scholarly journals 1533 The Effect of Hip Fracture Anatomy and The Modality of Surgery on Red Blood Cell Transfusion and Mortality: A Retrospective Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Greenhalgh ◽  
B Gowers ◽  
K Iyengar ◽  
R Adam
Keyword(s):  
Hip Fracture ◽  
Blood Transfusion ◽  
Hip Fractures ◽  
Blood Transfusions ◽  
Intramedullary Nails ◽  
Subtrochanteric Fractures ◽  
Total Hip ◽  
Increased Risk ◽  
One Year ◽  
Hip Arthroplasties

Abstract Introduction Hip fractures are common, with most requiring surgical management. Blood loss occurs from the fracture and intraoperatively. Often, blood transfusions are required. Hip fractures can be classified by their anatomy: intracapsular, intertrochanteric or subtrochanteric fractures. This study assesses the effect of fracture pattern and operation performed on transfusion rates within our centre. We aim to identify the patients most likely to require transfusion early, to improve outcomes. Method A retrospective cohort study of 324 consecutive hip fracture patients presenting to a district general hospital over one year. Data was collected from electronic patient records, the local transfusion laboratory, and the national hip fracture database. Results 324 hip fractures were divided into 188 (58%) intracapsular, 121 (37%) intertrochanteric and 15 (5%) subtrochanteric fractures. The most common operation performed was hemiarthroplasty (128), followed by dynamic hip screw fixation (75). 75 (23%) of all patients received a blood transfusion. 28 (15%) of intracapsular, 42 (35%) of intertrochanteric and 5 (33%) of subtrochanteric fractures received transfusions. 47% of long intramedullary nails, 45% of short intramedullary nails, 29% of dynamic hip screws, 18% of hemiarthroplasties and 9% of total hip arthroplasties resulted in blood transfusions. One-year mortality in the transfused cohort was 52% and 30.5% in non-transfused. Conclusions Almost a quarter of hip fracture patients received a blood transfusion, which was associated with an increased risk of mortality. Intertrochanteric fractures most commonly led to a transfusion. The operation most associated with transfusions were long intramedullary nailings, and total hip arthroplasties were the least.

scholarly journals TP9.1.3The Effect of Hip Fracture Anatomy and Surgical Modality on the Rate of Red Blood Cell Transfusion and Mortality: A Retrospective Analysis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Michael Greenhalgh ◽  
Benjamin Gowers ◽  
Karthikeyan Iyengar ◽  
Riad Adam
Keyword(s):  
Hip Fracture ◽  
Blood Transfusion ◽  
District General Hospital ◽  
Red Blood Cell Transfusion ◽  
Intramedullary Nails ◽  
Subtrochanteric Fractures ◽  
Total Hip ◽  
Increased Risk ◽  
One Year ◽  
Hip Arthroplasties

Abstract Aims This study assesses the effect of hip fracture anatomy and operation performed on transfusion rates within our centre. We aim to identify patients most likely to require transfusion early, to improve outcomes. Methods A retrospective cohort study of 324 consecutive hip fracture patients presenting to a district general hospital over one year. Data was collected from patient records, local transfusion laboratory and the national hip fracture database. Results 324 hip fractures were categorised as 188 (58%) intracapsular, 121 (37%) intertrochanteric and 15 (5%) subtrochanteric fractures. The most common operation performed was hemiarthroplasty (128), followed by dynamic hip screw fixation (75). 75 (23%) patients received a blood transfusion. 15% of intracapsular, 35% of intertrochanteric and 33% of subtrochanteric fractures received transfusions. 47% of long intramedullary nails, 45% of short intramedullary nails, 29% of dynamic hip screws, 18% of hemiarthroplasties and 9% of total hip arthroplasties resulted in blood transfusions. One-year mortality was higher in the transfused cohort at 52% compared to 30.5% in non-transfused, with an odds ratio of 2.466 (95% CI 1.4555 to 4.178, p = 0.0008). Conclusions Almost a quarter of hip fracture patients received a blood transfusion, which was associated with an almost two and a half times increased risk of one-year mortality. Extracapsular (intertrochanteric and subtrochanteric) fractures most commonly led to transfusions. Long intramedullary nailings were most associated with transfusions and total hip arthroplasties the least. Patients more likely to require transfusion and subsequently have a higher one-year mortality risk can therefore be identified at presentation.

