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Venishetty N, Jose J, Purudappa PPA, Mounasamy V, Sambandam S. Factors that influence the mortality of patients following hip hemiarthroplasty. ARTHROPLASTY 2024; 6:36. [PMID: 38844977 PMCID: PMC11157840 DOI: 10.1186/s42836-024-00247-1] [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: 09/27/2023] [Accepted: 03/07/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION Hip hemiarthroplasty (HHA) is one of the most common types of orthopedic surgery. With the prevalence and utilization of the surgery increasing year after year, this procedure is found to be associated with severe postoperative complications and eventually mortality. Thus, it is crucial to understand the factors that increase the risk of mortality following HHA. METHODS Using the Nationwide Inpatient Sample (NIS) database, patients undergoing HHA from 2016 to 2019 were identified. This sample was stratified into a mortality group and a control group. The data regarding patients' demographics, co-morbidities, and associated complications were compared between the groups. RESULTS Of the 84,067 patients who underwent the HHA procedures, 1,327 (1.6%) patients died. Additionally, the mortality group had a higher percentage of patients who were non-electively admitted (P < 0.001) and diabetic patients with complications (P < 0.001), but lower incidences of tobacco-related disorders (P < 0.001). Significant differences were also seen in age (P < 0.001), length of stay (P < 0.001), and total charges (P < 0.001) between the two groups. Preoperatively, those aged > 70 years (OR: 2.11, 95% CI [1.74, 2.56], P < 0.001) had diabetes without complications (OR: 0.32, 95% CI [0.23, 0.44], P < 0.001), tobacco-related disorders (OR: 0.24, 95% CI [0.17, 0.34], P < 0.001) and increased rates of mortality after HHA. Postoperatively, conditions, such as pulmonary embolisms (OR: 6.62, 95% CI [5.07, 8.65], P < 0.001), acute renal failure (OR: 4.58 95% CI [4.09, 5.13], P < 0.001), pneumonia (95% CI [2.72, 3.83], P < 0.001), and myocardial infarctions (OR: 2.65, 95% CI [1.80, 3.92], P < 0.001) increased likelihood of death after undergoing HHA. Patients who were electively admitted (OR: 0.46 95% CI [0.35, 0.61], P < 0.001) had preoperative obesity (OR: 0.67, 95% CI [0.44, 0.84], P = 0.002), and a periprosthetic dislocation (OR: 0.51, 95% CI [0.31, 0.83], P = 0.007) and were found to have a decreased risk of mortality following THA. CONCLUSIONS Analysis of pre- and postoperative complications relating to HHA revealed that several comorbidities and postoperative complications increased the odds of mortality. Old age, pulmonary embolisms, acute renal failure, pneumonia, and myocardial infraction enhanced the odds of post-HHA mortality.
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Affiliation(s)
- Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, 79905, USA.
| | | | | | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, 75390, USA
| | - Senthil Sambandam
- Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, 75390, USA.
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Wang YY, Chou YC, Tsai YH, Chang CW, Chen YC, Tai TW. Unplanned emergency department visits within 90 days of hip hemiarthroplasty for osteoporotic femoral neck fractures: Reasons, risks, and mortalities. Osteoporos Sarcopenia 2024; 10:66-71. [PMID: 39035225 PMCID: PMC11260006 DOI: 10.1016/j.afos.2024.05.005] [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: 01/09/2024] [Revised: 04/12/2024] [Accepted: 05/15/2024] [Indexed: 07/23/2024] Open
Abstract
Objectives Bipolar hemiarthroplasty is commonly performed to treat displaced femoral neck fractures in osteoporotic patients. This study aimed to assess the occurrence and outcomes of unplanned return visits to the emergency department (ED) within 90 days following bipolar hemiarthroplasty for displaced femoral neck fractures. Methods The clinical data of 1322 consecutive patients who underwent bipolar hemiarthroplasty for osteoporotic femoral neck fractures at a tertiary medical center were analyzed. Data from the patients' electronic medical records, including demographic information, comorbidities, and operative details, were collected. The risk factors and mortality rates were analyzed. Results Within 90 days after surgery, 19.9% of patients returned to the ED. Surgery-related reasons accounted for 20.2% of the patient's returns. Older age, a high Charlson comorbidity index score, chronic kidney disease, and a history of cancer were identified as significant risk factors for unplanned ED visits. Patients with uncemented implants had a significantly greater risk of returning to the ED due to periprosthetic fractures than did those with cemented implants (P = 0.04). Patients who returned to the ED within 90 days had an almost fivefold greater 1-year mortality rate (15.2% vs 3.1%, P < 0.001) and a greater overall mortality rate (26.2% vs 10.5%, P < 0.001). Conclusions This study highlights the importance of identifying risk factors for unplanned ED visits after bipolar hemiarthroplasty, which may contribute to a better prognosis. Consideration should be given to the use of cemented implants for hemiarthroplasty, as uncemented implants are associated with a greater risk of periprosthetic fractures.
