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García-Tercero E, Belenguer-Varea Á, Villalon-Ruibio D, López Gómez J, Trigo-Suarez R, Cunha-Pérez C, Borda MG, Tarazona-Santabalbina FJ. Respiratory Complications Are the Main Predictors of 1-Year Mortality in Patients with Hip Fractures: The Results from the Alzira Retrospective Cohort Study. Geriatrics (Basel) 2024; 9:47. [PMID: 38667514 PMCID: PMC11050287 DOI: 10.3390/geriatrics9020047] [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: 11/29/2023] [Revised: 02/21/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction: Hip fractures pose a significant challenge for older individuals given their high incidence and one-year mortality rate. The objective of this study was to identify the primary predictors of one-year mortality in older adults hospitalized for hip fractures. Methods: We conducted a retrospective cohort study involving adults aged 70 years or older who were admitted to the hospital for fragility hip fractures between 1 January 2014 and 31 December 2021. A total of 3229 patients were recruited, with 846 (26.2%) experiencing one-year mortality. Results: Respiratory complications (HR 2.42, 95%CI 1.42-4.14; p = 0.001) were the most significant predictors of one-year mortality, followed by hospital readmission (HR 1.96, 95%CI 1.66-2.32; p < 0.001), the male sex (HR 1.88, 95%CI 1.46-2.32; p < 0.001), cardiac complications (HR 1.88, 95%CI 1.46-2.32; p < 0.001), and a diagnosis of dementia at admission (HR 1.37, 95%CI 1.13-1.66; p = 0.001). The Charlson Index and the American Society of Anesthesiologists physical status classification system also significantly increased the mortality risk. Conversely, higher hemoglobin levels at admission and elevated albumin at discharge significantly reduced the mortality risk. Conclusions: The one-year mortality rate is substantial in older adults with hip fractures who are admitted to an orthogeriatric unit. The appropriate management of anemia, nutritional disorders, and comorbidity at admission and during the follow-up could potentially mitigate long-term mortality after hip fractures.
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Affiliation(s)
- Elisa García-Tercero
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Ángel Belenguer-Varea
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Daniela Villalon-Ruibio
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Jesús López Gómez
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Rodrigo Trigo-Suarez
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
| | - Cristina Cunha-Pérez
- School of Doctorate, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, 4068 Stavanger, Norway;
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Francisco Jose Tarazona-Santabalbina
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, 46600 Alzira, Spain; (Á.B.-V.); (D.V.-R.); (J.L.G.); (F.J.T.-S.)
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain
- Medical School, Universidad Católica de Valencia Sant Vicent Màrtir, 46001 Valencia, Spain
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Esper GW, Meltzer-Bruhn AT, Ganta A, Egol KA, Konda SR. Can we predict 1-year functional outcomes and mortality following hip fracture in middle-aged and geriatric patients at time of admission? Musculoskelet Surg 2024; 108:99-106. [PMID: 38218747 DOI: 10.1007/s12306-023-00804-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: 11/01/2022] [Accepted: 11/20/2023] [Indexed: 01/15/2024]
Abstract
This study's purpose is to determine if patients treated for hip fracture at highest risk for poor functional outcomes, shorter time to death, and death within 1-year can be predicted at the time of admission. We hypothesized that the Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) tool can be used to predict risk of these variables. Between February 2019-July 2020, 544 patients ≥ 55-years-old were treated for hip fracture [AO/OTA 31A/B, 32A/C]. Each patient's demographics, functional status, and injury details were used to calculate their respective risk (STTGMA) score at time of admission. Patients were divided into risk quartiles by STTGMA score. Patients were contacted by phone to complete EuroQol-5 Dimension (EQ5D-3L) questionnaires on functional status. Comparative analyses were conducted on outcomes and EQ5D-3L questionnaire results. 439 patients (80.7%) had at least 1-year follow-up. 82 patients (18.7%) died within 1-year after hospitalization. Mean STTGMA score was 1.67% ± 4.49%. The highest-risk cohort experienced a 42x (p < 0.01) and 2.5x (p = 0.01) increased rate of 1-year mortality compared to the minimal- and low-risk groups respectively. The highest-risk cohort had the shortest time to death (p = 0.015). The highest-risk cohort had the lowest EQ5D index (p < 0.01) and VAS scores (p < 0.01) along with the highest rate of 30 day readmission (p < 0.01) and the longest length of stay (p < 0.01). The STTGMA tool provides important prognostic information for middle-aged and geriatric hip fracture patients that can help modulate care levels. This information is useful when counseling patients, their families, and caregivers on expected outcomes.
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Affiliation(s)
- G W Esper
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E. 17th Street, 14th Floor, New York, NY, 10003, USA
| | - A T Meltzer-Bruhn
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E. 17th Street, 14th Floor, New York, NY, 10003, USA
| | - A Ganta
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E. 17th Street, 14th Floor, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - K A Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E. 17th Street, 14th Floor, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - S R Konda
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E. 17th Street, 14th Floor, New York, NY, 10003, USA.
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA.
- NYU Grossman School of Medicine, New York, NY, USA.
- Medisys Health Network, Richmond Hill, NY, USA.
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Thisayakorn P, Thipakorn Y, Tantavisut S, Sirivichayakul S, Vojdani A, Maes M. Increased IgA-mediated responses to the gut paracellular pathway and blood-brain barrier proteins predict delirium due to hip fracture in older adults. Front Neurol 2024; 15:1294689. [PMID: 38379706 PMCID: PMC10876854 DOI: 10.3389/fneur.2024.1294689] [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: 09/15/2023] [Accepted: 01/25/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Delirium is accompanied by immune response system activation, which may, in theory, cause a breakdown of the gut barrier and blood-brain barrier (BBB). Some results suggest that the BBB is compromised in delirium, but there is no data regarding the gut barrier. This study investigates whether delirium is associated with impaired BBB and gut barriers in elderly adults undergoing hip fracture surgery. Methods We recruited 59 older adults and measured peak Delirium Rating Scale (DRS) scores 2-3 days after surgery, and assessed plasma IgG/IgA levels (using ELISA techniques) for zonulin, occludin, claudin-6, β-catenin, actin (indicating damage to the gut paracellular pathway), claudin-5 and S100B (reflecting BBB damage), bacterial cytolethal distending toxin (CDT), LPS-binding protein (LBP), lipopolysaccharides (LPS), Porphyromonas gingivalis, and Helicobacter pylori. Results Results from univariate analyses showed that delirium is linked to increased IgA responses to all the self-epitopes and antigens listed above, except for LPS. Part of the variance (between 45-48.3%) in the peak DRS score measured 2-3 days post-surgery was explained by independent effects of IgA directed to LPS and LBP (or bacterial CDT), baseline DRS scores, and previous mild stroke. Increased IgA reactivity to the paracellular pathway and BBB proteins and bacterial antigens is significantly associated with the activation of M1 macrophage, T helper-1, and 17 cytokine profiles. Conclusion Heightened bacterial translocation, disruption of the tight and adherens junctions of the gut and BBB barriers, elevated CDT and LPS load in the bloodstream, and aberrations in cell-cell interactions may be risk factors for delirium.
