scholarly journals Hospital-, anaesthetist-, and patient-level variation in peripheral nerve block utilisation for hip fracture surgery: a population-based cross-sectional study

2021 ◽  
Author(s):  
Ryan McGinn ◽  
Robert Talarico ◽  
Gavin M. Hamiltoon ◽  
Reva Ramlogan ◽  
Duminda N. Wijeysundra ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Peripheral Nerve Block ◽  
Population Based ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Level Variation ◽  
Cross Sectional ◽  
Hip Fracture Surgery ◽  
Patient Level ◽  
Fracture Surgery

scholarly journals Short-term complications of anesthetic technique used in hip fracture surgery in elderly people

2018 ◽  
Vol 28 (3) ◽  
Author(s):  
Afsaneh Norouzi ◽  
Fozhan Behrouzibakhsh ◽  
Alireza Kamali ◽  
Bijan Yazdi ◽  
Babak Ghaffari
Keyword(s):  
Hip Fracture ◽  
Vital Signs ◽  
Cross Sectional Study ◽  
Anesthetic Technique ◽  
Sectional Study ◽  
Short Term ◽  
Cross Sectional ◽  
Hip Fracture Surgery ◽  
American Society ◽  
Fracture Surgery

Postoperative complications of fracture are one of the main problems in older patients with hip fracture. In this study, complications were observed 48 hours after surgery in different anesthetic procedures. This prospective cross sectional study was carried out over a 12-month period. All subjects over 55 years of age undergoing hip fracture surgery were selected for study with ASA class (American Society of Anesthesiology: one, two and three). After determining the vital signs in the operating room, anesthesia type (general, spinal and epidural) and various variables were recorded. It was observed that the spinal anesthesia method had the lowest level of postoperative disturbances of consciousness and had the shortest duration in terms of duration of time. On the other hand, general anesthesia was the least in terms of blood transfusion. Finally, epidural anesthetic method showed the least amount of pain 48 hours after operation and the least changes in blood pressure and heart rate.

scholarly journals Hospital-, Anesthesiologist-, and Patient-level Variation in Primary Anesthesia Type for Hip Fracture Surgery

2018 ◽  
Vol 129 (6) ◽  
pp. 1121-1131 ◽  
Author(s):  
Daniel I. McIsaac ◽  
Duminda N. Wijeysundera ◽  
Gregory L. Bryson ◽  
Allen Huang ◽  
Colin J. L. McCartney ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Odds Ratio ◽  
Antiplatelet Agents ◽  
Neuraxial Anesthesia ◽  
Hospital Level ◽  
Patient Factors ◽  
Cross Sectional ◽  
Hip Fracture Surgery ◽  
Patient Level ◽  
Fracture Surgery

Abstract Editor’s Perspective What We Already Know about This Topic What This Manuscript Tells Us That Is New Background Substantial variation in primary anesthesia type for hip fracture surgery exists. Previous work has demonstrated that patients cared for at hospitals using less than 20 to 25% neuraxial anesthesia have decreased survival. Therefore, the authors aimed to identify sources of variation in anesthesia type, considering patient-, anesthesiologist-, and hospital-level variables. Methods Following protocol registration (NCT02787031), the authors conducted a cross-sectional analysis of a population-based cohort using linked administrative data in Ontario, Canada. The authors identified all people greater than 65 yr of age who had emergency hip fracture surgery from April 2002 to March 2014. Generalized linear mixed models were used to account for hierarchal data and measure the adjusted association of hospital-, anesthesiologist-, and patient-level factors with neuraxial anesthesia use. The proportion of variation attributable to each level was estimated using variance partition coefficients and the median odds ratio for receipt of neuraxial anesthesia. Results Of 107,317 patients, 57,080 (53.2%) had a neuraxial anesthetic. The median odds ratio for receiving neuraxial anesthesia was 2.36 between randomly selected hospitals and 2.36 between randomly selected anesthesiologists. The majority (60.1%) of variation in neuraxial anesthesia use was explained by patient factors; 19.9% was attributable to the anesthesiologist providing care and 20.0% to the hospital where surgery occurred. The strongest patient-level predictors were absence of preoperative anticoagulant or antiplatelet agents, absence of obesity, and presence of pulmonary disease. Conclusions While patient factors explain most of the variation in neuraxial anesthesia use for hip fracture surgery, 40% of variation is attributable to anesthesiologist and hospital-level practice. Efforts to change practice patterns will need to consider hospital-level processes and anesthesiologists’ intentions and behaviors.

