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Lotti F, Elizondo CM, Barla J, Carabelli G, Soruco ML, Boietti BR, Benchimol JA. Impact of anticoagulants in elderly patients who suffer a hip fracture. Should we have a different approach? Acta Biomed 2020; 91:ahead of print. [PMID: 33525263 PMCID: PMC7927563 DOI: 10.23750/abm.v91i4.8975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/10/2019] [Indexed: 11/23/2022]
Abstract
Introduction: Hip fracture in the elderly is a frequent problem. Chronic treatment with anticoagulants is common in these patients and may delay surgery. Objectives: To compare time to surgery, hospital stay, in-hospital and 90 days complications between anticoagulated and non-anticoagulated groups. Methods: Retrospective cohort of >64 years-old patients with acute hip fracture. Period June-2014 to December 2019. We estimated crude and adjusted Odds Ratio (95%CI) for in-hospital complications with logistic regression model. We report the crude and adjusted Hazard Ratio for readmission and 90-days mortality with Cox proportional hazards model. Results: Of the 1058 patients, 123 (11%) were anticoagulated. Time to surgery was 26.4 hours (IIQ 13.9-48) in anticoagulated and 24 hours (IIQ 2.3-48) in non-anticoagulated, p 0.001. Hospital stay was 7 days (IIQ 5-9) in anticoagulated and 6 days (IIQ 5-10.5) in non-anticoagulated, p 0,000. In-hospital complications were 17 (14%) in anticoagulated and 81 (9%) in non-anticoagulated, p 0.064. The adjusted OR was 1.53 (95%CI 0.8-2.7) p 0.138. For 90-days readmission, the crude HR was 1.51 (95%CI 0.99-2.29) p 0.053 and the adjusted HR was 1.31 (95%CI 0.85-2.00) p0,09. For 90-days mortality, the crude HR was 0.80 (95%CI 0.45-1.43) p 0.464 and the adjusted HR was 0.70 (95% CI 0.39-1.25) p 0.239. Discussion: While we found differences between groups in time to surgery and hospital statistics these differences may not be clinically relevant. (www.actabiomedica.it)
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Affiliation(s)
- Francisco Lotti
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, CABA, Argentina.
| | - Cristina Maria Elizondo
- Área de investigación en medicina Interna, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, CABA Argentina.
| | - Jorge Barla
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, CABA, Argentina; .
| | - Guido Carabelli
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, CABA, Argentina; .
| | - Maria Lilliana Soruco
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, CABA, Argentina.
| | - Bruno Rafael Boietti
- Área de investigación en medicina Interna, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, CABA Argentina.
| | - Javier Alberto Benchimol
- Sección de Geriatría, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, CABA Argentina.
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Giunta DH, Alonso Serena M, Luna D, Peroni ML, Sanchez Thomas D, Binder F, Blugerman GA, Fuentes N, Elizondo CM, Gonzalez Bernaldo de Quirós F. Association between non‐attendance to outpatient clinics and emergency department consultations, hospitalizations and mortality in a Health Maintenance Organization. Int J Health Plann Manage 2020; 35:1140-1156. [DOI: 10.1002/hpm.3021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/07/2020] [Accepted: 06/05/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Diego Hernán Giunta
- Internal Medicine Research Unit Hospital Italiano de Buenos Aires CABA Argentina
- Research Department Hospital Italiano de Buenos Aires CABA Argentina
| | - Marina Alonso Serena
- Internal Medicine Research Unit Hospital Italiano de Buenos Aires CABA Argentina
| | - Daniel Luna
- Health Informatics Department Hospital Italiano de Buenos Aires CABA Argentina
| | - Maria Leticia Peroni
- Internal Medicine Research Unit Hospital Italiano de Buenos Aires CABA Argentina
| | - Diego Sanchez Thomas
- Internal Medicine Research Unit Hospital Italiano de Buenos Aires CABA Argentina
| | - Fernando Binder
- Internal Medicine Research Unit Hospital Italiano de Buenos Aires CABA Argentina
| | | | - Nora Fuentes
- Internal Medicine Research Unit Hospital Italiano de Buenos Aires CABA Argentina
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Benchimol JA, Elizondo CM, Giunta DH, Schapira MC, Pollan JA, Barla JD, Carabelli GS, Boietti BR. Survival and functionality in the elderly over 85 years of age with hip fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:265-271. [PMID: 32247622 DOI: 10.1016/j.recot.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/09/2020] [Accepted: 02/02/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND There is a tendency for the aging population to fracture their hips. Our aim was to compare survival and functionality at one year, among elderly and very elderly patients with hip fracture. MATERIAL AND METHODS A prospective cohort of patients included in the Institutional Registry of Elderly Patients with Hip Fracture between 2014 and 2017. We classified patients as elderly patients (EP) <65 and <85 years and very elderly patients (VEP) ≥85 years. RESULTS We included 952 patients, 43% were EP and 57% were VEP. The proportion of women was 84% and 86% (P=.33) and with 2 or more points in the Charlson comorbidities index (28 and 31%, P= .36), respectively. The VEP were more dependent according to the Barthel score (34% and 62%, P<.01) and frailer according to the Edmonton score (30% and 61%, P<.01). One-year survival was 91% (95% CI 86-93) in the EP and 76% (95% CI 70-89) in the VEP. In-hospital complications were more frequent in the VEP 12% (7% in the EP, P<.01). Age is an independent risk factor for one-year survival (HR 2.11; 95% CI 1.36-3.29, P<.001). CONCLUSIONS Age is a risk factor for the VEP group survival despite fragility and comorbidities. Because of their vulnerability, an appropriate care plan should be considered for VEP.