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Affiliation(s)
- Yang-Yi Wang
- Department of Orthopedic Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Yi-Chuan Chou
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, 701, Taiwan
| | - Yuan-Hsin Tsai
- Department of Orthopedic Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan
- Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung, 402, Taiwan
| | - Chih-Wei Chang
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ta-Wei Tai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Oh AR, Kwon JH, Jin G, Kong SM, Lee DJ, Park J. Association between inflammation-based prognostic markers and mortality after hip replacement. Sci Rep 2024; 14:9263. [PMID: 38649407 PMCID: PMC11035583 DOI: 10.1038/s41598-024-58646-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
We aimed to evaluate the association between inflammation-based prognostic markers and mortality after hip replacement. From March 2010 to June 2020, we identified 5,369 consecutive adult patients undergoing hip replacement with C-reactive protein (CRP), albumin, and complete blood count measured within six months before surgery. Receiver operating characteristic (ROC) curves were generated to evaluate predictabilities and estimate thresholds of CRP-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). Patients were divided according to threshold, and mortality risk was compared. The primary outcome was one-year mortality, and overall mortality was also analyzed. One-year mortality was 2.9%. Receiver operating characteristics analysis revealed areas under the curve of 0.838, 0.832, 0.701, and 0.732 for CAR, NLR, PLR, and modified Glasgow Prognostic Score, respectively. The estimated thresholds were 2.10, 3.16, and 11.77 for CAR, NLR, and PLR, respectively. According to the estimated threshold, high CAR and NLR were associated with higher one-year mortality after adjustment (1.0% vs. 11.7%; HR = 2.16; 95% CI 1.32-3.52; p = 0.002 for CAR and 0.8% vs. 9.6%; HR = 2.05; 95% CI 1.24-3.39; p = 0.01 for NLR), but PLR did not show a significant mortality increase (1.4% vs. 7.4%; HR = 1.12; 95% CI 0.77-1.63; p = 0.57). Our study demonstrated associations of preoperative levels of CAR and NLR with postoperative mortality in patients undergoing hip replacement. Our findings may be helpful in predicting mortality in patients undergoing hip replacement.
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Affiliation(s)
- Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Gayoung Jin
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - So Myung Kong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Dong Jae Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
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Chen B, Clement ND, Scott CEH. Risk factors influencing periprosthetic fracture and mortality in elderly patients following hemiarthroplasty with a cemented collarless polished taper stem for an intracapsular hip fracture. Bone Jt Open 2024; 5:269-276. [PMID: 38572531 PMCID: PMC10993022 DOI: 10.1302/2633-1462.54.bjo-2023-0140.r1] [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] [Indexed: 04/05/2024] Open
Abstract
Aims The aims of this study were to evaluate the incidence of reoperation (all cause and specifically for periprosthetic femoral fracture (PFF)) and mortality, and associated risk factors, following a hemiarthroplasty incorporating a cemented collarless polished taper slip stem (PTS) for management of an intracapsular hip fracture. Methods This retrospective study included hip fracture patients aged 50 years and older treated with Exeter (PTS) bipolar hemiarthroplasty between 2019 and 2022. Patient demographics, place of domicile, fracture type, delirium status, American Society of Anesthesiologists (ASA) grade, length of stay, and mortality were collected. Reoperation and mortality were recorded up to a median follow-up of 29.5 months (interquartile range 12 to 51.4). Cox regression was performed to evaluate independent risk factors associated with reoperation and mortality. Results The cohort consisted of 1,619 patients with a mean age of 82.2 years (50 to 104), of whom 1,100 (67.9%) were female. In total, 29 patients (1.8%) underwent a reoperation; 12 patients (0.7%) sustained a PFF during the observation period (United Classification System (UCS)-A n = 2; UCS-B n = 5; UCS-C n = 5), of whom ten underwent surgical management. Perioperative delirium was independently associated with the occurrence of PFF (hazard ratio (HR) 5.92; p = 0.013) and surgery for UCS-B PFF (HR 21.7; p = 0.022). Neither all-cause reoperation nor PFF-related surgery was independently associated with mortality (HR 0.66; p = 0.217 and HR 0.38; p = 0.170, respectively). Perioperative delirium, male sex, older age, higher ASA grade, and pre-fracture residential status were independently associated with increased mortality risk following hemiarthroplasty (p < 0.001). Conclusion The cumulative incidence of PFF at four years was 1.1% in elderly patients following cemented PTS hemiarthroplasty for a hip fracture. Perioperative delirium was independently associated with a PFF. However, reoperation for PPF was not independently associated with patient mortality after adjusting for patient-specific factors.
