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Ramamurti P, Fassihi SC, Sacolick D, Gu A, Wei C, Chodos MD. Impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture. Hip Int 2023; 33:345-353. [PMID: 34191641 DOI: 10.1177/11207000211028502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The metabolic abnormalities that occur secondary to chronic kidney disease (CKD) increase the risk of femoral neck fractures compared to the general population. The purpose of this study is to determine whether impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture. METHODS The ACS-NSQIP database was reviewed for patients who underwent total hip arthroplasty, hemiarthroplasty and open reduction internal fixation (ORIF) for femoral neck fractures between 2007 and 2018. Patients were split into cohorts based on calculated estimated glomerular filtration rate. Demographic information, comorbidities, and 30-day complications were analysed with univariate and multivariate analyses using chi-square, Fischer's exact and analysis of variance testing. RESULTS The total number of patients for the study was 163,717. Patients with CKD stage 4 and 5 had an increased rate of any complication (39.1 and 36.7% respectively) compared with higher eGFRs (p < 0.001). Similarly, 30-day mortality was increased at 6.0% and 6.7% for both stage 4 and 5 (p < 0.001). By multivariate regression, those with CKD Stage 4 and 5 were at increased risk for any complication compared to patients with a normal preoperative eGFR of 90-120 (p < 0.001). CONCLUSIONS This study demonstrated that patients with CKD Stage 4 and 5 are at increased risks of all complications, including death, renal, pulmonary and thromboembolic disease. Therefore, these patients should be cared for from a multidisciplinary approach with close attention to postoperative medications and fall prevention to help mitigate the risk of complications in the immediate postoperative period.
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Affiliation(s)
- Pradip Ramamurti
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Safa C Fassihi
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - David Sacolick
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Chapman Wei
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Marc D Chodos
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA
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Lan J, Zhang H, Sheng R, He Y. The impact of chronic kidney disease and dialysis therapy on outcomes of elderly patients with hip fractures: A systematic review and meta-analysis. Scott Med J 2022; 67:144-156. [PMID: 35862029 DOI: 10.1177/00369330221112175] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Hip fractures are a commonly occurring comorbidity in patients with chronic kidney disease. To evaluate the comparative rates of post-operative complications, revision surgery, and mortality after hip fracture surgery in chronic kidney disease patients undergoing hemodialysis. METHODS A systematic search of the academic literature was performed according to the PRISMA guidelines across five databases: Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE. A random-effect meta-analysis was conducted to evaluate the overall comparative risks of post-operative complications in chronic kidney disease patients. RESULTS Out of 993 studies, 11 eligible studies were included in the review, with a total of 72618 chronic kidney disease patients (mean age: 75.3 ± 3.0 years), and 50566 healthy controls (75.3 ± 2.6 years). Meta-analysis revealed a higher risk of post-operative complications (Odd's ratio: 1.76), revision surgeries (1.69), and mortality-related outcomes (2.47) after hip fracture surgery in chronic kidney disease patients undergoing hemodialysis as compared to chronic kidney disease patients not undergoing hemodialysis. CONCLUSION We report higher risks of post-operative complications, revision surgery, and mortality in chronic kidney disease patients undergoing hemodialysis as compared to chronic kidney disease patients not undergoing hemodialysis.
