scholarly journals 149 Reducing Complications and Improving Outcomes Following Total Hip Arthroplasty

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Al-Zubaidy ◽  
M Monem ◽  
C Hallett ◽  
D Ganesh ◽  
K Sarraf ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Nerve Block ◽  
Adverse Outcomes ◽  
Complication Rates ◽  
Neck Of Femur ◽  
Local Complications ◽  
Good Pain Relief ◽  
Hospital Acquired Pneumonia ◽  
Fascia Iliaca Block ◽  
Hospital Acquired

Abstract Aim Neck of femur (NOF) fractures are increasing, and the need to improve mobility and reduce complications whilst improving discharge time is an ongoing challenge. Hip fracture fixation and arthroplasty are essential in improving pain and mobility. NOF patients often undergo a fascia iliaca block (FIB) to improve outcomes. Guay J’s Cochrane systematic review confirms that FIBs reduce pain pre and postoperatively, decrease hospital-acquired pneumonia risk and improve mobility. Patients on anticoagulants are typically refused bedside blocks, however we are unsure if they truly impact adverse outcomes in FIBs for NOF patients. Method A retrospective observational study was undertaken to assess complication rates in 53 NOF patients who had a FIB at St Mary’s Hospital between 07/01/2020 and 26/06/2020. Patients whose NOF was the result of an inpatient fall were excluded. Pre-existing anticoagulant and antiplatelet use were noted, as were the A&E admission blood coagulation results. Local complications which may have arisen post-FIB were closely screened for in documentation until the patient’s discharge date. Results There were no local complications in all 53 patients. Interestingly, one patient had a documented thigh haematoma pre-nerve block, but did not have any evolution of the haematoma and achieved good pain relief from the block. Conclusions FIBs appear to be a safe and effective analgesic tool in the perioperative NOF patient and use has been reported to reduce early complications in those who undergo hip fracture treatment. We aim to implement these findings and increase the rate of nerve block procedures in NOF fractures.

Validation of Predictors of Adverse Outcomes in Hospital-Acquired Pneumonia in the ICU*

2013 ◽  
Vol 41 (9) ◽  
pp. 2151-2161 ◽  
Author(s):  
Mariano Esperatti ◽  
Miquel Ferrer ◽  
Valeria Giunta ◽  
Otavio Tavares Ranzani ◽  
Lina Maria Saucedo ◽  
...  
Keyword(s):  
Adverse Outcomes ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Modifiable risk factors for mortality in revision total hip arthroplasty for periprosthetic fracture

2020 ◽  
Vol 102-B (5) ◽  
pp. 580-585
Author(s):  
Victoria N. Gibbs ◽  
Robert A. McCulloch ◽  
Paula Dhiman ◽  
Andrew McGill ◽  
Adrian H. Taylor ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Modifiable Risk Factors ◽  
Revision Total Hip Arthroplasty ◽  
Factors Associated ◽  
Time To Surgery ◽  
Revision Tha ◽  
Hospital Acquired Pneumonia ◽  
One Year ◽  
Hospital Acquired

