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Neumann CJ, Kaiser TD, Smektala R. Anticoagulant Medication in Endoprosthetically Treated Proximal Femur Fracture - Complications and Mortality Considering the Time of Treatment as a Quality Criterion. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024. [PMID: 38889762 DOI: 10.1055/a-2324-1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
There is an international debate on the optimal time to surgery following hip fracture in older patients. Pre-existing anticoagulation seems to be a major concern when it comes to a delay in operative fracture treatment. The aim of this study was to examine complication and mortality rates for elderly anticoagulated hip fracture patients considering early (< 24 h) vs. delayed (> 24 h) surgery.Our Analysis is based on data of the external inpatient quality assurance of North Rhine Westphalia as the most populous German federal state. We identified 13,201 hip fracture patients with antithrombotic medication and a minimum age of 65 years treated from January 2015 to December 2017.Delayed surgery was associated with significantly higher rates of general and surgical complications as well as mortality. Except for pre-existing heart failure, we were not able to identify certain comorbidities that could clearly indicate, why there might have been a delay.In most cases, patients with antithrombotic medication have a poor outcome to be expected due to serious comorbidity. If there was a delay in surgery for those patients, treatment results were even worse. Thus, surgery with a delay of > 24 h must be avoided to reduce the risk of complications.
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Affiliation(s)
- Christoph Johannes Neumann
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Deutschland
| | - Tim Dario Kaiser
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Deutschland
| | - Rüdiger Smektala
- Knappschaftskrankenhaus Bochum Langendreer Orthopädie und Unfallchirurgie, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland
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Long A, Yang D, Jin L, Zhao F, Wang X, Zhang Y, Liu L. Admission Inflammation Markers Influence Long-term Mortality in Elderly Patients Undergoing Hip Fracture Surgery: A Retrospective Cohort Study. Orthop Surg 2024; 16:38-46. [PMID: 37984859 PMCID: PMC10782247 DOI: 10.1111/os.13932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/05/2020] [Accepted: 12/20/2020] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that some inflammation biomarkers may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission inflammation biomarkers in elderly patients with hip fracture. METHODS We reports on a retrospective study of elderly hip fracture patients admitted to a hospital in China between January 2015 and December 2019. A total of 1085 patients were included in the study, and their demographic and pre-operative characteristics were analyzed. The inflammation biomarkers included monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and C-reactive protein (CRP) to albumin ratio (CAR). The predictive performance of NLR, MLR and CAR was assessed by receiver operating characteristics (ROC) curve analysis and the association between admission inflammation markers and mortality was evaluated by Cox proportional regression. RESULTS The 30-day, 1-year, 2-year, and 4-year mortality were 1.6%, 11.5%, 21.4% and 48.9%, respectively. The optimal cut-off values of admission NLR, MLR and CAR for 1-year mortality were 7.28, 0.76, and 1.36. After adjusting the covariates, preoperative NLR ≥ 7.28 (HR = 1.419, 95% CI: 1.080-1.864, p = 0.012) were found to be only independent risk factors with 4-year all-cause mortality, the preoperative CAR ≥ 1.36 was independently associated with 1-year (HR = 1.700, 95% CI: 1.173-2.465, p = 0.005), 2 year (HR = 1.464, 95% CI: 1.107-1.936, p = 0.008), and 4-year (HR = 1.341, 95% CI: 1.057-1.700, p = 0.016) all-cause mortality, While age, CCI score, and low hemoglobin at admission were also risk factors for postoperative all-cause mortality. CONCLUSION Admission CAR and NLR may be useful indicators for predicting the long-term mortality of elderly patients undergoing hip fracture surgery, and that more research is needed to validate these findings.
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Affiliation(s)
- Anhua Long
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Dongxiang Yang
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Lu Jin
- Evidence‐Based Medicine CenterBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Feifei Zhao
- Evidence‐Based Medicine CenterBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Xuefei Wang
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Yakui Zhang
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Liang Liu
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
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Cacciola G, Mancino F, Holzer LA, De Meo F, De Martino I, Bruschetta A, Risitano S, Sabatini L, Cavaliere P. Predictive Value of the C-Reactive Protein to Albumin Ratio in 30-Day Mortality after Hip Fracture in Elderly Population: A Retrospective Observational Cohort Study. J Clin Med 2023; 12:4544. [PMID: 37445579 DOI: 10.3390/jcm12134544] [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: 03/04/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND C-reactive protein (CRP) to Albumin ratio (CAR) has been used in multiple clinical settings to predict early mortality. However, there is a lack of evidence on the predictive role of CAR in 30-day mortality after a hip fracture. The purpose of this study was to establish a potential association between CAR and 30-day mortality and to assess if the CAR Receiving Operating Characteristics curve (ROC) can be a reliable predictor of early mortality. METHODS We retrospectively reviewed the charts of 676 patients (>65 years) treated for hip fracture between 2006 and 2018. All hip fractures were included. Treatment strategies included closed reduction and internal fixation, open reduction and internal fixation, hemiarthroplasty, or total joint arthroplasty. Statistical analysis included T-test, Pearson correlation for CAR and other markers, ROC curves and area under the curve, Youden Model, and Odds Ratio. RESULTS The 30-day mortality rate analysis showed that higher preoperative levels of CAR were associated with higher early mortality. When analyzing the area under the ROC curve (AUROC) for 30-day mortality, the reported value was 0.816. The point of the ROC curve corresponding to 14.72 was considered a cut-off with a specificity of 87% and a sensibility of 40.8%. When analyzing values higher than 14.72, the 30-day mortality rate was 17.9%, whilst, for values lower than 14.72, the 30-day mortality rate was 1.8%. CONCLUSIONS Patients older than 65 years affected by a hip fracture with increased preoperative levels of CAR are associated with higher 30-day mortality. Despite a moderate sensibility, considering the low cost and the predictivity of CAR, it should be considered a standard predictive marker.