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Affiliation(s)
- Paul Thisayakorn
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yanin Thipakorn
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Saran Tantavisut
- Department of Orthopedics, Hip Fracture Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sunee Sirivichayakul
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Aristo Vojdani
- Immunosciences Lab Inc., Los Angeles, CA, United States
- Cyrex Labs LLC, Phoenix, AZ, United States
| | - Michael Maes
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
- Research Institute, Medical University of Plovdiv, Plovdiv, Bulgaria
- Kyung Hee University, Seoul, Republic of Korea
- Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Sun Z, Cheng K, Jin G, Jia J. Increasing serum miR-409-3p predicts the major adverse cardiac adverse events in elderly patients after hip fracture surgery. BMC Musculoskelet Disord 2023; 24:920. [PMID: 38017411 PMCID: PMC10683352 DOI: 10.1186/s12891-023-07049-7] [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: 09/15/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Major adverse cardiovascular events (MACE) are critical complications responsible for the morbidity and mortality of elderly hip fracture patients. There was an urgent need to explore an effect biomarker for predicting MACE in elderly patients receiving hip fracture surgery. OBJECTIVE This study focused on an age-related miRNA, miR-409-3p, and assessed its significance in elderly hip fracture patients. METHODS A total of 267 hip fracture patients were enrolled in this study including 104 elderly patients (age ≥ 60 years). All patients were followed up for 1 year to monitor the occurrence of MACE. The risk factors for the occurrence of MACE were evaluated by the logistic regression analysis. RESULTS Elderly age and reduced cardiac and renal function were identified as risk factors for MACE in hip fracture patients. Elderly patients also showed a high incidence of MACE. In elderly hip fracture patients, significant upregulation of miR-409-3p was observed, which was associated with patients' elderly age, higher level of revised cardiac risk index (RCRI), lower left ventricular ejection fraction (LVEF), and higher levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase-MB (CK-MB), and high sensitivity troponin I (hsTnI). Additionally, miR-409-3p was identified as an independent factor for the MACE in elderly patients received hip fracture surgery. CONCLUSION Upregulated miR-409-3p was an age-related miRNA and could predict the occurrence of MACE in elderly hip fracture patients.
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Affiliation(s)
- Zhengtao Sun
- Department of Osteoarticular Surgery, Linfen People's Hospital, No.319 Gulou West Street, Yao Du District, Linfen, 041000, China
| | - Kai Cheng
- Department of Osteoarticular Surgery, Linfen People's Hospital, No.319 Gulou West Street, Yao Du District, Linfen, 041000, China
| | - Guochao Jin
- Department of Osteoarticular Surgery, Linfen People's Hospital, No.319 Gulou West Street, Yao Du District, Linfen, 041000, China
| | - Jian Jia
- Department of Osteoarticular Surgery, Linfen People's Hospital, No.319 Gulou West Street, Yao Du District, Linfen, 041000, China.
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Huang J, Ge H, Zhu X, Xue C, Su Q, Chen X, Cheng B. Risk factors analysis and nomogram construction for postoperative pulmonary infection in elderly patients with hip fractures. Aging Clin Exp Res 2023; 35:1891-1899. [PMID: 37365389 PMCID: PMC10460316 DOI: 10.1007/s40520-023-02480-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE The purpose of this study was to predict the probability of postoperative pulmonary infection in elderly patients with hip fractures by developing and validating a precise model. METHODS The clinical data of 1008 elderly hip fracture patients undergoing surgical treatment in Shanghai Tenth Peoples' Hospital were retrospectively selected. A univariate analysis and multivariate regression were used to analyze the independent risk factors for postoperative pulmonary infection in elderly patients with hip fractures. A risk prediction model was established, and a nomogram was drawn. The area under the ROC curve and Hosmer‒Lemeshow test were used to evaluate the predictive effect of the model. RESULTS The multivariate regression analysis indicated that age > 73, time from fracture to surgery (d) > 4 days, smoking, ASA ≥ III level, COPD, hypoproteinemia, red cell distribution width > 14.8%, mechanical ventilation time > 180 min, and stay in the ICU were independent risk factors for postoperative pulmonary infection in elderly patients. The AUCs of the model were 0.891 and 0.881, 0.843, respectively, in the two verification groups. For the Hosmer‒Lemeshow test, the P values were 0.726 in the modeling group and 0.497 and 0.231 in the verification group (P > 0.05). CONCLUSION Overall, this study uncovered different independent risk factors for postoperative pulmonary infection in patients with hip fractures. The nomogram can effectively predict the occurrence of postoperative pulmonary infection.
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Affiliation(s)
- Jingbiao Huang
- Department of Sports Medicine, School of Medicine, Tongji Hospital, Tongji University, Shanghai, 200092, China
| | - Heng'an Ge
- Department of Sports Medicine, School of Medicine, Tongji Hospital, Tongji University, Shanghai, 200092, China
| | - Xiaoping Zhu
- Department of Nursing, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200092, China
| | - Chao Xue
- Department of Sports Medicine, School of Medicine, Tongji Hospital, Tongji University, Shanghai, 200092, China
| | - Qihang Su
- Department of Sports Medicine, School of Medicine, Tongji Hospital, Tongji University, Shanghai, 200092, China
| | - Xujuan Chen
- Department of Orthopaedic Surgery, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200092, China.
| | - Biao Cheng
- Department of Sports Medicine, School of Medicine, Tongji Hospital, Tongji University, Shanghai, 200092, China.
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Evaluation of the Association between Low-Density Lipoprotein (LDL) and All-Cause Mortality in Geriatric Patients with Hip Fractures: A Prospective Cohort Study of 339 Patients. J Pers Med 2023; 13:jpm13020345. [PMID: 36836579 PMCID: PMC9967768 DOI: 10.3390/jpm13020345] [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: 01/22/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Many factors affect the prognosis of hip fractures in the elderly. Some studies have suggested a direct or indirect association among serum lipid levels, osteoporosis, and hip fracture risk. LDL levels were found to have a statistically significant nonlinear U-shaped relationship with hip fracture risk. However, the relationship between serum LDL levels and the prognosis of patients with hip fractures remains unclear. Therefore, in this study, we assessed the influence of serum LDL levels on patient mortality over a long-term follow-up period. METHODS Elderly patients with hip fractures were screened between January 2015 and September 2019, and their demographic and clinical characteristics were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between LDL levels and mortality. Analyses were performed using Empower Stats and R software. RESULTS Overall, 339 patients with a mean follow-up period of 34.17 months were included in this study. Ninety-nine patients (29.20%) died due to all-cause mortality. Linear multivariate Cox regression models showed that LDL levels were associated with mortality (HR = 0.69, 95%CI: 0.53, 0.91, p = 0.0085) after adjusting for confounding factors. However, the linear association was unstable, and nonlinearity was identified. An LDL concentration of 2.31 mmol/L was defined as the inflection point for prediction. A LDL level < 2.31 mmol/L was associated with mortality (HR = 0.42, 95%CI: 0.25, 0.69, p = 0.0006), whereas LDL > 2.31 mmol/L was not a risk factor for mortality (HR = 1.06, 95%CI: 0.70, 1.63, p = 0.7722). CONCLUSIONS The preoperative LDL level was nonlinearly associated with mortality in elderly patients with hip fractures, and the LDL level was a risk indicator of mortality. Furthermore, 2.31 mmol/L could be considered a predictor cut-off for risk.
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Chen Y, Liang S, Wu H, Deng S, Wang F, Lunzhu C, Li J. Postoperative delirium in geriatric patients with hip fractures. Front Aging Neurosci 2022; 14:1068278. [PMID: 36620772 PMCID: PMC9813601 DOI: 10.3389/fnagi.2022.1068278] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Postoperative delirium (POD) is a frequent complication in geriatric patients with hip fractures, which is linked to poorer functional recovery, longer hospital stays, and higher short-and long-term mortality. Patients with increased age, preoperative cognitive impairment, comorbidities, perioperative polypharmacy, and delayed surgery are more prone to develop POD after hip fracture surgery. In this narrative review, we outlined the latest findings on postoperative delirium in geriatric patients with hip fractures, focusing on its pathophysiology, diagnosis, prevention, and treatment. Perioperative risk prediction, avoidance of certain medications, and orthogeriatric comprehensive care are all examples of effective interventions. Choices of anesthesia technique may not be associated with a significant difference in the incidence of postoperative delirium in geriatric patients with hip fractures. There are few pharmaceutical measures available for POD treatment. Dexmedetomidine and multimodal analgesia may be effective for managing postoperative delirium, and adverse complications should be considered when using antipsychotics. In conclusion, perioperative risk intervention based on orthogeriatric comprehensive care is the most effective strategy for preventing postoperative delirium in geriatric patients with hip fractures.