Aims The aim of this study was to identify modifiable risk factors associated with mortality in patients requiring revision total hip arthroplasty (THA) for periprosthetic hip fracture. Methods The electronic records of consecutive patients undergoing revision THA for periprosthetic hip fracture between December 2011 and October 2018 were reviewed. The data which were collected included age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, the preoperative serum level of haemoglobin, time to surgery, operating time, blood transfusion, length of hospital stay, and postoperative surgical and medical complications. Univariate and multivariate logistic regression analyses were used to determine independent modifiable factors associated with mortality at 90 days and one year postoperatively. Results A total of 203 patients were identified. Their mean age was 78 years (44 to 100), and 108 (53%) were female. The median time to surgery was three days (interquartile range (IQR) 2 to 5). The mortality rate at one year was 13.8% (n = 28). The commonest surgical complication was dislocation (n = 22, 10.8%) and the commonest medical complication within 90 days of surgery was hospital-acquired pneumonia (n = 25, 12%). Multivariate analysis showed that the rate of mortality one year postoperatively was five-fold higher in patients who sustained a dislocation (odds ratio (OR) 5.03 (95% confidence interval (CI) 1.60 to 15.83); p = 0.006). The rate of mortality was also four-fold higher in patients who developed hospital-acquired pneumonia within 90 days postoperatively (OR 4.43 (95% CI 1.55 to 12.67); p = 0.005). There was no evidence that the time to surgery was a risk factor for death at one year. Conclusion Dislocation and hospital-acquired pneumonia following revision THA for a periprosthetic fracture are potentially modifiable risk factors for mortality. This study suggests that surgeons should consider increasing constraint to reduce the risk of dislocation, and the early involvement of a multidisciplinary team to reduce the risk of hospital-acquired pneumonia. We found no evidence that the time to surgery affected mortality, which may allow time for medical optimization, surgical planning, and resource allocation. Cite this article: Bone Joint J 2020;102-B(5):580–585.

Outcome of surgery in neck of femur fracture patients with poor pre-fracture mobility

2019 ◽  
Vol 30 (6) ◽  
pp. 805-809
Author(s):  
Arijit Mallick ◽  
Shah Jehan ◽  
Daniel Omonbude
Keyword(s):  
Hip Fracture ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Respiratory Morbidity ◽  
Complication Rates ◽  
Neck Of Femur ◽  
Hip Fracture Surgery ◽  
Coronary Syndrome ◽  
Laboratory Test Results ◽  
Fracture Surgery

Background: Hip fractures are common with a UK incidence of over 70,000 cases and total healthcare costs of over £2 billion per year. Mortality rates of 10% at 30 days and up to 30% at 1-year have been reported. We wanted to assess the outcome of hip fracture surgery in patients with reduced pre-fracture mobility as this has not been exclusively studied previously. Methods: We retrospectively reviewed 168 hip fracture patients with reduced pre-fracture mobility (wheelchair bound, bed bound, walking with 2 aids or a frame) who underwent hip fracture surgery at our institution between 2008 and 2013 using case notes, discharge letters, outpatient clinic letters and laboratory test results. Measured outcomes included 30-day renal, cardiac and respiratory morbidity as well as 30-day and 1-year mortality. Results: Our study comprised 27% males and 73% females with a mean age of 82 years. The 30-day chest infection, acute renal failure and acute coronary syndrome rates were 26%, 7.7% and 4% respectively. In those patients who were either wheelchair or bed bound, 30-day and 1-year mortality rates were 11.8% and 52% respectively whereas in those who could mobilise with the help of 2 aids or frame, 30-day and 1-year mortality rates were 4.34% and 39.70% respectively. Conclusion: Our study highlighted increased 30-day and 1-year morbidity and mortality rates following hip fracture surgery with notable high rates of respiratory and renal complications in patients with reduced pre-fracture mobility. We would recommend pre- and postoperative optimisation with orthogeriatric review, chest physiotherapy and intravenous fluid hydration to reduce complication rates and improve morbidity and mortality.

scholarly journals Management of ongoing direct anticoagulant treatment in patients with hip fracture

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Carlo Rostagno ◽  
Alessandro Cartei ◽  
Gianluca Polidori ◽  
Roberto Civinini ◽  
Alice Ceccofiglio ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Demographic Data ◽  
Drug Intake ◽  
Control Group ◽  
Complication Rates ◽  
Adherence To Guidelines ◽  
Time To Surgery ◽  
Clinical Records ◽  
Current Guidelines ◽  
Type Of Fracture

