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Mant SJ, Amadi-Livingstone C, Ahmed MH, Panourgia M, Owles H, Pearce O. Orthogeriatric Care Following Hip Fracture: Improving Post-Operative Outcomes in an Aged Population. Life (Basel) 2024; 14:503. [PMID: 38672773 PMCID: PMC11050858 DOI: 10.3390/life14040503] [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: 02/27/2024] [Revised: 03/30/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Hip fractures globally are associated with high levels of morbidity, mortality, and significant financial burden. This audit aimed to assess the impact of orthogeriatric liaison care on post-operative outcomes following surgical management of neck or femur fractures. METHODS Here, 258 patients who underwent hip fracture surgery over 1-year were included. Data were collected as an audit following the transition to an orthogeriatric liaison care model, involving regular orthogeriatric review (thrice weekly ward rounds, daily board rounds), superseding orthogeriatric review as requested. The audit is meant to assess the development of post-operative non-surgical site infection (NSSI) and mortality and duration of inpatient stay. Outcomes were compared to previous data from our hospital site in 2015/2016. RESULTS Patients with severe cognitive impairment and systemic disease (Abbreviated Mental Test Score (AMTS) < 7 and American Society of Anesthesiologists (ASA) grade ≥ 3) showed significantly elevated NSSI risk, consistent across the study periods. Both periods demonstrated an increased risk of NSSI associated with admission from nursing homes. Despite the 2021/2022 cohort being notably older, NSSI risk decreased from 40.6% to 37.2% after implementing the orthogeriatric care model. NSSI risk was notably reduced for severe cognitive impairment (51.6% vs. 71%), and the p-value was 0.025. Average hospital stay decreased post-intervention (2.4 days shorter), with a notable reduction for NSSI patients (3.4 days shorter). Overall mortality rates were similar, although mortality due to infection was significantly reduced in 2021/2022 (44.4% vs. 93.3%), and the p-value was 0.003. CONCLUSION The orthogeriatric liaison care model significantly decreased NSSI only in individuals with severe cognitive impairment and infection-associated mortality. This highlights the integral role of orthogeriatricians in the care of elderly hip fracture patients.
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Affiliation(s)
- Sarah J. Mant
- The Medical School, University of Buckingham, Buckingham MK18 1EG, UK; (S.J.M.); (C.A.-L.)
| | | | - Mohamed H. Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK; (M.P.); (H.O.)
- Honorary senior lecturer. Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham MK18 1EG, UK
| | - Maria Panourgia
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK; (M.P.); (H.O.)
- Honorary senior lecturer. Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham MK18 1EG, UK
| | - Henry Owles
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK; (M.P.); (H.O.)
| | - Oliver Pearce
- Department of Trauma and Orthopedics, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK;
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Bermejo Boixareu C, Ojeda-Thies C, Guijarro Valtueña A, Cedeño Veloz BA, Gonzalo Lázaro M, Navarro Castellanos L, Queipo Matas R, Gómez Campelo P, Royuela Vicente A, González-Montalvo JI, Sáez-López P. Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures. Clin Interv Aging 2023; 18:441-451. [PMID: 36987460 PMCID: PMC10040167 DOI: 10.2147/cia.s386563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/19/2023] [Indexed: 03/30/2023] Open
Abstract
Objective The primary objective was to describe the clinical characteristics, management, and outcomes of centenarians with fragility hip fracture and compare them to other age groups. The secondary objective was to determine the variables associated with length of stay, in-hospital mortality and 30-day mortality. Materials and Methods This is a secondary analysis of the Spanish National Hip Fracture Registry. We included patients ≥75 years admitted for fragility hip fractures in 86 Spanish hospitals between 2017 and 2019, dividing the sample into four age groups. The variables studied were baseline characteristics, type of fracture, management, length of stay, in-hospital mortality and 30-day mortality. Results We included 25,938 patients (2888 were 75-79 years old; 14,762 octogenarians; 8,035 nonagenarians and 253 centenarians). Of the centenarians, 83% were women, 33% had severe dementia, 9% had severe dependency and 36% lived in residential care homes. Six out of ten had intertrochanteric fracture. Length of hospital stay was 8.6 days; in-hospital mortality was 10.3% and 30-day mortality 20.9%. Older age groups had more women, severe functional dependency, severe dementia, intertrochanteric fracture, living in care facilities and being discharged to nursing care. They had less frequent early mobilization, osteoporosis treatment and discharge to rehabilitation units. In-hospital and 30-day mortality were higher with increasing age. In centenarians, time to surgery >48 hours was independently associated with length of stay (correlation coefficient 3.99 [95% CI: 2.35-5.64; p<0.001]) and anaesthetic risk, based on an ASA score of V, was related to 30-day mortality (ASA score II [OR 0.25, 95% CI: 0.09-0.70; p=0.009] and ASA score III [OR 0.43, 95% CI: 0.19-0.96; p=0.039]). Conclusion Centenarians had different clinical characteristics, management and outcomes. Although centenarians had worse outcomes, nearly 4 out of 5 centenarians were alive one month after surgery.