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Affiliation(s)
- Jun Lan
- Department of Rheumatology and Nephrology, Zhejiang quhua hospital, Quzhou City, Zhejiang Province, China
| | - HuaYan Zhang
- Department of Rheumatology and Nephrology, Zhejiang quhua hospital, Quzhou City, Zhejiang Province, China
| | - RuDan Sheng
- Department of Rheumatology and Nephrology, Zhejiang quhua hospital, Quzhou City, Zhejiang Province, China
| | - YuanJun He
- Department of Rheumatology and Nephrology, Zhejiang quhua hospital, Quzhou City, Zhejiang Province, China
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Ongzalima C, Dasborough K, Narula S, Boardman G, Kumarasinghe P, Seymour H. Perioperative Management and Outcomes of Hip Fracture Patients with Advanced Chronic Kidney Disease. Geriatr Orthop Surg Rehabil 2022; 13:21514593221138658. [DOI: 10.1177/21514593221138658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
Aims To explore clinical characteristics, perioperative management and outcomes of Hip Fracture patients with advanced Chronic Kidney Disease (HF-aCKD) compared to the general Hip Fracture population without aCKD (HF-G) within a large volume tertiary hospital in Western Australia. Methods Retrospective chart review of patients admitted with hip fracture (HF) to a single large volume tertiary hospital registered on Australian and New Zealand Hip Fracture Registry (ANZHFR). We compared baseline demographic and clinical frailty scale (CFS) of HF-aCKD (n = 74), defined as eGFR < 30 mls/min/1.73 m2, with HF-G (n = 452) and determined their outcomes at 120 days. Results We identified 74 (6.97%) HF patients with aCKD. General demographics were similar in HF-aCKD and HF-G populations. 120-days mortality for HF-aCKD was double that of HF-G population (34% vs 17%, P = .001). For dialysis patients, 120-days mortality was triple that of HF-G population (57%). Except for the fit category of HF-aCKD group, higher CFS was associated with higher 120-days mortality in both groups. Of all HF-aCKD patients, 96% had operative intervention and 48% received blood transfusion. There were no new starts to dialysis peri-operatively. Each point reduction in eGFR below 12 mL/min/1.73 m2 was associated with 3% increased probability of death in hospital. Conclusions 120-days mortality was double in HF-aCKD and triple in HF-dialysis that of the HF-G within our institution. Clinical frailty scale can be useful in predicting mortality after HF in frail aCKD patients. High rate of blood transfusions was observed in HF-aCKD group. Further studies with larger HF-aCKD numbers are required to explore these associations in detail.
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Song IA, Lee YK, Park JW, Kim JK, Koo KH. Effectiveness of rapid response system in patients with hip fractures. Injury 2021; 52:1841-1845. [PMID: 33883073 DOI: 10.1016/j.injury.2021.04.029] [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: 02/05/2021] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Even with preoperative screening and medical preparation, elderly hip fracture surgery (HFS) patients may have serious events including cardiopulmonary arrest (CPA) and death during the perioperative period. The rapid response system (RRS) that responds early to changes in the condition of patients is helping to improve the survival rate. To date, there have been no studies on the effectiveness of rapid response system in HFS patients. METHODS In October 2012, our institution, a tertiary referral hospital, implemented an RRS. The system activated in heart rate <40/min or >140/min, systolic blood pressure <80mmHg, respiratory rate <10/min or >30/min, oxygen saturation <90%, sudden change in the level of consciousness, and seizure. We conducted before-and-after study using electronic medical records of patients older than 60 years, who underwent surgery during before implemented period (May 2003 to September 2012) and during after implemented period (October 2013 to December 2018). 1,483 pre-RRS patients and 1,315 post-RRS patients were enrolled in this study. We aimed to evaluate the effect of implementing the RRS on the management of patients undergoing HFS. We analysis 1) interval between the detection of abnormal vital sign and notification to attending physician; 2) interval between the detection of abnormal vital sign and adequate intervention; 3) incidence of CPA, 4) admission to intensive care unit 5) unexpected death; 6) duration of hospital stay; and 7) survival rate. RESULTS The interval between the detection of abnormal vital sign and notification to attending physician decreased from 23.9(±28.1) minutes to 11.4(±11.02) minutes (p<0.001). The interval between the detection of abnormal vital sign and intervention by the attending physician decreased from 67.3(±40.3) minutes to 15.8(±10.9) minutes (p<0.001). There were no significant differences in unexpected admission to intensive care unit (32/50 versus 20/88, p = 0.213) and in-hospital death (15 versus 16, p = 0.605) between the two groups. The duration of hospitalization decreased from 24.9 days to 15.4 days (p < 0.001). The 5-year survival rate was 57% in the pre-RRS group and 72% in the post-RRS group (hazard ratio = 0.73; 95% confidence interval = 0.61-0.87, p < 0.001). CONCLUSIONS Implementation of RRS rendered early notification and prompt intervention of deteriorating patients undergoing HFS and reduced the duration of hospital stay.
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Affiliation(s)
- In-Ae Song
- Interdepartment of Critical Care Medicine, Department of Anesthesiology and Pain medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, South Korea
| | - Jin-Kak Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Seoul National University College of Medicine, Seoul, South Korea.
