scholarly journals The consequences of out-of-hours hip fracture surgery: insights from a retrospective nationwide study

2021 ◽  
Author(s):  
Maximilian Peter Forssten ◽  
Ahmad Mohammad Ismail ◽  
Tomas Borg ◽  
Yang Cao ◽  
Per Wretenberg ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Internal Fixation ◽  
Poisson Regression ◽  
Surgical Intervention ◽  
Postoperative Mortality ◽  
Pathological Fractures ◽  
Out Of Hours ◽  
Nationwide Study ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Abstract Purpose The study aimed to investigate the association between out-of-hours surgery and postoperative mortality in hip fracture patients. Furthermore, internal fixation and arthroplasty were compared to determine if a difference could be observed in patients operated with these techniques at different times during the day. Methods All patients above 18 of age years in Sweden who underwent hip fracture surgery between 2008 and 2017 were eligible for inclusion. Pathological fractures, non-operatively managed fractures, or cases whose time of surgery was missing were excluded. The cohort was subdivided into on-hour (08:00–17:00) and out-of-hours surgery (17:00–08:00). Poisson regression with adjustments for confounders was used to evaluate the association between out-of-hours surgery and both 30-day and 90-day postoperative mortality. Results Out-of-hours surgery was associated with a 5% increase in the risk of both 30-day [adj. IRR (95% CI) 1.05 (1.00–1.10), p = 0.040] and 90-day [adj. IRR (95% CI) 1.05 (1.01–1.09), p = 0.005] mortality after hip fracture surgery compared to on-hour surgery. There was no statistically significant association between out-of-hours surgery and postoperative mortality among patients who received an internal fixation. Arthroplasties performed out-of-hours were associated with a 13% increase in 30-day postoperative mortality [adj. IRR (95% CI) 1.13 (1.04–1.23), p = 0.005] and an 8% increase in 90-day postoperative mortality [adj. IRR (95% CI) 1.08 (1.01–1.15), p = 0.022] compared to on-hour surgery. Conclusion Out-of-hours surgical intervention is associated with an increase in both 30- and 90-day postoperative mortality among hip fracture patients who received an arthroplasty, but not among patients who underwent internal fixation.

scholarly journals Case Report: 100-year-old COVID-positive Hip Fracture Patient for Hemiarthroplasty Under Spinal Anesthesia

2020 ◽  
Vol 6 ◽  
pp. 233372142095676 ◽  
Author(s):  
Jonathan C. Beathe ◽  
Stavros G. Memtsoudis
Keyword(s):  
Hip Fracture ◽  
Spinal Anesthesia ◽  
Surgical Intervention ◽  
Early Mobilization ◽  
Hip Fracture Surgery ◽  
Global Pandemic ◽  
Unique Experience ◽  
Novel Coronavirus ◽  
Fracture Surgery ◽  
Early Surgical Intervention

Elderly patients undergoing hip fracture surgery represent a myriad of perioperative challenges and risks. The arrival of the global pandemic of novel coronavirus disease 2019 (COVID-19) adds an unprecedented challenge to the management of hip fracture patients. We describe the unique experience and favorable outcome of a 100-year-old COVID-positive hip fracture patient that underwent spinal anesthesia for hemiarthroplasty and subsequent hydroxychloroquine (HCQ) therapy. Multiple factors of varying known benefit may have contributed to our outcome, including preoperative medical consultation and assessment, early surgical intervention, regional anesthesia with little to no sedation, early mobilization and HCQ therapy.

scholarly journals Postoperative mortality in hip fracture patients stratified by the Revised Cardiac Risk Index: a Swedish nationwide retrospective cohort study