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Affiliation(s)
- Yang Chen
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shuai Liang
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Huiwen Wu
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shihao Deng
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Fangyuan Wang
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Ciren Lunzhu
- Department of Orthopedics, Shannan City People’s Hospital, Shannan, China
| | - Jun Li
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China,*Correspondence: Jun Li,
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Han J, Kim CH, Kim JW. Handgrip strength effectiveness and optimal measurement timing for predicting functional outcomes of a geriatric hip fracture. Sci Rep 2022; 12:20600. [PMID: 36446812 PMCID: PMC9708680 DOI: 10.1038/s41598-022-25177-3] [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: 12/09/2021] [Accepted: 11/25/2022] [Indexed: 11/30/2022] Open
Abstract
Handgrip strength (HGS) now draws attention as one of the predictors of outcomes following geriatric hip fracture; however, its effectiveness and the optimal time to assess HGS remain unknown. Herein, we aimed to determine the usefulness of HGS in predicting the outcomes of geriatric hip fracture and to find the most effective time to measure HGS in both the low muscle strength and normal hip fracture groups. The study was performed prospectively for 79 geriatric hip fracture patients. HGS was measured during the admission period and the one-week postoperative period. Walking ability and quality of life were assessed using Koval scores and the European Quality of Life Five Dimension (EQ-5D) scale at the admission period and postoperatively at 3, 6, and 12 months, respectively. The relationship between pre/postoperative HGS and functional outcomes was assessed, and the functional score between the "low muscle strength" and "normal muscle strength" groups was compared. The association between HGS asymmetry and low strength with functional limitations was determined. For the preoperative HGS, the Koval score showed a significant relationship in the postoperative 6-month (r = -0.295, P = 0.008) and 12-month (r = -0.266, P = 0.019) periods; also, the EQ-5D score showed a significant relationship in the postoperative 6-month and 12-month periods (r = 0.344, P < 0.001, and r = 0.386, P = 0.001, respectively). For the postoperative HGS, the Koval score showed a significant relationship in the 6-month (r = -0.432, P < 0.001) and 12-month (r = -0.344, P = 0.002) postoperative periods. Also, the EQ-5D score showed a significant relationship in the 3-month (r = 0.340, P = 0.010), 6-month (r = 0.476, P < 0.001), and 12-month (r = 0.471, P < 0.001) postoperative periods. The incidence of preoperative and postoperative low HGS was 78.5% and 70.9%, respectively. The "low-strength" group had poor Koval scores and EQ-5D at postoperative month 12 and poor functional outcomes earlier in the follow-up (postoperative 6- and 12-month Koval scores and postoperative 3-, 6-, and 12-month EQ-5D), respectively (P = 0.008 and P = 0.003; P = 0.003, P = 0.001, and P = 0.001). The effect of HGS asymmetry and low strength on functional limitations remained undetermined. Both preoperative and postoperative HGS reflected functional outcomes of patients with hip fracture during the 12-month follow-up. Postoperative HGS had a higher prognostic value than preoperative HGS.
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Affiliation(s)
- Jeongae Han
- grid.267370.70000 0004 0533 4667University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chul-Ho Kim
- grid.254224.70000 0001 0789 9563Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea ,grid.267370.70000 0004 0533 4667Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Ji Wan Kim
- grid.267370.70000 0004 0533 4667Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
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Toro G, Pola E, Miranda R, Conte M, Braile A, Pezzella R, De Cicco A, D'auria S, Piscopo A, Panni AS. Extracapsular femoral neck fractures treated with total hip arthroplasty: identification of a population with better outcomes. Orthop Rev (Pavia) 2022; 14:38576. [PMID: 36267219 PMCID: PMC9568433 DOI: 10.52965/001c.38576] [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: 01/06/2025] Open
Abstract
BACKGROUND Femoral neck fractures (FNF) are associated to patient's disability, reduced quality of life and mortality. None of the fixation devices commonly used for extracapsular (EC) FNF (i.e., dynamic hip screws (DHS) and intramedullary nails (IN)) is clearly superior to the other, especially in case of unstable fractures (31.A2 and 31.A3 according to AO/OTA classification). The aim of our study was to identify a sub-population of patients with EC fractures in which better outcomes could be obtainable using total hip arthroplasty (THA). METHODS All patients with EC unstable fractures treated with THA were included in the present study. Demographic data, American Society of Anesthesiologists (ASA) score, hospitalization length, transfusion rate, implant-related complications and mortality rate were collected. Clinical outcomes were evaluated using the Oxford Hip Score (OHS), while patients' general health status through the 12 Item Short Form questionnaires (SF-12). RESULTS 30 patients (7 male; 23 female) with a mean age of 78.8 years were included. The 1-year mortality rate was 13.3%. The mean OHS was 27.5, while the mean SF-12 were 45.84 for the mental item and 41.6 for the physical one. Age was the only factor associated with the OHS and patients older than 75 years presented a 12- fold higher risk of developing bad outcomes. CONCLUSIONS THA seems to be a viable option for unstable EC fractures, with good clinical outcomes, especially in patients younger than 75 years of age. The mortality rate associated with THA in EC fractures is low and anyway comparable with IN.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli"
| | - Enrico Pola
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli"
| | - Roberta Miranda
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli"
| | - Michele Conte
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli"; Unit of Orthopaedics and Traumatology, Ospedale Sacro Cuore di Gesù Fatebenefratelli
| | - Adriano Braile
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli"
| | | | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli"
| | - Salvatore D'auria
- Unit of Orthopaedics and Traumatology, Ospedale Sacro Cuore di Gesù Fatebenefratelli
| | - Antonio Piscopo
- Unit of Orthopaedics and Traumatology, Ospedale Sacro Cuore di Gesù Fatebenefratelli
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli"
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10
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Lu YN, Wang L, Zhang YZ. The promising roles of macrophages in geriatric hip fracture. Front Cell Dev Biol 2022; 10:962990. [PMID: 36092716 PMCID: PMC9458961 DOI: 10.3389/fcell.2022.962990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
As aging becomes a global burden, the incidence of hip fracture (HF), which is the most common fracture in the elderly population and can be fatal, is rapidly increasing, and its extremely high fatality rate places significant medical and financial burdens on patients. Fractures trigger a complex set of immune responses, and recent studies have shown that with aging, the immune system shows decreased activity or malfunctions in a process known as immune senescence, leading to disease and death. These phenomena are the reasons why elderly individuals typically exhibit chronically low levels of inflammation and increased rates of infection and chronic disease. Macrophages, which are key players in the inflammatory response, are critical in initiating the inflammatory response, clearing pathogens, controlling the innate and adaptive immune responses and repairing damaged tissues. Tissue-resident macrophages (TRMs) are widely present in tissues and perform immune sentinel and homeostatic functions. TRMs are combinations of macrophages with different functions and phenotypes that can be directly influenced by neighboring cells and the microenvironment. They form a critical component of the first line of defense in all tissues of the body. Immune system disorders caused by aging could affect the biology of macrophages and thus the cascaded immune response after fracture in various ways. In this review, we outline recent studies and discuss the potential link between monocytes and macrophages and their potential roles in HF in elderly individuals.