ESA use in women with cancer: Consequences of the 2008 FDA clinical alert.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5040-5040
Author(s):  
Kimberly M. Dickinson ◽  
Bachir Joseph Sakr
Keyword(s):  
Blood Transfusion ◽  
Blood Transfusions ◽  
Entire Study ◽  
Time Period ◽  
Increased Risk ◽  
Significant Difference ◽  
Study Population ◽  
Time Periods ◽  
One Year ◽  
First Time

5040 Background: Erythropoietin stimulating agents (ESA) are used clinically as an alternative to blood transfusions in cancer patients suffering from symptoms of anemia. However, more recent randomized controlled trials of ESA usage concluded that its use is associated with an increased risk of tumor progression and death. As a result, in July 2008 the FDA issued a clinical alert restricting the use of ESA. A reduction in the prescribing of ESA was immediately seen but changes in blood transfusion rates have not been examined. Methods: A retrospective chart review was conducted drawing from patients under treatment in the Program in Women’s Oncology at Women and Infant’s Hospital from one year before the clinical alert (August 2007-July 2008) to one year afterward (August 2008-July 2009). The primary outcomes were blood transfusion and ESA administration rates compared across the two time periods. Results: The study population (n=776) included patients with a cancer diagnosis who received chemotherapy during one or both time periods. 165 (21.3%) patients received ESA treatment. The total number of ESA treatments administered in the study period of interest was 1,277, with the majority (60%) given prior to the FDA alert. The mean number of ESA treatments in the first time period was 6.39 per person as compared to 0.61 per person in the second time period. Of the study population, 186 (23.8%) patients received at least one blood transfusion. A total of 463 blood transfusions were administered during the entire study period but a significant difference was not observed in the proportion of those delivered prior to the FDA alert (52%) versus after the FDA alert (48%). The average number of transfusions given in the first time period was 2.34 per person, as compared to 2.17 per person in the second period. Conclusions: Our results indicate that despite a steep decline in the use of ESA for chemotherapy-induced anemia, blood transfusion rates were not significantly different between the two periods. Interestingly, a slight downward trend was observed from before the FDA alert to after the alert. While more work is needed to understand the implications of these findings, it suggests that resource utilization did not increase despite the reduction in ESA use.

scholarly journals Prior Admissions as a Risk Factor for Readmission in Patients Surgically Treated for Femur Fractures: Implications for a Potential Hip Fracture Bundle

2021 ◽  
Vol 12 ◽  
pp. 215145932199616
Author(s):  
Robert Erlichman ◽  
Nicholas Kolodychuk ◽  
Joseph N. Gabra ◽  
Harshitha Dudipala ◽  
Brook Maxhimer ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hip Fracture ◽  
Logistic Regression Analysis ◽  
Hip Fractures ◽  
Surgical Procedure ◽  
Hospital Admissions ◽  
Fracture Care ◽  
Increased Risk ◽  
Payment Models

Introduction: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost. Methods: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed. Results: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9). Discussion: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients. Conclusions: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.

scholarly journals Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Firas J. Raheman ◽  
Djamila M. Rojoa ◽  
Jvalant Nayan Parekh ◽  
Reshid Berber ◽  
Robert Ashford
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Case Fatality Rate ◽  
Excess Mortality ◽  
Meta Analysis ◽  
Case Fatality ◽  
Pooled Analysis ◽  
Fatality Rate ◽  
Increased Risk ◽  
The Impact

AbstractIncidence of hip fractures has remained unchanged during the pandemic with overlapping vulnerabilities observed in patients with hip fractures and those infected with COVID-19. We aimed to investigate the independent impact of COVID-19 infection on the mortality of these patients. Healthcare databases were systematically searched over 2-weeks from 1st–14th November 2020 to identify eligible studies assessing the impact of COVID-19 on hip fracture patients. Meta-analysis of proportion was performed to obtain pooled values of prevalence, incidence and case fatality rate of hip fracture patients with COVID-19 infection. 30-day mortality, excess mortality and all-cause mortality were analysed using a mixed-effects model. 22 studies reporting 4015 patients were identified out of which 2651 (66%) were assessed during the pandemic. An excess mortality of 10% was seen for hip fractures treated during the pandemic (OR 2.00, p = 0.007), in comparison to the pre-pandemic controls (5%). Estimated mortality of COVID-19 positive hip fracture patients was four-fold (RR 4.59, p < 0.0001) and 30-day mortality was 38.0% (HR 4.73, p < 0.0001). The case fatality rate for COVID-19 positive patients was 34.74%. Between-study heterogeneity for the pooled analysis was minimal (I2 = 0.00) whereas, random effects metaregression identified subgroup heterogeneity for male gender (p < 0.001), diabetes (p = 0.002), dementia (p = 0.001) and extracapsular fractures (p = 0.01) increased risk of mortality in COVID-19 positive patients.

scholarly journals Hepatic encephalopathy increases the risk of hip fracture: a nationwide cohort study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kuang-Ting Yeh ◽  
Tzai-Chiu Yu ◽  
Ru-Ping Lee ◽  
Jen-Hung Wang ◽  
Kuan-Lin Liu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hepatic Encephalopathy ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Human Life ◽  
National Database ◽  
Research Database ◽  
Older Individuals ◽  
Osteoporotic Hip Fracture ◽  
Increased Risk