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Affiliation(s)
- Bin Chen
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, Suzhou, China
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick D. Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - Chloe E. H. Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
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Wang SH, Chang CW, Chai SW, Huang TS, Soong R, Lau NC, Chien CY. Surgical intervention may provides better outcomes for hip fracture in nonagenarian patients: A retrospective observational study. Heliyon 2024; 10:e25151. [PMID: 38322977 PMCID: PMC10844277 DOI: 10.1016/j.heliyon.2024.e25151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/02/2024] [Accepted: 01/22/2024] [Indexed: 02/08/2024] Open
Abstract
Background Hip fracture is a common disease in the elderly. Among these patients, surgical intervention for hip fracture should be carefully considered because of old age and multiple comorbidities. There are still insufficient comparisons between nonagenarian patients treated with surgery and those treated non-surgically. We studied hip fracture nonagenarian patients to compare the different outcomes between surgical and non-surgical treatments. Materials and methods Nonagenarian patients visiting the emergency department with hip fractures between March 2010 and December 2020 were identified. Overall survival was estimated using multivariate Cox proportional hazards models. The mortality rates, the length of hospital stay, complication and readmission rates were also recorded. Results A total of 173 patients who underwent surgery and 32 who received conservative treatments were included. The median survival time was 58.47 months in the OP group, which was significantly higher than the 24.28 months in the non-OP group. After adjusting for covariates, including age, sex, Charlson Comorbidity Index (CCI), injury severity score, and fracture type, the risk of death was reduced by surgery (hazard ratio [HR] = 0.427; 95 % confidence interval [CI]: 0.207-0.882; p = 0.021). CCI was also an independent risk factor for poor survival rate (HR = 1.3; 95 % CI: 1.115-1.515; p = 0.001). After adjusting for several factors, surgery within 48 h improved overall survival (HR: 2.518; 95 % CI: 1.299-4.879; p = 0.006) in operative group. Conclusion Our study suggests that surgical treatment may provide better survival for nonagenarian patients with hip fractures than non-operation, especially patients with less concurrent comorbidities.
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Affiliation(s)
- Suo-Hsien Wang
- Department of Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City, 23652, Taiwan
| | - Chia-Wei Chang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shion-Wei Chai
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of General Surgery, Jen Ai Hospital, Taichung, 400, Taiwan
| | - Ting-Shuo Huang
- Department of General Surgery, Jen Ai Hospital, Taichung, 400, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Rueyshyang Soong
- Division of Transplantation, Department of Surgery, Taipei Municipal Wan-Fang Hospital, Taiwan
| | - Ngi-Chiong Lau
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Ying Chien
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taiwan
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Karuna Pathirannehelage NR, Niroshana L, Sood M. Optimising Soft-Tissue Balancing in Hip Hemiarthroplasty Surgery Using a Simple Planning Protocol. Cureus 2023; 15:e50280. [PMID: 38196432 PMCID: PMC10776174 DOI: 10.7759/cureus.50280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction Intracapsular neck of the femur fractures are some of the most common fragility fractures with significant morbidity and mortality. Cemented hemiarthroplasty is the standard treatment in most cases. Restoring the horizontal offset and leg length is important to optimize the outcome of hip hemiarthroplasty. Preoperative templating based on a scaled radiograph is common prior to total hip arthroplasty surgery to achieve optimum offset and leg length. It is not routine to have scaled radiographs available prior to a hemiarthroplasty surgery. Our simple non-scaled radiograph templating protocol (NSRTP) was introduced to help establish the correct offset and leg length in the absence of scaled radiographs. Methods A retrospective, comparative, case-control study was carried out in an acute hospital setting. Scaled radiographs were not available for any patients in the study, as is usual for hemiarthroplasty patients in our hospital. One group had surgery without any templating. The other group had surgery using the NSRTP. The NSRTP determined optimal ipsilateral offset based on preoperative measurement of the contralateral hip offset and ipsilateral head diameter on unscaled radiographs together with intraoperative measurement of the diameter of the ipsilateral femoral head removed at surgery. To help achieve the correct length, the NSRTP also included assessment and restoration of the contralateral greater trochanter tip-to-head relationship. The neck cut was tailored to restore the correct relationship. Results Twenty-three patients underwent hemiarthroplasty surgery without any templating and 23 had surgery using the NSRTP. The implants used were C-STEM™ (DePuy Synthes, Raynham, Massachusetts, United States) and SPECTRON (Smith & Nephew plc, London, United Kingdom); stems were used together with monopolar heads. The stems were available in standard and high offset versions and with a variety of neck lengths, allowing the correct combination to be selected to restore offset. When the NSRTP was used, horizontal offset and leg length were restored to within 2 mm of the contralateral hip in 22 patients out of 23. There was a statistically significant improvement in restoration of offset and leg length when the NSRTP was used, compared to the control group. Conclusion Restoration of the offset and leg length is important to maximize the outcome of hip arthroplasty surgery. Preoperative templating is helpful to achieve offset and leg length in total hip replacement. In the absence of scaled radiographs, NSRTP enables restoration of offset and leg length to within 2 mm of normal in more than 96% of patients. This protocol requires knowledge of the offset of the hemiarthroplasty stems being used, which is easily available from the relevant manufacturer.
