Use of calcium antagonists and need for perioperative transfusion in older patients with hip fracture: observational study

Hip fracture (HF) in older patients is associated with a high six-month mortality rate. Several clinical conditions may affect outcome, including baseline characteristics, co-existing acute illnesses, perioperative factors, and postoperative complications. Our primary objective was to estimate the respective effect of these four domains on six-month mortality after HF. A retrospective observational study using a monocentric cohort of older patients was conducted. All patients ≥ 70 years old admitted to the emergency department for HF and hospitalized in our perioperative geriatric care unit from June 2009 to September 2018 were included. Among 1015 included patients, five (0.5%) were lost to follow-up, and 1010 were retained in the final analysis (mean age 86 ± 6 years). The six-month mortality rate was 14.8%. The six-month attributable mortality estimates were as follows: baseline characteristics (including age, gender, comorbidities, autonomy, type of fracture): 62.4%; co-existing acute illnesses (including acute events present before surgery that could result from the fracture or cause it): 0% (not significantly associated with six-month mortality); perioperative factors (including blood transfusion and delayed surgery): 12.3%; severe postoperative complications: 11.9%. Baseline characteristics explained less than two-thirds of the six-month mortality after HF. Optimizing patients care by improving management of perioperative factors and thus decreasing postoperative complications, could reduce by a maximum of one quarter of the six-month mortality rate after HF.

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Use of calcium antagonists and risk of pulmonary embolism in older patients with hip fracture

American Journal of Hypertension ◽

10.1016/s0895-7061(97)90716-0 ◽

1998 ◽

Vol 11 (4) ◽

pp. 4A

Author(s):

G ZUCCALA

Keyword(s):

Pulmonary Embolism ◽

Hip Fracture ◽

Calcium Antagonists ◽

Older Patients

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Post-hospital care pathway for individuals with hip fracture: what is the optimal setting and rehabilitation intensity? An observational study

Disability and Rehabilitation ◽

10.1080/09638288.2021.1897692 ◽

2021 ◽

pp. 1-8

Author(s):

Mattia Morri ◽

Cristiana Forni ◽

Monica Guberti ◽

Paolo Chiari ◽

Alessia Pecorari ◽

...

Keyword(s):

Hip Fracture ◽

Observational Study ◽

Hospital Care ◽

Care Pathway ◽

Optimal Setting

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Markers of renal function at admission and mortality in hip fracture patients - a single center prospective observational study

Scandinavian Journal of Clinical and Laboratory Investigation ◽

10.1080/00365513.2021.1884892 ◽

2021 ◽

pp. 1-7

Author(s):

Magnus H. Jonsson ◽

Anna Åkesson ◽

Ami Hommel ◽

Anders Grubb ◽

Peter Bentzer

Keyword(s):

Renal Function ◽

Hip Fracture ◽

Observational Study ◽

Prospective Observational Study ◽

Single Center

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Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)

The Ultrasound Journal ◽

10.1186/s13089-021-00230-w ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Luigi Vetrugno ◽

Enrico Boero ◽

Elena Bignami ◽

Andrea Cortegiani ◽

Santi Maurizio Raineri ◽

...

Keyword(s):

Hip Fracture ◽

Postoperative Complications ◽

Observational Study ◽

Elderly Patients ◽

Fracture Fixation ◽

Frail Elderly ◽

Statistical Power ◽

Lung Ultrasound ◽

Preoperative Evaluation ◽

Cardiac Complications

Abstract Background Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of “indirect” and “direct” cardiac and pulmonary lung ultrasound signs. Methods LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged > 65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns—each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. Conclusions Lung ultrasound (LU), as a tool within the anesthesiologist’s armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracture patients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019.

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