Re: Urinary Retention in Older Patients in Connection With Hip Fracture Surgery

Abstract Background Postoperative delirium (POD) is a common complication of older people undergoing hip fracture surgery, which negatively affects clinical- and healthcare-related outcomes. Unfortunately, POD pathophysiology is still largely unknown, despite previous studies showing that neuroinflammation, neuroendocrine dysfunction, increased reactive oxidative stress (ROS), and endothelial dysfunctions may be involved. There is also evidence that many of the pathophysiological mechanisms which are involved in delirium are involved in sarcopenia too. This article describes the protocol of a pilot study to evaluate the feasibility of a larger one that will explore the pathophysiological mechanisms correlating POD with sarcopenia. We will analyse whether various biomarkers reflecting neuroinflammation, ROS, neuroendocrine disorders, and microvasculature lesions will be simultaneously expressed in in the blood, cerebrospinal fluid (CSF), and muscles of patients developing POD. Methods Two centres will be involved in this study, each recruiting a convenient sample of ten older patients with hip fracture. All of them will undergo a baseline Comprehensive Geriatric Assessment, which will be used to construct a Rockwood-based Frailty Index (FI). Blood samples will be collected for each patient on the day of surgery and 1 day before. Additionally, CSF and muscle fragments will be taken and given to a biologist for subsequent analyses. The presence of POD will be assessed in each patient every morning until hospital discharge using the 4AT. Delirium subtypes and severity will be assessed using the Delirium Motor Subtype Scale-4 and the Delirium-O-Meter, respectively. We will also evaluate the patient’s functional status at discharge, using the Cumulated Ambulation Score. Discussion This study will be the first to correlate biomarkers of blood, CSF, and muscle in older patients with hip fracture.

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Older patients' perception of their own capacity to regain pre-fracture function after hip fracture surgery – an explorative qualitative study

International Journal of Orthopaedic and Trauma Nursing ◽

10.1016/j.ijotn.2016.04.005 ◽

2017 ◽

Vol 24 ◽

pp. 50-58 ◽

Cited By ~ 13

Author(s):

Berit Gesar ◽

Ami Hommel ◽

Hanne Hedin ◽

Carina Bååth

Keyword(s):

Hip Fracture ◽

Qualitative Study ◽

Older Patients ◽

Hip Fracture Surgery ◽

Fracture Function ◽

Fracture Surgery

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Fecal impaction is associated with postoperative urinary retention after hip fracture surgery

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2020.101464 ◽

2021 ◽

Vol 64 (6) ◽

pp. 101464

Author(s):

Maëlys Teng ◽

Lorène Zerah ◽

Audrey Rouet ◽

Charlotte Tomeo ◽

Marc Verny ◽

...

Keyword(s):

Hip Fracture ◽

Urinary Retention ◽

Fecal Impaction ◽

Postoperative Urinary Retention ◽

Hip Fracture Surgery ◽

Fracture Surgery

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Comparison of regional with general anaesthesia on postoperative delirium (RAGA-delirium) in the older patients undergoing hip fracture surgery: study protocol for a multicentre randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2017-016937 ◽

2017 ◽

Vol 7 (10) ◽

pp. e016937 ◽

Cited By ~ 11

Author(s):

Ting Li ◽

Joyce Yeung ◽

Jun Li ◽

Yan Zhang ◽

Teresa Melody ◽

...

Keyword(s):

Clinical Trial ◽

Hip Fracture ◽

General Anaesthesia ◽

Older Patients ◽

Postoperative Delirium ◽

Controlled Trial ◽

Controlled Clinical Trial ◽

Hip Fracture Surgery ◽

Randomised Controlled ◽

Fracture Surgery

IntroductionPostoperative delirium (POD) is a common serious postoperative complication especially in older people and is associated with increased mortality, morbidity and healthcare costs. There is no clear consensus which anaesthesia is associated with less incidence of POD for older patients. We aim to assess whether regional anaesthesia results in lower incidence of POD comparing with general anaesthesia (GA) among older patients undergoing hip fracture surgery.Methods and analysisRAGA-delirium is a pragmatic, multicentre, prospective, parallel grouped, randomised controlled clinical trial comparing RA or GA for hip fracture surgery. A total of 1000 patients who are 65 years or over and who are having planned hip fracture surgery in nine clinical trial centres of China will be randomised in a 1:1 ratio to receive either anaesthesia for the surgery. The primary endpoint will be the incidence of POD at day 7. The secondary endpoints will be the subtype, severity and duration of delirium, postoperative acute pain score, incidence of other postoperative non-delirium complications, quality of life and cost-effective outcomes. Randomisation will be performed at the patient level using computer-generated assignment. Outcome assessors will be blinded from intervention assignment. Assessments will be conducted before surgery, intraoperatively, postoperatively, during the hospital stay, at 30-day, 6-month and 1-year postoperative intervals.Potential impact of studyThis study will provide clinical evidence with a more robust methodology to help anaesthetists in selecting appropriate anaesthesia for older patients with high risk for POD. At the era of increasing emphasis on delirium prevention, this trial has the potential to inform the future national guideline to reduce POD.Ethics and disseminationEthical approved by the local institutional review board. Trial results will be presented at national and international academic conferences, and published in peer-reviewed journals.Trial registration numberClinicalTrials.gov (NCT02213380); pre-results.

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