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Affiliation(s)
| | - Lamindu Niroshana
- Trauma and Orthopaedics, Bedfordshire Hospitals NHS Foundation Trust, Bedford, GBR
| | - Manoj Sood
- Trauma and Orthopaedics, Bedfordshire Hospitals NHS Foundation Trust, Bedford, GBR
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Baidya J, Gordon AM, Nian PP, Schwartz J, Golub IJ, Abdelgawad AA, Kang KK. Social determinants of health in patients undergoing hemiarthroplasty: are they associated with medical complications, healthcare utilization, and payments for care? Arch Orthop Trauma Surg 2023; 143:7073-7080. [PMID: 37697051 DOI: 10.1007/s00402-023-05045-z] [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: 05/01/2023] [Accepted: 08/20/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Social determinants of health (SDOH) have previously been shown to impact orthopedic surgery outcomes. This study assessed whether greater socioeconomic disadvantage in patients undergoing hemiarthroplasty following femoral neck fracture was associated with differences in (1) medical complications, (2) emergency department (ED) utilization, (3) readmission rates, and (4) payments for care. METHODS A US nationwide database was queried for hemiarthroplasties performed between 2010 and 2020. Area Deprivation Index (ADI), a validated measure of socioeconomic disadvantage reported on a scale of 0-100, was used to compare two cohorts of greater and lesser deprivation. Patients undergoing hemiarthroplasty from high ADI (95% +) were 1:1 propensity score matched to a comparison group of lower ADI (0-94%) while controlling for age, sex, and Elixhauser Comorbidity Index. This yielded 75,650 patients evenly distributed between the two cohorts. Outcomes studied were 90-day medical complications, ED utilizations, readmissions, and payments for care. Multivariate logistic regression models were utilized to calculate odds ratios (ORs) of the relationship between ADI and outcomes. p Values < 0.05 were significant. RESULTS Patients of high ADI developed greater medical complications (46.74% vs. 44.97%; OR 1.05, p = 0.002), including surgical site infections (1.19% vs. 1.00%; OR 1.20, p = 0.011), cerebrovascular accidents (1.64% vs. 1.41%; OR 1.16, p = 0.012), and respiratory failures (2.27% vs. 2.02%; OR 1.13, p = 0.017) compared to patients from lower ADIs. Although comparable rates of ED visits (2.92% vs. 2.86%; OR 1.02, p = 0.579), patients from higher ADI were readmitted at diminished rates (10.57% vs. 11.06%; OR 0.95, p = 0.027). Payments were significantly higher on the day of surgery ($7,570 vs. $5,974, p < 0.0001), as well as within 90 days after surgery ($12,700 vs. $10,462, p < 0.0001). CONCLUSIONS Socioeconomically disadvantaged patients experience increased 90-day medical complications and payments, similar ED utilizations, and decreased readmissions. These findings can be used to inform healthcare providers to minimize disparities in care. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Joydeep Baidya
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Adam M Gordon
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA.
- Questrom School of Business, Boston University, Boston, MA, USA.
| | - Patrick P Nian
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jake Schwartz
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Ivan J Golub
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Amr A Abdelgawad
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Kevin K Kang
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
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Huang YY, Hui CK, Lau NC, Ng YT, Lin TY, Chen CH, Wang YC, Tang HC, Chen DWC, Chang CW. Total intravenous anesthesia for geriatric hip fracture with severe systemic disease. Eur J Trauma Emerg Surg 2023; 49:2139-2145. [PMID: 37354341 PMCID: PMC10520204 DOI: 10.1007/s00068-023-02291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/23/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Our study aimed to determine the impact of a novel technique of anesthesia administration on the clinical outcomes and complications in geriatric patients with severe systemic disease undergoing hip surgery. METHODS We retrospectively identified patients aged > 65 years with severe systemic disease that was a constant of life [American Society of Anesthesiologists (ASA) IV] who underwent surgery for hip fracture between January 2018 and January 2020. The patients were divided into two groups: Group I [fascia iliaca compartment block plus propofol-based total intravenous anesthesia (FICB + TIVA)] and Group II [general anesthesia (GA)]. The primary outcomes were 30-day and 1-year mortality. The secondary outcomes included length of hospital stay, length of intensive care unit (ICU) stay, postoperative morbidity, Visual Analog Scale score, and consumption of analgesics. RESULTS There was no significant difference in the 30-day mortality (5 vs. 3.8%, p = 0.85) and 1-year mortality (15 vs. 12%, p = 0.73) between the groups. Group I had significantly lower ICU requirements (p = 0.01) and shorter lengths of ICU stay (p < 0.001) and hospital stay (p < 0.001). Moreover, a smaller proportion of patients in Group I required postoperative morphine or oral opiates. CONCLUSION Geriatric patients who underwent hip surgery under FICB + TIVA required fewer ICU admissions, shorter lengths of ICU and hospital stay, and had lesser postoperative opioid consumption than those who were under GA. Hence, we recommend the novel FICB + TIVA technique for hip fracture surgery in geriatric patients with poor general health status and high surgical risks (ASA IV).
