scholarly journals Vitamin D Levels and Nutritional Risk Index: Mobility and Mortality After Hip Fracture Surgery (P01-013-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Lihong Hao ◽  
Yvette Schlussel ◽  
Jeffrey Carson ◽  
Sue Shapses
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Vitamin D Deficiency ◽  
Risk Index ◽  
Nutritional Risk ◽  
Walking Ability ◽  
Hip Fracture Surgery ◽  
Vitamin D Levels ◽  
Nutritional Risk Index ◽  
Fracture Surgery

Abstract Objectives Hip fractures are associated with a high rate of morbidity and mortality, and successful ambulation after surgery is an important outcome in this patient population. This study aims to determine whether 25-hydroxyvitamin D (25(OH)D) or the Geriatric Nutritional Risk Index (GNRI) is associated with short term mortality or ability to walk after hip fracture surgery. Methods Patients undergoing hip fracture repair were included in this study. Mortality and walking ability were assessed at 30 and 60 days after hip fracture surgery. Pre-operative serum albumin and 25(OH)D were measured. Patients were characterized with 25(OH)D <12 ng/mL, 12 to <20, 20 to <30 or ≥30. GNRI was calculated from albumin and body weight and patients were categorized into major/moderate nutritional risk (<92), low risk (92 to <98) or in good nutritional status (≥98). Results Of the 290 patients (82 ± 7 years, BMI 25 ± 5 kg/m2), 73% were females. Compared to patients with vitamin D deficiency (<12 ng/mL), those with vitamin D levels in higher categories had increased ability to walk at 30 days (P = 0.031): 12 to <20 ng/ml (adjusted odds ratio = 2.61; 95% confidence interval = 1.13–5.99); 20 to <30 ng/ml (3.48; 1.53–7.95); ≥30 ng/ml (2.84; 1.12–7.20). In addition, patients also had increased mobility at 60 days in these same higher vitamin D categories 12 to <20 (2.67; 1.14–6.25); 20 to <30 (3.42; 1.46–8.00); ≥30 ng/ml (3.67; 1.37–9.82) compared to the reference group (<12 ng/mL; P = 0.028). There was no association of vitamin D with mortality at either time point. GNRI was not associated with mortality or walking ability. Conclusions In patients with hip fracture, vitamin D deficiency (<12 ng/mL) was associated with reduced ambulation after surgery, whereas GNRI was not associated with any outcomes. Mechanisms that attenuate mobility due to vitamin D deficiency should be examined in future studies. Funding Sources ONE Nutrition Grant to SAS and JLC.

scholarly journals Vitamin D deficiency is associated with reduced mobility after hip fracture surgery: a prospective study

2020 ◽  
Vol 112 (3) ◽  
pp. 613-618 ◽  
Author(s):  
Lihong Hao ◽  
Jeffrey L Carson ◽  
Yvette Schlussel ◽  
Helaine Noveck ◽  
Sue A Shapses
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Nutritional Status ◽  
Vitamin D Deficiency ◽  
Risk Index ◽  
Fracture Repair ◽  
Nutritional Risk ◽  
Hip Fracture Surgery ◽  
Nutritional Risk Index ◽  
Fracture Surgery