2021 ◽  
Vol 6 (1) ◽  
pp. e000778
Author(s):  
Maximilian Peter Forssten ◽  
Ahmad Mohammad Ismail ◽  
Tomas Borg ◽  
Rebecka Ahl ◽  
Per Wretenberg ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Risk Index ◽  
Postoperative Mortality ◽  
Cardiac Risk ◽  
Significant Linear Trend ◽  
Hip Fracture Surgery ◽  
Cardiac Risk Index ◽  
Postoperative Myocardial Infarction ◽  
National Quality ◽  
Fracture Surgery

ObjectivesThe Revised Cardiac Risk Index (RCRI) is a tool that can be used to evaluate the 30-day risk of postoperative myocardial infarction, cardiac arrest and mortality. This study aims to confirm its association with postoperative mortality in patients who underwent hip fracture surgery.MethodsAll adults who underwent primary emergency hip fracture surgery in Sweden between January 1, 2008 and December 31, 2017 were included in this study. The database was retrieved by cross-referencing the Swedish National Quality Register for hip fractures with the Swedish National Board of Health and Welfare registers. The outcomes of interest were the association between the RCRI score and mortality at 30 days, 90 days and 1 year postoperatively.Results134 915 cases were included in the current study. There was a statistically significant linear trend in postoperative mortality with increasing RCRI scores at 30 days, 90 days and 1 year. An RCRI score ≥4 was associated with a 3.1 times greater risk of 30-day postoperative mortality (adjusted incidence rate ratio (IRR) 3.13, p<0.001), a 2.5 times greater risk of 90-day postoperative mortality (adjusted IRR 2.54, p<0.001) and a 2.8 times greater risk of 1-year postoperative mortality (adjusted HR 2.81, p<0.001) compared with that observed with an RCRI score of 0.ConclusionAn increasing RCRI score is strongly associated with an elevated risk 30-day, 90-day and 1-year postoperative mortality after primary hip fracture surgery. The objective and easily retrievable nature of the variables included in the RCRI calculation makes it an appealing choice for risk stratification in the clinical setting.Levels of evidenceLevel III.

scholarly journals Artificial Neural Network and Cox Regression Models for Predicting Mortality after Hip Fracture Surgery: A Population-Based Comparison

Medicina ◽  
2020 ◽  
Vol 56 (5) ◽  
pp. 243
Author(s):  
Cheng-Yen Chen ◽  
Yu-Fu Chen ◽  
Hong-Yaw Chen ◽  
Chen-Tsung Hung ◽  
Hon-Yi Shi
Keyword(s):  
Hip Fracture ◽  
Hospital Volume ◽  
Global Sensitivity Analysis ◽  
Cox Regression ◽  
Postoperative Mortality ◽  
Ann Model ◽  
Performance Indices ◽  
Global Sensitivity ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

This study purposed to validate the accuracy of an artificial neural network (ANN) model for predicting the mortality after hip fracture surgery during the study period, and to compare performance indices between the ANN model and a Cox regression model. A total of 10,534 hip fracture surgery patients during 1996–2010 were recruited in the study. Three datasets were used: a training dataset (n = 7374) was used for model development, a testing dataset (n = 1580) was used for internal validation, and a validation dataset (1580) was used for external validation. Global sensitivity analysis also was performed to evaluate the relative importances of input predictors in the ANN model. Mortality after hip fracture surgery was significantly associated with referral system, age, gender, urbanization of residence area, socioeconomic status, Charlson comorbidity index (CCI) score, intracapsular fracture, hospital volume, and surgeon volume (p < 0.05). For predicting mortality after hip fracture surgery, the ANN model had higher prediction accuracy and overall performance indices compared to the Cox model. Global sensitivity analysis of the ANN model showed that the referral to lower-level medical institutions was the most important variable affecting mortality, followed by surgeon volume, hospital volume, and CCI score. Compared with the Cox regression model, the ANN model was more accurate in predicting postoperative mortality after a hip fracture. The forecasting predictors associated with postoperative mortality identified in this study can also bae used to educate candidates for hip fracture surgery with respect to the course of recovery and health outcomes.