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Affiliation(s)
- Giorgio Cacciola
- Orthopaedic Institute of Southern Italy "Franco Scalabrino", 98165 Messina, Italy
| | - Fabio Mancino
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
| | - Lukas A Holzer
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
| | - Federico De Meo
- Orthopaedic Institute of Southern Italy "Franco Scalabrino", 98165 Messina, Italy
| | - Ivan De Martino
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy
- Adult Reconstruction and Joint Replacement Unit, Division of Sports Traumatology and Joint Replacement, Department of Ageing, Orthopaedic and Rheumatologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | | | - Salvatore Risitano
- A.O.U. Città della Salute e della Scienza, Centro Traumatologico Ortopedico (C.T.O.), Universitá di Torino, 10024 Turin, Italy
| | - Luigi Sabatini
- A.O.U. Città della Salute e della Scienza, Centro Traumatologico Ortopedico (C.T.O.), Universitá di Torino, 10024 Turin, Italy
| | - Pietro Cavaliere
- Orthopaedic Institute of Southern Italy "Franco Scalabrino", 98165 Messina, Italy
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Sun L, Wang C, Zhang M, Li X, Zhao B. The Surgical Timing and Prognoses of Elderly Patients with Hip Fractures: A Retrospective Analysis. Clin Interv Aging 2023; 18:891-899. [PMID: 37287528 PMCID: PMC10243344 DOI: 10.2147/cia.s408903] [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: 02/16/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023] Open
Abstract
Background Guidelines exist for the surgical treatment of hip fractures, but the association between the surgical timing and the incidence of postoperative complications and other important outcomes in elderly patients with hip fracture remains controversial. Objective This study aims to explore the association between the surgical timing and the prognoses in elderly patients with hip fracture. Methods A total of 701 elderly patients (age ≥ 65 years) with hip fractures who were treated in our hospital from June 2020 to June 2021 were selected. Patients who underwent surgery within 2 d of admission were assigned to the early surgery group, and those who underwent surgery after 2 d of admission were assigned to the delayed surgery group. The prognosis indices of the patients in the two groups were recorded and compared. Results The length of postoperative hospitalisation in the early surgery group was significantly lower than that in the delayed surgery group (P < 0.001). The European quality of life questionnaire (EQ-5D) utility in the delayed surgery group was significantly lower than that in the early surgery group at 30 days and 6 months after operation (P<0.05). Compared with the delayed surgery group, the incidence of pulmonary infection, urinary tract infection (UTI) and deep vein thrombosis (DVT) in the early surgery group were significantly lower. There were no significant differences between the two groups in terms of mortality and excellent rates of the HHS at six months after the operation. In addition, the early surgery group had a lower readmission rate than the delayed surgery group [34 (9.5%) vs 56 (16.3%), P = 0.008]. Conclusion Earlier surgery can reduce the incidence of pulmonary infections, UTI, DVT and readmission rate among elderly patients with hip fractures, shorten postoperative hospitalisation.
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Affiliation(s)
- Lili Sun
- Department of Emergency, Beijing Jishuitan Hospital, Beijing, People’s Republic of China
| | - Cong Wang
- Department of Emergency, Beijing Jishuitan Hospital, Beijing, People’s Republic of China
| | - Mingqing Zhang
- Department of Emergency, Beijing Jishuitan Hospital, Beijing, People’s Republic of China
| | - Xiang Li
- Department of Emergency, Beijing Jishuitan Hospital, Beijing, People’s Republic of China
| | - Bin Zhao
- Department of Emergency, Beijing Jishuitan Hospital, Beijing, People’s Republic of China
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Buunaaim ADB, Osman I, Salisu WJ, Bukari MIS, Yempabe T. Epidemiology of elderly fractures in a tertiary hospital in Northern Ghana: a 3-year retrospective descriptive review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:473-479. [PMID: 36527505 DOI: 10.1007/s00590-022-03450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The incidence of elderly fractures is closely related to the increasing proportion of the elderly population in sub-Saharan Africa, making it a relevant public health concern. Epidemiological profiles of these fractures and treatment options are necessary for resource-poor settings to optimise planning and patient care. METHODS A retrospective descriptive cross-sectional study was conducted at Tamale Teaching Hospital. Data of 69 elderly patients (60 years and above) with fractures admitted to the trauma and orthopaedic unit from January 2017 to December 2019 were collected. Simple descriptive and bivariate analysis was conducted on some variables, whereas the Chi-square was used to test for some associations for categorical data. RESULTS The mean age of the study participants was 70.3(± 8.6). Elderly males (55.1%) were three times more likely to sustain fractures than females. The primary mechanism of injury was a road traffic accident (RTA) (59.4%), followed by falls from slips (29.0%). There was a significant association between gender and mechanisms (RTA and Falls from slips) of injury (p = 0.002). The most fractured bone was the femur (50.7%). Hip fractures (33.3%) were more common among females than males and mainly among the (71-80) age group. Open fractures were more common among males than females. CONCLUSION RTAs were the most typical cause of fractures in the elderly. Contrary to other studies, males were more commonly involved in accidents than females, albeit females were the majority for hip fractures. Therefore, significant public health policies with resource allocation should address the unmet health needs of this unique age group in our growing populations in low- and middle-income countries.
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Affiliation(s)
- A D B Buunaaim
- Department of Surgery/Department Physician Assistant Studies, School of Medicine, University for Development Studies, Tamale, Ghana.