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Affiliation(s)
- Cristina Bermejo Boixareu
- Geriatrics Department, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
- Correspondence: Cristina Bermejo Boixareu, Geriatrics Department, Puerta de Hierro University Hospital, Madrid, Spain, Email
| | - Cristina Ojeda-Thies
- Orthopaedic Surgery and Traumatology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Ainhoa Guijarro Valtueña
- Orthopaedic Surgery and Traumatology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | | | | | - Laura Navarro Castellanos
- La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
| | - Rocío Queipo Matas
- La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
- European University of Madrid, Madrid, Spain
| | - Paloma Gómez Campelo
- La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Royuela Vicente
- Biostatistics Unit, Puerta de Hierro Majadahonda University Hospital, IDIPHISA, CIBERESP, Madrid, Spain
| | - Juan Ignacio González-Montalvo
- La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
- Geriatrics Department, La Paz University Hospital, Madrid, Spain
| | - Pilar Sáez-López
- La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
- Geriatrics Department, Fundación Alcorcón University Hospital, Madrid, Spain
- Spanish National Hip Fracture Registry, Madrid, Spain
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Modifiable factors associated with postoperative atrial fibrillation in older patients with hip fracture in an orthogeriatric care pathway: a nested case–control study. BMC Geriatr 2022; 22:845. [DOI: 10.1186/s12877-022-03556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Few data are available regarding post-operative atrial fibrillation (POAF) in non-cardiothoracic surgery, particularly orthopedic surgery. Hence, given the frequent incidence of POAF after surgery and its marked impact, we need to identify modifiable factors associated with POAF after hip fracture surgery in older patients.
Methods
We conducted a nested case–control study in the unit for perioperative geriatric care of an academic hospital in Paris from July 1, 2009 to December 31, 2019, enrolling all consecutive patients aged ≥ 70 years with hip fracture surgery and no history of permanent AF before admission (retrospective analysis of prospectively collected data). Patients with and without POAF were matched 1:5 on 5 baseline characteristics (age, hypertension, diabetes, coronary artery disease, cardiac failure).
Results
Of the 757 patients included, 384 were matched, and 64 had POAF. The incidence of POAF was 8.5%. The mean age was 86 ± 6 years, 298 (78%) patients were female, and the median Charlson Comorbidity Index was 6 (interquartile range 4–8). The median time from surgery to the occurrence of POAF was 2 days (1–4). On multivariable conditional logistic regression analysis (matched cohort), the modifiable factors present at admission associated with POAF were time to surgery > 48 h (odds ratio [OR] = 1.66, 95% confidence interval [1.01–2.81]) and > 2 units of packed red blood cells (OR = 3.94, [1.50–10.03]).
Conclusions
This study provides new information about POAF in older patients with hip fracture surgery, a surgical emergency whose complexity requires multidisciplinary care.
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The effects of dementia on the prognosis and mortality of hip fracture surgery: a systematic review and meta-analysis. Aging Clin Exp Res 2021; 33:3161-3172. [PMID: 33913118 DOI: 10.1007/s40520-021-01864-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Dementia is a common mental disorder that affects the life quality in elders. Recently, emerging studies reported the negative impacts of dementia on prognosis after hip surgeries. However, the integrated and reliable role of dementia in hip surgery is not illustrated. METHODS We searched the relevant literatures before June 2020 and extracted the data that met the inclusion criteria. The influence of dementia on postoperative walking ability, complications including infection, cardiovascular complications, hip dislocation, delirium, and respiratory complications, and survival rate at different periods were evaluated. Qualitative and quantitative analysis were conducted using Review Manager Version 5.3. RESULTS The meta-analysis enrolled a total of 30 studies with 1,037,049 patients. The pooled results revealed that there were significant negative impacts of dementia on the recovery of postoperative walking ability, postoperative infection, hip dislocation, delirium and respiratory complications and mortality at different periods. CONCLUSIONS Dementia is a crucial risk factor for the poor prognosis after hip fracture surgery. Therefore, when making clinical strategies for hip fracture patients with dementia, countermeasures for possible complications should be generated.