scholarly journals Increasing Risk of Hospital‐Treated Infections and Community‐Based Antibiotic Use After Hip Fracture Surgery: A Nationwide Study 2005–2016

2018 ◽  
Vol 34 (3) ◽  
pp. 437-446 ◽  
Author(s):  
Kaja E Kjørholt ◽  
Søren P Johnsen ◽  
Nickolaj R Kristensen ◽  
Daniel Prieto‐Alhambra ◽  
Alma B Pedersen
Keyword(s):  
Hip Fracture ◽  
Antibiotic Use ◽  
Community Based ◽  
Nationwide Study ◽  
Hip Fracture Surgery ◽  
Increasing Risk ◽  
Fracture Surgery

scholarly journals End-Stage Renal Failure Is an Independent Risk Factor for 1-Year Mortality After Hip Fracture Surgery

2018 ◽  
Vol 9 ◽  
pp. 215145931877056 ◽  
Author(s):  
Louise Woon Theng Lo ◽  
Xu Yanling ◽  
Andrew Chia Chen Chou ◽  
Tet Sen Howe ◽  
John Carson Allen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Risk Factor ◽  
Hip Fracture ◽  
Independent Risk Factor ◽  
Postoperative Mortality ◽  
End Stage Renal Failure ◽  
Hip Fracture Surgery ◽  
End Stage ◽  
Fracture Surgery

Introduction: End-stage renal failure (ESRF) with its associated comorbidities increase postoperative mortality in hip fracture patients. This study investigated the association of ESRF with various comorbidities in patients on dialysis and assessed rates ESRF as an independent risk factor for all-cause postoperative 1- year mortality rates. Methods: This was a retrospective cohort study on patients aged 55 years and older who underwent their first nonpathological, low-energy hip fracture surgery at an Asian tertiary hospital from June 2007 to 2012. Patients were identified as cases with ESRF on dialysis (study group) or non-ESRF patients (controls). Various comorbidity factors and postoperative 1-year mortality status were obtained from institutional electronic medical records. Univariate and multivariate logistic regression were used to identify significant risk factors for all-cause, 1-year mortality. Results: With no loss to follow-up, the 1-year postoperative mortality rate was 19.6% for the 46 patients with ESRF on dialysis and 8.4% for non-ESRF controls ( P = .028). Fisher exact test showed that hypertension, ischemic heart disease (IHD), diabetes mellitus (DM), anemia, cerebrovascular disease, and vascular disease were significantly associated with ESRF ( P < .05). Multivariable logistic regression analysis identified ESRF (adjusted odds ratio[AOR] = 2.85, P = .021), cancer (AOR = 3.04, P = .003), IHD (AOR = 2.07, P = .020), DM (AOR = 2.03, P = .022), and age (AOR = 1.08, P <.0001) as independent risk factors for 1-year mortality following hip fracture surgery. The area under the receiver–operating characteristic curve (95% confidence interval) for the multivariable predictor of 1-year mortality was 0.75 (0.60-0.82). Conclusions: Although associated with multiple comorbidities, ESRF was found to be independently predictive of 1-year mortality in patients undergoing hip fracture surgery, second to cancer in terms of magnitude of risk posed. As ESRF is a negative prognostic factor for 1-year mortality after hip fracture surgery, its importance should be recognized with implications on preoperative counseling to patients about the increased risk and implications on fracture prevention.

scholarly journals Predicting 1-Year Mortality after Hip Fracture Surgery: An Evaluation of Multiple Machine Learning Approaches