- Department of Surgery, Trauma/Orthopaedic Unit, Tamale Teaching Hospital, Tamale, Ghana.
| | - I Osman
- Department of Surgery, Trauma/Orthopaedic Unit, Tamale Teaching Hospital, Tamale, Ghana
| | - W J Salisu
- Department of Nursing, Tamale Teaching Hospital, Tamale, Ghana
| | - M I S Bukari
- Department of Surgery/Department Physician Assistant Studies, School of Medicine, University for Development Studies, Tamale, Ghana
| | - T Yempabe
- Department of Surgery, Trauma/Orthopaedic Unit, Tamale Teaching Hospital, Tamale, Ghana
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Chen X, Zhang J, Lin Y, Liu Z, Sun T, Wang X. Risk factors for postoperative mortality at 30 days in elderly Chinese patients with hip fractures. Osteoporos Int 2022; 33:1109-1116. [PMID: 34993561 DOI: 10.1007/s00198-021-06257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
UNLABELLED Arrhythmia, pneumonia, cardiac insufficiency, a high leukocyte count, and low albumin concentrations were associated with increased 30-day mortality in elderly hip fracture patients after surgery. It is important to improve short-term survival rates by optimizing the respiratory and cardiac function of geriatric patients before they undergo surgery. INTRODUCTION This study aims to investigate the 30-day mortality and related risk factors for elderly patients following surgery for hip fractures. METHODS This retrospective study examined chart reviews for evaluating associations of gender, age, fracture site, biochemical indicators, pre-surgery comorbidities, number of pre-surgery comorbidities, time to surgery and anesthesia and surgery methods with postoperative 30-day mortality in elderly hip fracture surgery patients. RESULTS A total of 1,004 patients were included in the study and 43 (4.3%) patients died within 30 days after surgery. Univariate analysis showed that patients in the non-survival group had a higher mean age, higher leukocyte counts, lower hemoglobin and albumin levels, a higher proportion of arrhythmias, pneumoniae and cardiac insufficiency and number of presurgical comorbidities than the survival group (all P-values < 0.05). Multivariate logistic analysis further confirmed that arrhythmia (OR = 2.033, P = 0.038), pneumonia (OR = 2.246, P = 0.041), cardiac insufficiency (OR = 2.833, P = 0.029), high leukocyte count (OR = 1.139, P = 0.009), and low albumin (OR = 0.925, P = 0.041) were all significant risk factors for mortality 30 days after surgery. CONCLUSIONS This study demonstrates that arrhythmia, pneumonia, cardiac insufficiency, a high leukocyte count, and low albumin concentrations were associated with increased 30-day mortality in elderly hip fracture patients after surgery.
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Affiliation(s)
- X Chen
- Department of Orthopaedics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - J Zhang
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - Y Lin
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - Z Liu
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - T Sun
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - X Wang
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China.
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Length of hospital stay and mortality of hip fracture surgery in patients with Coronavirus disease 2019 (COVID-19) infection. CURRENT ORTHOPAEDIC PRACTICE 2022; 33:172-177. [PMID: 35222789 PMCID: PMC8862679 DOI: 10.1097/bco.0000000000001087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Analysis of Factors Affecting the Third- and Twelfth-Month Mortality in Patients with Hip Fractures Aged 80 Years and Older. Indian J Orthop 2021; 56:601-607. [PMID: 35342528 PMCID: PMC8921353 DOI: 10.1007/s43465-021-00574-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the possible risk factors that are related with mortality at third and twelfth months after hip fractures in a large population of patients aged 80 years and older. METHODS 605 patients were evaluated in terms of the localization of the fracture, gender, age, side of the fracture, the type of applied procedure, anesthesia type, hospitalization time, time to operation, comorbidities, ASA score, the values of preoperative hemoglobin, lymphocyte and neutrophil percentage, white blood cell, albumin, sodium levels. The state mortality system was used to investigate whether patients are alive or died. Statistical analysis was performed to evaluate the important factors on third- and twelfth-month mortality. RESULTS Male gender, neurologic-cardiac-chronic obstructive pulmonary (COP) diseases, preoperative hemoglobin level < 10 g/dL, arthroplasty and external fixator groups, ASA grade ≥ 3, delaying the surgery more than 4 days, longer hospitalization time, lower albumin levels and advanced age were found to be statistically significant factors for 3-month mortality (p values were; 0.01, 0.02, 0.01, 0.01, 0.047, 0.01, 0.02, 0.002, < 0.001, 0.002 and 0.01, respectively). Male gender, hypertension-neurologic-cardiac diseases, preoperative hemoglobin level < 10 g/dL, delaying the surgery more than 4 days, longer hospitalization time, lower lymphocyte percentage, lower albumin levels and advanced age were found to be statistically significant factors for 12-month mortality (p values were; < 0.001, 0.01, 0.01, 0.01, 0.03, 0.01, < 0.001, 0.01, 0.004 and < 0.001, respectively). CONCLUSION COP, advanced age, and heart disease were the most important factors in 3-month mortality. Long hospitalization time, male gender and advanced age were the most important factors affecting the 12-month mortality.Level of Evidence Prognostic level IV.
