• HHS
• LRCa3
• functional recovery
• hip fracture
• inflammatory indices

• Anaesthesia in orthopaedics
• Meta-Analysis
• Mortality

• Humans
• Biomarkers/blood
• Orthopedic Procedures
• Postoperative Complications/blood
• Postoperative Complications/mortality
• Preoperative Period

• Capital’s Funds for Health Improvement and Research

• Humans
• Female
• Male
• Aged
• Aged, 80 and over
• Hemoglobins/analysis
• Hemoglobins/metabolism
• Prognosis
• Lymphocytes
• Serum Albumin/analysis
• Blood Platelets
• Femoral Fractures/mortality
• Femoral Fractures/blood
• Biomarkers/blood
• ROC Curve
• Proximal Femoral Fractures

• Humans
• Hip Fractures/surgery
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Female
• Aged
• Male
• Aged, 80 and over
• Risk Factors
• Nomograms
• Risk Assessment/methods
• ROC Curve
• C-Reactive Protein/metabolism
• C-Reactive Protein/analysis

• hip fracture
• mortality
• orthopaedics
• risk
• trauma

• CRP
• MLR
• NLR
• PLR
• SII
• geriatric
• hip fracture
• mortality

• hip arthroplasty
• hip fracture
• mortality
• outcome
• periprosthetic fracture
• time to surgery

• Humans
• Female
• Male
• Aged
• Periprosthetic Fractures/surgery
• Periprosthetic Fractures/mortality
• Periprosthetic Fractures/etiology
• Retrospective Studies
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/mortality
• Aged, 80 and over
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Postoperative Complications/mortality
• Middle Aged
• Time-to-Treatment/statistics & numerical data
• Femoral Fractures/surgery
• Femoral Fractures/mortality
• Hip Fractures/surgery
• Hip Fractures/mortality
• Time Factors

• Fracture
• Hip function
• Inflammatory factors
• Prevention
• Risk factors

• Hip fracture
• Meta-analysis
• Mortality
• Older adults
• Risk factors
• Systematic review

• Humans
• Hip Fractures/surgery
• Hip Fractures/mortality
• Risk Factors
• Osteoporotic Fractures/mortality
• Osteoporotic Fractures/surgery
• Prognosis
• Age Factors
• Risk Assessment/methods
• Sex Factors
• Preoperative Period
• Comorbidity

• c-reactive protein (crp) to albumin ratio
• elderly patients
• hip fracture
• mini nutritional assessment-short form
• mortality

• Humans
• Hip Fractures/surgery
• Hip Fractures/mortality
• Hip Fractures/blood
• Female
• Male
• Aged
• Cross-Sectional Studies
• C-Reactive Protein/analysis
• Aged, 80 and over
• Serum Albumin/analysis
• Risk Factors
• Biomarkers/blood
• Preoperative Period
• ROC Curve

• C-reactive protein to albumin ratio
• Hip fracture
• Inflammation
• Long-term mortality
• Neutrophil to lymphocyte ratio

• Humans
• Aged
• Retrospective Studies
• Inflammation/metabolism
• Hip Fractures/surgery
• Biomarkers/metabolism
• Lymphocytes/metabolism
• Prognosis

• Algorithm
• Classification
• Risk factors
• Therapy
• Time to surgery

• Humans
• Retrospective Studies
• Periprosthetic Fractures/surgery
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Knee/adverse effects
• Reoperation/adverse effects
• Femoral Fractures/surgery
• Femur/surgery

• Fragility hip fracture
• Inflammation
• Nutrition
• Platelet-to-lymphocyte ratio
• Survival

• fragility hip fractures
• geriatric hip fracture
• inflammatory indices
• nutritional indices
• surgical site infection

• Humans
• Surgical Wound Infection/epidemiology
• Retrospective Studies
• Hematologic Tests
• Hip Fractures/surgery
• Anticoagulants

• C-reactive protein
• albumin
• arthroplasty
• early mortality
• elderly patients
• femoral fractures
• femoral nailing
• intramedullary nail
• total hip arthroplasty

• C-reactive protein
• Hip fracture
• Hip fracture surgery
• Mortality

• Vietnam
• functional recovery
• harris hip score
• hip fracture
• mortality

• Elderly
• Femoral neck fracture
• Hemiarthroplasty
• Lymphocyte-to-C-reactive protein ratio
• Mortality

The purpose of this study was to identify which of the risk factors would contribute to the contralateral fracture in very elderly patients after intramedullary nail fixation.