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Scala A, Ponsiglione AM, Loperto I, Della Vecchia A, Borrelli A, Russo G, Triassi M, Improta G. Lean Six Sigma Approach for Reducing Length of Hospital Stay for Patients with Femur Fracture in a University Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062843. [PMID: 33799518 PMCID: PMC8000325 DOI: 10.3390/ijerph18062843] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
Surgical intervention within 48 h of hospital admission is the gold standard procedure for the management of elderly patients with femur fractures, since the increase in preoperative waiting time is correlated with the onset of complications and longer overall length of stay (LOS) in the hospital. However, national evidence demonstrates that there is still the need to provide timely intervention for this type of patient, especially in some regions of central southern Italy. Here we discuss the introduction of a diagnostic–therapeutic assistance pathway (DTAP) to reduce the preoperative LOS for patients undergoing femur fracture surgery in a university hospital. A Lean Six Sigma methodology, based on the DMAIC cycle (Define, Measure, Analyze, Improve, Control), is implemented to evaluate the effectiveness of the DTAP. Data were retrospectively collected and analyzed from two groups of patients before and after the implementation of DTAP over a period of 10 years. The statistics of the process measured before the DTAP showed an average preoperative LOS of 5.6 days (standard deviation of 3.2), thus confirming the need for corrective actions to reduce the LOS in compliance with the national guidelines. The influence of demographic and anamnestic variables on the LOS was evaluated, and the impact of the DTAP was measured and discussed, demonstrating the effectiveness of the improvement actions implemented over the years and leading to a significant reduction in the preoperative LOS, which decreased to an average of 3.5 days (standard deviation of 3.60). The obtained reduction of 39% in the average LOS proved to be in good agreement with previously developed DTAPs for femur fracture available in the literature.
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Affiliation(s)
- Arianna Scala
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (A.S.); (I.L.); (M.T.); (G.I.)
| | - Alfonso Maria Ponsiglione
- Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, 80125 Naples, Italy
- Correspondence:
| | - Ilaria Loperto
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (A.S.); (I.L.); (M.T.); (G.I.)
| | - Antonio Della Vecchia
- Hospital Directorate, “San Giovanni di Dio e Ruggi d’Aragona” University Hospital of Salerno, 84125 Salerno, Italy; (A.D.V.); (A.B.)
| | - Anna Borrelli
- Hospital Directorate, “San Giovanni di Dio e Ruggi d’Aragona” University Hospital of Salerno, 84125 Salerno, Italy; (A.D.V.); (A.B.)
| | - Giuseppe Russo
- Hospital Directorate, National Hospital A.O.R.N. “Antonio Cardarelli” of Naples, 80131 Naples, Italy;
| | - Maria Triassi
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (A.S.); (I.L.); (M.T.); (G.I.)
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples “Federico II”, 80131 Naples, Italy
| | - Giovanni Improta
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (A.S.); (I.L.); (M.T.); (G.I.)