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Affiliation(s)
- Yu-Yi Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Chung-Kun Hui
- Department of Anesthesiology, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
| | - Ngi-Chiong Lau
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Yuet-Tong Ng
- Department of Anesthesiology, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
| | - Tung-Yi Lin
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Chien-Hao Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Ying-Chih Wang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Hao-Che Tang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Dave Wei-Chih Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
| | - Chia-Wei Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204 Taiwan
- College of Medicine, Chang Gung University, No. 259, Wunhua 1st Rd., Guishan Dist., Taoyuan City, 333 Taiwan
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Konda SR, Esper GW, Meltzer-Bruhn AT, Ganta A, Egol KA. Hip Fracture Care during COVID-19: Evolution through the Pandemic. Cureus 2023; 15:e42696. [PMID: 37654921 PMCID: PMC10465306 DOI: 10.7759/cureus.42696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION The purpose of this epidemiologic study was to analyze the care provided by our institution to middle-aged and geriatric hip fracture patients throughout the pandemic to examine for any differences compared to pre-pandemic care and across the pandemic stages. METHODS Consecutive patients >55 years old treated for hip fractures at our institution between October 2014 and January 2022 were analyzed for demographics, coronavirus disease 2019 (COVID-19) and vaccination status at admission, injury characteristics, hospital quality measures, and outcomes. Patients were divided into three separate cohorts: Pre-COVID-19 (PRECOV), COVID-19 Pre-Vaccine (PREVAX), and COVID-19 Post-Vaccine (POSTVAX). A sub-analysis removed COVID-19-positive patients across the study period. Comparative analyses were conducted. RESULTS A total of 2,633 hip fracture patients were included. For the overall cohort, there was no difference in the rate of inpatient deaths between the PRECOV, PREVAX, and POSTVAX cohorts (p=0.278). PRECOV had a significantly lower 30-day mortality rate compared to PREVAX or POSTVAX (p=0.012). Differences in complication rates for surgical site infection, urinary tract infection, and anemia (p<0.01 for all) were seen between cohorts. PRECOV had the longest length of hospital stay (p<0.01). PREVAX patients required more ICU level of care (p<0.01). When removing COVID-19-positive patients, all three cohorts had similar inpatient (p=0.872) and 30-day mortality rates (p=0.130). CONCLUSION The care of patients treated for hip fractures did not change throughout the pandemic at our institution. The elevated mortality rate due to the effects of COVID-19 seen in the pre-vaccine cohort decreased over time as the understanding of COVID-19 improved and the vaccine was introduced. We recommend continuation of the same hip fracture care protocols as used pre-pandemic.
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Affiliation(s)
- Sanjit R Konda
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Garrett W Esper
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Ariana T Meltzer-Bruhn
- Medical School, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Abhishek Ganta
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
| | - Kenneth A Egol
- Orthopedic Surgery, NYU (New York University) Langone Health, New York, USA
- Orthopedic Surgery, Jamaica Hospital Medical Center, New York, USA
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10
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Olsen F, Hård af Segerstad M, Dalla K, Ricksten SE, Nellgård B. Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients. F1000Res 2023; 12:210. [PMID: 37497335 PMCID: PMC10366555 DOI: 10.12688/f1000research.130387.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 07/28/2023] Open
Abstract
Background: Systemic haemodynamic effects of intrathecal anaesthesia in an aging and frail population has not been well investigated. We examined the systemic haemodynamics of fractional spinal anaesthesia following intermittent microdosing of a local anaesthetic and an opioid. Methods: We included 15 patients aged over 65 with significant comorbidities, planned for hip fracture repair. Patients received a spinal catheter and cardiac output monitoring using the LiDCOplus system. All measurements were performed prior to start of surgery. Invasive mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), heart rate and stroke volume index (SVI) were registered. Two doses of bupivacaine 2.25 mg and fentanyl 15 µg were administered with 25-minute intervals. Hypotension was defined as a fall in MAP by >30% or a MAP <65 mmHg. Results: The incidence of hypotension was 30%. Hypotensive patients (n=5) were treated with low doses of norepinephrine (0.01-0.12 µg/kg/min). MAP showed a maximum reduction of 17% at 10 minutes following the first dose. CI, systemic vascular resistance index and stroke volume index decreased by 10%, 6%, and 7%, respectively, while heart rate was unchanged over time. After the second dose, none of the systemic haemodynamic variables were affected. Conclusions: Fractional spinal anaesthesia administered prior to surgery induced a minor to moderate fall in MAP, mainly caused by a reduction in cardiac output, induced by systemic venodilation, causing a fall in venous return. Our results are contrary to the widely held belief that hypotension is mainly the result of a reduction of systemic vascular resistance.
