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.

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 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 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.

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.

Malnutrition increases the 30-day complication and re-operation rates in hip fracture patients treated with total hip arthroplasty

2019 ◽  
Vol 30 (5) ◽  
pp. 635-640
Author(s):  
Jared M Newman ◽  
Nipun Sodhi ◽  
Anton Khlopas ◽  
Nicolas S Piuzzi ◽  
George A Yakubek ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Propensity Scores ◽  
Improvement Program ◽  
Surgical Quality ◽  
Total Hip ◽  
Data Regression ◽  
Increased Risk ◽  
Preoperative Albumin

Introduction: This study sought to determine the effect that malnutrition, defined as hypoalbuminemia, has on hip fracture patients treated with total hip arthroplasty (THA). Specifically, we evaluated: (1) demographics and perioperative data; (2) postoperative complications; and (3) re-operation rates. Methods: The National Surgical Quality Improvement Program database was utilised to identify hip fracture patients who underwent THA from 2008 to 2015. Propensity scores were calculated for the likelihood of having a preoperative albumin measurement. Hip fracture patients who underwent THA and had preoperative hypoalbuminemia (<3.5 g/dL) ( n = 569) were compared to those who had normal albumin levels (⩾3.5 g/dL) ( n = 1098) in terms of demographics and perioperative data. Regression models were adjusted for age, sex, modified Charlson/Deyo scores, and propensity scores to evaluate complication and re-operation rates. Results: Compared to controls, hypoalbuminemia patients were older (p = 0.006), more likely male ( p = 0.024), had higher Charlson/Deyo scores ( p = 0.0001), more likely smokers ( p < 0.0001), more likely functionally dependent ( p < 0.0001), had ASA scores ⩾3 ( p < 0.0001) and had longer LOS ( p < 0.0001). Compared to controls, hypoalbuminemia patients had 80% higher risk for any complication (OR = 1.80; 95% CI, 1.43–2.26), 113% higher risk for major complications (OR = 2.13; 95% CI, 1.31–3.48), and 79% higher risk for minor complications (OR = 1.79; 95% CI, 1.42–2.26), and 97% increased risk for re-operation (OR = 1.97; 95% CI, 1.20–3.23). Conclusions: The findings in the present study indicate the need to develop better pre- and postoperative medical and nutritional care for malnourished hip fracture patients who undergo THA in order to potentially mitigate their increased risk.

scholarly journals Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260146
Author(s):  
Helen Mary Badge ◽  
Tim Churches ◽  
Justine M. Naylor ◽  
Wei Xuan ◽  
Elizabeth Armstrong ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
High Volume ◽  
Deep Infection ◽  
Total Hip ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Post Surgery ◽  
Increased Risk ◽  
Adjusted Logistic Regression ◽  
One Year

Background Total hip and total knee replacement (THR/TKR) are common and effective surgeries to reduce the pain and disability associated with arthritis but are associated with small but significant risks of preventable complications such as surgical site infection (SSI) and venous-thrombo-embolism (VTE). This study aims to determine the degree to which hospital care was compliant with clinical guidelines for the prevention of SSI and VTE after THR/TKR; and whether non-compliant prophylaxis is associated with increased risk of complications. Methods and findings A prospective multi-centre cohort study was undertaken in consenting adults with osteoarthritis undergoing elective primary TKR/THR at one of 19 high-volume Australian public or private hospitals. Data were collected prior to surgery and for one-year post-surgery. Four adjusted logistic regression analyses were undertaken to explore associations between binary non-compliance and the risk of surgical complications: (1) composite (simultaneous) non-compliance with both (VTE and antibiotic) guidelines and composite complications [all-cause mortality, VTE, readmission/reoperation for joint-related reasons (one-year) and non-joint-related reasons (35-days)], (2) VTE non-compliance and VTE outcomes, (3) antibiotic non-compliance and any SSI, and (4) antibiotic non-compliance and deep SSI. Data were analysed for 1875 participants. Guideline non-compliance rates were high: 65% (VTE), 87% (antibiotics) and 95% (composite guideline). Composite non-compliance was not associated with composite complication (12.8% vs 8.3%, adjusted odds ratio [AOR] = 1.41, 95%CI 0.68–3.45, p = 0.40). Non-compliance with VTE guidelines was associated with VTE outcomes (5% vs 2.4%, AOR = 2.83, 95%CI 1.59–5.28,p < 0.001). Non-compliance with antibiotic guidelines was associated with any SSI (14.8% vs 6.1%, AOR = 1.98, 95%CI 1.17–3.62,p = 0.02) but not deep infection (3.7% vs 1.2%,AOR = 2.39, 95%CI 0.85–10.00, p = 0.15). Conclusions We found high rates of clinical variation and statistically significant associations between non-compliance with VTE and antibiotic guidelines and increased risk of VTE and SSI, respectively. Complications after THR/TKR surgery may be decreased by improving compliance with clinical guidelines.

scholarly journals Mortality and Medical Complications of Subtrochanteric Fracture Fixation