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Affiliation(s)
- J A Benchimol
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Sección de Geriatría, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - C M Elizondo
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Área de Investigación en Medicina Interna, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - D H Giunta
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Área de Investigación en Medicina Interna, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - M C Schapira
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Sección de Geriatría, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - J A Pollan
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - J D Barla
- Servicio de Ortopedia, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - G S Carabelli
- Servicio de Ortopedia, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - B R Boietti
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Área de Investigación en Medicina Interna, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Sección de Geriatría, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Briatore A, Tarsetti EV, Latorre A, Gonzalez Bernaldo de Quirós F, Luna D, Fuentes NA, Elizondo CM, Baum A, Alonso Serena M, Giunta DH. Causes of appointment attendance, nonattendance, and cancellation in outpatient consultations at a university hospital. Int J Health Plann Manage 2019; 35:207-220. [DOI: 10.1002/hpm.2890] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Agustina Briatore
- Departamento de Informática en SaludHospital Italiano de Buenos Aires CABA Argentina
| | | | - Agustin Latorre
- Servicio de PediatríaHospital de Clínicas “José de San Martín” CABA Argentina
| | - Fernan Gonzalez Bernaldo de Quirós
- Área de Investigación en Medicina InternaHospital Italiano de Buenos Aires CABA Argentina
- Servicio de Clínica MédicaHospital Italiano de Buenos Aires CABA Argentina
| | - Daniel Luna
- Departamento de Informática en SaludHospital Italiano de Buenos Aires CABA Argentina
| | - Nora Angélica Fuentes
- Área de Investigación en Medicina InternaHospital Italiano de Buenos Aires CABA Argentina
| | - Cristina Maria Elizondo
- Área de Investigación en Medicina InternaHospital Italiano de Buenos Aires CABA Argentina
- Servicio de Clínica MédicaHospital Italiano de Buenos Aires CABA Argentina
| | - Analia Baum
- Departamento de Informática en SaludHospital Italiano de Buenos Aires CABA Argentina
| | - Marina Alonso Serena
- Área de Investigación en Medicina InternaHospital Italiano de Buenos Aires CABA Argentina
| | - Diego Hernán Giunta
- Área de Investigación en Medicina InternaHospital Italiano de Buenos Aires CABA Argentina
- Servicio de Clínica MédicaHospital Italiano de Buenos Aires CABA Argentina
- Departamento de investigaciónHospital Italiano de Buenos Aires CABA Argentina
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Serra MM, Besada CH, Cabana Cal A, Saenz A, Stefani CV, Bauso D, Golimstok AB, Bandi JC, Giunta DH, Elizondo CM. Central nervous system manganese induced lesions and clinical consequences in patients with hereditary hemorrhagic telangiectasia. Orphanet J Rare Dis 2017; 12:92. [PMID: 28521822 PMCID: PMC5437640 DOI: 10.1186/s13023-017-0632-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/13/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Around 47-74% of patients with hereditary hemorrhagic telangiectasia (HHT) have hepatic vascular malformations (HVMs); magnetic resonance images (MRI) of the central nervous system (CNS) might show in T1 sequences a hyper-intensity signal in different areas, mainly in the basal ganglia (BG) as consequence of manganese (Mn) deposits as observed in cirrhotic patients. These patients might suffer from different neuropsychiatric disorders (hepatic encephalopathy). In HHT patients, even in the presence of hepatic shunts, hepatocellular