Abstract Background Osteoporotic hip fracture is a common general health problem with a significant impact on human life because it debilitates the patients and largely decreases their quality of life. Early prevention of fractures has become essential in recent decades. This can be achieved by evaluating the related risk factors, as a reference for further intervention. This is especially useful for the vulnerable patient group with comorbidities. Hepatic encephalopathy (HE), a major complication of liver cirrhosis, may increase the rate of falls and weaken the bone. This study evaluated the correlation between hepatic encephalopathy and osteoporotic hip fracture in the aged population using a national database. Methods This retrospective cohort study used data from Taiwan’s National Health Insurance Research Database between 2000 and 2012. We included people who were older than 50 years with hepatic encephalopathy or other common chronic illnesses. Patients with and without hepatic encephalopathy were matched at a ratio of 1:4 for age, sex, and index year. The incidence and hazard ratios of osteoporotic hip fracture between the both cohorts were calculated using Cox proportional hazard regression models. Results The mean age of the enrolled patients was 66.5 years. The incidence ratio of osteoporotic hip fracture in the HE group was significantly higher than that in the non-HE group (68/2496 [2.7%] vs 98/9984 [0.98%]). Patients with HE were 2.15-times more likely to develop osteoporotic hip fractures than patients without HE in the whole group. The risk ratio was also significantly higher in female and older individuals. The results were also similar in the comorbidity subgroups of hypertension, diabetes mellitus, hyperlipidemia, senile cataract, gastric ulcer, and depression. Alcohol-related illnesses seemed to not confound the results of this study. Conclusions HE is significantly associated with an increased risk of osteoporotic hip fractures, and the significance is not affected by the comorbidities in people aged more than 50 years. The cumulative risk of fracture increases with age.

scholarly journals Systematic Review and Meta-Analysis on the Impact of Thrombolytic Therapy in Liver Transplantation Following Donation after Circulatory Death

2018 ◽  
Vol 7 (11) ◽  
pp. 425 ◽  
Author(s):  
Kumar Jayant ◽  
Isabella Reccia ◽  
Francesco Virdis ◽  
A. Shapiro
Keyword(s):  
Liver Transplantation ◽  
Blood Transfusion ◽  
Graft Survival ◽  
Meta Analysis ◽  
Donation After Cardiac Death ◽  
Clinical Trial Registry ◽  
Increased Risk ◽  
Increasing Demand ◽  
One Year ◽  
The Impact

Aim: The livers from DCD (donation after cardiac death) donations are often envisaged as a possible option to bridge the gap between the availability and increasing demand of organs for liver transplantation. However, DCD livers possess a heightened risk for complications and represent a formidable management challenge. The aim of this study was to evaluate the effects of thrombolytic flush in DCD liver transplantation. Methods: An extensive search of the literature database was made on MEDLINE, EMBASE, Cochrane, Crossref, Scopus databases, and clinical trial registry on 20 September 2018 to assess the role of thrombolytic tissue plasminogen activator (tPA) flush in DCD liver transplantation. Results: A total of four studies with 249 patients in the tPA group and 178 patients in the non-tPA group were included. The pooled data revealed a significant decrease in ischemic-type biliary lesions (ITBLs) (P = 0.04), re-transplantation rate (P = 0.0001), and no increased requirement of blood transfusion (P = 0.16) with a better one year graft survival (P = 0.02). Conclusions: To recapitulate, tPA in DCD liver transplantation decreased the incidence of ITBLs, re-transplantation and markedly improved 1-year graft survival, without any increased risk for blood transfusion, hence it has potential to expand the boundaries of DCD liver transplantation.

scholarly journals Incidence and risk factors of transfusion reactions in postpartum blood transfusions

2019 ◽  
Vol 3 (15) ◽  
pp. 2298-2306 ◽  
Author(s):  
Lars Thurn ◽  
Agneta Wikman ◽  
Magnus Westgren ◽  
Pelle G. Lindqvist
Keyword(s):  
Blood Transfusion ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adverse Reactions ◽  
Study Cohort ◽  
Blood Transfusions ◽  
Birth Registry ◽  
High Resource ◽  
Increased Risk ◽  
Transfusion Reactions