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Genet B, Lamy T, Cohen-Bittan J, Glasman P, Verny M, Riou B, Boddaert J, Zerah L. Lack of Association Between Perioperative Medication and Postoperative Delirium in Hip Fracture Patients in an Orthogeriatric Care Pathway. J Am Med Dir Assoc 2021; 23:623-630.e2. [PMID: 34653382 DOI: 10.1016/j.jamda.2021.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/07/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Units for perioperative geriatric care are playing a growing role in the care of older patients after hip fracture surgery. Postoperative delirium is one of the most common complications after hip fracture, but no study has assessed the impact of therapeutics received during a dedicated orthogeriatric care pathway on its incidence. Our main objective was to assess the association between drugs used in emergency, operating, and recovery departments and postoperative delirium during the acute stay. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS All patients ≥70 years old admitted for hip fracture to the emergency department and hospitalized in our unit for perioperative geriatric care after hip fracture surgery under general anesthesia between July 2009 and December 2019 in an academic hospital in Paris. METHODS Demographic, clinical, and biological data and all medications administered pre-, peri-, and postoperatively were prospectively collected by 3 geriatricians. Postoperative delirium in the unit for perioperative geriatric care was assessed by using the confusion assessment method scale. Logistic regression analysis was used to assess variables independently associated with postoperative delirium. RESULTS A total of 490 patients were included [mean (SD) age 87 (6) years]; 215 (44%) had postoperative delirium. The occurrence was not associated with therapeutics administered during the dedicated orthogeriatric care pathway. Probability of postoperative delirium was associated with advanced age [>90 years, odds ratio (OR) 2.03, 95% confidence interval (CI) 1.07-3.89], dementia (OR 3.51, 95% CI 2.14--5.82), depression (OR 1.85, 95% CI 1.14-3.01), and preoperative use of beta-blockers (OR 1.75, 95% CI 1.10-2.79). CONCLUSIONS AND IMPLICATIONS No emergency or anesthetic drugs were significantly associated with postoperative delirium. Further studies are needed to demonstrate a possible causal link between preoperative use of beta-blockers and postoperative delirium.
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Affiliation(s)
- Bastien Genet
- Department of Geriatric Medicine, Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France.
| | - Tina Lamy
- Department of Geriatric Medicine, Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France
| | - Judith Cohen-Bittan
- Department of Geriatric Medicine, Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France
| | - Pauline Glasman
- Department of Anesthesiology and Critical Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France
| | - Marc Verny
- Department of Geriatric Medicine, Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France; Team Neuronal Cell Biology and Pathology, Sorbonne Université, UMR CNRS 8256, Paris, France
| | - Bruno Riou
- Department of Emergency Medicine and Surgery, Sorbonne Université, UMRS INSERM 1166, IHU ICAN, APHP, Hôpital la Pitié-Salpêtrière, Paris, France
| | - Jacques Boddaert
- Department of Geriatric Medicine, Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France; Sorbonne Université, UMR INSERM 1135, Paris, France
| | - Lorène Zerah
- Department of Geriatric Medicine, Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France; Sorbonne Université, UMRS INSERM 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
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Jorissen RN, Inacio MC, Cations M, Lang C, Caughey GE, Crotty M. Effect of Dementia on Outcomes After Surgically Treated Hip Fracture in Older Adults. J Arthroplasty 2021; 36:3181-3186.e4. [PMID: 34059366 DOI: 10.1016/j.arth.2021.04.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/29/2021] [Accepted: 04/26/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hip fractures are associated with increased mortality and functional limitations. However, the effect that dementia has on these outcomes in individuals in aged care settings after fracture is not well established. This study examined the association of dementia with post-hip fracture mortality, permanent residential aged care entry, transition care use, and change in activities of daily living (ADL) needs. METHODS A retrospective cohort study using data from the Registry of Senior Australians (2003-2015) was conducted. Individuals with a hip fracture while receiving aged care services were included. Associations of dementia with mortality, risks of transition and permanent care use, and ADL needs progression were estimated using multivariable Cox, Fine-Gray, and logistic regression methods, respectively. RESULTS Of 4771 individuals evaluated, 76% were women, the median age was 86 years (IQR 82-90), and 71% already lived in permanent residential aged care at the time of fracture. Within two years of their hip fracture, 50.4% (95% CI 48.9%-51.8%) of individuals died, 16.2% (95% CI 14.2%-18.2%) entered a transition care program, 59.1% (95% CI 56.5%-61.7%) entered permanent residential aged care, and 32% had greater ADL needs. Dementia was associated with higher risk of two-year mortality (HR = 1.19, 95% CI 1.09-1.30), 90-day entry into permanent care (sHR = 1.96, 95% CI 1.60-2.38), and increased likelihood of ADL limitations (OR = 1.36, 95% CI 1.00-1.85). Minor differences were seen in transition care use by dementia status. CONCLUSION Dementia is a strong risk factor for mortality after hip fractures in individuals in aged care settings and associated with a high risk of entry into permanent care. LEVEL OF EVIDENCE Prognostic level III.