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Affiliation(s)
- Yi-ning Lu
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ling Wang
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Ying-ze Zhang, ; Ling Wang,
| | - Ying-ze Zhang
- Department of Orthopedic Research Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Ying-ze Zhang, ; Ling Wang,
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Zhou J, Chen C, Cheng N, Xing J, Guo R, Li L, Yang D, Hei Z, Zhou S. Perioperative administration of methylprednisolone was associated with postoperative pulmonary complications in elderly patients undergoing hip fracture surgery. Aging Clin Exp Res 2022; 34:2005-2012. [PMID: 35925516 DOI: 10.1007/s40520-022-02166-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/26/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) seriously affect the postoperative prognosis of elderly patients underwent hip fracture surgery. Although methylprednisolone is increasingly used, the association between perioperative methylprednisolone and PPCs is still controversial. The study aims to determine whether perioperative administration of methylprednisolone is associated with PPCs in elderly patients during hip fracture surgery. PATIENTS AND METHODS In this retrospective cohort study, records of 584 patients (≥ 65 years) who underwent hip fracture surgery between January 2013 and October 2020 were extracted. Univariate and multivariate regression analysis were performed to identify the risk factors for PPCs. To further explore the association between administration of methylprednisolone and PPCs, 53 patients received methylprednisolone and 53 patients without methylprednisolone were matched for the confounding factors using propensity score matching (PSM) analysis. The odds ratios (OR) and 95% confidence intervals (CI) for the above variables were analyzed. RESULTS The incidence of PPCs during postoperative hospitalization was 6.83% (38/556) among the elderly patients following hip fracture surgery. Patients with PPCs had higher postoperative mortality rate, longer hospital stay, more hospitalization cost, and higher incidence of cardiac arrest (all P < 0.05). Multivariate logistic regression analysis showed that age, hypertension, hypoglycemia, hypoproteinemia and perioperative methylprednisolone were independent risk factors for PPCs. Moreover, administration of methylprednisolone was significantly correlated with PPCs both before PSM adjustment (OR = 3.25; 95% CI, 1.67 to 6.33; P = 0.001) and after PSM adjustment (OR = 6.68; 95% CI, 1.40 to 31.82; P = 0.017). CONCLUSION Perioperative administration of methylprednisolone is a risk factor for PPCs in elderly patients undergoing hip fracture surgery.
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Affiliation(s)
- Jun Zhou
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
| | - Chaojin Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, China.
| | - Nan Cheng
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
| | - Jibin Xing
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
| | - Rongchang Guo
- Guangzhou AID Cloud Technology Co., LTD, Guangzhou, 510000, China
| | - Lusi Li
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, China
| | - Dong Yang
- Guangzhou AID Cloud Technology Co., LTD, Guangzhou, 510000, China
| | - Ziqing Hei
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, China.
| | - Shaoli Zhou
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, China.
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Jang SY, Lee JW, Kim KJ, Kim HY, Choy WS, Cha Y. Comparative Interrupted Time Series Analysis of Long-term Direct Medical Costs in Patients With Hip Fractures and a Matched Cohort: A Large-database Study. Clin Orthop Relat Res 2022; 480:891-902. [PMID: 34807010 PMCID: PMC9007206 DOI: 10.1097/corr.0000000000002051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies on medical costs in patients with hip fractures have focused on medical costs incurred for a short period after the injury. However, patients often had comorbidities before their hip fractures that would have affected medical costs even had they not sustained a fracture. Consequently, these studies may have overestimated the costs associated with hip fractures and did not characterize the duration of increased medical costs adequately. Without knowing this crucial information, it is difficult to craft thoughtful health policy to support these patients' needs. QUESTIONS/PURPOSES (1) To compare the direct medical costs for 5 years before fracture and up to 5 years after injury in a group of patients who underwent hip fracture surgery with a matched group of patients who did not experience a hip fracture, (2) to analyze the duration over which the increased direct medical costs associated with a hip fracture continues, and (3) to analyze whether there is a difference in direct medical costs according to age group using a nationwide claims database in South Korea. METHODS The National Health Insurance Service Sample cohort in South Korea consisted of 1 million patients who were selected using a systematic, stratified, random sampling method from 48,222,537 individuals on December 31, 2006. Under a compulsory social insurance system established by the National Health Insurance Act, all patients were followed until 2015. Patients with hip fractures and matched controls were selected from the National Health Insurance Service sample of South Korea. Patients with hip fractures were defined as those who were hospitalized with a diagnosis of femoral neck fracture or intertrochanteric fracture and who underwent surgical treatment. We excluded patients with hip fractures before January 1, 2007 to ensure a minimum 5-year period that was free of hip fractures. Patients with hip fractures were matched with patients of the same age and gender at the date of admission to an acute care hospital for surgery (time zero). If patients with hip fractures died during the follow-up period, we performed matching among patients whose difference from the time of death was within 1 month. This method of risk-set matching was repeated sequentially for the next patient until the last patient with a hip fracture was matched. We then sequentially performed 1:5 random sampling for each risk set. A total of 3583 patients in the hip fracture cohort (patients with hip fractures) and 17,915 patients in the matched cohort (those without hip fractures) were included in this study. The mean age was 76 ± 9 years, and 70% were women in both groups. Based on the Charlson comorbidity index score, medication, and medical history, the patients with hip fractures had more comorbidities. Person-level direct medical costs per quarter were calculated for 5 years before time zero and up to 5 years after time zero. Direct medical costs were defined as the sum of that insurer's payments (that is, the National Health Insurance Service's payments), and that patient's copayments, excluding uncovered payments. We compared direct medical costs between patients with hip fractures and the patients in the matched cohort using a comparative interrupted time series analysis. The difference-in-difference estimate is the ratio of the differences in direct medical costs before and after time zero in the hip fracture cohort to the difference in direct medical costs before and after time zero in the matched cohort; the difference in difference estimates were calculated each year after injury. To identify changes in direct medical cost trends in patients with hip fractures and all subgroups, joinpoint regression was estimated using statistical software. RESULTS The direct medical costs for the patients with hip fractures were higher than those for patients in the matched cohort at every year during the observation period. The difference in direct medical costs between the groups before time zero has increased every year. The direct medical costs in patients with hip fractures was the highest in the first quarter after time zero. Considering the differential changes in direct medical costs before and after time zero, hip fractures incurred additional direct medical costs of USD 2514 (95% CI 2423 to 2606; p < 0.01) per patient and USD 264 (95% CI 166 to 361; p < 0.01) per patient in the first and second years, respectively. The increase in direct medical costs attributable to hip fracture was observed for 1.5 to 2 years (difference-in-difference estimate at 1 year 3.0 [95% CI 2.8 to 3.2]; p < 0.01) (difference-in-difference estimate at 2 years 1.2 [95% CI 1.1 to 1.3]; p < 0.01; joinpoint 1.5 year). In the subgroups of patients younger than 65, patients between 65 and 85, and patients older than 85 years of age, the increase in direct medical costs attributable to hip fracture continued up to 1 year (difference-in-difference estimate ratio at 1 year 2.7 [95% CI 2.1 to 3.4]; p < 0.01; joinpoint 1 year), 1.5 to 2 years (difference-in-difference estimate ratio at 1 year 2.8 [95% CI 2.6 to 3.1]; p < 0.01; difference-in-difference estimate ratio at 2 years 1.2 [95% CI 1.1 to 1.3]; p < 0.01; joinpoint 1.5 years), and 39 months to 5 years (difference-in-difference estimate ratio at 1 year 5.2 [95% CI 4.4 to 6.2]; p < 0.01; difference-in-difference estimate ratio at 5 years 2.1 [95% CI 1.4 to 3.1]; p < 0.01; joinpoint 39 months) from time zero, respectively. CONCLUSION The direct medical costs in patients with hip fractures were higher than those in the matched cohort every year during the 5 years before and after hip fracture. The increase in direct medical costs because of hip fractures was maintained for 1.5 to 2 years and was greater in older patients. Based on this, we suggest that health policies should focus on patients' financial and social needs, with particular emphasis on the first 2 years after hip fracture with stratification based on patients' ages. LEVEL OF EVIDENCE Level II, economic analysis.
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Affiliation(s)
- Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Jang-Won Lee
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Kap-Jung Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Ha-Yong Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
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Fu Y, Zhu LJ, Li DC, Yan JL, Zhang HT, Xuan YH, Meng CL, Sun YH. Evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fracture. World J Clin Cases 2022; 10:3069-3077. [PMID: 35647121 PMCID: PMC9082697 DOI: 10.12998/wjcc.v10.i10.3069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/07/2022] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Elderly patients tend to have poor self-efficacy and poor confidence in postoperative rehabilitation for hip fractures, and are prone to negative emotions, which affect treatment compliance.
AIM To evaluate the effects of evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fractures.