ABSTRACT Background Hip fractures are associated with a high rate of morbidity and mortality, and successful ambulation after surgery is an important outcome in this patient population. Objective This study aims to determine whether 25-hydroxyvitamin D [25(OH)D] concentration or the Geriatric Nutritional Risk Index (GNRI) is associated with mortality or rates of walking in a patient cohort after hip fracture surgery. Methods Patients undergoing hip fracture repair from a multisite study in North America were included. Mortality and mobility were assessed at 30 and 60 d after surgery. Serum albumin, 25(OH)D, and intact parathyroid hormone were measured. Patients were characterized according to 25(OH)D &lt;12 ng/mL, 12 to &lt;20 ng/mL, 20 to &lt;30 ng/mL, or ≥30 ng/mL. GNRI was categorized into major/moderate nutritional risk (&lt;92), some risk (92 to &lt;98), or in good nutritional status (≥98). Results Of the 290 patients [aged 82 ± 7 y, BMI (kg/m2): 25 ± 5], 73% were women. Compared with patients with &lt;12 ng/mL, those with higher 25(OH)D concentrations had higher rates of walking at 30 d (P = 0.031): 12 to &lt;20 ng/mL (adjusted OR: 2.61; 95% CI: 1.13, 5.99); 20 to &lt;30 ng/mL (3.48; 1.53, 7.95); ≥30 ng/mL (2.84; 1.12, 7.20). In addition, there was also greater mobility at 60 d (P = 0.028) in patients with higher 25(OH)D compared with the reference group (&lt;12 ng/mL). Poor nutritional status (GNRI &lt;92) showed an overall trend to reduce mobility (unadjusted P = 0.044 and adjusted P = 0.056) at 30 but not at 60 d. There was no association of vitamin D or GNRI with mortality at either time. Conclusions Vitamin D deficiency (&lt;12 ng/mL) is associated with reduced ambulation after hip fracture surgery, whereas GNRI also contributes to immobility but is a less reliable predictor. Mechanisms that can explain why vitamin D deficiency is associated with mobility should be addressed in future studies.

scholarly journals The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery

2020 ◽  
Author(s):  
Maximilian Peter Forssten ◽  
Ahmad Mohammad Ismail ◽  
Gabriel Sjolin ◽  
Rebecka Ahl ◽  
Per Wretenberg ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Operative Mortality ◽  
Risk Index ◽  
Cardiac Risk ◽  
Hip Fracture Surgery ◽  
Cardiac Risk Index ◽  
Short Term Mortality ◽  
Fracture Register ◽  
Fracture Surgery ◽  
Electronic Hospital

Abstract Purpose The post-operative mortality after hip fracture surgery is high and has remained largely unchanged during the last decades. The Revised Cardiac Risk Index (RCRI) is a tool used to evaluate the 30-day risk of, among other outcomes, post-operative mortality. The aim of this study is to determine the association between the RCRI score and post-operative mortality in patients undergoing hip fracture surgery. Methods Data was obtained from the national hip fracture register which was cross-referenced with patients’ electronic hospital records. All adults who underwent primary emergency hip fracture surgery in Orebro County, Sweden, between January 1, 2013 and December 31, 2017, were included. Patients were divided into two cohorts: low RCRI (score = 0–1) and high RCRI (score ≥ 2). A Poisson regression model was employed to investigate the association between a high RCRI score and 30- and 90-day post-operative mortality. Results A total of 2443 patients, of whom 446 (18%) had a high RCRI score, were included in the current study. When adjusting for age, sex, comorbidities and type of surgery, the incidence of 30-day mortality increased by 46% in the high RCRI cohort (adj. IRR 1.46, 95% CI, 1.10–1.94, p = 0.010). Similar results were observed for 90-day mortality (adj. IRR 1.50, 95% CI, 1.21–1.84, p < 0.001). Conclusion The RCRI is applicable to patients that undergo surgery for traumatic hip fractures. A high RCRI score is associated with an increased incidence of both 30- and 90-day post-operative mortality. Future studies to evaluate these findings are needed.