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Fu M, Guo J, Zhang Y, Zhao Y, Zhang Y, Wang Z, Hou Z. Effect of Wearing Medical Masks on Perioperative Respiratory Complications in Older Adults with Hip Fracture: A Retrospective Cohort Study. Clin Interv Aging 2021; 16:1967-1974. [PMID: 34824528 PMCID: PMC8610772 DOI: 10.2147/cia.s333238] [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: 08/09/2021] [Accepted: 11/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Respiratory complication is one of the major challenges in the treatment of older adults with hip fractures. However, no study so far has investigated the effect of wearing medical masks on the prevention of perioperative respiratory complications in these patients. Patients and Methods In this retrospective cohort study, 1016 consecutive patients aged ≥65 years with hip fractures were included and assigned to two groups: the control group and the observation group. The two groups received the same perioperative management modalities. In addition, patients in the observation group were asked to wear medical masks for protection. Data of patients’ demographics, fracture type, surgical methods, comorbidities, the incidence of perioperative respiratory and other complications, and hospital outcomes were collected and compared between the two groups. Subgroup analyses were also performed stratified by fracture types. Results A total of 1016 patients (292 females and 724 males) with a mean age of 79.4±7.3 years were analyzed in the study, including 533 in the control group and 483 in the observation group. The overall incidence of perioperative respiratory complication, and the incidence of pulmonary infection, respiratory failure and arrhythmia in the observation group were significantly lower than the control group, especially in winter and spring. There was no difference in other complications, hospital length of stay, and total hospital costs. Further subgroup analyses showed that the incidence of heart failure and arrhythmia in the observation group was lower than that in the control group for patients with femoral neck fractures, which was different from patients with intertrochanteric fractures. Conclusion The incidence of perioperative respiratory complications, including pulmonary infection and respiratory failure, could be reduced in older adults with hip fractures by strengthening personal protection, including wearing medical masks, especially in winter and spring. Wearing medical masks could also effectively reduce the incidence of perioperative heart failure and arrhythmia in femoral neck fracture patients and do not increase the incidence of other complications and the burden of hospitalization.
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Affiliation(s)
- Mingming Fu
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yaqian Zhang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yuqi Zhao
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China.,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China
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Forssten MP, Mohammad Ismail A, Borg T, Cao Y, Wretenberg P, Bass GA, Mohseni S. The consequences of out-of-hours hip fracture surgery: insights from a retrospective nationwide study. Eur J Trauma Emerg Surg 2021; 48:709-719. [PMID: 34622327 PMCID: PMC9001198 DOI: 10.1007/s00068-021-01804-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/28/2021] [Indexed: 12/21/2022]
Abstract
Purpose The study aimed to investigate the association between out-of-hours surgery and postoperative mortality in hip fracture patients. Furthermore, internal fixation and arthroplasty were compared to determine if a difference could be observed in patients operated with these techniques at different times during the day. Methods All patients above 18 of age years in Sweden who underwent hip fracture surgery between 2008 and 2017 were eligible for inclusion. Pathological fractures, non-operatively managed fractures, or cases whose time of surgery was missing were excluded. The cohort was subdivided into on-hour (08:00–17:00) and out-of-hours surgery (17:00–08:00). Poisson regression with adjustments for confounders was used to evaluate the association between out-of-hours surgery and both 30-day and 90-day postoperative mortality. Results Out-of-hours surgery was associated with a 5% increase in the risk of both 30-day [adj. IRR (95% CI) 1.05 (1.00–1.10), p = 0.040] and 90-day [adj. IRR (95% CI) 1.05 (1.01–1.09), p = 0.005] mortality after hip fracture surgery compared to on-hour surgery. There was no statistically significant association between out-of-hours surgery and postoperative mortality among patients who received an internal fixation. Arthroplasties performed out-of-hours were associated with a 13% increase in 30-day postoperative mortality [adj. IRR (95% CI) 1.13 (1.04–1.23), p = 0.005] and an 8% increase in 90-day postoperative mortality [adj. IRR (95% CI) 1.08 (1.01–1.15), p = 0.022] compared to on-hour surgery. Conclusion Out-of-hours surgical intervention is associated with an increase in both 30- and 90-day postoperative mortality among hip fracture patients who received an arthroplasty, but not among patients who underwent internal fixation.
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Affiliation(s)
- Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Tomas Borg
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, 701 82 Orebro, Sweden
| | - Per Wretenberg
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Gary Alan Bass
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, USA
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
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Chen J, Yue C, He P, Huang Z, Li L, Zhang X, Fan Y, Liu Y. Comparison of clinical outcomes with hip replacement versus PFNA in the treatment of intertrochanteric fractures in the elderly: A systematic review and meta-analysis (PRISMA). Medicine (Baltimore) 2021; 100:e24166. [PMID: 33655910 PMCID: PMC7939162 DOI: 10.1097/md.0000000000024166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/10/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The purpose of this meta-analysis was to evaluate the clinical efficacy and safety of HR and PFNA in the treatment of intertrochanteric fractures in the elderly. METHODS We carried out this review according to the principle of preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline. The clinical randomized controlled trials (RCTs), prospective cohort studies, retrospective cohort studies (RCSs), and case-control studies involving HR and PFNA in the treatment of intertrochanteric fractures in the elderly from 2000 to 2020 were compared by searching Web of Science, Pubmed, the Cochrane Library, and Embase. The quality of the included cohort study (CS) lines was evaluated using the Newcastle-Ottawa Scale (NOS). The quality of the included RCT lines was evaluated using Jadad. Forest plots were drawn by RevMan5.4 software based on the results and the data were analyzed. RESULTS After screening, a total of 9 articles were included, of which one was a clinical RCT and eight were RCSs with 1374 patients. The operative time of the PFNA group was shorter [WMD = 15.20; 95% CI (13.17, 17.23), P < .05] and the intraoperative blood loss was less [WMD = 178.81; 95% CI (97.24, 260.38), P < .05] than the HR group, while the first weight-bearing time of the HR group was shorter [WMD = -7.70; 95% CI (-10.54, -4.86), P < .05] than the PFNA group. There was no significant difference in the length of hospital stay, HHS, postoperative orthopedic complications, and postoperative medical complications between the 2 groups. CONCLUSION With the development of HR technology and minimally invasive technology, the trauma caused by surgery is decreasing. Under the premise of improving perioperative management, such as optimizing the preoperative preparation and postoperative management, shortening the operative time, reducing intraoperative blood loss, and actively managing co-existing diseases, HR has more advantages than PFNA in the treatment of senile intertrochanteric fractures.