2021 ◽  
Vol 10 (3) ◽  
pp. 540
Author(s):  
Michalis Panteli ◽  
Marilena P. Giannoudi ◽  
Christopher J. Lodge ◽  
Robert M. West ◽  
Ippokratis Pountos ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Hospital Stay ◽  
Subtrochanteric Fracture ◽  
Weekend Effect ◽  
Medical Complications ◽  
Chronic Obstructive ◽  
Subtrochanteric Fractures ◽  
High Dependency ◽  
Increased Risk ◽  
One Year

The aim of this study was to define the incidence and investigate the associations with mortality and medical complications, in patients presenting with subtrochanteric femoral fractures subsequently treated with an intramedullary nail, with a special reference to advancement of age. Materials and Methods: A retrospective review, covering an 8-year period, of all patients admitted to a Level 1 Trauma Centre with the diagnosis of subtrochanteric fractures was conducted. Normality was assessed for the data variables to determine the further use of parametric or non-parametric tests. Logistic regression analysis was then performed to identify the most important associations for each event. A p-value < 0.05 was considered significant. Results: A total of 519 patients were included in our study (age at time of injury: 73.26 ± 19.47 years; 318 female). The average length of hospital stay was 21.4 ± 19.45 days. Mortality was 5.4% and 17.3% for 30 days and one year, respectively. Risk factors for one-year mortality included: Low albumin on admission (Odds ratio (OR) 4.82; 95% Confidence interval (95%CI) 2.08–11.19), dementia (OR 3.99; 95%CI 2.27–7.01), presence of pneumonia during hospital stay (OR 3.18; 95%CI 1.76–5.77) and Charlson comorbidity score (CCS) > 6 (OR 2.94; 95%CI 1.62–5.35). Regarding the medical complications following the operative management of subtrochanteric fractures, the overall incidence of hospital acquired pneumonia (HAP) was 18.3%. Patients with increasing CCS (CCS 6–8: OR 1.69; 95%CI 1.00–2.84/CCS > 8: OR 2.02; 95%CI 1.03–3.95), presence of asthma/chronic obstructive pulmonary disease (COPD) (OR 2.29; 95%CI 1.37–3.82), intensive care unit (ICU)/high dependency unit (HDU) stay (OR 3.25; 95%CI 1.77–5.96) and a length of stay of more than 21 days (OR 8.82; 95%CI 1.18–65.80) were at increased risk of this outcome. The incidence of post-operative delirium was found to be 10.2%. This was associated with pre-existing dementia (OR 4.03; 95%CI 0.34–4.16), urinary tract infection (UTI) (OR 3.85; 95%CI 1.96–7.56), need for an increased level of care (OR 3.16; 95%CI 1.38–7.25), pneumonia (OR 2.29; 95%CI 1.14–4.62) and post-operative deterioration of renal function (OR 2.21; 95%CI 1.18–4.15). The incidence of venous thromboembolism (VTE) was 3.7% (pulmonary embolism (PE): 8 patients; deep venous thrombosis (DVT): 11 patients), whilst the incidence of myocardial infarction (MI)/cerebrovascular accidents (CVA) was 4.0%. No evidence of the so called “weekend effect” was identified on both morbidity and mortality. Regression analysis of these complications did not reveal any significant associations. Conclusions: Our study has opened the field for the investigation of medical complications within the subtrochanteric fracture population. Early identification of the associations of these complications could help prognostication for those who are at risk of a poor outcome. Furthermore, these could be potential “warning shots” for clinicians to act early to manage and in some cases prevent these devastating complications that could potentially lead to an increased risk of mortality.

Blood Transfusion and Risk of Venous Thromboembolism: A Population-Based Cohort Study

2019 ◽  
Vol 120 (01) ◽  
pp. 156-167 ◽  
Author(s):  
Shih-Yi Lin ◽  
Yun-Lung Chang ◽  
Hung-Chieh Yeh ◽  
Cheng-Li Lin ◽  
Chia-Hung Kao
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Blood Transfusion ◽  
Population Based ◽  
Red Blood Cell Transfusion ◽  
Research Database ◽  
Control Cohort ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Cox Proportional Hazard Models

Abstract Background The risk of venous thromboembolism (VTE) in generally ill patients, both under outpatient and inpatient care, following blood transfusion has not been determined. Methods This retrospective population-based cohort study was conducted using the National Health Insurance Research Database. We studied patients who received blood transfusion, defined as red blood cell transfusion of any type, from January 1, 2000 to December 31, 2011. The index date was defined as the date of blood transfusion. The primary outcome was VTE. Propensity score matching and Cox proportional hazard models were used. Results A total of 41,866 patients who underwent blood transfusion and 41,866 matched controls were studied. Generally, the blood transfusion cohort has 2.98 times higher risk of VTE than the control cohort (95% confidence interval [CI] = 1.23–7.22). The blood transfusion cohort had respectively 1.99 and 1.64 times higher risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) compared with the control cohort (DVT, 95% CI = 1.65–2.41; PE, 95% CI = 1.19–2.26). Patients in the blood transfusion cohort who did not use warfarin were 1.95 times more likely to develop VTE than those in the control cohort (adjusted hazard ratio [HR]: 1.95, 95% CI = 1.65–2.31). Patients in the blood transfusion cohort were 1.74 times more likely to die than those in the control cohort (adjusted HR: 1.74, 95% CI = 1.48–2.05). Conclusion Blood transfusion is associated with an increased risk of VTE. The risk of VTE decreased in those who took warfarin.

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