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples “Federico II”, 80131 Naples, Italy
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Liao CY, Tan TL, Lu YD, Wu CT, Lee MS, Kuo FC. Does preoperative dipyridamole-thallium scanning reduce 90-day cardiac complications and 1-year mortality in patients with femoral neck fractures undergoing hemiarthroplasty? J Orthop Surg Res 2020; 15:385. [PMID: 32894146 PMCID: PMC7487939 DOI: 10.1186/s13018-020-01918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to evaluate the effect of dipyridamole-thallium scanning (DTS) on the rates of 90-day cardiac complications and 1-year mortality in patients with a femoral neck fracture treated with hemiarthroplasty. Methods Between 2008 and 2015, 844 consecutive patients who underwent cemented or cementless hemiarthroplasty were identified from the database of a single level-one medical center. One-hundred and thirteen patients (13%) underwent DTS prior to surgery, and 731 patients (87%) did not. Patient characteristics, comorbidities, surgical variables, and length of the delay until surgery were recorded. A propensity score-matched cohort was utilized to reduce recruitment bias in a 1:3 ratio of DTS group to control group, and multivariate logistic regression was performed to control confounding variables. Results The incidence of 90-day cardiac complications was 19.5% in the DTS group and 15.6% in the control group (p = 0.343) among 452 patients after propensity score-matching. The 1-year mortality rate (10.6% vs 13.3%, p = 0.462) was similar in the two groups. In the propensity score-matched patients, utilization of DTS was not associated with a reduction in the rate of 90-day cardiac complications (matched cohort, adjusted odds ratio [aOR] = 1.32; 95% confidence interval [CI] 0.75–2.33, p = 0.332) or the 1-year mortality rate (aOR = 0.62; 95% CI 0.27–1.42, p = 0.259). Risk factors for cardiac complications included an American Society of Anesthesiologists grade ≥ 3 (OR 3.19, 95% CI 1.44–7.08, p = 0.004) and pre-existing cardiac comorbidities (OR 5.56, 95% CI 3.35–9.25, p < 0.001). Risk factors for 1-year mortality were a long time to surgery (aOR 1.15, 95% CI 1.06–1.25, p = 0.001), a greater age (aOR 1.05, 95% CI 1.00 to 1.10, p = 0.040), a low body mass index (BMI; aOR 0.89, 95% CI 0.81–0.98, p = 0.015), and the presence of renal disease (aOR 4.43, 95% CI 1.71–11.46, p = 0.002). Discussion Preoperative DTS was not associated with reductions in the rates of 90-day cardiac complications or 1-year mortality in patients with a femoral neck fracture undergoing hemiarthroplasty. The necessity for DTS should be re-evaluated in elderly patients with femoral neck fractures, given that this increases the length of the delay until surgery. Level of evidence Prognostic level III
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Affiliation(s)
- Chin-Yi Liao
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No. 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Timothy L Tan
- Rothman Institute Orthopedic Research Department, Thomas Jefferson University, Rothman Institute Sheridan Building, Suite 1000, 25 S 9th Street, Philadelphia, PA, 19107, USA
| | - Yu-Der Lu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No. 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Cheng-Ta Wu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No. 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Mel S Lee
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No. 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Feng-Chih Kuo
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, No. 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan.
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Jang SY, Ha YC, Cha Y, Kim KJ, Choy W, Koo KH. The Influence of Renal Dialysis on All-Cause Mortality in Older Patients with Hip Fracture: a Korean Nationwide Cohort Study. J Korean Med Sci 2020; 35:e190. [PMID: 32567258 PMCID: PMC7308139 DOI: 10.3346/jkms.2020.35.e190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/21/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to analyze the all-cause mortality rate over time after elderly hip fracture in end-stage renal disease (ESRD) patients with dialysis, using a Korean nationwide claims database. METHODS This retrospective nationwide study identified subjects from the Korean National Health Insurance Service-Senior cohort (NHIS-Senior). The NHIS-Senior (total of 588,147 participants) was constructed by 10% random sampling and was designed to represent the elderly living in Korea. Subjects were patients aged 65-99 years who underwent surgical treatment for femoral neck fractures or intertrochanteric fractures. A generalized estimating equation model with Poisson distribution and logarithmic link function was used to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) to measure associations between renal dialysis and cumulative mortality in various time frames. RESULTS The total number of patients included in this study was 16,818. These patients were divided into two groups: 116 (0.69%) in the dialysis group and 16,702 (99.31%) in the no-dialysis group. The mean length of hospital stay was 43.87 ± 48.45 days in the dialysis group and 36.29 ± 37.49 days in the no-dialysis group (P = 0.095). The effect of renal dialysis on all-cause mortality was 2.29-fold (aRR; 95% CI, 1.29-4.06; P = 0.005) within 30 days and 1.72-fold (aRR; 95% CI, 1.34-2.21; P < 0.001) within 1-year after hip fracture compared to the no-dialysis group. And, the effect of renal dialysis of in-hospital mortality was 2.72-fold (aRR; 95% CI, 1.71-4.33; P < 0.001) compared to the no-dialysis group. CONCLUSION Elderly patients who underwent dialysis have very high mortality rates after hip fracture. Therefore, it is considered that postoperative care through multidisciplinary management and understanding of pathophysiology for the ESRD patients is necessary.
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Affiliation(s)
- Suk Yong Jang
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Yong Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea.
| | - Kap Jung Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Wonsik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Kyung Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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