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Affiliation(s)
- Junming Chen
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Chen Yue
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Peilin He
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Zeling Huang
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Li Li
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Xue Zhang
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Yanan Fan
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Youwen Liu
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
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12
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George J, Sharma V, Farooque K, Mittal S, Trikha V, Malhotra R. Factors associated with delayed surgery in elderly hip fractures in India. Arch Osteoporos 2021; 16:7. [PMID: 33409699 DOI: 10.1007/s11657-020-00858-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/13/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Early hip fracture surgery is recommended to decrease the morbidity and mortality. The extent to which such guidelines are being followed in developing countries like India is unknown. About 20% of the patients presented to hospital after 24 hours of injury, and only one-third had surgery within 48 hours of presentation. INTRODUCTION Early hip fracture surgery is recommended to decrease the morbidity and mortality following hip fractures. Understanding the factors responsible for delay in surgery is important to improve the quality of hip fracture care. This study was conducted to study the factors causing delay in elderly hip fracture surgery in India. METHODS In this prospective study, 272 consecutive hip fracture surgeries at a single hospital were included. Delayed surgery was defined as when the time to surgery (reaching hospital to start of incision) was more than 48 hours. Additionally, the total time to surgery (including time taken for patients to reach hospital after injury) was studied. Factors associated with delayed surgery were assessed using regression models. RESULTS Eighty-seven (32%) patients had a surgery within 48 hours of presentation. Majority of the patients had a delay (82%, N = 151/185) due to one or more medical reasons. Fifty-four (20%) patients presented to hospital after 24 hours of injury. The mean total time to surgery was 112 ± 90 hours with time after reaching hospital contributing to 78% of the total time. Multiple comorbidities (odds ratio, OR = 3.47 [1.42-8.45]), fall as mode of injury (OR = 3.54 [1.61-7.80]), requiring an additional investigation (OR = 10.4 [3.4-31.81]), and requiring arthroplasty (OR = 40.57 [7.01-234.97]) were independently associated with delayed surgery. CONCLUSION Only about one-third of the patients received surgery within 48 hours of reaching the hospital, and about 20% of the patients presented to hospital after 24 hours of injury. Delayed surgery was primarily due to medical comorbidities. Hospitals should establish protocols to ensure faster optimization of patients.
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Affiliation(s)
- Jaiben George
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vijay Sharma
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India. .,Department of Orthopaedic Surgery, JPNA Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Kamran Farooque
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India.,Department of Orthopaedic Surgery, JPNA Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Samarth Mittal
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India.,Department of Orthopaedic Surgery, JPNA Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vivek Trikha
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India.,Department of Orthopaedic Surgery, JPNA Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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13
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Hancıoğlu S, Gem K, Tosyali HK, Okçu G. Clinical and Radiological Outcomes of Trochanteric AO/OTA 31A2 Fractures: Comparison between Helical Blade and Lag Screw - A Retrospective Cohort Study. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 160:278-286. [PMID: 33233011 DOI: 10.1055/a-1291-8619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The purpose of this study was to compare the clinical and radiological outcomes of AO/OTA type 31A2 fractures treated by the use of trochanteric nails either with a blade or a screw. PATIENTS AND METHODS This study was designed retrospectively. Between May 2007 and May 2014, a total of 144 patients with trochanteric fractures were admitted to the clinic, and only 65 of them met the inclusion criteria. Thirty-two of them (blade group) were treated with a helical blade and the rest of the 33 patients (screw group) were treated with a screw. The mean ages of the patients were 76.01 and 75.82, respectively (p = 0.905). The mean follow-up time was 27.6 months (blade group: 34.2 ± 19.1 months; screw group: 18.6 ± 7.9 months; p < 0.001). Between these two groups, we evaluated the differences in tip apex distances (TAD), calcar-referenced tip-apex distances (Cal-TAD), implant positions, cut-out rates, and implant failures. Functional outcomes were measured with the help of the Harris Hip Score. RESULTS No significant differences were seen between the blade and screw groups by means of cutting out, implant positions, and varus collapse. Cutting out was seen in a total of six patients (blade group n = 2; screw group = 4; p = 0.672) and varus collapse in nine patients (blade group n = 5, screw group n = 4; p = 0.733). Harris Hip Scores were similar between the two groups (blade group: 72.70 ± 18.43; screw group: 80.83 ± 18.75; p = 0.84).
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Affiliation(s)
- Sertan Hancıoğlu
- Orthopedics and Traumatology, Republic of Turkey Ministry of Health Izmir Provincial Health Directorate Izmir University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Kadir Gem
- Orthopedics and Traumatology Clinic, Alasehir State Hospital, Manisa, Turkey
| | - Hakan Koray Tosyali
- Orthopedics and Traumatology, Celal Bayar Universitesi Tip Fakultesi, Manisa, Turkey
| | - Güvenir Okçu
- Orthopedics and Traumatology, Celal Bayar Universitesi Tip Fakultesi, Manisa, Turkey
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14
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Alsheikh KA, Alsebayel FM, Alsudairy FA, Alzahrani A, Alshehri A, Alhusain FA, Alsaeed A, Almubarak A, Alhandi AA. One-year postoperative mortality rate among the elderly with hip fractures at a single tertiary care center. Ann Saudi Med 2020; 40:298-304. [PMID: 32757984 PMCID: PMC7410227 DOI: 10.5144/0256-4947.2020.298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hip fractures are one of the leading causes of disability and dependency among the elderly. The rate of hip fractures has been progressively increasing due to the continuing increase in average life expectancy. Surgical intervention is the mainstay of treatment, but with an increasing prevalence of comorbid conditions and decreased functional capacity in elderly patients, more patients are prone to postoperative complications. OBJECTIVES Assess the value of surgical intervention for hip fractures among the elderly by quantifying the 1-year mortality rate and assessing factors associated with mortality. DESIGN Medical record review. SETTING Tertiary care center. PATIENTS AND METHODS All patients 60 years o age or older who sustained a hip fracture between the period of 2008 to 2018 in a single tertiary healthcare center. Data was obtained from case files, using both electronic and paper files. MAIN OUTCOME MEASURES The 1-year mortality rate for hip fracture, postoperative complications and factors associated with mortality. SAMPLE SIZE 802 patients. RESULTS The majority of patients underwent surgical intervention (93%). Intra- and postoperative complications were 3% and 16%, respectively. Four percent of the sample died within 30 days, and 11% died within one year. In a multivariate analysis, an increased risk of 1-year mortality was associated with neck of femur fractures and postoperative complications (P=.034, <.001, respectively) CONCLUSION: The 1-year mortality risk in our study reinforces the importance of aggressive surgical intervention for hip fractures. LIMITATION Single-centered study. CONFLICT OF INTEREST None.