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Affiliation(s)
- Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Monica Cations
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia; Department of Rehabilitation, Aged and Extended Care, Flinders University, Flinders Medical Centre, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Flinders Medical Centre, Australia
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Prognostic value of orthogeriatric assessment parameters on mortality: a 2-year follow-up. Eur J Trauma Emerg Surg 2021; 48:2905-2914. [PMID: 34173021 PMCID: PMC9360057 DOI: 10.1007/s00068-021-01727-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/08/2021] [Indexed: 12/04/2022]
Abstract
Introduction Since the arise of orthogeriatric co-management patients’ outcome and survival has improved. There are several assessment parameters that screen the precondition of orthogeriatric patients including mobility, activities of daily living, comorbidities, place of residence and need for care just to name a few. In a 2-year follow-up on an orthogeriatric co-managed ward the fracture-independent predictive value of typical assessment parameters and comorbidities on the associated mortality was examined. Methods All patients treated on an orthogeriatric co-managed ward from February 2014 to January 2015 were included. No fracture entity was preferred. Emphasis was set on following parameters: age, gender, Parker-Mobility Score (PMS), Barthel Index (BI), Charlson-Comorbidity Index (CCI), dementia, depression, sarcopenia, frequent falling, length of stay (LOS), care level (CL) and place of residence (POR). In a 2-year follow-up the patients’ death rates were acquired. SPSS (IBM Corp., Armonk, New York, USA) and Cox regression was used to univariately analyze the expression of the mentioned parameters and mortality course over 2 years from discharge. In a multivariate analysis intercorrelations and independent relationships were examined. Results A follow-up rate of 79.6% by assessing 661 patients was achieved. In the univariate analysis linear inverse correlation between PMS and BI and mortality and a linear positive correlation between CCI and higher mortality were observed. There was also a significant relationship between lower survival and age, dementia, sarcopenia, frequent falling, higher institutionalized place of residence and higher CL. No univariate correlation between 2-year mortality and gender, depression and LOS was found. In the multivariate Cox regression, the only independent risk factors remaining were lower PMS (HR: 1.81; 95%CI: 1.373–2.397), lower BI (HR: 1.64; 95%CI: 1.180–2.290) and higher age per year (HR: 1.04; 95%CI: 1.004–1.067). Conclusion Age, PMS, BI, CCI, preexisting dementia, sarcopenia, frequent falling, POR and CL are univariate predictors of survival in the orthogeriatric context. An independency could only be found for PMS, BI and age in our multivariate model. This underlines the importance of preexisting mobility and capability of self-support for the patient’s outcome in terms of survival.
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Tarazona-Santabalbina FJ, Ojeda-Thies C, Figueroa Rodríguez J, Cassinello-Ogea C, Caeiro JR. Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3049. [PMID: 33809573 PMCID: PMC7999190 DOI: 10.3390/ijerph18063049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms "hip fracture", "geriatric assessment", "second hip fracture", "surgery", "perioperative management" and "orthogeriatric care", in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.