Clinical data of 227 intertrochanteric fracture patients aged 80 years or older were retrospectively reviewed. Intramedullary nails (IMNs) were used on all of the patients. Potential risk factors for contralateral hip refractures were determined using univariate and logistic regression analyses.

Contralateral hip refractures occurred in 11 patients (4.84%). Univariate analysis revealed that age, gender, body mass index, fracture classification, hematocrit, D-dimer, and CRP level were not associated with contralateral fractures (P > 0.05). However, neurological diseases, cardiovascular disease, and visual impairments were significantly associated with contralateral fractures (P < 0.05). Multivariate analysis further revealed that neurological diseases (OR 4.25, P = 0.044) and visual impairments (OR 5.42, P = 0.015) were independent risk factors associated with contralateral refractures.

To prevent contralateral refractures, more attention should be paid to elderly intertrochanteric fracture patients with underlying neurological disease and visual impairments.

• Beijing Medical and Health Foundation

• albumin
• clr
• c-reactive protein
• lymphocyte
• motality

• Aged
• Aged, 80 and over
• Biomarkers
• C-Reactive Protein/analysis
• Hip Fractures/surgery
• Humans
• Prognosis
• Retrospective Studies
• Serum Albumin/analysis

The main purpose of this study is to evaluate prognostic factors that affected the patients' early (<30 days) and late (six months, one year, and overall) postoperative mortality following hip fracture surgery.

This retrospective study included 515 patients older than 75 years old with surgically treated osteoporotic hip fracture. The demographic data, American Society of Anesthesiologists (ASA) classification, type of anesthesia, duration of hospital stay, and history of intensive care unit (ICU) stay were collected. An analysis of laboratory values was also performed to determine their relationship with mortality. The primary outcome was survival, determined as the time from the surgery to death or the end of the study. The patients were divided into four groups according to survival time: at the first month, six months, first year, and overall survival. An analysis of demographic and laboratory values was performed to determine their validity as prognostic factors for each group.

Postoperative C-reactive protein (CRP) level showed an independent association with a poor survival at the first month. ASA classification, admission to the ICU, and preoperative CRP levels showed an independent association with a poor survival for the first six months. Preoperative CRP level showed an independent association with a poor survival for the first year. ASA classification, admission to the ICU, and the preoperative CRP levels showed an independent association with a poor overall survival.

CRP level, a high ASA classification, and postoperative ICU admission were related to poorer overall survival rate following hip fracture surgery in the elderly.

• Cause of death
• Elderly
• Geriatric fracture
• Hip fractures
• Mortality

• general medicine (see internal medicine)
• geriatric medicine
• respiratory infections

• Aged
• Hip Fractures/surgery
• Humans
• Oxygen
• Partial Pressure
• Pneumonia/diagnosis
• Pneumonia/epidemiology
• Pneumonia/etiology
• Retrospective Studies
• Risk Factors

• Shaanxi Natural Science Foundation of China

• Hip fracture
• Mortality
• Osteoporosis
• Risk prediction

• Aged
• Cohort Studies
• Hip Fractures/surgery
• Humans
• Logistic Models
• ROC Curve
• Risk Assessment
• Risk Factors

The mortality of femoral neck fracture (FNF) is high and every effort should be made to identify and manage any possible risk factors. The aim of this study was to evaluate whether on-admission hemoglobin (Hb) level, C-reactive protein (CRP), and serum creatinine were associated with 2-year mortality after FNF.