Vitamin D predicts independent walking recovery after hip fracture surgery

2013 ◽  
Vol 4 ◽  
pp. S43-S44
Author(s):  
E. Savino ◽  
A. Ferrari ◽  
M.L. Davoli ◽  
E. Martini ◽  
A. Nardelli ◽  
...  
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Hip Fracture Surgery ◽  
Walking Recovery ◽  
Fracture Surgery

scholarly journals Discharge transition experienced by older Korean women after hip fracture surgery: a qualitative study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Young Ji Ko ◽  
Ju Hee Lee ◽  
Seung-Hoon Baek
Keyword(s):  
Hip Fracture ◽  
Qualitative Study ◽  
Older Women ◽  
Transition Period ◽  
Walking Ability ◽  
Hip Fracture Surgery ◽  
Post Surgery ◽  
Discharge Transition ◽  
Partial Weight ◽  
Fracture Surgery

Abstract Background This study aimed to explore older Korean women’s discharge transition experiences after hip fracture surgery. Methods This was a descriptive qualitative study. Face-to-face interviews following hip fracture surgery were conducted on 12 women aged 65–87 years. Data were collected 1 to 2 days before discharge and again 4 weeks after discharge following hip fracture surgery, and were analyzed using qualitative content analysis. Results Four main themes were identified: (1) challenge of discharge transition: unprepared discharge, transfer into other care settings, and eagerness for recovery; (2) physical and psychological distress against recovery: frail physical state and psychological difficulties; (3) dependent compliance: absolute trust in healthcare providers, indispensable support from the family, and passive participation in care; and (4) walking for things they took for granted: hope of walking and poor walking ability. Conclusions After their hip fracture surgeries, older women hoped to be able to walk and perform simple daily chores they previously took for granted. Considering the physical and psychological frailty of older women undergoing hip surgery, systematic nursing interventions including collaboration and coordination with other healthcare professionals and settings are necessary to ensure the quality of continuous care during their post-surgery discharge transition. Encouraging partial weight bearing and initiating intervention to reduce fear of falling at the earliest possible time are essential to attain a stable discharge transition. Additionally, older women should be invited to participate in their care, and family involvement should be encouraged during the discharge transition period in South Korea.

scholarly journals Postoperative mortality in hip fracture patients stratified by the Revised Cardiac Risk Index: a Swedish nationwide retrospective cohort study

2021 ◽  
Vol 6 (1) ◽  
pp. e000778
Author(s):  
Maximilian Peter Forssten ◽  
Ahmad Mohammad Ismail ◽  
Tomas Borg ◽  
Rebecka Ahl ◽  
Per Wretenberg ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Risk Index ◽  
Postoperative Mortality ◽  
Cardiac Risk ◽  
Significant Linear Trend ◽  
Hip Fracture Surgery ◽  
Cardiac Risk Index ◽  
Postoperative Myocardial Infarction ◽  
National Quality ◽  
Fracture Surgery

ObjectivesThe Revised Cardiac Risk Index (RCRI) is a tool that can be used to evaluate the 30-day risk of postoperative myocardial infarction, cardiac arrest and mortality. This study aims to confirm its association with postoperative mortality in patients who underwent hip fracture surgery.MethodsAll adults who underwent primary emergency hip fracture surgery in Sweden between January 1, 2008 and December 31, 2017 were included in this study. The database was retrieved by cross-referencing the Swedish National Quality Register for hip fractures with the Swedish National Board of Health and Welfare registers. The outcomes of interest were the association between the RCRI score and mortality at 30 days, 90 days and 1 year postoperatively.Results134 915 cases were included in the current study. There was a statistically significant linear trend in postoperative mortality with increasing RCRI scores at 30 days, 90 days and 1 year. An RCRI score ≥4 was associated with a 3.1 times greater risk of 30-day postoperative mortality (adjusted incidence rate ratio (IRR) 3.13, p<0.001), a 2.5 times greater risk of 90-day postoperative mortality (adjusted IRR 2.54, p<0.001) and a 2.8 times greater risk of 1-year postoperative mortality (adjusted HR 2.81, p<0.001) compared with that observed with an RCRI score of 0.ConclusionAn increasing RCRI score is strongly associated with an elevated risk 30-day, 90-day and 1-year postoperative mortality after primary hip fracture surgery. The objective and easily retrievable nature of the variables included in the RCRI calculation makes it an appealing choice for risk stratification in the clinical setting.Levels of evidenceLevel III.

scholarly journals Coronavirus in HIP Fractures CHIP 2: Is Vitamin D Deficiency Associated with Increased Mortality from COVID-19 Infections in A Hip Fracture Population?