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Affiliation(s)
- Fredrik Olsen
- Anesthesia and Critical Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Keti Dalla
- Anesthesia and Critical Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Anesthesia and Critical Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Nellgård
- Anesthesia and Critical Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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11
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Fu H, Zheng J, Lai J, Xia VW, He K, Du D. Risk factors of serious postoperative outcomes in patients aged ≥90 years undergoing surgical intervention. Heliyon 2023; 9:e13117. [PMID: 36747573 PMCID: PMC9898676 DOI: 10.1016/j.heliyon.2023.e13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Objective We aimed to identify preoperative and intraoperative factors associated with serious postoperative outcomes, which may help patients and clinicians make better-informed decisions. Methods We conducted a retrospective study including all patients aged ≥90 years who underwent surgery between January 1, 2011, and January 1, 2021, at Chongqing University Central Hospital. We assessed 30 pre- and intraoperative demographic and clinical variables. Logistic regression was used to identify the independent risk factors for serious postoperative outcomes in patients aged ≥90 years. Results A total of 428 patients were included in our analysis. The mean age was 92.6 years (SD ± 2.6). There were 240 (56.1%) females and 188 (43.9%) males. The most common comorbidities were hypertension (44.9%) and arrhythmias (34.8%). The 30-day hospital mortality was 5.6%, and severe morbidity was 33.2%. Based on the multivariate logistic regression classification analysis of the American Society of Anesthesiologists (ASA)≥ Ⅳ [odds ratio (OR), 5.39, 95% confidence interval (CI), 2.06-14.16, P = .001], emergency surgery (OR, 5.02, 95% CI, 2.85-15.98, P = .001) and chronic heart failure (OR, 6.11, 95% CI, 1.93-13.06, P = .001) were identified as independent risk factors for 30-day hospital mortality, and ASA≥ Ⅳ (OR, 4.56, 95%CI, 2.56-8.15, P < .001), Barthel index (BI) < 35 (OR, 2.28, 95%CI, 1.30-3.98, P = .001), chronic heart failure (OR, 3.67, 95%CI, 1.62-8.31, P = .002), chronic kidney disease (OR, 4.24, 95%CI, 1.99-9.05, P < .001), general anesthesia (OR, 3.31, 95%CI, 1.91-5.76, P < .001), emergency surgery (OR, 3.72, 95%CI, 1.98-6.99, P < .001), and major surgery (OR, 3.44, 95%CI, 1.90-6.22, P < .001) were identified as independent risk factors for serious postoperative complications. Conclusions Patients aged ≥90 years with ASA≥ Ⅳ, BI < 35, combined with chronic heart failure or chronic kidney disease, undergoing emergency surgery, major surgery or general anesthesia have a higher risk of serious postoperative outcomes. Identifying these risk factors in an early stage may contribute to our clinical decision-making and improve the quality of treatments.
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Affiliation(s)
- Hong Fu
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
- Corresponding author. Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, No 1, JianKang Road, Yuzhong District, Chongqing 400014, China.
| | - Jiang Zheng
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jingyi Lai
- Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Victor W. Xia
- Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Kaiping He
- Division of Medical Record Statistical, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Dingyuan Du
- Department of Traumatology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
- Corresponding author. Department of traumatology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing 400014, China.
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12
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Sakurai S, Takegami Y, Tokutake K, Kuwahara Y, Shibata R, Ota H, Kumagai H, Imagama S. Are the Clinical Results of Locking Plate Fixation for Distal Radius Fractures Inferior in Patients over 80 Years of Age? A Multicentre (TRON Group) Study. Indian J Orthop 2023; 57:117-123. [PMID: 36660494 PMCID: PMC9789222 DOI: 10.1007/s43465-022-00788-0] [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: 08/10/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
Introduction With the aging of the population, the proportion of distal radius fracture patients who are > 80 years of age is increasing. In this study, we compared the postoperative clinical and radiographic outcomes between super-elderly patients (age: ≥ 80 years) and middle-elderly (age: 65-79 years) who were treated with volar locking plate (VLP) fixation for distal radius fractures. Patients and Methods Patients of > 65 years of age with distal radius fractures treated by VLP fixation between 2015 and 2019, and who were followed for at least 6 months after surgery were included in our database (named TRON). Patients with open fractures, multiple-trauma, or who received fixation with implants other than a VLP were excluded. We evaluated postoperative complications, Mayo wrist score (MWS), and radiographic outcomes. Results We identified 589 patients in this study; 452 were 65-79 years of age (Group A) and 137 were ≥ 80 years of age (Group B). After propensity score matching, we evaluated 309 patients in Group A and 103 patients in Group B. The mean follow-up period was 10.7 ± 4.6 months. Twenty-eight patients (9.1%) in Group A and 5 patients in Group B (4.9%) experienced post-operative complications (non-significant: p = 0.212). The postoperative MWS at 1, 3, and 6 months, respectively, was 65.4 ± 11.7, 75.2 ± 11.0, and 79.6 ± 10.5 in Group A and 67.1 ± 9.61, 75.7 ± 10.7, and 80.6 ± 9.7 in Group B (non-significant: p = 0.418, 0.893, 0.452, respectively). The differences in volar tilt, radial inclination, ulnar variance between the postoperative and last follow-up radiographs did not differ between the two groups to a statistically significant extent (p = 0.053, 0.437, 0.529, respectively). Conclusion Our study showed that the clinical and radiographic outcomes of distal radius fractures treated with VLP in super-elderly patients were comparable to those in middle-elderly patients.