In this retrospective observational cohort study, we considered for inclusion all displaced FNF patients 65 years and above treated with hemi-arthroplasty between February 2011 and May 2015. We documented the age, sex, cognitive status, and American Society of Anesthesiologists (ASA) classification. The Hb level, CRP, and serum creatinine were measured. The medical records were followed up for 2 years. We fitted different crude and adjusted Cox proportional hazards models to examine whether Hb level <100 g/L, CRP >20 mg/L, and serum creatinine >100 μmol/L were associated with the 2-year mortality, adjusted for age, sex, and ASA class.

A total of 290 patients [208 females (72%), mean age 84 years] were included in the study. More than 50% of patients had impaired cognition and ASA class 3–4. Of the 290 patients, 38.3% (n = 111) had died within 2 years after surgery. Mortality among males was 46.3% (n = 38) while mortality among females was 35,1% (n = 73), p = 0.07. We found that on-admission Hb level <100 g/L was associated with 2-year mortality (HR = 3.3, 95% CI: 1.3–8.3, p < 0.01) while CRP >20 mg/L and serum creatinine >100 μmol/L were not associated with 2-year mortality (p = 0.89 and p = 0.31, respectively).

On-admission Hb level <100 g/L, but not CRP >20 mg/L and serum creatinine >100 μmol/L, was associated with 2-year mortality. These results can help healthcare providers identify high-risk FNF patients who probably would benefit from optimized perioperative medical management.

• C-reactive protein
• anemia
• creatinine
• femoral neck fracture
• hip fracture
• mortality

• hip joint function
• inflammatory response
• osteoporotic femoral neck fractures
• periarticular injection

• Aged
• Arthroplasty, Replacement, Hip
• Betamethasone/administration & dosage
• Biomarkers/blood
• Drug Therapy, Combination
• Epinephrine/administration & dosage
• Female
• Femoral Neck Fractures/surgery
• Humans
• Inflammation Mediators/blood
• Injections, Intra-Articular
• Intraoperative Care
• Isoxazoles/administration & dosage
• Male
• Morphine/administration & dosage
• Osteoporotic Fractures/surgery
• Postoperative Complications/prevention & control
• Recovery of Function
• Ropivacaine/administration & dosage

• CAR
• CRP to albumin ratio
• elderly patients
• hip fracture
• mortality

The superiority of distinct anesthesia methods for geriatric hip fracture surgery remains unclear. We evaluated high mobility group box-1 (HMGB1) and interleukin-6 (IL-6) with three different anesthesia methods in elderly patients undergoing hip fracture surgery. Routine blood test findings, postoperative morbidity, and mortality were assessed as secondary outcome. In total, 176 patients were randomized into desflurane (n = 60), propofol (n = 58), or spinal groups (n = 58) that received desflurane-based balanced anesthesia, propofol-based total intravenous anesthesia (TIVA), or spinal anesthesia, respectively. The spinal group required less intraoperative vasopressors (p < 0.001) and fluids (p = 0.006). No significant differences in HMGB1 (p_group×time = 0.863) or IL-6 (p_group×time = 0.575) levels were noted at baseline, postoperative day (POD) 1, or POD2. Hemoglobin, albumin, creatinine, total lymphocyte count, potassium, troponin T, and C-reactive protein were comparable among groups at all time-points. No significant differences in postoperative hospital stay, intensive care unit (ICU) stay, and ventilator use among groups were observed. Postoperative pulmonary, cardiac, and neurologic complications; and in-hospital, 30-day, and 90-day mortality were not significantly different among groups (p = 0.974). In conclusion, HMGB1 and IL-6, and all secondary outcomes, were not significantly different between desflurane anesthesia, propofol TIVA, and spinal anesthesia.

• HMGB1
• IL-6
• anesthesia
• elderly
• hip fracture
• mortality

Patients sustaining a hip fracture have a high mortality rate during the first postoperative year and the Sernbo score may stratify patients into a high, intermediate and low risk of death during this period. We assessed its predictive properties on patients from the National Swedish Hip Fracture Register.

55,716 hip fracture patients, 69% women older than 65 years at surgery (registered between 2010 and 2015) with complete Sernbo scores and mortality data were studied. Receiver-operating characteristics analyses (ROC) were used. Validation of Sernbo score was performed.