Association of Hospital-level Neuraxial Anesthesia Use for Hip Fracture Surgery with Outcomes

2018 ◽  
Vol 128 (3) ◽  
pp. 480-491 ◽  
Author(s):  
Daniel I. McIsaac ◽  
Duminda N. Wijeysundera ◽  
Allen Huang ◽  
Gregory L. Bryson ◽  
Carl van Walraven
Keyword(s):  
Hip Fracture ◽  
Population Based ◽  
Neuraxial Anesthesia ◽  
Sensitivity Analyses ◽  
Causal Mechanism ◽  
Hospital Level ◽  
Hip Fracture Surgery ◽  
Patient Level ◽  
A Prospective Study ◽  
Fracture Surgery

Abstract Background There is consistent and significant variation in neuraxial anesthesia use for hip fracture surgery across jurisdictions. We measured the association of hospital-level utilization of neuraxial anesthesia, independent of patient-level use, with 30-day survival (primary outcome) and length of stay and costs (secondary outcomes). Methods We conducted a population-based cohort study using linked administrative data in Ontario, Canada. We identified all hip fracture patients more than 65 yr of age from 2002 to 2014. For each patient, we measured the proportion of hip fracture patients at their hospital who received neuraxial anesthesia in the year before their surgery. Multilevel, multivariable regression was used to measure the association of log-transformed hospital-level neuraxial anesthetic-use proportion with outcomes, controlling for patient-level anesthesia type and confounders. Results Of 107,317 patients, 57,080 (53.2%) had a neuraxial anesthetic; utilization varied from 0 to 100% between hospitals. In total, 9,122 (8.5%) of patients died within 30 days of surgery. Survival independently improved as hospital-level neuraxial use increased (P = 0.009). Primary and sensitivity analyses demonstrated that most of the survival benefit was realized with increase in hospital-level neuraxial use above 20 to 25%; there did not appear to be a substantial increase in survival above this point. No significant associations between hospital neuraxial anesthesia-use and other outcomes existed. Conclusions Hip fracture surgery patients at hospitals that use more than 20 to 25% neuraxial anesthesia have improved survival independent of patient-level anesthesia type and other confounders. The underlying causal mechanism for this association requires a prospective study to guide improvements in perioperative care and outcomes of hip fracture patients.

scholarly journals Prevalence of disabilities and non-communicable diseases in an elderly population in the Telangana state, India: a population-based cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041755
Author(s):  
Srinivas Marmamula ◽  
Satya Brahmanandam Modepalli ◽  
Thirupathi Reddy Kumbham ◽  
Rajesh Challa ◽  
Jill E Keeffe
Keyword(s):  
Elderly Population ◽  
Self Care ◽  
The Elderly ◽  
Population Based ◽  
Cross Sectional Study ◽  
Communicable Diseases ◽  
Self Report ◽  
Sectional Study ◽  
Cross Sectional ◽  
Non Communicable Diseases

ObjectivesTo assess the prevalence of disabilities (vision, hearing, mobility, cognitive, self-care and communication) and non-communicable diseases (NCDs) among the elderly population in two districts in Telangana, India.DesignPopulation-based cross-sectional study using a cluster random sampling method to select the study clusters.SettingElderly population in Khammam and Warangal districts were recruited. Detailed interviews were conducted by trained community health workers. Personal and demographic information such as age, gender, level of education and a self-report of NCDs was collected. The Washington Disability Questionnaire was administered to assess the presence of disabilities.Participants1821 participants aged ≥60 years, 54.5% were women, and 73.3% had no education.Primary outcome measurePrevalence of disabilities and NCDs.ResultsOverall, the prevalence of at least disability was 20.3% (95% CI 16.3 to 24.9). The prevalence of self- reported disabilities were: seeing (5.9%; 95% CI 4.4 to 7.8), mobility (12.8%; 95% CI 9.7 to 16.8), hearing (3.6%; 95% CI 2.7 to 4.8), cognition (4.8%; 95% CI 3.5 to 6.7), self-care (3.3%; 95% CI 2.3 to 4.7) and communication (1.8%; 95% CI 1.2 to 2.6). Overall, the prevalence of at least one NCD was 34.2% (95% CI 30.9 to 37.7). Hypertension was the most common systemic condition (25.4%; 95% CI 22.4 to 28.7), followed by diabetes (9.0%; 95% CI 7.3 to 11.0), and body pains (muscle-skeletal) (9.9%; 95% CI 8.1 to 12.2).ConclusionEvery fifth elderly person in the districts of Khammam and Warangal in Telangana had at least one self-reported disability. Besides, a third of the elderly had at least one NCD. There is a definite need to develop comprehensive public health strategies to address disabilities and NCDs in Telangana.

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