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Affiliation(s)
- Khalid A Alsheikh
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,From the Department of Orthopedic Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Firas M Alsebayel
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Faisal Abdulmohsen Alsudairy
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah Alzahrani
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,From the Department of Orthopedic Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ali Alshehri
- From the Department of Orthopedic Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Faisal Ahmed Alhusain
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah Alsaeed
- From the Department of Orthopedic Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulaziz Almubarak
- From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ali A Alhandi
- From the Department of Orthopedic Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia.,From the Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Abstract
UNLABELLED This study aimed to determine factors affecting the survival of patients with hip fracture in Shiraz, Iran. Alzheimer's disease, hypertension, and cardiovascular diseases were risk factors, while female gender and living with family members or in nursing homes were protective factors against mortality following hip fracture. PURPOSE Hip fractures are the most common orthopedic fractures in elderly. This study aimed to determine the factors affecting the survival of patients with hip fracture in Shiraz. METHODS This historical cohort study was conducted in Shiraz, Iran. All patients with hip fracture who were admitted to any of the hospitals providing orthopedic services in Shiraz, from September 1, 2011, to August 30, 2012, were included in the study. The log rank test, Kaplan-Meier methods, and the univariate and multivariate Cox regression model were used for data analysis. RESULTS A total of 631 patients were enrolled, of these, 264 (41.8%) were male. The mean age of patients was 74.9 ± 11.5. The patients' survival rate after the 1st, 2nd, 3rd, 4th, and 5th year were 81.1%, 73.7%, 69.4%, 64.8%, and 60.2%, respectively. After adjusting data for age, Alzheimer's disease (HR = 4.9, 95% CI 1.4-7.3, P = 0.023), hypertension (HR = 2.27, 95% CI 1.3-3.8, P = 0.003), and cardiovascular diseases (HR = 2.02, 95% CI 1.04-3.09, P = 0.039) remained as risk factors for mortality in patients with hip fracture. However, female patients (HR = 0.46, 95% CI 0.27-0.8, P = 0.006) and those who lived with family members or in nursing homes (HR = 0.43, 95% CI 0.19-0.92, P = 0.03) were protective factors. CONCLUSION This study showed that women are more likely to have hip fractures, but mortality among men is more observable. Alzheimer's disease, hypertension, and cardiovascular diseases were considered as risk factors, while patients who were female and those who lived with the family member or in nursing homes had better survival.
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16
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Kulshrestha V, Sood M, Kumar S, Sharma P, Yadav YK. Outcomes of Fast-Track Multidisciplinary Care of Hip Fractures in Veterans: A Geriatric Hip Fracture Program Report. Clin Orthop Surg 2019; 11:388-395. [PMID: 31788160 PMCID: PMC6867922 DOI: 10.4055/cios.2019.11.4.388] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/24/2019] [Indexed: 01/04/2023] Open
Abstract
Background Hip fractures are a significant cause of morbidity and mortality in the elderly. Fast-track multidisciplinary co-management of these patients, rapid preoperative optimization, early surgery, and expeditious rehabilitation may minimize morbidity and mortality. In this study, we evaluated outcomes of fixation of hip fractures in the elderly patients managed by Geriatric Hip Fracture Program at a military hospital in India. Methods A total of 114 patients above 60 years of age with hip fractures were enrolled. They were comanaged by a team of specialists and fast-tracked to surgery. Independent ambulation with support of a walker was achieved before discharge to home. Patients were followed up for 1 year. Results The average age of the 114 patients was 77 years; 24 patients were octogenarian. Eighty-four percent of injuries were due to a domestic fall. Hypertension (41%) and diabetes (22%) were the most common comorbidities. All patients were optimized before surgery. The average delay from injury to admission was 1.7 days (range, 0 to 14 days) and that from admission to surgery was 1.8 days (range, 0 to 19 days). Hence, the average time from injury to surgery was 3.5 days. The length of stay in hospital was, as per rehabilitative milestones achieved, 2 to 5 days in 40% of the patients and 6 to 15 days in 60% of the patients. At 1 year after surgery, 95 patients were independently ambulant (56 patients with support and 39 patients without support). Twenty-three percent of the patients had postoperative complications and eight patients died (7.7%) at 1-year follow-up; 11 patients were lost to follow-up. Conclusions Elderly hip fracture has a high risk of mortality (14%–58%). Thus, expeditious surgery within 24 hours of admission has been advocated in the Western literature to minimize mortality. Mortality rate at 1 year after surgery remains at 10% to 24%. In our study, even with aggressive co-management, the average delay to hip fracture fixation was more than 3 days; however, the 1-year mortality was relatively low (7.7%). This indicates the importance of preoperative optimization and postoperative rehabilitation for independent ambulation and mortality reduction in the elderly population.