The overall 1-year mortality rate was 26%—and 17%, 27.4% and 55.6% in the low, intermediate and high-risk groups, respectively. The ROC analysis indicated a predictive ability of the Sernbo score, with an AUC of 0.69 (CI 0.68–0.69).

In this registry-based study, the easy-to-use Sernbo scoring system proved to be appropriate and useful way to identify hip fracture patients with a high-risk mortality during the first postoperative year.

The online version of this article (10.1007/s00068-020-01375-4) contains supplementary material, which is available to authorized users.

• Elderly
• Femoral neck fracture
• Hip fracture
• Mortality
• Score

• Female
• Hip Fractures/surgery
• Humans
• Male
• Postoperative Period
• ROC Curve
• Registries
• Risk Factors

• Bioelectrical impedance
• Functional outcomes
• Hip fractures
• Phase angle
• Rehabilitation

Introduction

The aim of the current study is to investigate the relationship between mortality rate in geriatric patients undergoing surgery with preoperative serum levels of procalcitonin, C-reactive protein, and erythrocyte sedimentation rate.

Methods

This was a single-center retrospective study, including three groups with 101 patients, who are older than 65 years of age. A retrospective investigation was carried out from the laboratory information system for all groups from January to December 2018. Group 1 included patients who had surgery and then mortality within 30 days after surgery. Group 2 included hospitalized patients who had surgery and no mortality within 30 days after surgery. Group 3 included outpatient patients, who had suspicion for a bacterial infection and then no surgery or no mortality within 30 days.

Results

When three group comparisons were made for procalcitonin, C-reactive protein, and erythrocyte sedimentation rate values, the p-value of one-way analysis of variance (ANOVA) was higher than 0.05 for procalcitonin and lower than 0.05 for C-reactive protein and erythrocyte sedimentation rate, suggesting that one or more groups were significantly different. When post-hoc multiple comparison methods were applied, there were statistically significant differences between Groups 1 and 3 for C-reactive protein and erythrocyte sedimentation rate.

Conclusions

Procalcitonin levels do not predict mortality following surgery. C-reactive protein and erythrocyte sedimentation rate are more useful biomarkers predicting mortality in geriatric patients undergoing surgery.

• geriatric medicine
• mortality
• procalcitonin
• surgery

• C-reactive protein
• femoral neck fracture
• postoperative complications

• Aged
• Aged, 80 and over
• C-Reactive Protein
• Female
• Femoral Neck Fractures
• Humans
• Male
• Postoperative Complications
• Retrospective Studies

• Hip fracture
• Inflammatory markers
• Mortality
• Prognosis

• Aged
• Aged, 80 and over
• Biomarkers/blood
• C-Reactive Protein/analysis
• Databases, Factual
• Denmark
• Female
• Ferritins/blood
• Hip Fractures/mortality
• Humans
• Male
• Proportional Hazards Models
• Receptors, Urokinase Plasminogen Activator/blood
• Retrospective Studies

This study aimed to compare femoral obturator nerve block (FONB) with fascia iliaca compartment block (FICB) in the management of acute preoperative pain in elderly patients with hip fracture.

Patients ≥65 years (n=154) diagnosed with hip fracture who had surgery within 48 hours of hospital admission included two groups who received ultrasound-guided nerve block, the FONB group (n=77), and the FICB group (n=77). The visual analog scale (VAS) score for pain, requirement for analgesic drugs, nursing care requirements after hospitalization, post-operative complications, and rehabilitation were compared between the FONB and FICB patient groups.

The VAS scores after both nerve block procedures were significantly reduced compared with those before both nerve block procedures (P<0.05), but there were no differences on the second day after nerve block. The VAS scores at rest and on exercise in the FONB group were significantly lower than those in the FICB group at 30 min and one day after nerve block (P<0.05). The requirement for postoperative analgesic drugs in the FONB group was significantly lower than that in the FICB group (P=0.048). The incidence of nausea and vertigo in the FICB group were significantly higher than in the FONB group (P=0.031 and P=0.034, respectively). Patients in the FONB group experienced significantly improved quality of postoperative function (P=0.029).