AbstractAim of the present study was to investigate the effects of ongoing treatment with DOACs on time from trauma to surgery and on in-hospital clinical outcomes (blood losses, need for transfusion, mortality) in patients with hip fracture. Moreover we evaluated the adherence to current guidelines regarding the time from last drug intake and surgery. In this observational retrospective study clinical records of patients admitted for hip fracture from January 2016 to January 2019 were reviewed. 74 patients were in treatment with DOACs at hospital admission. Demographic data, comorbidities and functional status before trauma were retrieved. As control group we evaluated 206 patients not on anticoagulants matched for age, gender, type of fracture and ASA score. Time to surgery was significantly longer in patients treated with DOACs (3.6 + 2.7 vs. 2.15 ± 1.07 days, p < 0.0001) and treatment within 48 h was 47% vs. 80% in control group (p < 0.0001). The adherence to guidelines’ suggested time from last drug intake to surgery was 46%. Neither anticipation nor delay in surgery did result in increased mortality, length of stay or complication rates with the exception of larger perioperative blood loss (Hb levels < 8 g/dl) in DOACs patients (34% vs 9% p < 0.0001). Present results suggest that time to surgery is significantly longer in DOAC patients in comparison to controls and adherence to guidelines still limited.

scholarly journals In Vitro Activity of Doripenem, a Carbapenem for the Treatment of Challenging Infections Caused by Gram-Negative Bacteria, against Recent Clinical Isolates from the United States

2008 ◽  
Vol 52 (12) ◽  
pp. 4388-4399 ◽  
Author(s):  
Chris M. Pillar ◽  
Mohana K. Torres ◽  
Nina P. Brown ◽  
Dineshchandra Shah ◽  
Daniel F. Sahm
Keyword(s):  
The United States ◽  
Clinical Isolates ◽  
Gram Negative Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Coagulase Negative Staphylococci ◽  
Hospital Acquired Pneumonia ◽  
Abdominal Infections ◽  
Hospital Acquired ◽  
Gram Positive Cocci

ABSTRACT Doripenem, a 1β-methylcarbapenem, is a broad-spectrum antibiotic approved for the treatment of complicated urinary tract and complicated intra-abdominal infections. An indication for hospital-acquired pneumonia including ventilator-associated pneumonia is pending. The current study examined the activity of doripenem against recent clinical isolates for the purposes of its ongoing clinical development and future longitudinal analysis. Doripenem and comparators were tested against 12,581 U.S. clinical isolates collected between 2005 and 2006 including isolates of Staphylococcus aureus, coagulase-negative staphylococci, Streptococcus pneumoniae, Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter spp. MICs (μg/ml) were established by broth microdilution. By MIC90, doripenem was comparable to imipenem and meropenem in activity against S. aureus (methicillin susceptible, 0.06; resistant, 8) and S. pneumoniae (penicillin susceptible, ≤0.015; resistant, 1). Against ceftazidime-susceptible Enterobacteriaceae, the MIC90 of doripenem (0.12) was comparable to that of meropenem (0.12) and superior to that of imipenem (2), though susceptibility of isolates exceeded 99% for all evaluated carbapenems. The activity of doripenem was not notably altered against ceftazidime-nonsusceptible or extended-spectrum β-lactamase screen-positive Enterobacteriaceae. Doripenem was the most potent carbapenem tested against P. aeruginosa (MIC90/% susceptibility [%S]: ceftazidime susceptible = 2/92%S, nonsusceptible = 16/61%S; imipenem susceptible = 1/98.5%S, nonsusceptible = 8/56%S). Against imipenem-susceptible Acinetobacter spp., doripenem (MIC90 = 2, 89.1%S) was twice as active by MIC90 as were imipenem and meropenem. Overall, doripenem potency was comparable to those of meropenem and imipenem against gram-positive cocci and doripenem was equal or superior in activity to meropenem and imipenem against Enterobacteriaceae, including β-lactam-nonsusceptible isolates. Doripenem was the most active carbapenem tested against P. aeruginosa regardless of β-lactam resistance.

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