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Affiliation(s)
| | - Munish Sood
- Department of Orthopaedics, Command Hospital, Panchkula, India
| | - Santhosh Kumar
- Department of Orthopaedics, Air Force Hospital, Bangaluru, India
| | - Pramila Sharma
- Department of Orthopaedics and Rehabilitation, Air Force Hospital, Kanpur, India
| | - Yash Kumar Yadav
- Department of Orthopaedics and Rehabilitation, Air Force Hospital, Kanpur, India
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17
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Abstract
INTRODUCTION Multiple studies have shown the impact of hip fractures on geriatric mortality. Few evaluate mortality after proximal humerus (PH) or distal humerus (DH) fractures, and fewer determine differences in mortality based on management. We aim to evaluate a statewide cohort of elderly patients with PH or DH fractures to evaluate mortality, length of stay, discharge data, readmission, and differences based on management. METHODS The New York Statewide Planning and Research Cooperative System database was used to identify patients 60 years and older admitted with a PH or DH fracture. Patient demographics, including age, gender, sex, race, weight, and insurance status, along with comorbid conditions using the Charlson Comorbidity Index, were determined. Seven-day, 30-day, and 1-year mortality was determined for operative and nonoperative cohorts. Logistic regression determined the competing risk of mortality when controlling for patient demographics, comorbid conditions, and treatment. RESULTS Forty-two thousand five hundred eleven PH and 7654 DH fractures were evaluated. PH fractures had higher mortality than DH. Nonoperative treatment occurred in 76.2% of PH fractures and 53% of DH fractures. There were more comorbid conditions, longer length of stay, and higher mortality at 7 days, 30 days, and 1 year in patients treated nonoperatively. After controlling for patient demographics and comorbid conditions, there was no difference in mortality between PH and DH fractures, but operative treatment for either PH or DH was associated with lower mortality at all time points. DISCUSSION Fewer PH than DH fractures were treated operatively. Operative treatment was associated with improved survival in patients hospitalized with PH or DH fracture even after controlling for patient demographic and comorbid factors. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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18
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Predictive factors for thirty day mortality in geriatric patients with hip fractures: a prospective study. INTERNATIONAL ORTHOPAEDICS 2018; 43:275-281. [PMID: 30054670 DOI: 10.1007/s00264-018-4057-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/12/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE The study aims to analyze the incidence of 30-day mortality in elderly patients who underwent surgery for hip fractures and its associated factors. METHODS A prospective multicentric study was performed. All patients aged ≥ 65 years, with fragility hip fractures, consecutively admitted in two Italian hospitals were included. Patients with periprosthetic or pathological fractures were excluded. Logistic regression was used to identify patient and patient care variables that independently influenced the 30-day mortality and receiver operating characteristic (ROC) curve analysis to assess their predictive capacity on the outcome. RESULTS Of the patients, 728 met the inclusion criteria, of whom approximately 5% died within 30 days after admission. The 45.7% of the deceased patients died while hospitalized. Multivariate analysis showed that advancing age was the only independent predictor of 30-day mortality (OR = 1.084, 95% CI = 1.024-1.147), while a higher presence of informal caregivers was a protective factor (OR = 0.988, 95% CI = 0.979-0.997). The area under the ROC curve of the model was 0.723 (CI95% 0.676-0.770) for 30-day mortality in elderly hip fractures patients. CONCLUSIONS Patients with an advanced age need careful follow-up, especially within 30 days following operation for hip fracture; at the same time, the presence of informal caregivers at the patient's bedside should be promoted.
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19
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Siletz A, Childers CP, Faltermeier C, Singer ES, Hu QL, Ko CY, Kates SL, Maggard-Gibbons M, Wick E. Surgical Technical Evidence Review of Hip Fracture Surgery Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery. Geriatr Orthop Surg Rehabil 2018; 9:2151459318769215. [PMID: 29844947 PMCID: PMC5964861 DOI: 10.1177/2151459318769215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/16/2018] [Accepted: 03/07/2018] [Indexed: 01/04/2023] Open
Abstract
Background: Enhanced recovery pathways (ERPs) have been shown to improve patient outcomes in a variety of contexts. This review summarizes the evidence and defines a protocol for perioperative care of patients with hip fracture and was conducted for the Agency for Healthcare Research and Quality safety program for improving surgical care and recovery. Study Design: Perioperative care was divided into components or “bins.” For each bin, a semisystematic review of the literature was conducted using MEDLINE with priority given to systematic reviews, meta-analyses, and randomized controlled trials. Observational studies were included when higher levels of evidence were not available. Existing guidelines for perioperative care were also incorporated. For convenience, the components of care that are under the auspices of anesthesia providers will be reported separately. Recommendations for an evidence-based protocol were synthesized based on review of this evidence. Results: Eleven bins were identified. Preoperative risk factor bins included nutrition, diabetes mellitus, tobacco use, and anemia. Perioperative management bins included thromboprophylaxis, timing of surgery, fluid management, drain placement, early mobilization, early alimentation, and discharge criteria/planning. Conclusions: This review provides the evidence basis for an ERP for perioperative care of patients with hip fracture.