Both FONB and FICB provided pain control for elderly patients with hip fracture. However, compared with FICB, FONB resulted in significantly improved analgesia with a reduced requirement for analgesic drugs.

• Elderly patients
• Hip fracture
• Mortality
• TSH
• Thyroid-stimulating hormone

• 90-year old
• Geriatric
• Head trauma
• Mortality
• Spine trauma

Hip fracture is a common and devastating event in older adults causing increased dependence, comorbidity, and mortality. Since new surgical techniques have not significantly improved the mortality rate, a better understanding of patient risk factors could improve the treatment algorithm and outcomes. This prospective study aimed to document the 1-year survival rate of patients with intertrochanteric fracture treated surgically in Latin America and to investigate risk factors associated with 1-year mortality.

Between January 2013 and March 2015, 199 patients were prospectively enrolled. Inclusion criteria were aged 60 years or older, isolated intertrochanteric fracture (AO/OTA 31-A), and time to surgery within 10 days after injury. The follow-up period was 1 year. The association between mortality and patient demographics, comorbidity, surgical details, and preoperative laboratory parameters was assessed using log-rank tests.

Twenty patients died by 365 days after surgery (including 5 that died within 30 days of surgery) resulting in a 1-year survival rate of 89.8% (95% confidence interval = 84.6-93.3). The 1-year mortality was significantly associated with age (≥85 years old, P = .032), existing comorbidity (P = .002), preinjury mobility level (P = .026), mental state (Mini-Mental State Examination > 23, P = .040), low preoperative plasma albumin level (P = .007), and high preoperative blood C-reactive protein level (CRP; P = .012). At the 1-year follow-up, patients on average did not regain their preinjury hip function and mobility, although the self-assessed quality of life was equal or better than before the injury.

As a prospective study, the current patient population had clear inclusion and exclusion criteria and was relatively homogeneous. The resulting associations between 1-year postoperative mortality and preoperative hypoalbuminemia and preoperative elevated CRP level are therefore especially notable. Previously identified risk factors such as male gender and time to surgery showed no significant association with 1-year mortality—the overall favorable condition of the current population or the lack of statistical power maybe responsible for this observation.

The current results showed that under the condition of optimal surgical treatment and low surgery-related complication, preinjury health status as indicated by the blood level of albumin and CRP has a direct and significant impact on 1-year mortality rate.

• C-reactive protein
• CRP
• albuminemia
• hip fracture
• mortality
• risk factor

• C-reactive protein
• Complication
• Intertrochanteric femoral fracture
• Postoperative systemic infection

• cholecystitis
• inflammatory biomarkers
• neutrophil-to-lymphocyte ratio
• prognosis

• cognition disorders
• comprehensive geriatric care
• delirium
• geriatric ward
• hip fractures
• interdisciplinary
• multidisciplinary

• Aged
• Delirium/prevention & control
• Geriatrics
• Hip Fractures/therapy
• Humans
• Orthopedic Procedures
• Randomized Controlled Trials as Topic

More and more older patients receive the surgery after hip fracture. However, the mortality rate is high. Prognostic nutritional index (PNI) is associated with prognosis in hip fracture patients. In the current study, we proposed a novel prognostic score, named c-reactive protein/PNI ratio (CRP/PNI ratio), for predicting the prognosis for geriatric orthopedic population.

This is a prospective study. Eighty cases of hip fracture surgery in the elderly population were studied to reveal the relationship between the CRP/PNI ratio and the clinicopathological characteristics of the elderly patients. Clinical data included age, sex, weight, length of stay, duration of surgery, comorbidity, and biological data were collected. The primary endpoint was the 1-year mortality rate.

Cox regression and log-rank tests were used to evaluate the correlation of CRP/PNI to the one-year mortality. The one-year mortality rate was low in the patients with a low CRP/PNI ratio (P < 0.001). Univariate and multivariate survival analyses proved that CRP/PNI was an important factor to predict the one-year mortality rate of the geriatric hip fracture surgery patients.

Low CRP/PNI ratio was significantly associated with low one-year mortality rate in older patients after hip fracture surgery.

• C-reactive protein/prognostic nutritional index
• elderly population
• hip fracture
• mortality