function is usually preserved. Additionally, Mn shares iron absorption mechanisms, transferrin and CNS transferrin receptors. In iron deficiency conditions, the Mn may harbor transferrin and access BG. The objectives were to describe frequency of BG Mn deposit-induced lesions (BGMnIL) in HHT patients, its relationship with iron deficiency anemia (IDA) and HVMs. Finally, explore the association between neuropsychological and motor consequences. We performed a cross-sectional study. We determined HHT patients with or without BG-MnIL by the MRI screening of the CNS. We included all patients with lesions and a random sample of those without lesions. All patients underwent standardized and validated neuropsychological assessment to evaluate BG actions. Results were analyzed with multiple logistic regression, adjusting for potential confounders. RESULTS Among 307 participants from a cohort included in the Institutional HHT Registry, 179 patients had MRI performed and Curaçao Criteria ≥3. The prevalence of BG-MnIL was 34.6% (95%CI 27.69-42.09). While neuropsychological symptoms were present in all patients, BG-MnIL patients performed poorly in three of the neuropsychological tests (serial dotting, line tracing time, number connection test A). HVMs frequency in BG-MnIL was 95.1%, versus 71.4% in those without lesions (p < 0.001). IDA frequency was 90.3% versus 54% (p < 0.001). When IDA is present, estimated risk for BG-MnIL is remarkably high (OR 7.73, 95%CI 2.23-26.73). After adjustment for possible confounders (gender, age, presence of HVMs), IDA was still associated with increased risk of BG-MnIL (adjusted OR 6.32, 95% CI 2.32-17.20; p < 0.001). CONCLUSIONS Physicians should assess BG-MnIL in HHT patients in CNS-MRI. IDA and HVMs present increased risk of lesions. Patients with BG-MnIL have neuropsychological impairment, and they might benefit from sparing IDA, or undergoing future therapeutic options. TRIAL REGISTRATION NCT01761981 . Registered January 3rd 2013.
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Affiliation(s)
- M M Serra
- Internal Medicine Department. Hospital Italiano de Buenos Aires. Argentina (HIBA), Presidente Perón 4190, Cuidad Autónoma de Buenos Aires, C1199ABB, Argentina. .,HHT Unit. Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina. .,ARG (Argentine Rendu Study Group), Ciudad Autonoma de Buenos Aires, Argentina.
| | - C H Besada
- Radiology Department, HIBA, Ciudad Autonoma de Buenos Aires, Argentina
| | - A Cabana Cal
- Neurology Department, HIBA, Ciudad Autonoma de Buenos Aires, Argentina
| | - A Saenz
- ARG (Argentine Rendu Study Group), Ciudad Autonoma de Buenos Aires, Argentina
| | - C V Stefani
- Neurology Department, HIBA, Ciudad Autonoma de Buenos Aires, Argentina
| | - D Bauso
- Neurology Department, HIBA, Ciudad Autonoma de Buenos Aires, Argentina
| | - A B Golimstok
- Neurology Department, HIBA, Ciudad Autonoma de Buenos Aires, Argentina
| | - J C Bandi
- Internal Medicine Department. Hospital Italiano de Buenos Aires. Argentina (HIBA), Presidente Perón 4190, Cuidad Autónoma de Buenos Aires, C1199ABB, Argentina.,HHT Unit. Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina.,Hepatology area, HIBA, Ciudad Autonoma de Buenos Aires, Argentina
| | - D H Giunta
- Internal Medicine Department. Hospital Italiano de Buenos Aires. Argentina (HIBA), Presidente Perón 4190, Cuidad Autónoma de Buenos Aires, C1199ABB, Argentina.,Internal Medicine Research Unit, HIBA, Ciudad Autonoma de Buenos Aires, Argentina
| | - C M Elizondo
- Internal Medicine Department. Hospital Italiano de Buenos Aires. Argentina (HIBA), Presidente Perón 4190, Cuidad Autónoma de Buenos Aires, C1199ABB, Argentina.,ARG (Argentine Rendu Study Group), Ciudad Autonoma de Buenos Aires, Argentina.,Internal Medicine Research Unit, HIBA, Ciudad Autonoma de Buenos Aires, Argentina
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