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Affiliation(s)
- Saki Sakurai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Yutaro Kuwahara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Ryutaro Shibata
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Hideyuki Ota
- Department of Orthopaedic Sugery, Nagoya Ekisaikai Hospital, 4-66 Matunen-cho, Nakagawa-ku, Nagoya, 454-8502 Japan
| | - Hiroaki Kumagai
- Department of Orthopaedic Sugery, Nagoya Ekisaikai Hospital, 4-66 Matunen-cho, Nakagawa-ku, Nagoya, 454-8502 Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
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ASLAN A. yaşlılarda kalça kırığı; genel bir bakış. ACTA MEDICA ALANYA 2022. [DOI: 10.30565/medalanya.1161785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
hip fracture in elderly; an overwiev
hip fracture in elderly; an overwiev
hip fracture in elderly; an overwiev
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Affiliation(s)
- Ahmet ASLAN
- Alanya Alaaddin Keykubat Üniversitesi, Tıp Fakültesi
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14
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Dincer R, Gulcu A, Tolga A, Başal Ö, Aslan A, Baykal YB. Effect of Vertical and Lateral Offset Restoration on Clinical Outcomes in Intracapsular and Extracapsular Hip Fractures Undergoing Hemiarthroplasty. Cureus 2022; 14:e22617. [PMID: 35371728 PMCID: PMC8958139 DOI: 10.7759/cureus.22617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We aimed to investigate whether there is a change in the postoperative lateral and vertical femoral offset (FO) in patients who underwent bipolar straight stem hemiarthroplasty (SSHA) and calcar stem hemiarthroplasty (CRHA) and whether this change makes a difference in the comparison of both groups. Material and methods This study included 109 patients who met these criteria. Patients are divided into two groups according to treatment methods. There were 58 patients (group 1) who underwent SSHA due to intracapsular (AO type 31-B neck and 31-C head fracture) femur fracture, and there were 51 patients (group 2) who underwent CRHA due to extracapsular (AO type 31-A intertrochanteric) femur fracture. We analyzed femoral vertical and lateral femoral offset, Wiberg angle, and head-neck angle difference in both groups. Results The median age was significantly higher in the CRHA group (p=0.042). The Harris hip score (HHS) was significantly higher in the SSHA group (p=0.023). The femoral offset difference was 5 mm in the SSHA group, while it was significantly lower (-6 mm) in the CRHA group (p<0.001). The Wiberg angle difference did not differ significantly between patient groups (p=0.214). The limb length difference was found to be similar in both surgical groups (p=0.483). Conclusions The study results show that there was no negative correlation between clinical and radiological outcomes in the SSHA group, whereas there was a negative correlation between clinical and radiological outcomes in the CRHA group. It is very difficult to control vertical and lateral offset reconstruction, especially in extracapsular hip fractures reconstructed by hemiarthroplasty. Deficiencies in lateral and vertical stabilization restoration may be associated with poor clinical outcomes in CRHA patients. Orthopedic surgeries should be performed carefully when restoring leg length and femoral offset, especially calcar replacement hemiarthroplasties.
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15
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Bertault-Le Gourrierec J, Cavaignac E, Berard E, Moretti F, Marot V, Chiron P, Reina N. Comparative study of total hip arthroplasties with dual mobility cups versus hemiarthroplasties in management of femoral neck fractures: Survival and dislocation rate at 5 years of follow-up? Orthop Traumatol Surg Res 2022; 108:103098. [PMID: 34624538 DOI: 10.1016/j.otsr.2021.103098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/02/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Instability after hip arthroplasty, whether it is a total (THA) or intermediate (HA), poses a major risk, however arthroplasty is the standard treatment for displaced intracapsular fractures of the femoral neck of the elderly. Three types of arthroplasties can be proposed: total prostheses with or without a dual mobility cup (DM THA) reducing the risk of dislocation, and hemiarthroplasties. In the absence of clear recommendations regarding the type of implant to be used and the scarcity of studies comparing HA and DM THA, we conducted a monocentric comparative retrospective study using the propensity score method to compare DM THA versus HA on recently displaced femoral neck fractures: (1) survival and risk of dislocation, (2) functional results, (3) mortality. HYPOTHESIS The rate of dislocation of THA fitted with a DM cup is lower than that of HA. PATIENTS AND METHODS We retrospectively identified 112 patients in the HA group and 153 patients in the DM THA group who underwent an emergency arthroplasty for a displaced cervical fracture between 2010 and 2013. The minimum follow-up was 5 years (range, 5-9 years). The mean age at surgery was 81 years (range, 55-101 years). Elective surgery patients (n=2), hardware fractures (n=10), pathological fractures of the femoral neck (n=6), associated fractures (n=3), and revision surgeries (n=5) were excluded. The primary outcome measure was instability. Clinical follow-up was performed by the WOMAC score and the risk of mortality was determined after adjusting for confounding factors using the propensity score method. RESULTS After adjustment by the propensity score, the dislocation rate at 2-years was 2.2% (n=3/153) in the dual mobility THA group and 6.3% (n=7/112) in the HA group (OR=0.34 [95% CI: 0.06-1.96] (p=0.23)). After adjustment by the propensity score, the mean WOMAC score was 8.20 (±6.56) in the THA group, compared to 10.78±3.92 on average in the HA group (p=0.031). After adjustment by the propensity score, we did not find any significant difference in the reoperation rate without changing implants and revisions, and postoperative complications. After adjustment by the propensity score, mortality was significantly higher in the HA group 45.5% (n=69/152) versus 91.5% (n=102/112) in the HA group (OR=0.50 [95% CI: 0.25-0.98] (p=0.042)). DISCUSSION Few studies have compared these two types of implant in the context of trauma. Although the results of our study are not significant regarding the risk of dislocation, the use of a dual mobility cup seems to be a very satisfactory solution in this trauma context. LEVEL OF EVIDENCE III; comparative retrospective cohort.