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Affiliation(s)
- Francisco José Tarazona-Santabalbina
- Department of Geriatric Medicine, Hospital Universitario de la Ribera, Alzira, 46600 Valencia, Spain
- CIBERFES, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, Instituto Carlos III, 28029 Madrid, Spain
| | - Cristina Ojeda-Thies
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Jesús Figueroa Rodríguez
- Department of Physical Medicine and Rehabilitation, Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | | | - José Ramón Caeiro
- Department of Orthopaedics and Traumatology, Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
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Teng M, Zerah L, Rouet A, Tomeo C, Verny M, Cohen-Bittan J, Boddaert J, Haddad R. Fecal impaction is associated with postoperative urinary retention after hip fracture surgery. Ann Phys Rehabil Med 2020; 64:101464. [PMID: 33285293 DOI: 10.1016/j.rehab.2020.101464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/24/2020] [Accepted: 11/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Postoperative urinary retention (POUR) is a common hip fracture (HF) complication. Although fecal impaction (FI) is one of the oft-cited causes of POUR in clinical practice, evidence regarding this association is scarce. OBJECTIVE The aim of this study was to determine whether FI was associated with POUR after HF surgery in older patients. METHODS All patients consecutively admitted after a HF surgery in a geriatric perioperative unit were included in this cross-sectional study. FI was systematically assessed by a digital rectal exam at admission and according to clinical suspicion during the hospital stay. The dependent variable was POUR, systematically screened according to the department protocol and defined as a bladder volume > 400 ml requiring catheterization. The association between FI and POUR was assessed by multivariable analysis. RESULTS A total of 256 patients were included (mean [SD] age 86 [6] years), 76% women): 108 (42%) presented FI and 63 (25%) POUR. The frequency of FI was higher with than without POUR (73% vs 32%, P<0.001). On multivariable analysis, after adjusting for age, sex, Cumulative Illness Rating Scale score and anticholinergic load, FI was the only factor independently associated with POUR (odds ratio 4.78 [95% confidence interval 2.44-9.71], P<0.001. CONCLUSIONS FI was the only independent factor associated with POUR after HF surgery in older adults. Further studies are needed to optimize perioperative geriatric care including FI and POUR assessment and management.
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Affiliation(s)
- Maëlys Teng
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Unit of Peri-Operative Geriatric Care (UPOG), 47-83 boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Université, GRC 001, GREEN Groupe de recherche en Neuro-Urologie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Rothschild 5 rue Santerre, 75012 Paris, France.
| | - Lorène Zerah
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Unit of Peri-Operative Geriatric Care (UPOG), 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Audrey Rouet
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Unit of Peri-Operative Geriatric Care (UPOG), 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Charlotte Tomeo
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Unit of Peri-Operative Geriatric Care (UPOG), 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Marc Verny
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Unit of Peri-Operative Geriatric Care (UPOG), 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Judith Cohen-Bittan
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Unit of Peri-Operative Geriatric Care (UPOG), 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Jacques Boddaert
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Unit of Peri-Operative Geriatric Care (UPOG), 47-83 boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Université, UMR INSERM U1135, 15-21 rue de l'Ecole de médecine, 75006 Paris, France
| | - Rebecca Haddad
- Sorbonne Université, GRC 001, GREEN Groupe de recherche en Neuro-Urologie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Rothschild 5 rue Santerre, 75012 Paris, France; Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium
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Brunn M, Diefenbacher A, Volpe-Gillot L. Psychiatrists and neurologists in dementia care: Professionalism, practice, and perspectives. Gen Hosp Psychiatry 2020; 64:105-107. [PMID: 32067822 DOI: 10.1016/j.genhosppsych.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Matthias Brunn
- Université de Montpellier, Université de Montpellier, CEPEL, CNRS, 39 rue de l'Université, 34060 Montpellier, France.
| | - Albert Diefenbacher
- Evangelisches Krankenhaus Königin Elisabeth Herzberge, Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Herzbergstraße 79, 10365 Berlin, Germany.
| | - Lisette Volpe-Gillot
- Hôpital Leopold Bellan, Service de Neuro-Psycho-Gériatrie, 185 C, rue Raymond-Losserand, 75014 Paris, France.