METHODS A total of 120 patients with hip fracture surgically treated from June 2018 to June 2020 at the orthopedic department of our hospital were selected and divided into intervention and routine groups (n = 60 each) according to different nursing methods. The basic rehabilitation methods of the two groups were consistent, but patients in the intervention group received evidence-based nursing interventions at the same time. Differences between groups in the scores of motion phobia, pain fear, rehabilitation training compliance, self-efficacy, nursing satisfaction, and hip joint function were compared before and after the intervention.
RESULTS Before the intervention, there were no statistically significant differences in motion phobia and pain fear scores between the groups (all P > 0.05). However, motion phobia scores at 1 wk after intervention initiation (P < 0.05), and pain fear scores at 1 wk and 2 wk after intervention initiation (all P < 0.05), were significantly lower in the intervention group than in the routine group. On the first day of intervention, there was no significant difference in rehabilitation treatment compliance between the groups (P > 0.05); however, at 2 wk after intervention initiation, rehabilitation compliance was significantly better in the intervention group than in the routine group (P < 0.05). Before the intervention, there were no statistically significant differences in the scores for the two self-efficacy dimensions (overcoming difficulties and rehabilitation exercise self-efficacy) and the total self-efficacy score between the groups (all P > 0.05). After 2 wk of intervention, the scores for these two dimensions of self-efficacy and the total self-efficacy score were significantly higher in the intervention group than in the routine group (all P < 0.05). At 3 and 6 mo after surgery, hip function as evaluated by the Harris hip score, was significantly better in the intervention group than in the routine group (P < 0.05). Additionally, overall nursing satisfaction was significantly higher in the intervention group than in the routine group (P < 0.05).
CONCLUSION Evidence-based nursing intervention can alleviate fear of postoperative rehabilitation in elderly patients who underwent hip fracture surgery, and improve rehabilitation treatment compliance and patient self-efficacy, which promote hip function recovery.
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Affiliation(s)
- Ying Fu
- Joints Osteopathic Department, Chengde Central Hospital, Chengde 067000, Hebei Province, China
| | - Li-Juan Zhu
- Traumatic Osteopathic Department, Chengde Central Hospital, Chengde 067000, Hebei Province, China
| | - Da-Cheng Li
- Traumatic Osteopathic Department, Chengde Central Hospital, Chengde 067000, Hebei Province, China
| | - Jing-Lei Yan
- Joints Osteopathic Department, Chengde Central Hospital, Chengde 067000, Hebei Province, China
| | - Hai-Ting Zhang
- Joints Osteopathic Department, Chengde Central Hospital, Chengde 067000, Hebei Province, China
| | - Yu-Hong Xuan
- Nursing Department, Chengde Central Hospital, Chengde 067000, Hebei Province, China
| | - Chun-Ling Meng
- Joints Osteopathic Department, Chengde Central Hospital, Chengde 067000, Hebei Province, China
| | - Yan-Hong Sun
- Joints Osteopathic Department, Chengde Central Hospital, Chengde 067000, Hebei Province, China
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14
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Kong D, Luo W, Zhu Z, Sun S, Zhu J. Factors associated with post-operative delirium in hip fracture patients: what should we care. Eur J Med Res 2022; 27:40. [PMID: 35279208 PMCID: PMC8917680 DOI: 10.1186/s40001-022-00660-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/14/2022] [Indexed: 02/08/2023] Open
Abstract
Background The postoperative delirium is a common yet serious complication in elderly patients with hip fracture. We aimed to evaluate the potential risk factors of delirium in patients with hip fracture, to provide reliable evidence to the clinical management of hip fracture. Methods This study was a retrospective design. Elderly patients who underwent hip fracture surgery in our hospital from June 1, 2019 to December 30, 2020 were selected. The characteristics and treatment data of delirium and no delirium patients were collected and compared. Multivariate logistic regression analysis was performed to analyze the influencing factors affecting postoperative delirium in elderly patients with hip fracture. Results A total of 245 patients with hip fracture were included, the incidence of postoperative delirium in patients with hip fracture was 13.06%. There were significant differences in the age, BMI, history of delirium, estimated blood loss and duration of surgery (all p < 0.05). There were significant differences in the albumin and TSH between delirium and no delirium group (all p < 0.05), Logistics analyses indicated that age ≥ 75 years (OR 3.112, 95% CI 1.527–5.742), BMI ≥ 24 kg/m2 (OR 2.127, 95% CI 1.144–3.598), history of delirium (OR 1.754, 95% CI 1.173–2.347), estimated blood loss ≥ 400 mL (OR 1.698, 95% CI 1.427–1.946), duration of surgery ≥ 120 min (OR 2.138, 95% CI 1.126–3.085), preoperative albumin ≤ 40 g/L (OR 1.845, 95% CI 1.102–2.835) and TSH ≤ 2 mU/L (OR 2.226, 95% CI 1.329–4.011) were the independent risk factors of postoperative delirium in patients with hip fracture(all p < 0.05). Conclusions Postoperative delirium is very common in elderly patients with hip fracture, and it is associated with many risk factors, clinical preventions targeted on those risk factors are needed to reduce the postoperative delirium. Supplementary Information The online version contains supplementary material available at 10.1186/s40001-022-00660-9.
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Şahın İG, Gültaç E, Can Fİ, Kılınç CY, Aydoğan NH. An Evaluation of the Fear of Falling, Balance Levels, and Prognostic Blood Parameters Among the Geriatric Population With Hip Fractures. Cureus 2022; 14:e21704. [PMID: 35242472 PMCID: PMC8883147 DOI: 10.7759/cureus.21704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/05/2022] Open
Abstract
Background In this study, we determined that among patients who had been operated upon for hip fractures at our hospital, prognostic factors for mortality and functional recovery in the preoperative period were indicated via laboratory parameters using the International Falls Efficacy Scale (FES-I) and Berg Balance Scale (BBS) scores. Methodology Between January 2020 and January 2021, the results of 64 patients who had been surgically treated for a hip fracture and 57 patients who had scheduled elective surgery were compared retrospectively. The groups’ demographic data and blood parameters were compared. We used the FES-I and BBS scores to determine patients’ physical functional status and fear of falling. Results The case group’s statistically significant FES-I score was high, and its BBS score was low (p = 0.001/0.001). As expected, the case group’s D-dimer measurement was higher than the control group’s (p = 0.001). In addition, hemoglobin, platelet, lymphocyte, albumin, total protein, and calcium levels were lower in the case group (p = 0.001 for all levels). No significant difference was found for other parameters. Conclusions The scales are used by physical therapy, neurology, and orthopedics professionals to evaluate the geriatric population’s physical functional status and fear of falling. We believe prevention and cost-effective treatments for hip fractures can be achieved by determining geriatric patients’ hemoglobin, platelet, lymphocyte, albumin, total protein, and calcium levels upon hospital admission and by directing these patients to relevant clinics using the fear-of-falling and balance scales.
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Liu R, Zhang YN, Fei XJ, Wang JY, Hua RL, Tong YN, Li K, Cao WW, Chen SH, Zhang BF, Chen J, Zhang YM. Association between Neutrophil Levels on Admission and All-Cause Mortality in Geriatric Patients with Hip Fractures: A Prospective Cohort Study of 2,589 Patients. Int J Clin Pract 2022; 2022:1174521. [PMID: 36628151 PMCID: PMC9797311 DOI: 10.1155/2022/1174521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the association between neutrophil levels and all-cause mortality in geriatric hip fractures. METHODS Elderly patients with hip fractures were screened between January 2015 and September 2019. Demographic and clinical characteristics of the patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between neutrophil levels and mortality. Analyses were performed using Empower Stats and R software. RESULTS A total of 2,589 patients were included in this study. The mean follow-up period was 38.95 months. During the study period, 875 (33.80%) patients died due to various causes. Linear multivariate Cox regression models showed that neutrophil levels were associated with mortality after adjusting for confounding factors, when neutrophil concentration increased by 1∗109/L, the mortality risk increased by 3% (HR = 1.03, 95% CI: 1.00-1.06, and P=0210). Neutrophil concentration was used as a categorical variable; we only found statistically significant differences when neutrophil levels were high (HR = 1.27, 95% CI:1.05-1.52, and P=0.0122). In addition, the results are stable in P for trend and propensity score matching sensitivity analysis. CONCLUSIONS Neutrophil levels are associated with mortality in geriatric hip fractures and could be considered a predictor of death risk in the long-term. This study is registered with the Chinese Clinical Trial Registry (ChiCTR) as number ChiCTR2200057323.