2021 ◽  
Vol 11 (8) ◽  
pp. 727
Author(s):  
Maximilian Peter Forssten ◽  
Gary Alan Bass ◽  
Ahmad Mohammad Ismail ◽  
Shahin Mohseni ◽  
Yang Cao
Keyword(s):  
Hip Fracture ◽  
Area Under The Curve ◽  
Postoperative Mortality ◽  
Predictive Ability ◽  
Metastatic Carcinoma ◽  
Support Vector ◽  
Learning Approaches ◽  
Relative Importance ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Postoperative death within 1 year following hip fracture surgery is reported to be up to 27%. In the current study, we benchmarked the predictive precision and accuracy of the algorithms support vector machine (SVM), naïve Bayes classifier (NB), and random forest classifier (RF) against logistic regression (LR) in predicting 1-year postoperative mortality in hip fracture patients as well as assessed the relative importance of the variables included in the LR model. All adult patients who underwent primary emergency hip fracture surgery in Sweden, between 1 January 2008 and 31 December 2017 were included in the study. Patients with pathological fractures and non-operatively managed hip fractures, as well as those who died within 30 days after surgery, were excluded from the analysis. A LR model with an elastic net regularization were fitted and compared to NB, SVM, and RF. The relative importance of the variables in the LR model was then evaluated using the permutation importance. The LR model including all the variables demonstrated an acceptable predictive ability on both the training and test datasets for predicting one-year postoperative mortality (Area under the curve (AUC)= 0.74 and 0.74 respectively). NB, SVM, and RF tended to over-predict the mortality, particularly NB and SVM algorithms. In contrast, LR only over-predicted mortality when the predicted probability of mortality was larger than 0.7. The LR algorithm outperformed the other three algorithms in predicting 1-year postoperative mortality in hip fracture patients. The most important predictors of 1-year mortality were the presence of a metastatic carcinoma, American Society of Anesthesiologists (ASA) classification, sex, Charlson Comorbidity Index (CCI)≤ 4, age, dementia, congestive heart failure, hypertension, surgery using pins/screws, and chronic kidney disease.

scholarly journals β-Adrenergic blockade in patients with dementia and hip fracture is associated with decreased postoperative mortality

2021 ◽  
Author(s):  
Ioannis Ioannidis ◽  
Ahmad Mohammad Ismail ◽  
Maximilian Peter Forssten ◽  
Yang Cao ◽  
Gary Alan Bass ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Beta Blocker ◽  
Postoperative Mortality ◽  
Adrenergic Blockade ◽  
Blocker Therapy ◽  
Beta Blocker Therapy ◽  
Hip Fracture Surgery ◽  
Diagnosis Of Dementia ◽  
Relevant Variables ◽  
Fracture Surgery

Abstract Purpose Dementia, present in 20% of hip fracture patients, is associated with an almost threefold increase in postoperative mortality risk. These patients have a substantially higher incidence of cardiovascular, respiratory, and cerebrovascular mortality after hip fracture surgery compared to patients without dementia. This study aimed to investigate the association between beta-blocker therapy and postoperative mortality in patients with dementia undergoing hip fracture surgery. Methods This nationwide study included all patients in Sweden with the diagnosis of dementia who underwent emergency surgery for a hip fracture between January 2008 and December 2017. Cases where the hip fracture was pathological or conservatively managed were not included. Poisson regression analysis with robust standard errors was performed while controlling for confounders to determine the relationship between beta-blocker therapy and all-cause, as well as cause-specific, postoperative mortality. Results A total of 26,549 patients met the study inclusion criteria, of whom 8258 (31%) had ongoing beta-blocker therapy at time of admission. After adjusting for clinically relevant variables, the incidence of postoperative mortality in patients receiving beta-blocker therapy was decreased by 50% at 30 days [adj. IRR (95% CI) 0.50 (0.45–0.54), p < 0.001] and 34% at 90 days [adj. IRR (95% CI) 0.66 (0.62–0.70), p < 0.001]. Cause-specific mortality analysis demonstrated a significant reduction in the incidence of postoperative cardiovascular, respiratory, and cerebrovascular death within 30 and 90 days postoperatively. Conclusion Beta-blocker therapy is associated with decreased postoperative mortality in hip fracture patients with dementia up to 90 days after surgery. This finding warrants further investigation.

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