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Mossello E, Rivasi G, Tortù V, Giordano A, Iacomelli I, Cavallini MC, Rafanelli M, Ceccofiglio A, Cartei A, Rostagno C, Di Bari M, Ungar A. Renal function and delirium in older fracture patients: different information from different formulas? Eur J Intern Med 2020; 71:70-75. [PMID: 31711727 DOI: 10.1016/j.ejim.2019.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/24/2019] [Accepted: 10/17/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES the association between renal function and delirium has not been investigated in older fracture patients. Creatinine is frequently low in these subjects, which may influence the association between delirium and renal function as estimated with creatinine-based formulas. Cystatin C could be a more reliable filtration marker in these patients. AIM to confirm the association between renal function and delirium in older fracture patients comparing creatinine- and cystatin-based estimated glomerular filtration rate (eGFR) METHODS: patients aged 65+ requiring surgery for traumatic bone fractures were included. Six equations were used to calculate eGFR, based on serum creatinine and/or cystatin C obtained within 24 h of admission: Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology (CKD-EPIcr, CKD-EPIcys, CKD-EPIcr-cys) and Berlin Initiative Study equations (BIS-1, BIS-2). Delirium was identified with a chart-based method. RESULTS 571 patients (mean age 83) were enrolled. Delirium occurred in the 34% and was associated with a lower eGFR regardless of the equation used. In a multivariable model, the association between moderate renal impairment (eGFR 30-60 ml/min/1.73 m2) and delirium remained significant in patients aged 75-84 and only when estimated with cystatin-based or BIS-1 equations. Only dementia was significantly associated with delirium in subjects 85+. CONCLUSIONS in older fracture patients, moderate renal impairment was independently associated with delirium only among subjects aged 75-84, when eGFR was estimated with cystatin-based or BIS 1 equations, and not with the most commonly used equations (MDRD, CKD-EPIcr).
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Affiliation(s)
- Enrico Mossello
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Giulia Rivasi
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy
| | - Virginia Tortù
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy
| | - Antonella Giordano
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Iacopo Iacomelli
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy
| | - Maria Chiara Cavallini
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Martina Rafanelli
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Alice Ceccofiglio
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Alessandro Cartei
- Internal and post-surgery Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Carlo Rostagno
- Internal and post-surgery Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Mauro Di Bari
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Andrea Ungar
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 6, 50139 Florence, Italy.
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12
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Cognitive impairment and postoperative outcomes in patients undergoing primary total hip arthroplasty: A systematic review. J Clin Anesth 2019; 56:65-76. [DOI: 10.1016/j.jclinane.2019.01.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/12/2019] [Accepted: 01/18/2019] [Indexed: 12/11/2022]
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13
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Kristoffersen MH, Dybvik E, Steihaug OM, Bartz-Johannesen CA, Martinsen MI, Ranhoff AH, Engesæter LB, Gjertsen JE. Validation of orthopaedic surgeons' assessment of cognitive function in patients with acute hip fracture. BMC Musculoskelet Disord 2019; 20:268. [PMID: 31153373 PMCID: PMC6545206 DOI: 10.1186/s12891-019-2633-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND About one fourth of patients with hip fracture have cognitive impairment. These patients are at higher risk of surgical and medical complications and are often excluded from participating in clinical research. The aim of the present study was to investigate orthopaedic surgeons' ability to determine the cognitive status of patients with acute hip fracture and to compare the treatment given to patients with and without cognitive impairment. METHODS The cognitive function of 1474 hip fracture patients reported by the orthopaedic surgeons to the nationwide Norwegian Hip Fracture Register was compared with data registered in quality databases in two hospitals with orthogeriatric service on the same patients. Cognitive function registered in the quality databases was determined either by the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) or by pre-fracture diagnosis of dementia. The information registered in the quality databases was defined as the reference standard. Cognitive function in the Norwegian Hip Fracture Register was reported as: Chronic cognitive impairment? "Yes", "Uncertain" or "No" by the orthopaedic surgeons. Sensitivity, specificity, negative and positive predictive values for chronic cognitive impairment reported to the Norwegian Hip Fracture Register by the orthopaedic surgeons was calculated. Baseline data and treatment of hip fractures in patients with and without cognitive impairment in the Norwegian Hip Fracture Register were compared. RESULTS Orthopaedic surgeons reported chronic cognitive impairment in 31% of the patients. Using documented dementia or IQCODE > 4.0 as the reference, this assessment of cognitive impairment by the orthopaedic surgeons had a sensitivity of 69%, a specificity of 90%, a positive predictive value of 78%, and a negative predictive value of 84% compared to information registered in the two hospital quality databases. There were no differences in type of hip fracture or type of surgical treatment by cognitive function. CONCLUSION The treatment of hip fractures was similar in patients with chronic cognitive impairment and cognitively well-functioning patients. The surgeons had an acceptable ability to identify and report chronic cognitive impairment in the peri-operative period, indicating that the Norwegian Hip Fracture Register is a valuable resource for future registry-based research also on hip fracture patients with chronic cognitive impairment.
