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Fenwick A, Pfann M, Mayr J, Antonovska I, Von der Helm F, Nuber S, Förch S, Mayr E. Concomitant fractures in patients with proximal femoral fractures lead to a prolonged hospital stay but not to increased complication rates or in-house mortality if treated surgically: a matched pair analysis. Aging Clin Exp Res 2023; 35:607-614. [PMID: 36694062 PMCID: PMC10014667 DOI: 10.1007/s40520-023-02348-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Impact of concomitant fractures on patients sustaining a proximal femur fracture remains unclear. Rising numbers and patient need for rehab is an important issue. The objective of our study was to investigate the impact of concomitant fractures, including all types of fractures, when treated operatively, for proximal femur fractures on the length of hospital stay, in-house mortality and complication rate. METHODS Observational retrospective cohort single-center study including 85 of 1933 patients (4.4%) with a mean age of 80.5 years, who were operatively treated for a proximal femoral and a concomitant fracture between January 2016 and June 2020. A matched pair analysis based on age, sex, fracture type and anticoagulants was performed. Patient data, length of hospital stay, complications and mortality were evaluated. RESULTS The most common fractures were osteoporosis-associated fractures of the distal forearm (n = 34) and the proximal humerus (n = 36). The group of concomitant fractures showed a higher CCI than the control group (5.87 vs. 5.7 points; p < 0.67). Patients with a concurrent fracture had a longer hospital stay than patients with an isolated hip fracture (15.68 vs. 13.72 days; p < 0.056). Complications occurred more often in the group treated only for the hip fracture (11.8%, N = 20), whilst only 7.1% of complications were recorded for concomitant fractures (p < 0.084). The in-house mortality rate was 2.4% and there was no difference between patients with or without a concomitant fracture. CONCLUSIONS A concomitant fracture to a hip fracture increases the length of hospital stay significantly but does not increase the complication rate or the in-house mortality. This might be due to the early mobilization, which is possible after early operative treatment of both fractures.
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Affiliation(s)
- Annabel Fenwick
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
| | - Michael Pfann
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Jakob Mayr
- Zentrum Für Unfallchirurgie Und Orthopädie, Klinikum Ingolstadt GmbH, Krumenauerstraße 25, 85049, Ingolstadt, Germany
| | - Iana Antonovska
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Franziska Von der Helm
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Stefan Nuber
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Stefan Förch
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Edgar Mayr
- Department of Trauma, Orthopedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
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Kim HS, Lee JE, Choi RJ, Kim CH. Impact of concomitant upper-extremity injuries in patients with hip fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04608-w. [PMID: 36074171 DOI: 10.1007/s00402-022-04608-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/29/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Combined hip and upper-extremity fractures raise clinical concerns because upper-extremity fractures may hinder early mobilization, thereby affecting rehabilitation and mortality. This systematic review and meta-analysis aimed to evaluate the effects of combined upper-extremity and hip fractures on rehabilitation and mortality. MATERIALS AND METHODS We systematically searched MEDLINE, Embase, and the Cochrane Library for studies published before March 20, 2022, that evaluated the impact of concomitant upper-extremity injuries in geriatric patients with hip fractures. The pooled analysis identified differences in the (1) length of hospital stay, (2) discharge destination, and (3) mortality rates between the isolated and combined hip fracture groups. RESULTS A total of 217,233 patients with isolated hip fractures (n = 203,816) and combined hip and upper-extremity fractures (n = 13,417) from 12 studies were analyzed. The average length of hospital stay was significantly longer in the combined upper-extremity fracture group than in the isolated hip fracture group (mean difference = 1.67 days; 95% confidence interval [CI] 0.63-2.70; P = 0.002). Patients in the combined upper limb fracture group were less likely to be discharged directly home (odds ratio [OR] = 0.64; 95% CI 0.52-0.80; P < 0.001) and showed significantly higher 30-day mortality (OR = 1.44; 95% CI 1.32-1.58; P < 0.001). The mortality rate after 30 days was not significantly different between the two groups. CONCLUSIONS Concomitant upper-extremity fractures have debilitating effects on rehabilitation and early mortality in geriatric patients with hip fractures. Therefore, more focus should be placed on the early ambulation of patients with hip fractures and simultaneous upper limb fractures to promote rehabilitation and alleviate the public health burden. LEVEL OF EVIDENCE III meta-analysis.
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Affiliation(s)
- Han Soul Kim
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon, Republic of Korea
| | - Jung Eun Lee
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon, Republic of Korea
| | - Rak Jun Choi
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-gu, Incheon, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-ku, Seoul, 06973, Republic of Korea.
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Takagi K, Matsugaki R, Fujimoto K, Mine Y, Muramatsu K, Fujino Y, Matsuda S. Analysis of the risk factors of mortality in elderly patients with hip fracture using a combined database of medical and long-term care insurance claims data. J Orthop Sci 2022; 28:627-630. [PMID: 35123843 DOI: 10.1016/j.jos.2022.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/27/2021] [Accepted: 01/06/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND The present study evaluated the risk of mortality in elderly hip fracture, focusing on comorbidities and nursing care levels. METHODS The present study was an observational cohort study that used a combined database of medical and long-term care insurance (LTCI) claims data from one prefecture in Japan between 2011 and 2016. In total, 6125 patients aged 65 years and older were selected from acute care hospitals with a diagnosis of "hip fracture" between March 2011 and March 2012. The impact of long-term care insurance claim evaluation levels and comorbidities at recruitment time was investigated using this dataset. These patients were followed up monthly until March 2016. Based on this person-month dataset, survival analysis was performed with death as the endpoint. Cases in which receipt data were missing during the middle of the observation period and cases in which the patient survived at the end of the observation period were censored. RESULTS The number of deaths during the observation period was 635 (10.4%). The impact of comorbidities and nursing care level on mortality were both significant as follows: high nursing care level before the fracture (hazard ratio: 1.09, P < 0.001), comorbidities of malignant diseases (HR: 1.45, P < 0.001), heart disease (hazard ratio: 1.20, P = 0.037), pneumonia (hazard ratio: 1.27, P < 0.001), chronic obstructive pulmonary disease (hazard ratio: 1.28, P = 0.026), renal failure (hazard ratio: 1.44, P < 0.001), and dementia (hazard ratio: 1.27, P = 0.013). CONCLUSION The results of this study showed that a high level of nursing care and presence of comorbidities such as malignant diseases, heart diseases, pneumonia, chronic obstructive pulmonary disease, renal failure, and dementia increased mortality in elderly patients with hip fracture. Furthermore, this study showed the usefulness of a combined database of medical and LTCI claims data for clinical and health service-related research in the field of orthopedics.
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Affiliation(s)
- Kuniaki Takagi
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan
| | - Ryutaro Matsugaki
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan.
| | - Kenji Fujimoto
- Information Management Centre, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan
| | - Yuko Mine
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan; Information Management Centre, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan
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