bladder pathology and it has been commonly associated as a side effect of sleep disorders. This has led to the study of melatonin and melatonin receptor agonists as a primary treatment for nocturia hypothesized to be secondary to sleep disorders. We aim to systematically review the efficacy and reported safety of melatonin and melatonin receptor agonists in the treatment of nocturia. METHODS A search strategy of EMBASE and Pubmed/Medline databases was utilized to identify eligible studies. Two thousand and twenty-eight unique references were identified in concordance with the Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines for systematic reviews, of which nine papers met the inclusion criteria. The Cochrane Collaboration risk of bias criteria in the open label and nonplacebo studies was used to assess bias. RESULTS The nine studies identified included 3 randomized double-blinded placebo-controlled trials, 2 randomized non-placebo trial, and 4 prospective open-label trials. Three utilized the melatonin-receptor agonist ramelteon (8 mg) and six utilized melatonin (four 2 mg extended release, two 2 mg normal release). Nocturia improved in 8 studies varying from moderate to low efficacy related to reduction in nocturia episodes. Five studies evaluated sleep parameters finding improvement in both nocturia and sleep quality. Male subjects represented 76.8% of 371 total subjects in prospective and randomized trials. Ramelteon and melatonin were both reported as well tolerated during nocturia treatment. A meta-analysis was not able to be performed due to the heterogeneity of bladder diagnoses. CONCLUSIONS At this time, there is insufficient evidence to routinely recommend melatonin as an effective treatment for nocturia given the limitations of current clinical studies. Randomized placebo-controlled trials and prospective open label studies in non-neurogenic populations report a trend towards nocturia improvement with good tolerability and rare side effects. Therefore, further larger scale randomized trials with focused urologic diagnoses in well-characterized patient populations are warranted.
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Affiliation(s)
- Christine Anh Burke
- Departments of Urology and Gynecology, Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine, Los Angeles, California, USA
| | - Victor W Nitti
- Departments of Urology and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Lynn Stothers
- Departments of Urology and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Jung B, Ngan A, Trent S, Katz A, Virk S, Essig D. A National Database Retrospective Review of Short-Term Postoperative Mortality in the Geriatric Population: A Comparison Between Emergency Spine Fractures and Hip Fractures. Cureus 2024; 16:e55038. [PMID: 38420294 PMCID: PMC10901040 DOI: 10.7759/cureus.55038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Mortality rates following emergency spine fracture surgery are high, especially in the elderly. However, how the postoperative mortality rate following spine fractures compares to other geriatric fractures such as hip fractures remains unclear. Therefore, this retrospective cohort study aimed to compare 30-day mortality rates and risk factors between emergency spine fracture versus hip fracture surgery in the elderly. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried between 2011 and 2021 for emergency spine fractures and hip fractures in the elderly. Univariate analyses evaluated demographic data, perioperative factors, comorbidities, and 30-day mortality rates as the primary outcomes. A multivariable regression model was then constructed to control for significant baseline and demographic differences and evaluate independent predictors of mortality. RESULTS A total of 18,287 emergency hip fractures and 192 emergency spine fractures were included in our study. Univariate analysis demonstrated significant differences in female sex, body mass index (BMI), operation time, length of hospital stays, disseminated cancer, and functional dependence between spine and hip fractures. Thirty-day mortality rates were significantly higher in spine versus hip fractures (9.4% vs. 5%). Multivariate regression analysis demonstrated emergent spine fracture surgery, disseminated cancer, functional dependence, and length of stay as independent predictors of mortality in our cohort. Female sex, BMI, and operation time were protective factors for mortality in our cohort. CONCLUSIONS Emergency spine fractures in the elderly represent an independent predictor for 30-day postoperative mortality compared to emergency hip fractures. Disseminated cancer, functional dependence, and length of stay were independent predictors of mortality while female sex, BMI, and operation time were protective factors. These data demonstrate the severity of injury and high rates of mortality that clinicians can use to counsel patients and their families.
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Affiliation(s)
- Bongseok Jung
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | - Alex Ngan
- Orthopedics, Northwell Health, Manhasset, USA
| | - Sarah Trent
- Orthopedics, Northwell Health, Manhasset, USA
| | - Austen Katz
- Orthopedic Surgery, Northwell Health, Hempstead, USA
| | - Sohrab Virk
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
| | - David Essig
- Orthopedic Spine Surgery, Northwell Health, Manhasset, USA
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Ilic I, Ristic B, Stojadinovic I, Ilic M. Epidemiology of Hip Fractures Due to Falls. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1528. [PMID: 37763647 PMCID: PMC10533163 DOI: 10.3390/medicina59091528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: The epidemiological pattern of the hip fracture burden attributable to falls in Central European countries is still insufficiently known. The aim of this study was to assess the regional and national trends of hip fractures due to falls in Central Europe from 1990 to 2019. Materials and Methods: Using the Global Burden of Disease (GBD) 2019 study, this descriptive epidemiological study presents trends in incidence of and Years Lived with Disability (YLDs) from hip fractures due to falls in the region of Central Europe. All estimates (age- and sex-specific rates, and age-standardized rates) were expressed per 100,000. A joinpoint regression analysis was used to assess trends: the average annual percent change (AAPC) with a corresponding 95% confidence interval (95% CI) was calculated. Results: Among all new cases of hip fracture in the population as a whole in Central Europe in 2019, 3.9% in males and 7.0% in females were attributable to falls, while the share of hip fractures due to falls in the population aged 70 and over was 16.9% in males and 20.0% in females. About 400,000 new cases of hip fracture due to falls occurred in the Central European region in 2019 (220,000 among males and 160,000 among females), resulting in 55,000 YLDs (32,000 in females and 22,000 in males). About one-third of all new cases (59,326 in males and 72,790 in females) and YLDs (8585 in males, and 10,622 in females) of hip fractures due to falls were recorded in Poland. From 1990 to 2019, the age-standardized incidence rates of hip fracture due to falls showed a decreasing tendency in females (AAPC = -1.1%), and an increasing tendency in males (AAPC = 0.1%). Both in males and females, YLDs rates of hip fracture due to falls in the Central European region decreased (AAPC = -1.6% and AAPC = -2.4%, respectively). Conclusions: Hip fracture due to falls represents an important health issue in the Central European region, although incidences and YLDs declined in the most recent decades. However, further efforts to reduce the burden of hip fractures attributed to falls are needed.
