A delay of 2 or more days in surgical repair of hip fracture substantially increases mortality rates

Background Spinal anesthesia for surgical repair of hip fracture in the elderly is associated with a high incidence of hypotension. The synergism between intrathecal opioids and local anesthetics may make it possible to achieve reliable spinal anesthesia with minimal hypotension using a minidose of local anesthetic. Methods Twenty patients aged > or = 70 yr undergoing surgical repair of hip fracture were randomized into two groups of 10 patients each. Group A received a spinal anesthetic of bupivacaine 4 mg plus fentanyl 20 microg, and group B received 10 mg bupivacaine. Hypotension was defined as a systolic pressure of < 90 mmHg or a 25% decrease in mean arterial pressure from baseline. Hypotension was treated with intravenous ephedrine boluses 5-10 mg up to a maximum 50 mg, and thereafter by phenylephrine boluses of 100-200 microg. Results All patients had satisfactory anesthesia. One of 10 patients in group A required ephedrine, a single dose of 5 mg. Nine of 10 patients in group B required vasopressor support of blood pressure. Group B patients required an average of 35 mg ephedrine, and two patients required phenylephrine. The lowest recorded systolic, diastolic, and mean blood pressures as fractions of the baseline pressures were, respectively, 81%, 84%, and 85% versus 64%, 69%, and 64% for group A versus group B. Conclusions A "minidose" of 4 mg bupivacaine in combination with 20 microg fentanyl provides spinal anesthesia for surgical repair of hip fracture in the elderly. The minidose combination caused dramatically less hypotension than 10 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure.

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Clinical Evaluation of Anesthesia for Surgical Repair of Hip Fracture in the Elderly

Korean Journal of Anesthesiology ◽

10.4097/kjae.1998.34.1.86 ◽

1998 ◽

Vol 34 (1) ◽

pp. 86

Author(s):

Guie Yong Lee ◽

Choon Hi Lee

Keyword(s):

Hip Fracture ◽

Clinical Evaluation ◽

Surgical Repair ◽

The Elderly

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Searching for the ‘winner’ hip fracture patient: the effect of modifiable and non-modifiable factors on clinical outcomes following hip fracture surgery

Hip International ◽

10.1177/1120700019878814 ◽

2019 ◽

pp. 112070001987881 ◽

Cited By ~ 1

Author(s):

Konstantinos G Makridis ◽

Leonidas S Badras ◽

Stelios L Badras ◽

Theofilos S Karachalios

Keyword(s):

Quality Of Life ◽

Hip Fracture ◽

Medical Treatment ◽

Clinical Outcomes ◽

Hip Fractures ◽

Mortality Rates ◽

Factors Affecting ◽

Modifiable Factors ◽

Modifiable Factor

Background: Various factors, other than the quality of surgery, may influence clinical outcomes of hip fracture patients. We aimed to evaluate the relative impact of several factors on functional outcome, quality of life, re-fracture and mortality rates following surgery for hip fractures. Methods: We studied 498 (62.2%) women and 302 (37.8%) men with a mean age of 81.3 years (range, 60–95) with hip fractures (femoral neck and pertrochanteric). The mean follow-up was 74 months (range 58–96). Various patient-related and surgery-related parameters were recorded and correlated to both objective and subjective mobility, functional recovery and quality of life scales. Mortality and re-fracture rates were also evaluated. Results: Using multiple regression analysis, age >80 years ( p = 0.000; 95% CI, 1.077–1.143) and ASA score III and IV ( p = 0.000; 95% CI, 2.088–3.396) (both non-modifiable factors) both proved to be independent (s.s.) factors affecting mortality rates. Age <80 years ( p = 0.000; 95% CI, 0.932–0.974), surgery delay less (modifiable factor) than 48 hours ( p = 0.046; 95% CI, 0.869–0.999), low dementia CDR index ( p = 0.005; 95% CI, 0.471–0.891) (non-modifiable factor), and osteoporosis medical treatment (modifiable factor) ( p = 0.006; 95% CI, 0.494–0.891) were shown to be independent (s.s.) factors affecting HOOS-symptoms. Osteoporosis medical treatment used proved to be an independent (s.s.) factor affecting HOOS-daily activities ( p = 0.049; 95% CI, 0.563–1.000) and quality of life (E-Qol-5D) ( p = 0.036; 95% CI, 0.737–1.325). Conclusions: A hip fracture patient aged <80 years old, with an ASA I-II, with low dementia CDR index and on osteoporosis medication has a better chance of an improved outcome (winner patient).

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Safe Resumption of Maintenance Electroconvulsive Therapy 12 Days After Surgical Repair of Hip Fracture

Journal of Ect ◽

10.1097/yct.0000000000000193 ◽

2015 ◽

Vol 31 (2) ◽

pp. 81-82 ◽

Cited By ~ 4

Author(s):

Ethan O. Bryson ◽

Lauren Liebman ◽

Roya Nazarian ◽

Charles H. Kellner

Keyword(s):

Hip Fracture ◽

Electroconvulsive Therapy ◽

Surgical Repair

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Spinal or general anaesthesia for surgical repair of hip fracture and subsequent risk of mortality and morbidity: a database analysis using propensity score‐matching

Anaesthesia ◽

10.1111/anae.15042 ◽

2020 ◽

Vol 75 (9) ◽

pp. 1173-1179 ◽

Cited By ~ 1

Author(s):

L. Morgan ◽

T. M. McKeever ◽

J. Nightingale ◽

D. E. Deakin ◽

I. K. Moppett

Keyword(s):

Hip Fracture ◽

Propensity Score ◽

Propensity Score Matching ◽

General Anaesthesia ◽

Surgical Repair ◽

Database Analysis ◽

Mortality And Morbidity ◽

Risk Of Mortality ◽

Subsequent Risk

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Epidemiology of hip fracture and the development of a FRAX model for Uzbekistan

Archives of Osteoporosis ◽

10.1007/s11657-020-00792-7 ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

O Lesnyak ◽

S Ismailov ◽

M Shakirova ◽

N Alikhanova ◽

A Zakroyeva ◽

...

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Mortality Rates ◽

Population Based ◽

Fracture Probability ◽

Medical Attention ◽

National Mortality ◽

The Republic ◽

Country Specific ◽

Population Based Survey

Abstract Summary A prospective population-based survey in a region of the Republic of Uzbekistan determined the incidence of fractures at the hip. The hip fracture rates were used to create a FRAX® model to facilitate fracture risk assessment in Uzbekistan. Objective This paper describes the epidemiology of hip fracture in the Republic of Uzbekistan that was used to develop a country-specific FRAX® tool for fracture prediction. Methods During a 1-year (2016/17) prospective population-based survey in the Pap district of the Republic of Uzbekistan, hip fractures were prospectively identified from hospital registers, trauma centres and primary care and community sources. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Uzbekistan. Fracture probabilities were compared with those from neighbouring Kazakhstan and Kyrgystan. Results Approximately 41% of hip fracture cases did not come to medical attention, and two thirds of patients overall were not admitted to hospital. The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 16,764 and is predicted to increase more than three-fold to 60,272 in 2050. FRAX-based probabilities were higher in Uzbekistan than Kazakhstan or Kyrgystan. Conclusion The FRAX model should enhance accuracy of determining fracture probability among the Uzbek population and help guide decisions about treatment.

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