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Affiliation(s)
- Anaar Siletz
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Christopher P Childers
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Claire Faltermeier
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Emily S Singer
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Q Lina Hu
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,American College of Surgeons, Chicago, IL, USA
| | - Clifford Y Ko
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,American College of Surgeons, Chicago, IL, USA
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Elizabeth Wick
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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20
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Vasu BK, Ramamurthi KP, Rajan S, George M. Geriatric Patients with Hip Fracture: Frailty and Other Risk Factors Affecting the Outcome. Anesth Essays Res 2018; 12:546-551. [PMID: 29962632 PMCID: PMC6020579 DOI: 10.4103/aer.aer_61_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hip fracture is a devastating health-care problem in a geriatric patient, leading to high mortality and morbidity. Preoperative risk assessment in the geriatric patient is often inexact because of the difficulty in measuring their poor physiologic reserves. AIMS The primary objective was to find the association of modified frailty index (MFI) with 90-day mortality in geriatric patients who received anesthesia for fractured hip. Secondary objectives were to assess the association of preoperative waiting time with the 90-day mortality and the correlation of preexisting medical conditions with poor functional outcome among the survivors. SETTINGS AND DESIGNS This prospective, observational study was conducted at a tertiary care institution. SUBJECTS AND METHODS In this prospective observational study, done over a period of 1 year, 60 geriatric patients aged ≥65 years who received anesthesia for fractured hip and fulfilled selection criteria were recruited. The association of MFI with 90-day mortality and the correlation of preexisting comorbidities with poor functional outcome among the survivors were assessed. STATISTICAL ANALYSIS USED Independent sample t-test, Mann-Whitney test, and odds ratio were used as applicable. RESULTS Total 60 patients were available for analysis as two patients dropped off from final 62 on follow up, fifty three patients survived after 90 days. MFI and 90-day mortality showed a significant direct correlation with P < 0.0001. However, no association was found between the preoperative waiting time and 90-day mortality. Preexisting medical conditions showed a significant association of dementia with total dependence afterward with a P = 0.02. CONCLUSION There is significant statistical correlation of MFI with the 90-day mortality in the geriatric hip-fractured patients undergoing surgery.
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Affiliation(s)
- Bindu K. Vasu
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Kruthika P. Ramamurthi
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sunil Rajan
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Mathew George
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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21
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Pincus D, Desai SJ, Wasserstein D, Ravi B, Paterson JM, Henry P, Kreder HJ, Jenkinson R. Outcomes of After-Hours Hip Fracture Surgery. J Bone Joint Surg Am 2017; 99:914-922. [PMID: 28590376 DOI: 10.2106/jbjs.16.00788] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Given single-institution studies showing trends between after-hours hip fracture surgical procedures and adverse outcomes, as well as fixation time targets that may increasingly compel after-hours operations, we investigated the relationship between after-hours hip fracture surgical procedures and adverse outcomes in a large, population-based cohort. METHODS All Ontarians who were ≥60 years of age and underwent a hip fracture surgical procedure between April 2002 and March 2014 were eligible for study inclusion. Data were obtained from linked health administrative databases. The primary exposure was after-hours provision of surgical procedures, occurring weekday evenings between the hours of 5 P.M. and 12 A.M. or over the weekend, but not overnight (after 12 A.M. to 7 A.M.). Surgical complications up to 6 months following a hip fracture surgical procedure comprised the primary outcome. Medical complications, including mortality, up to 90 days postoperatively were also assessed. Odds ratios (ORs) were calculated using a logistic regression model that accounted for clustering at the hospital level and adjusted for patient, provider, and fracture characteristics previously shown to explain the majority of variance in hip fracture outcomes. RESULTS During the study period, 87,647 patients underwent an isolated hip fracture surgical procedure; 51.2% of these patients had femoral neck fractures, 44.1% had intertrochanteric fractures, and 4.7% had subtrochanteric fractures. The surgical procedure occurred after hours in 59,562 patients (68.0%), and 27,240 patients (31.1%) underwent a surgical procedure during normal hours (7 A.M. to 5 P.M.). Only 845 patients (1%) underwent a surgical procedure overnight. We observed no significant relationships between timing of the surgical procedure and adverse outcomes, except for patients who had undergone an after-hours surgical procedure and had fewer inpatient surgical complications (OR, 0.90 [95% confidence interval, 0.83 to 0.99]; p = 0.01). CONCLUSIONS Adverse outcomes following a hip fracture surgical procedure were similar whether a surgical procedure occurred during normal hours or after hours. Concerns regarding the quality of after-hours surgical procedures should not influence hip fracture prioritization policy. However, given that the great majority of hip fracture surgical procedures occurred after hours, future research should examine other potential consequences of this practice, such as financial impact and surgeon burnout. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel Pincus
- 1Division of Orthopaedic Surgery, Department of Surgery (D.P., D.W., B.R., P.H., H.J.K., and R.J.), and Institute of Health Policy, Management and Evaluation (D.P., J.M.P., and H.J.K.), University of Toronto, Toronto, Ontario, Canada 2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada 3Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Giannoulis D, Calori GM, Giannoudis PV. Thirty-day mortality after hip fractures: has anything changed? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2016; 26:365-70. [PMID: 26943870 PMCID: PMC4856719 DOI: 10.1007/s00590-016-1744-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 01/21/2016] [Indexed: 12/26/2022]
Abstract
Bone density insufficiency is the main cause for significant musculoskeletal trauma in the elderly population following low-energy falls. Hip fractures, in particular, represent an important public health concern taking into account the complicated needs of the patients due to their medical comorbidities as well as their rehabilitation and social demands. The annual cost for the care of these patients is estimated at around 2 billion pounds (£) in the UK and is ever growing. An increased early and late mortality rate is also recognised in these injuries together with significant adversities for the patients. Lately, in order to improve the outcomes of this special cohort of patients, fast-track care pathways and government initiatives have been implemented. It appears that these measures have contributed in a steady year-by-year reduction of the 30-day mortality rates. Whether we have currently reached a plateau or whether an ongoing reduction in mortality rates will continue to be observed is yet to be seen.
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Affiliation(s)
- Dionysios Giannoulis
- Academic Department of Trauma and Orthopaedics Surgery, School of Medicine, University of Leeds, Leeds, UK
| | - Giorgio M Calori
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Milan, Milan, Italy
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics Surgery, School of Medicine, University of Leeds, Leeds, UK.
- NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, West Yorkshire, LS7 4SA, UK.
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