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Affiliation(s)
- Rui Liu
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Yan-Ning Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Xu-Jing Fei
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Jing-Ya Wang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Rong-Li Hua
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Ying-Na Tong
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Kun Li
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Wen-Wen Cao
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Shao-Hua Chen
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Juan Chen
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
| | - Yu-Min Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Beilin District, Xi'an, Shaanxi, China
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Velarde-Mayol C, de la Hoz-García B, Angulo-Sevilla D, Torres-Barriga C. [Health consequences (mortality and institutionalization) of hip fracture among the elderly people: Population cohort study in Segovia]. Aten Primaria 2021; 53:102129. [PMID: 34157660 PMCID: PMC8220413 DOI: 10.1016/j.aprim.2021.102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE In order to know the social and health consequences of hip fractures (HF). DESIGN A retrospective cohort study of an entire health area was carried out in patients aged 75 or more, over a period of 5 years. SITE: Segovia Health Area. PARTICIPANTS All patients older than 75 years with a diagnosis of HF, excluding displaced and passerby. INTERVENTIONS The socio-sanitary changes that occur after the HF in respect to their baseline situation (family situation, comorbidities, dependence and mental situation) and the variables which most influence mortality and institutionalization after the HF were analyzed. MAIN MEASUREMENTS One thousand one hundred fifty-nine HF were recorded, with a constant annual incidence of 10.7‰. The prevalence was higher in women: 7.4% versus 3.7%. RESULTS The baseline profile is a pluripatological, non-institutionalized, 87-year-old woman, who retains her independent in her daily life and suffers from a HF due to an accidental fall in her home. At the end of the study period 51% were permanently institutionalized, negatively influencing having worse mental deterioration, worse dependence and subsequent readmissions and in addition, 45.5% died, 25.5% during the first year. The most unfavorable conditions were being previously dependent, having severe mental deterioration, male and within the comorbidities the most influential was previously having an anemia. CONCLUSIONS Our data confirms the deterioration of the autonomy-functional capacity after a HF, in line with what has been published, and has allowed to identify which elderly people are at the greatest risk of complications in the short and medium term (institutionalization and death).
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Affiliation(s)
| | | | - David Angulo-Sevilla
- Medicina de Familia y Comunitaria, Centro de Salud Segovia 1 y Unidad Docente Multiprofesional de Atención Familiar y Comunitaria de Segovia, Segovia, España
| | - Corina Torres-Barriga
- Medicina de Familia y Comunitaria, Centro de Salud Segovia 1 y Unidad Docente Multiprofesional de Atención Familiar y Comunitaria de Segovia, Segovia, España
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You F, Ma C, Sun F, Liu L, Zhong X. The risk factors of heart failure in elderly patients with hip fracture: what should we care. BMC Musculoskelet Disord 2021; 22:832. [PMID: 34583660 PMCID: PMC8479890 DOI: 10.1186/s12891-021-04686-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heart failure is a common adverse postoperative complication in elderly patients. It is necessary to explore the risk factors of heart after the operation of elderly patients with hip fracture during hospitalization. METHODS Patients with hip fractures admitted to our hospital from January 1, 2019 to December 31 2020 were included, all the patients received internal fixation surgery. The characteristics of patients with and without postoperative heart failure were compared. Multivariate logistic regression analyses were applied to analyze the risk factors of heart failure in elderly patients with hip fracture. RESULTS A total of 283 patients with hip fractures were included, the incidence of heart failure was 12.37 %. There were significant differences in the age, hypertension, anemia hypoalbuminemia and duration of surgery between heart failure and no heart failure group(all p < 0.05). There were no significant differences in the gender, BMI, diabetes mellitus, hyperlipidemia, history of heart failure, cognitive dysfunction, type of fracture, preoperative oxygen saturation, white blood cell count, platelet count, red blood cell count, creatinine, alanine aminotransferase, aspartate aminotransferase and estimated blood loss during surgery between heart failure and no heart failure group(all p > 0.05). Logistic regression analyses indicated that age ≥ 70y(OR2.446, 95% CI1.044 ~ 4.149), hypertension(OR2.152, 95% CI1.125 ~ 4.023), anemia(OR3.094, 95% CI1.294 ~ 5.907), hypoalbuminemia(OR2.377, 95% CI1.205 ~ 4.537), duration of surgery ≥ 120 min(OR1.683, 95% CI1.094 ~ 2.782) were the risk factors of heart failure in elderly patients with hip fracture(all p < 0.05). CONCLUSIONS The incidence of postoperative heart failure in elderly patients with hip fracture is relatively high, which is the result of a combination of high-risk factors. Peri-period risk assessment and prevention of related risks are the keys to a good prognosis for patients.
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Affiliation(s)
- Fei You
- Department of Rehabilitation Medicine, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, No.26 Shengli Street, Jiang'an District, Wuhan City, Hubei Province, China.
| | - Chaoyang Ma
- Department of Rehabilitation Medicine, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, No.26 Shengli Street, Jiang'an District, Wuhan City, Hubei Province, China
| | - Fangfang Sun
- Department of Rehabilitation Medicine, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, No.26 Shengli Street, Jiang'an District, Wuhan City, Hubei Province, China.
| | - Lian Liu
- Department of Rehabilitation Medicine, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, No.26 Shengli Street, Jiang'an District, Wuhan City, Hubei Province, China
| | - Xiuwen Zhong
- Department of Rehabilitation Medicine, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, No.26 Shengli Street, Jiang'an District, Wuhan City, Hubei Province, China
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Ramírez-García E, García de la Torre GS, Rodríguez Reyes EJ, Moreno-Tamayo K, Espinel-Bermudez MC, Sánchez-García S. Factors Associated with Recovered Functionality After Hip Fracture in Non-Institutionalized Older Adults: A Case-Control Study Nested in a Cohort. Clin Interv Aging 2021; 16:1515-1525. [PMID: 34429592 PMCID: PMC8380132 DOI: 10.2147/cia.s320341] [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: 05/15/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify factors associated with recovered functionality after a hip fracture in a sample of older adult patients. Patients and Methods Nested case-control study in a cohort. Older adults (60 years or older) with a hip fracture were recruited between May 2017 and October 2018. The Barthel scale was used to measure performance in activities of daily living (ADL). A questionnaire was applied to collect information about demographic, clinic, psychological and social variables, and anthropometric measurements were taken. A logistic regression model was built to analyze various factors related to recovered functionality. Results A total of 346 older adults with a hip fracture were studied (n=173 cases and n=173 controls); 69.4% (n=240) women and 30.6% (n=140) men. Mean age was 79.4 years (±8.7) overall; for cases, 77.4 (±7.9) years and for controls, 81.4 (±9.0). Mean schooling was 6.3 (± 4.3) years. Recovered functionality was associated with normal nutritional status (OR 4.81, 95% CI = 2.54–9.12), absence of heart disease (OR 4.08, 95% CI = 1.48–11.20), self-efficacy for ADL (OR 4.07, 95% CI = 2.15–7.72), absence of depressive symptoms (OR 2.99, 95% CI = 1.69–5.28), prior functionality (OR 2.83, 95% CI = 1.51–5.31), high socioeconomic level (OR 2.41, 95% CI = 1.24–4.65) and transcervical fracture (OR 2.34, 95% CI = 1.05–5.22). Conclusion In older adults who have suffered a hip fracture, clinical, psychological, and demographic characteristics are associated with recovered functionality. These factors should be considered as a priority in the care of older adults who have experienced hip fractures.