2021 ◽  
Vol 3 (6) ◽  
pp. 111-116
Author(s):  
A. Mahmood ◽  
F. Rashid ◽  
D. Hawkes ◽  
W. J. Harrison
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Primary Outcome Measure ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Fracture Population ◽  
The Impact ◽  
The Relationship

Purpose: There is controversy as to whether vitamin D deficiency is associated with increased mortality from coronavirus infection. The aim of the study was to assess the relationship between vitamin D levels and 30-day mortality in hip fracture patients co-infected with COVID-19. Methods: This was a national observational audit conducted between 23 March 2020 (start of UK lockdown) and 31st December 2020. The cohort consisted of patients aged >60 years presenting with a hip fracture. Patients were included if they had a vitamin D level done during the admission episode, diagnosis of COVID-19 infection via a viral reverse transcriptase PCR swab, and a hip fracture. There were 517 patients included in the study from 43 different hospital trusts. The primary outcome measure was 30-day mortality. Secondary outcomes were the percentage of patients who had vitamin D deficiency, the percentage of patients who were prescribed Vitamin D, and the impact of vitamin D prescribing on mortality Results: Vitamin D deficiency was not associated with a higher 30-day mortality. Low serum vitamin D was observed in 56% of the patients on admission. Vitamin D was prescribed prior to admission in 28% and during admission in a further 49%. Pre-hospital vitamin D therapy reduced the chance of vitamin D deficiency. Starting vitamin D before or on admission did not affect the mortality rates. Conclusion: Vitamin D deficiency was common, but not associated with a higher 30-day mortality in the hip fracture population co-infected with COVID-19.

scholarly journals Preoperative Vitamin D Deficiency is Associated with Postoperative Functional Recovery and Complications after Hip Fracture Surgery

2021 ◽  
Vol 28 (4) ◽  
pp. 333-338
Author(s):  
Chaemoon Lim ◽  
Young Ho Roh ◽  
Saeil Kim ◽  
Kwang Woo Nam
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Vitamin D Deficiency ◽  
Functional Recovery ◽  
Walking Ability ◽  
Preoperative Serum ◽  
The Mean ◽  
Deficient Group

Background: Low concentrations of vitamin D are considered one of the risk factors for hip fracture and are associated with worse outcomes. The purpose of this retrospective study was to compare vitamin D deficient group and vitamin D sufficient group and assess the association preoperative vitamin D deficiency and postoperative walking ability after hip fracture surgery.Methods: Between January 2014 and January 2020, 1,029 elderly patients with hip fracture (243 in men and 785 in women) were measured preoperative serum 25-hydroxy-vitamin D3 levels. Among 1,029 elderly patients, 702 patients were classified as Vitamin D deficient group (<20 ng/mL). Outcome parameters for functional recovery were the length of the hospital stay and KOVAL score, and those for complications were delirium, pneumonia, and thromboembolism.Results: The mean length of the hospital stay in the vitamin D deficient group was significantly longer than in the vitamin D sufficient group (27.7±17.8 vs. 2.9±11.8 days; odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05; P=0.001). The mean postoperative KOVAL score in the deficient group was significantly higher than in the sufficient group (4.0±2.1 vs. 3.1±1.9 days; OR, 1.21; 95% CI, 1.11-1.32; P=0.001). Vitamin D deficiency was significantly associated with a higher risk of delirium and pneumonia in deficiency group.Conclusions: Preoperative vitamin D deficiency in hip fractures patients was associated with prolonged duration of hospital stay and decrease of postoperative ambulatory status, and may increase the risk of delirium and pneumonia. Therefore, it is necessary to evaluate the preoperative vitamin D level and recommend vitamin D supplementation in elderly patients with a high probability of hip fracture.

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