Abstract Postpartum hemorrhages with blood transfusions are increasing in many high-resource countries. Currently, up to 3% of all women receive blood transfusion postpartum. Most blood transfusions are safe and, in many cases, are lifesaving, but there are significant concerns about adverse reactions. Pregnancy is associated with higher levels of leukocyte antibodies and has a modulating effect on the immune system. Our objective was to investigate whether blood transfusions postpartum are accompanied by an increased risk for transfusion reactions (TRs) compared with transfusions given to nonpregnant women. We included all women who gave birth in Stockholm County, Sweden between 1990 and 2011. Data from the Swedish National Birth Registry were linked to the Stockholm Transfusion Database and included information on blood components administered and whether a TR occurred in women who received blood transfusions postpartum. Background controls were nonpregnant women who received blood transfusions during the study period. The study cohort consisted of 517 854 women. Of these, 12 183 (2.4%) received a blood transfusion. We identified 96 events involving a TR postpartum, giving a prevalence of 79 per 10 000 compared with 40 per 10 000 among nonpregnant women (odds ratio, 2.0; 95% confidence interval, 1.6-2.5). Preeclampsia was the single most important risk factor for TRs (odds ratio, 2.1; 95% confidence interval, 1.7-2.6). We conclude that special care should be taken when women with preeclampsia are considered for blood transfusion postpartum, because our findings indicate that pregnancy is associated with an increased risk for TRs.

scholarly journals Total Hip Arthroplasty Outperforms Hemiarthroplasty in Patients Aged 65 Years and Older: A Propensity-Matched Study of Short-Term Outcomes

2019 ◽  
Vol 10 ◽  
pp. 215145931987685 ◽  
Author(s):  
Jared A. Warren ◽  
Kavin Sundaram ◽  
Hiba K. Anis ◽  
Nicolas S. Piuzzi ◽  
Carlos A. Higuera ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Short Term ◽  
Improvement Project ◽  
Treatment Pathways ◽  
Total Hip ◽  
Displaced Femoral Neck Fractures ◽  
Increased Risk ◽  
Payment Models

Introduction: Displaced femoral neck fractures in the elderly individuals may be treated with total hip arthroplasty (THA) or hip hemiarthroplasty (HHA). However, it is unclear what the short-term medical outcomes are related to these surgical options. The purpose of this study was to compare early postoperative outcomes in THA patients to those of HHA patients. Methods: In this study, we compared 30-day mortality, likelihood of still being in the hospital at 30 days, postoperative major and minor complications, discharge disposition, reoperation and readmission, length of stay, days from admission to surgery, and operative time between THA and HHA. Using the American College of Surgeons National Surgical Quality Improvement Project database, hip fracture patients ≥65 years old from 2008 to 2016 were identified. After propensity score matching, there were 2795 THAs and 2795 HHAs. To assess the effect of THA on the above-mentioned outcomes, bivariate regression models were created. Results: The THA patients ≥65 years old were at reduced risk for mortality ( P = .029) and still being in the hospital at 30 days ( P = .017). The THA patients were at an increased risk for minor complications ( P = .011) and longer operative times ( P < .001). However, THA patients were more likely to have a home discharge ( P < .001). Discussion: Patients ≥65 years who underwent THA for hip fractures had reduced short-term mortality risk, were more likely to be discharged home, and had less likelihood of being in the hospital at 30 days. This is the first study to explore short-term outcomes in patients ≥65 and has direct implications for alternate payment and merit-based payment models. Conclusion: As hip fracture treatment has come under scrutiny with respect to alternate payment models and merit-based incentive payments, this analysis of short-term outcomes warrants consideration when evaluating treatment pathways.

scholarly journals Profiles of Biomarkers of Excess Alcohol Consumption in Patients Undergoing Total Hip Replacement: Correlation with Function

2011 ◽  
Vol 11 ◽  
pp. 1804-1811 ◽  
Author(s):  
Paul J. Jenkins ◽  
Andrew D. Duckworth ◽  
Francis P. C. Robertson ◽  
Colin R. Howie ◽  
James S. Huntley
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Alcohol Misuse ◽  
Future Research ◽  
Total Hip ◽  
Increased Risk ◽  
Functional Scores ◽  
Hip Function ◽  
One Year ◽  
General Physical

Aims. Patients who misuse alcohol may be at increased risk of surgical complications and poorer function following hip replacement. Identification and intervention may lead to harm reduction and improve the outcomes of surgery. The aim of this study was to determine the prevalence of biomarker elevation in patients undergoing hip replacement and to investigate any correlation with functional scores and complications.Methods. We performed a retrospective study that examined the profile of biomarkers of alcohol misuse in 1049 patients undergoing hip replacement.Results. Gamma-glutamyltransferase was elevated in 150 (17.6%), and mean corpuscular volume was elevated in 23 (4%). At one year general physical health was poorer where there was elevation ofγGT, and the mental health and hip function was poorer with elevation of MCV. There were no differences in complications.Discussion. Raised biomarkers can alert clinicians to potential problems. They also provide an opportunity to perform further investigation and offer intervention. Future research should focus on the use in orthopaedic practice of validated screening questionnaires and more sensitive biomarkers of alcohol misuse.Conclusion. This study demonstrates a potential substantial proportion of unrecognised alcohol misuse that is associated with poorer functional scores in patients after total hip replacement.

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