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Affiliation(s)
- Eliseo Ramírez-García
- Epidemiological and Health Services Research Unit, Aging Area, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | | | - Karla Moreno-Tamayo
- Epidemiological and Health Services Research Unit, Aging Area, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - María Claudia Espinel-Bermudez
- Clinical Epidemiology Research Unit, UMAE Specialties Hospital, Western Medical Center, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Sergio Sánchez-García
- Epidemiological and Health Services Research Unit, Aging Area, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Quaranta M, Miranda L, Oliva F, Migliorini F, Pezzuti G, Maffulli N. Haemoglobin and transfusions in elderly patients with hip fractures: the effect of a dedicated orthogeriatrician. J Orthop Surg Res 2021; 16:387. [PMID: 34134743 PMCID: PMC8207795 DOI: 10.1186/s13018-021-02524-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/03/2021] [Indexed: 01/02/2023] Open
Abstract
Background Hip fractures are common in elderly patients, in whom it is important to monitor blood loss; however, unnecessary transfusions should be avoided. The primary objective of this study was to assess whether the employment of a dedicated orthogeriatrician in an Orthopaedic Department allows to optimise the clinical conditions of patients, influencing blood loss and consequently the number of transfusions. The secondary objective was to determine whether the influence of the orthogeriatrician differs according to the type of surgical treatment. Methods A total of 620 elderly patients treated for hip fracture were included in the study. These patients were divided into two groups according to the presence or not of the orthogeriatrician. For each patient, age, sex, comorbidities, type of fracture, surgical treatment, length of hospital stay, time from hospitalisation and surgery, time from surgery to discharge, haemoglobin (Hb) values (admission, 24h post-surgery, lowest Hb reached, discharge) and the number of transfusions were recorded. Results Regardless of the surgical procedure performed, in patients managed by the orthogeriatrician, the Hb at discharge was significantly higher (p = 0.003). In addition to the highest Hb at discharge, in patients who underwent hemiarthroplasty, the number of transfusions per patient is significantly reduced (p = 0.03). Conclusion The introduction of the orthogeriatrician in an orthopaedic ward for the management of elderly patients treated for hip fracture allows to discharge the patients with higher Hb values, reducing the risk of anemisation and the costs related to possible re-admission.
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Affiliation(s)
- Marco Quaranta
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - Luca Miranda
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - Filippo Migliorini
- Department of Orthopedic and Trauma Surgery, RWTH University Clinic Aachen, Pauwelsstr. 31, 52074, Aachen, Germany.
| | - Gabriela Pezzuti
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.,Guy Hilton Research Centre, Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England
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21
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Crespo-Fresno A, Vidal-Guitart X, Sánchez-Raya J, Pagès-Bolíbar E, Cuxart-Fina A. Predictive validity of the functional capacity of the CUPAX questionnaire in older adults with hip fracture. Med Clin (Barc) 2021; 158:111-117. [PMID: 33846003 DOI: 10.1016/j.medcli.2020.12.041] [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: 08/14/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Osteoporotic hip fracture is a relevant pathology due to its prevalence and social and health impact. The aim of this study is to explore the predictive validity of the CUPAX questionnaire on mortality, place of residence and post-fracture functionality. MATERIALS AND METHODS Prospective observational study. Two hundred and six patients older than 65 years were included, admitted after a hip fracture. The CUPAX questionnaire score was collected before fracture and one year later, and the place of residence and survival at hospital discharge, and after 6 and 12 months. The statistical analysis was carried out with the SAS® 9.4 and Stata® 13.1 programmes. RESULTS The median age of the sample was 87.0 years (80.1% women). The in-hospital and one-year mortality rate were 5.8% and 19.1%, respectively. Most of the patients were admitted from home (71.4%), and the most frequent discharge destination was a social health centre (48.2%). The percentage of retention of previous functional level in the total sample was 50%, being higher in the younger patients. The area under the curve ROC for mortality one year later was .697 (95% CI .626-.760) and .659 (95% CI .576-.741) for the discharge destination of patients admitted from home. Evaluation of functional retention one year after the fracture, identified three groups of patients based on the pre-fracture CUPAX value. CONCLUSIONS These findings support the clinical utility of the CUPAX questionnaire as a predictive functional tool in elderly patients with hip fracture.
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Affiliation(s)
- Almudena Crespo-Fresno
- Servicio de Medicina Física y Rehabilitación, Hospital Vall d'Hebron, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España.
| | - Xavier Vidal-Guitart
- Universidad Autónoma de Barcelona, Barcelona, España; Servicio de Farmacología Clínica, Hospital Vall d'Hebron, Barcelona, España
| | - Judith Sánchez-Raya
- Servicio de Medicina Física y Rehabilitación, Hospital Vall d'Hebron, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España
| | - Esther Pagès-Bolíbar
- Servicio de Medicina Física y Rehabilitación, Hospital Nostra Senyora de Meritxell, Andorra la Vella, Andorra
| | - Ampar Cuxart-Fina
- Servicio de Medicina Física y Rehabilitación, Hospital Vall d'Hebron, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España
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22
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Duaso E, Gamboa-Arango A, Formiga F, Marimón P, Salgado MT, Murga V, Lumbreras C, Tarrida A. [Prognostic factors of mortality one year after a hip fragility fracture. Anoia hip study]. Rev Esp Geriatr Gerontol 2020; 56:18-23. [PMID: 33081979 DOI: 10.1016/j.regg.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Most of the patients who had a hip fragility fracture are characterized by advanced age, frailty, multimorbidity and high mortality rate into the first year. Our aim is to describe the prognostic factors of mortality one year after a hip fragility fracture. MATERIAL AND METHODS Observational prospective study. During the study period we included patients older than 69 years with hip fragility fracture who were admitted to the Acute Geriatric Unit. RESULTS We have followed 364 patients, 100 of them died (27.5%). The independent prognostic factors of mortality one year after a hip fragility fracture had been: have a less basis score in Lawton and Brody Scale 0.603 (0.505-0.721) (p< 0.001); have a higher score in Charlson Comorbidity Index 2.332 (1.308-4.157) p = 0.04); have a surgical waiting time ≥ 3 days 3.013 (1.330-6.829) p = 0.008); finding hydroelectrolytic disorders and/or deterioration of glomerular filtration 1.212 (1.017-1.444) p = 0.031) during hospital stay; discriminatory capacity of the area under the curve (AUC) (± 95%): 0.888 (0.880-0.891). CONCLUSIONS Prognostic predictors of mortality at one year after a hip fragility fracture are those variables that reflect a worse state of health, complications during hospital stay and a longer surgical waiting time.
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Affiliation(s)
- Enric Duaso
- Unidad Geriátrica de Agudos. Servicio de Geriatría. Hospital de Igualada, Igualada, Barcelona.