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Affiliation(s)
- Irena Ilic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Branko Ristic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Department of Traumatology, Clinic for Orthopedics and Traumatology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Ivan Stojadinovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Department of Spinal Surgery, Clinic for Orthopedics and Traumatology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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Ferris H, Merron G, Coughlan T. 1 year mortality after hip fracture in an Irish urban trauma centre. BMC Musculoskelet Disord 2023; 24:487. [PMID: 37312089 DOI: 10.1186/s12891-023-06605-5] [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: 04/11/2023] [Accepted: 06/05/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Hip fracture accounts for a considerable burden of disease in older adults, yet there is a paucity of data pertaining to longer-term outcomes in the Irish Hip Fracture population. Understanding the factors that influence longer-term survival would allow care pathways to be refined to optimise patient outcomes. In Ireland, there is no linkage to death registration at a national or regional level, nor are longer-term outcomes captured by the Irish Hip Fracture Database. This study aimed to quantify 1-year mortality in an Irish hip fracture cohort and identify factors that influence survival at 1 year. METHODS A retrospective review of hip fracture cases in an Irish urban trauma centre over a 5-year period was conducted. Mortality status was obtained via the Inpatient Management System and correlated with the Irish Death Events Register. A range of routinely collected patient and care process variables were analysed using logistic regression. RESULTS A total of 833 patients were included. Within 1 year of sustaining a hip fracture, 20.5% (171/833) had died. On multivariate analysis, female gender (OR 0.36, p < 0.001, 95% CI 0.23-0.57), independent mobility pre-fracture (OR 0.24, p < 0.001, 95% CI 0.14-0.41) and early mobilisation on the day of or after surgery (OR 0.48, p < 0.001, 95% CI 0.30-0.77) reduced the likelihood of dying within 1 year (AUC 0.78). CONCLUSION Of the variables examined, early postoperative mobilisation was the only modifiable factor identified that conferred a longer-term survival benefit. This underscores the importance of adhering to international best practice standards for early postoperative mobilisation.
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Affiliation(s)
- Helena Ferris
- Department of Public Health, Health Service Executive - South, Cork, Ireland.
| | - Georgia Merron
- Department of Age-Related Health Care, Tallaght University Hospital, Dublin, Ireland
| | - Tara Coughlan
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
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Fenwick A, Pfann M, Mayr J, Antonovska I, Von der Helm F, Nuber S, Förch S, Mayr E. Concomitant fractures in patients with proximal femoral fractures lead to a prolonged hospital stay but not to increased complication rates or in-house mortality if treated surgically: a matched pair analysis. Aging Clin Exp Res 2023; 35:607-614. [PMID: 36694062 PMCID: PMC10014667 DOI: 10.1007/s40520-023-02348-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Impact of concomitant fractures on patients sustaining a proximal femur fracture remains unclear. Rising numbers and patient need for rehab is an important issue. The objective of our study was to investigate the impact of concomitant fractures, including all types of fractures, when treated operatively, for proximal femur fractures on the length of hospital stay, in-house mortality and complication rate. METHODS Observational retrospective cohort single-center study including 85 of 1933 patients (4.4%) with a mean age of 80.5 years, who were operatively treated for a proximal femoral and a concomitant fracture between January 2016 and June 2020. A matched pair analysis based on age, sex, fracture type and anticoagulants was performed. Patient data, length of hospital stay, complications and mortality were evaluated. RESULTS The most common fractures were osteoporosis-associated fractures of the distal forearm (n = 34) and the proximal humerus (n = 36). The group of concomitant fractures showed a higher CCI than the control group (5.87 vs. 5.7 points; p < 0.67). Patients with a concurrent fracture had a longer hospital stay than patients with an isolated hip fracture (15.68 vs. 13.72 days; p < 0.056). Complications occurred more often in the group treated only for the hip fracture (11.8%, N = 20), whilst only 7.1% of complications were recorded for concomitant fractures (p < 0.084). The in-house mortality rate was 2.4% and there was no difference between patients with or without a concomitant fracture. CONCLUSIONS A concomitant fracture to a hip fracture increases the length of hospital stay significantly but does not increase the complication rate or the in-house mortality. This might be due to the early mobilization, which is possible after early operative treatment of both fractures.
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Affiliation(s)
- Annabel Fenwick
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
| | - Michael Pfann
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Jakob Mayr
- Zentrum Für Unfallchirurgie Und Orthopädie, Klinikum Ingolstadt GmbH, Krumenauerstraße 25, 85049, Ingolstadt, Germany
| | - Iana Antonovska
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Franziska Von der Helm
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Stefan Nuber
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Stefan Förch
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Edgar Mayr
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
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