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Affiliation(s)
- Målfrid Holen Kristoffersen
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway. .,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Haukelandsveien 28, N 5009, Bergen, Norway.
| | - Eva Dybvik
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway
| | | | | | | | - Anette Hylen Ranhoff
- Diakonhjemmet Hospital, Postboks 23 Vindern, N 0319, Oslo, Norway.,Department of Clinical Sciences, Faculty of Medicine, University of Bergen, Haukelandsveien 28, N 5009, Bergen, Norway
| | - Lars Birger Engesæter
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Haukelandsveien 28, N 5009, Bergen, Norway
| | - Jan-Erik Gjertsen
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Haukelandsveien 28, N 5009, Bergen, Norway
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14
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Boddaert J, Na N, Le Manach Y, Raux M, Cohen-Bittan J, Vallet H, Meziere A, Khiami F, Riou B. Prediction of postoperative mortality in elderly patients with hip fracture: are specific and geriatric scores better than general scores? Br J Anaesth 2018; 118:952-954. [PMID: 28575342 DOI: 10.1093/bja/aex148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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15
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Clinical impact of recovery room on post-operative walking performance in elderly patients submitted to hip surgery: a real-world analysis. Aging Clin Exp Res 2018; 30:999-1003. [PMID: 29198056 DOI: 10.1007/s40520-017-0860-2] [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: 10/09/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Strategies aimed at favouring functional recovery after surgery for hip fracture may be of clinical importance. AIMS To test the clinical utility of a recovery room (RR) in terms of postoperative walking performance in an elderly population submitted to hip fracture surgery. METHODS Postoperative walking performance at rollator was assessed in 242 consecutive orthogeriatric patients able to follow the institutional physiotherapy protocol starting on day 1 after hip surgery. Group 1 (n = 186, age 86.0 ± 9.3 years, 24.7% male) was admitted to the RR for postoperative monitoring, whereas Group 2 (n = 56, age 85.2 ± 5.7 years, 23.2% male) was directly admitted to the ward. The best performance observed during the first three postoperative days was considered. RESULTS Group 1 showed a better walking performance than Group 2, with a 50% lower probability of walking < 5 m (relative risk 0.51, p = 0.0005) and a two-fold higher probability of walking > 10 m (relative risk 2.10, p = 0.0005). Multivariable analysis confirmed a favourable independent effect of the RR stay on walking performance (β = 0.205, p = 0.005). DISCUSSION Admission to the RR in elderly patients submitted to hip fracture surgery could have an independent beneficial effect on postoperative walking functional recovery. This beneficial effect could probably depend on the possibility of ensuring a more rapid management of postoperative issues CONCLUSIONS: These findings support the clinical utility of a RR implementation in facilities where hip surgery in elderly subjects is routinely performed.
