Increased 30-Day Complications in Geriatric Hip-Fracture Patients with Postoperative Weight-Bearing Restrictions: An American College of Surgeons NSQIP Analysis of 4,918 Patients

Introduction: Perioperative delirium in elderly hip fracture patients has been correlated with significant morbidity. The purpose of this study was to determine the preoperative risk factors for and short-term sequelae of postoperative delirium in geriatric hip fracture patients. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program to identify geriatric (≥65 years) patients who sustained operative hip fractures in 2016. Cohorts of patients with and without documented postoperative delirium were identified. Primary data on patient demographics and comorbidities were collected and correlated with postoperative complications and hip fracture outcome measures. Multivariate regression was used to compute risk-adjusted odds ratios (OR) of risk factors and sequelae of delirium. Results: In total, 8,439 geriatric hip fracture patients were identified of whom 2,569 patients (30.4%) had postoperative delirium. Age (OR 1.03 [1.02-1.04, p < 0.001), white race (OR 1.54 [1.19-2.00], p = 0.001), American Society of Anesthesiologists classification (OR 1.20 [1.07-1.36], p = 0.003), baseline dementia (OR 2.46 [2.11-2.86], p < 0.001), and preoperative delirium (OR 10.06 [8.12-12.45], p < 0.001) were independent risk factors for postoperative delirium in multivariate analysis. Patients with postoperative delirium had a significantly higher risk-adjusted 30-day mortality (12.0% vs. 4.8%, OR 2.22 [1.74-2.84], p < 0.001) and morbidity profile. Postoperative delirium was also independently associated with higher rates of discharge to (OR 1.65 [1.32-2.06], p < 0.001) and prolonged stay in (OR 1.79 [1.53-2.09], p < 0.001) an inpatient facility, hospital readmission (OR 1.94 [1.58-2.38], p < 0.001) and hospital length of stay (7.6 ± 5.0 vs. 6.1 ± 4.1 days, p < 0.001), as well as lower rates of immediate postoperative weight bearing (OR 0.73 [0.63-0.86], p < 0.001). Discussion: Postoperative delirium is a common occurrence in geriatric hip fractures with multiple risk factors. Delirium portends higher mortality and worse perioperative hospital-based outcomes. Conclusions: Multidisciplinary foreknowledge and management efforts are warranted to mitigate the risk of developing delirium, which strongly predicts perioperative morbidity, mortality, and hip fracture outcomes.

Download Full-text

Timing of Adverse Events Following Geriatric Hip Fracture Surgery: A Study of 19,873 Patients in the American College of Surgeons National Surgical Quality Improvement Program

The American Journal of Orthopedics ◽

10.12788/ajo.2018.0080 ◽

2018 ◽

Vol 47 (9) ◽

Cited By ~ 4

Author(s):

Daniel D. Bohl ◽

Andre M. Samuel ◽

Matthew L. Webb ◽

Adam M. Lukasiewicz ◽

Nathaniel T. Ondeck ◽

...

Keyword(s):

Quality Improvement ◽

Hip Fracture ◽

Adverse Events ◽

Quality Improvement Program ◽

Improvement Program ◽

Surgical Quality ◽

Hip Fracture Surgery ◽

American College Of Surgeons ◽

Geriatric Hip Fracture ◽

Fracture Surgery

Download Full-text

Evaluation of TXA Prior to Surgery in the Geriatric Hip Fracture Population

Case Medical Research ◽

10.31525/ct1-nct03923959 ◽

2019 ◽

Author(s):

Keyword(s):

Hip Fracture ◽

Geriatric Hip Fracture ◽

Fracture Population

Download Full-text

Faculty Opinions recommendation of Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732327569.793541007 ◽

2017 ◽

Author(s):

Davide Cattano

Keyword(s):

Hip Fracture ◽

Serum Albumin ◽

Postoperative Course ◽

Geriatric Hip Fracture

Download Full-text

Identification of hip fracture patients at risk for postoperative mobilisation complications via handgrip strength assessment

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03756-9 ◽

2021 ◽

Author(s):

Johannes Gleich ◽

Daniel Pfeufer ◽

Alexander M. Keppler ◽

Stefan Mehaffey ◽

Julian Fürmetz ◽

...

Keyword(s):

Hip Fracture ◽

Gait Speed ◽

Handgrip Strength ◽

Weight Bearing ◽

Proximal Femur Fracture ◽

Term Outcome ◽

Long Term Outcome ◽

Strength Assessment ◽

Positive Correlation ◽

Prospective Study Design

Abstract Introduction Treatment of older adult hip fracture patients can be challenging and requires early postoperative mobilisation to prevent complications. Simple clinical tools to predict mobilisation/weight-bearing difficulties after hip fracture surgery are scarcely available and analysis of handgrip strength could be a feasible approach. In the present study, we hypothesised that patients with reduced handgrip strength show incapability to follow postoperative weight-bearing instructions. Materials and methods Eighty-four patients aged ≥ 65 years with a proximal femur fracture (trochanteric, n = 45 or femoral neck, n = 39), who were admitted to a certified orthogeriatric center, were consecutively enrolled in a prospective study design. Five days after surgery (intramedullary nailing or arthroplasty), a standardised assessment of handgrip strength and a gait analysis (via insole forcesensors) was performed. Results Handgrip strength showed positive correlation with average peak force during gait on the affected limb (0.259), postoperative Parker Mobility Score (0.287) and Barthel Index (0.306). Only slight positive correlation was observed with gait speed (0.157). These results were congruent with multivariate regression analysis. Conclusion Assessment of handgrip strength is a simple and reliable tool for early prediction of postoperative mobilisation complications like the inability to follow weight-bearing instructions in older hip fracture patients. Follow-up studies should evaluate if these findings also match with other fracture types and result in personalised adjustment of current aftercare patterns. In addition, efforts should be made to combine objectively collected data as handgrip strength or gait speed in a prediction model for long-term outcome of orthogeriatric patients.

Download Full-text

Predictive Model of Gait Recovery at One Month after Hip Fracture from a National Cohort of 25,607 Patients: The Hip Fracture Prognosis (HF-Prognosis) Tool

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073809 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3809

Author(s):

Cristina González de Villaumbrosia ◽

Pilar Sáez López ◽

Isaac Martín de Diego ◽

Carmen Lancho Martín ◽

Marina Cuesta Santa Teresa ◽

...

Keyword(s):

Hip Fracture ◽

Predictive Model ◽

Weight Bearing ◽

Individual Characteristics ◽

Predicted Probability ◽

National Cohort ◽

Probability Threshold ◽

Anesthetic Risk ◽

Validation Set ◽

Operative Delay

The aim of this study was to develop a predictive model of gait recovery after hip fracture. Data was obtained from a sample of 25,607 patients included in the Spanish National Hip Fracture Registry from 2017 to 2019. The primary outcome was recovery of the baseline level of ambulatory capacity. A logistic regression model was developed using 40% of the sample and the model was validated in the remaining 60% of the sample. The predictors introduced in the model were: age, prefracture gait independence, cognitive impairment, anesthetic risk, fracture type, operative delay, early postoperative mobilization, weight bearing, presence of pressure ulcers and destination at discharge. Five groups of patients or clusters were identified by their predicted probability of recovery, including the most common features of each. A probability threshold of 0.706 in the training set led to an accuracy of the model of 0.64 in the validation set. We present an acceptably accurate predictive model of gait recovery after hip fracture based on the patients’ individual characteristics. This model could aid clinicians to better target programs and interventions in this population.

Download Full-text