Length of hospital stay and mortality of hip fracture surgery in patients with Coronavirus disease 2019 (COVID-19) infection

Introduction: The large and increasing number of hip fracture patients, in combination with the large impact that this is having on daily living activities, is emphasizing the importance of identifying factors that have a detrimental impact on post-operative outcomes. There are benefits to planning the ward in a way that prevents a steep decline in recovery after hip fracture surgery. Adding the patient`s perspective into the healthcare assessment, via shared healthcare decision-making, allows the patient’s needs and preferences to be taken fully into account. The aim of this study was to identify factors that predict how patients recover after hip fracture surgery.Methods: A descriptive quality register/questionnaire study in acute orthopaedic wards, 2 to 5 days after surgery, with a follow-up 4 months later. The patients included were ≥65 years of age and had been previously healthy and living independently before the hip fracture.Results: The participants in this study had returned to their own homes after 4 months, but only 21% reported themselves as being fully or almost fully recovered. In several domains of recovery, all 3 age groups (65-74, 75-84 and 85-97) reported different challenges both during their acute hospital stay and at the 4 months follow-up. The recovery phase is heterogeneous and requires individual care. The way that this is planned has an influence on patient outcome.Conclusion: Patients sustaining a hip fracture are heterogeneous and different age groups experience different challenges. At 4 months follow-up, one fifth of the participants reported themselves fully or almost fully recovered and most of them had returned to their own homes. The Swedish National Hip Fracture Register and the patient-reported questionnaires employed in this study are appropriate tools to audit further development of healthcare to improve quality of life after hip fracture surgery.

Download Full-text

Effect of Goal-directed Haemodynamic Therapy Guided by Non-invasive Monitoring on Perioperative Complications in Elderly Hip Fracture Patients Within an Enhanced Recovery Pathway.

10.21203/rs.3.rs-736990/v1 ◽

2021 ◽

Author(s):

Juan Victor Lorente ◽

Francesca Reguant ◽

Anna Arnau ◽

Marcelo Borderas ◽

Juan Carlos Prieto ◽

...

Keyword(s):

Hip Fracture ◽

Hospital Stay ◽

Enhanced Recovery ◽

Perioperative Complications ◽

Intervention Group ◽

Control Group ◽

Haemodynamic Instability ◽

Hip Fracture Surgery ◽

One Year ◽

Fracture Surgery

Abstract Background: Goal-Directed Hemodynamic Therapy (GDHT) has been shown to reduce morbidity and mortality in high-risk surgical patients. However, there is little evidence of its efficacy in patients undergoing hip fracture surgery. This study aims to evaluate the effect of GDHT guided by non-invasive haemodynamic monitoring on perioperative complications in patients undergoing hip fracture surgery.Methods: Patients > 64 years undergoing hip fracture surgery within an Enhanced Recovery Pathway were enrolled in this single-center, non-randomized, intervention study with a historical control group and 12-months follow-up. Exclusion criteria were patients with pathological fractures, traffic-related fractures and refractures. Control group patients received the standard care given at our hospital. Intervention group patients received an individualized management strategy aimed at achieving an optimal stroke volume by fluid administration, in addition to a systolic blood pressure > 90 mmHg and an optimal cardiac index according to the patient's age and baseline metabolic equivalents. No changes were made between groups in the enhanced recovery protocols, nor in the composition of the multidisciplinary team during the study period. Primary combined outcome was perioperative complications. Intraoperatively: haemodynamic instability, sustained cardiac arrhythmias. Postoperative complications: cardiovascular, respiratory, infectious and renal complications. Secondary outcomes were administered fluids, vasopressor requirements, perioperative transfusion, length of hospital stay, readmission and one-year survival.Results: 551 patients (Control group=272; Intervention group=279). Intraoperative haemodynamic instability was lower in the intervention group (37.5% vs 28.0%; p=0.017). GDHT patients had fewer postoperative cardiovascular (18.8% vs 7.2%; p < 0.001), respiratory (15.1% vs 3.6%; p<0.001) and infectious complications (21% vs 3.9%; p<0.001) but not renal (12.1% vs 33.7%; p<0.001). Intervention group patients had less vasopressors requirements (p<0.001) and received less fluids (p=0.001) than control group. Fewer patients required transfusion in GDHT group (p<0.001). For intervention group patients, median length of hospital stay was shorter (p < 0.001) and one-year survival higher (p<0.003).Conclusions: The use of GDHT decreases intraoperative complications and postoperative cardiovascular, respiratory and infectious but not postoperative renal complications. This strategy was associated with a shorter hospital stay and increased one-year survival.Trial registration: Clinicaltrials.gov: NCT02479321

Download Full-text