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Rehabilitation strategy for hip fracture, focused on behavioral psychological symptoms of dementia for older people with cognitive impairment: A nationwide Japan rehabilitation database. PLoS One 2018; 13:e0200143. [PMID: 29975757 PMCID: PMC6033436 DOI: 10.1371/journal.pone.0200143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/20/2018] [Indexed: 11/25/2022] Open
Abstract
The aim is to investigate the relationship between a positive outcome on rehabilitation after hip fracture and behavioral psychological symptoms of dementia (BPSD) transition during rehabilitation. This study is a retrospective cohort study based on the Japan Rehabilitation Database. We recruited 756 subjects 65 years of age or older from 31 hospitals in the database. All subjects were in the hospital as patients undergoing rehabilitation for hip fracture. Functional independence measure (FIM), walking ability, Mini-Mental State Examination (MMSE), and BPSD were measured both at the beginning and at the end of rehabilitation. MMSE for 23 or under was defined as the cognitive-impaired group. MMSE for 24 or over was used as the cognitively intact group. Cognitive impaired participants were divided into four groups: participants presented no BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (-/-)), participants presented BPSD at the beginning of rehabilitation but resolved at the end of rehabilitation (Group (+/-)), participants had no BPSD at the beginning of rehabilitation but appeared at the end of rehabilitation (Group (-/+)) and participants had sign of BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (+/+)). The endpoints were waking ability, FIM gain. As results, one hundred thirty-seven cognitive-impaired older people patients out of 471 (29.1%) suffered from BPSD at the beginning of rehabilitation. FIM gains in cognitively intact group, Group (-/-), Group (+/-), Group (-/+) and Group (+/+) were 24.8 ± 18.7, 17.5 ± 16.9, 27.3 ± 19.7, 17.8 ± 12.2 and 12.2 ± 17.2, respectively. The Group (+/-) was significantly connected to a positive outcome for rehabilitation. The present study suggested that the management of BPSD can lead to better functional recovery during rehabilitation.
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17
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Zerah L, Dourthe L, Cohen-Bittan J, Verny M, Raux M, Mézière A, Khiami F, Tourette C, Neri C, Le Manach Y, Riou B, Vallet H, Boddaert J. Retrospective Evaluation of a Restrictive Transfusion Strategy in Older Adults with Hip Fracture. J Am Geriatr Soc 2018; 66:1151-1157. [PMID: 29676780 DOI: 10.1111/jgs.15371] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To compare the association between a restrictive transfusion strategy and cardiovascular complications during hospitalization for hip fracture with the association between a liberal transfusion strategy and cardiovascular complications, accounting for all transfusions from the emergency department to postacute rehabilitation settings. DESIGN Retrospective study. SETTING Perioperative geriatric care unit. PARTICIPANTS All individuals aged 70 and older admitted to the emergency department for hip fracture and hospitalized in our perioperative geriatric care unit (N=667; n=193 in the liberal transfusion group, n=474 in the restrictive transfusion group) from July 2009 to April 2016. INTERVENTION A restrictive transfusion strategy (hemoglobin level threshold ≥8 g/dL or symptoms) used from January 2012 to April 2016 was compared with the liberal transfusion strategy (hemoglobin level threshold ≥10 g/dL) used from July 2009 to December 2011. MEASUREMENTS Primary endpoint was in-hospital acute cardiovascular complications (heart failure, myocardial infarction, atrial fibrillation or stroke). RESULTS The change to a restrictive transfusion strategy was associated with fewer acute cardiovascular complications (odds ratio=0.45, 95% confidence interval (CI)=0.31-0.67, p<.001), without any noticeable difference in in-hospital or 6-month mortality. The change also led to a reduction in packed red blood cell units used per participant (median 1, interquartile range (IQR) 0-2 in restrictive vs median 2, IQR 0-3 in liberal transfusion strategy, P<.001). In rehabilitation settings, the frequency of transfusion was greater with the restrictive transfusion strategy than the liberal transfusion strategy (18% vs 9%, P<.001). CONCLUSION A restrictive transfusion strategy in older adults with hip fracture was found to be safe and was associated with fewer cardiovascular complications but more transfusions in rehabilitation settings. Prospective studies are needed to confirm these findings.
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Affiliation(s)
- Lorene Zerah
- Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Lucile Dourthe
- Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Judith Cohen-Bittan
- Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Verny
- Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Mathieu Raux
- Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Unit es Mixtes de Recherche Scientifique (UMRS) Institut National de la Santée et de la Recherche Médicale (INSERM) 1158, Paris, France
| | - Anthony Mézière
- Rehabilitation Geriatric Department, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frédéric Khiami
- Department of Orthopedic Surgery and Trauma, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cendrine Tourette
- Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Christian Neri
- Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Yannick Le Manach
- Department of Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Population Health Research Institute, Perioperative Medicine and Surgical Research Unit, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Bruno Riou
- Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.,Department of Emergency Medicine and Surgery, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hélène Vallet
- Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Jacques Boddaert
- Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Hospitalo-Universitaire Fight Aging and Stress, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Unit es Mixtes de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 8256 and Unit es Mixtes de Recherche (UMR) Institut National de la Sant é et de la Recherche M édicale (INSERM) 1166, Institut Hospitalo-Universitaire (IHU) Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
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