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Affiliation(s)
- Juliette Bertault-Le Gourrierec
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Etienne Cavaignac
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France; I2R - Riquet Research Institute, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Emilie Berard
- Department of epidemiology, university hospital of Toulouse, Purpan faculty of medicine, 37, allées Jules-Guesdes, 31000 Toulouse, France; CERPOP, Inserm, UPS, Purpan faculty of medicine, university of Toulouse, 37, allées Jules-Guesdes, 31000 Toulouse, France
| | - Federico Moretti
- Department of epidemiology, university hospital of Toulouse, Purpan faculty of medicine, 37, allées Jules-Guesdes, 31000 Toulouse, France
| | - Vincent Marot
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Philippe Chiron
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Nicolas Reina
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France; I2R - Riquet Research Institute, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France.
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Demirel E, Şahin A. Predictive Value of Blood Parameters and Comorbidities on Three-Month Mortality in Elderly Patients With Hip Fracture. Cureus 2021; 13:e18634. [PMID: 34765379 PMCID: PMC8576146 DOI: 10.7759/cureus.18634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 11/05/2022] Open
Abstract
Background Knowing the factors that increase the risk of death in patients with hip fractures will help us to take precautions and intervene when necessary in the pre- and postoperative periods. Therefore, it is important to have inexpensive and practical biomarkers that can predict postoperative complications and mortality. The present study aimed to identify the factors that contribute to early mortality in elderly patients with hip fractures in the first three months after trauma, as well as the parameters that may be determinants of mortality. Methods The data of 1,015 patients over 65 years of age with femoral neck and intertrochanteric fractures admitted between January 2009 and January 2020 were retrospectively reviewed. A total of 763 patients who met the inclusion criteria were included in the study. Our study was designed to include 110 (14.4%) patients in Group 1 who were determined to have died within three months after the diagnosis of hip fracture and 653 (85.6%) patients in Group 2 who were determined not to have died within one year after the trauma. Age, gender, comorbid diseases, American Society of Anesthesiologists (ASA) score, type of anesthesia, operation time, type of implant used, time until surgery, and some biochemical blood values were compared between the two groups. Our data were analyzed statistically using the IBM Statistical Product and Service Solutions (SPSS) software for Windows, v. 25.0 (IBM SPSS Statistics for Windows, Armonk, NY). Results Of all of the patients, 370 (48.5%) were female and 393 (51.5%) were male. The patients who survived had an average age of 76.08, while the patients who died had an average age of 80.57. The mean age among the groups is significantly higher in patients who died. High creatinine, alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and low albumin values were found to be associated with mortality. Conclusion It has been determined that advanced age, delayed operation time, high ASA score, and the number of comorbid diseases are associated with mortality in elderly patients with hip fractures, and biomarkers, such as creatinine, ALT, and LDH, can be used as markers for early mortality. With the increase of studies of similar nature, it will be possible to calculate a systematic risk map for mortality in elderly patients with a proximal femur fracture.
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Affiliation(s)
- Esra Demirel
- Department of Orthopedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum, TUR
| | - Ali Şahin
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, TUR
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Capkin S, Guler S, Ozmanevra R. C-Reactive Protein to Albumin Ratio May Predict Mortality for Elderly Population Who Undergo Hemiarthroplasty Due to Hip Fracture. J INVEST SURG 2020; 34:1272-1277. [PMID: 32668996 DOI: 10.1080/08941939.2020.1793038] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although the relationship of preoperative C-reactive protein (CRP) and albumin levels to mortality in elderly patients who have undergone surgery due to hip fracture has been previously investigated, the CRP to albumin ratio (CAR) has not been investigated. This study aimed to investigate the relationship between preoperative CAR and mortality. METHODS A total of 254 patients (mean age, 78.74 years) were retrospectively analyzed using the following data: age, gender, fracture type, American Society of Anesthesiologists (ASA) score, type of anesthesia, time between fracture and surgery, time between fracture and discharge, length of hospital stay, preexisting comorbidities, preoperative CRP and albumin levels, and mortality. The serum CRP level was divided by the serum albumin level to calculate the preoperative CAR. Multivariate logistic regression was used to evaluate the association between risk factors and 1-year mortality. RESULTS One-year mortality was 22.8% (58 patients). Age >85 years, male gender, ASA score ≥3, presence of ≥3 comorbidities, and CAR ≥2.49 were identified as mortality risk factors in the univariate analysis. The following factors were included in the binary logistic regression analysis to determine the major predictors of 1-year mortality: ASA score ≥3, presence of ≥3 comorbidities, and CAR ≥2.49. CONCLUSION Detection of CAR above 2.49 is a strong indicator for 1-year mortality in patients operated due to hip fracture in the elderly population. ASA score ≥3 and presence of ≥3 comorbid diseases were also related to mortality.
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Affiliation(s)
- Sercan Capkin
- Department of Orthopedics and Traumatology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
| | - Serkan Guler
- Department of Orthopedics and Traumatology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
| | - Ramadan Ozmanevra
- Department of Orthopedics and Traumatology, Faculty of Medicine, University of Kyrenia, Kyrenia, Cyprus
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