| | - Andrés Gamboa-Arango
- Unidad Geriátrica de Agudos. Servicio de Geriatría. Hospital de Igualada, Igualada, Barcelona
| | - Francesc Formiga
- Programa de Geriatría. Medicina Interna. Hospital Universitario de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
| | - Patrícia Marimón
- Unidad Geriátrica de Agudos. Servicio de Cirugía Ortopédica y Traumatología. Hospital de Igualada, Igualada, Barcelona
| | - Maria Teresa Salgado
- Servicio de Fisioterapia. Fundación Sociosanitaria Sant Josep de Igualada, Igualada, Barcelona
| | - Victor Murga
- Unidad Geriátrica de Agudos. Servicio de Anestesiología. Hospital de Igualada, Igualada, Barcelona
| | - Célia Lumbreras
- Unidad Geriátrica de Agudos. Servicio de Geriatría. Hospital de Igualada, Igualada, Barcelona
| | - Anna Tarrida
- Unidad Geriátrica de Agudos. Servicio de Geriatría. Hospital de Igualada, Igualada, Barcelona
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Coto Caramés L, Codesido Vilar PI, Bravo Pérez M, Mendoza Revilla GA, Ojeda-Thies C, Blanco Hortas A, Quevedo García LA. Influence of surgical parameters on mortality after surgery for extracapsular hip fractures in the elderly. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Coto Caramés L, Codesido Vilar PI, Bravo Pérez M, Mendoza Revilla GA, Ojeda-Thies C, Blanco Hortas A, Quevedo García LA. Influence of surgical parameters on mortality after surgery for extracapsular hip fractures in the elderly. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:342-349. [PMID: 32482576 DOI: 10.1016/j.recot.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hip fracture is a very frequent traumatic pathology in the elderly with high mortality. Different factors have been associated with mortality after surgery (age comorbidities). There are surgical factors that are associated with mortality, but they have not been related to the different mortality rates and medical comorbidities. OBJECTIVE To analyze the surgical parameters with influence on mortality in surgery of extracapsular hip fractures in the elderly patient, as well as the influence of medical comorbidities of these patients on mortality, by means of the Charlson comorbidity index (CCI). METHOD Retrospective review of 187 patients operated on in 2015. Data were collected on age and sex, laterality and type of fracture; surgical delay, surgical time, type of osteosynthesis material, mean stay. The presence of comorbidities was determined using the JRC. RESULTS Mean age was 85 years. Regarding the Charlson comorbidity index in brief, 67.4% of patients had a score between 0 and 1, 23.5% of 2, and 9.1% >2. Mortality at one month and one year after surgery was 5.3% and 14.4% respectively. Forty-three complications were recorded, of which 31 were medical complications. Of the 27 patients who died in the first year, 14 (51.8%) suffered complications, 48.2% of which were medical complications. DISCUSSION Multivariate analysis showed significant differences with respect to age, medical complications and Charlson index abbreviated to 2 with respect to mortality. There is no association between delay and surgical time with increased mortality. CONCLUSIONS No association was demonstrated between the surgical parameters studied (surgical delay and time, fracture pattern and stability, reduction criteria, surgical complications) and increased short and long-term mortality. Patients with older age, comorbidities measured with abbreviated CCI and those suffering medical complications have a higher risk of mortality at the month and year of surgery.
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Affiliation(s)
- Laura Coto Caramés
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Lucus Augusti, Lugo, España.
| | | | - Manuel Bravo Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Lucus Augusti, Lugo, España
| | | | - Cristina Ojeda-Thies
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Andrés Blanco Hortas
- Unidad de Epidemiología, Fundación Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS), Hospital Universitario Lucus Augusti, Lugo, España
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Gamboa-Arango A, Duaso E, Formiga F, Marimón P, Sandiumenge M, Salgado M, Escalante E, Lumbreras C, Tarrida A. Prognostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2019.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Gamboa-Arango A, Duaso E, Formiga F, Marimón P, Sandiumenge M, Salgado MT, Escalante E, Lumbreras C, Tarrida A. Pronostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 64:57-63. [PMID: 31377157 DOI: 10.1016/j.recot.2019.06.007] [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: 04/15/2019] [Revised: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Hip fracture usually occurs in frail elderly patients and is associated with an important morbi-mortality in the first year. The objective of the study is to describe the prognostic factors that would allow maintaining functionality at 12 months. METHOD From June 1, 2010 to May 31, 2013, all patients older than 69 years with hip fracture due to bone fragility admitted to the Geriatric Acute Unit of our hospital were included. We define as functional maintenance those patients who have lost between 0-15 points in the Barthel Index with respect to the previous to the fracture. Prospective study of bivariate data analysis for related and multivariate prognostic factors for predictive predictors. RESULTS 271 patients were included, of them, 146 (54.8%), maintained functionality at 12 months and 122 (45.2%) no. Patients who maintain functional status are younger: average age 83.4 vs 85.80 years (P=.002); with better scores in the indexes of: Lawton prior to fracture 4.42 vs 2.40 (P<.001) and Barthel at discharge 34.2 vs. 27.1 (P=.002). There are also differences in the score of the "Geriatric Dementia Scale" 2.59 vs. 3.13 (P=.009), in the score of the "American Society Anesthesiologist"<II 62.2% vs 37.8% (P=0.006) and have presented less delirium during hospitalization 4.7% vs 35.3% (P=.002). In the multivariate analysis they maintained statistical significance, age OR: 1.044 (95% CI: 1.002-1.088) (P=.04) and the Lawton Index OR: 0.869 (95% CI: 0.804-0.940) (P <.001). CONCLUSIONS Prognostic factors of functional maintenance at 12 months are age and the ability to perform instrumental activities of daily life.
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Affiliation(s)
- A Gamboa-Arango
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España.
| | - E Duaso
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - F Formiga
- Programa de Geriatría, Medicina Interna, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, España
| | - P Marimón
- Unidad Geriátrica de Agudos, Servicio de Traumatología y Cirugía Ortopédica, Hospital de Igualada, Igualada, España
| | - M Sandiumenge
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - M T Salgado
- Servicio de Fisioterapia, Fundación Sanitaria San José, Igualada, España
| | - E Escalante
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - C Lumbreras
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - A Tarrida
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
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da Casa C, Pablos-Hernández C, González-Ramírez A, Julián-Enriquez JM, Blanco JF. Geriatric scores can predict long-term survival rate after hip fracture surgery. BMC Geriatr 2019; 19:205. [PMID: 31370806 PMCID: PMC6676564 DOI: 10.1186/s12877-019-1223-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/22/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The management of hip fractures is nowadays mainly performed in Orthogeriatric Units, one of whose fundamental tools is the application of geriatric scores. The purpose of this study is to establish the potential usefulness of Barthel Index, Katz Index, Lawton-Brody Index and Physical Red Cross Scale geriatric scores as predictors of survival rate and readmission rate in older patients after hip fracture surgery. METHODS We designed a prospective single-center observational study, including 207 older adults over age 65 who underwent hip fracture surgery in the first half of 2014 and followed up to September 2018. Cumulative survival and readmission rates were analyzed by Kaplan-Meier; group comparison, by Log-Rank and hazard ratio, by Cox regression. RESULTS We found statistical differences (p < 0.001) for cumulative survival rate by every geriatric score analyzed (BI HR = 0.98 [0.97,0.99]; KI HR = 1.24 [1.13-1.37]; LBI HR = 1.25 [1.16, 1.36]; PCRS HR = 1.67 [1.37,2.04]). Furthermore, we could determinate an inflection point for survival estimation by Barthel Index (BI 0-55/60-100*, p < 0.001, HR = 2.37 [1.59,3.53]), Katz Index (KI A-B*/C-G, p < 0.001, HR = 2.66 [1.80, 3.93], and Lawton-Brody Index (LBI 0-3/4-8*, p < 0.001, HR = 3.40 [2.09,5.25]). We reveal a correlation of the Charlson Index (p = 0.002) and Katz Index (p = 0.041) with number of readmissions for the study period. CONCLUSIONS The geriatric scores analyzed are related to the cumulative survival rate after hip fracture surgery for more than 4 years, independently of other clinical and demographic factors. Katz Index in combination with Charlson Index could also be a potential predictor of the number of readmissions after surgery for hip fracture patients.
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Affiliation(s)
- Carmen da Casa
- Instituto de investigación biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Carmen Pablos-Hernández
- Instituto de investigación biomédica de Salamanca (IBSAL), Salamanca, Spain
- Othogeriatric Unit, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Alfonso González-Ramírez
- Instituto de investigación biomédica de Salamanca (IBSAL), Salamanca, Spain
- Othogeriatric Unit, Hospital Universitario de Salamanca, Salamanca, Spain
| | - José Miguel Julián-Enriquez
- Trauma and Orthopedic Surgery Department, Hospital Universitario de Salamanca, Paseo San Vicente, 58-182, 37007 Salamanca, Spain
| | - Juan F. Blanco
- Instituto de investigación biomédica de Salamanca (IBSAL), Salamanca, Spain
- Trauma and Orthopedic Surgery Department, Hospital Universitario de Salamanca, Paseo San Vicente, 58-182, 37007 Salamanca, Spain
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