Effect of music on clinical outcome after hip fracture operations (MCHOPIN): study protocol of a multicentre randomised controlled trial

BackgroundPatients undergoing proximal femur fracture surgery are at high risk of postoperative complications, with postoperative delirium occurring in 25%–40% of patients. Delirium has profound effects on patient outcome and recovery, the patient’s family, caregivers and medical costs. Perioperative music has a beneficial effect on eliciting modifiable risk factors of delirium. Therefore, the aim of this trial was to evaluate the effect of perioperative recorded music on postoperative delirium in patients with proximal femur fracture undergoing surgery.Methods and analysisThe Music on Clinical Outcome after Hip Fracture Operations study is an investigator-initiated, multicentre, randomised controlled, open-label, clinical trial. Five hundred and eight patients with proximal femur fracture meeting eligibility criteria will be randomised to the music intervention or control group with concealed allocation in a 1:1 ratio, stratified by hospital site. The perioperative music intervention consists of preselected lists totalling 30 hours of music, allowing participants to choose their preferred music from these lists (classical, jazz and blues, pop and Dutch). The primary outcome measure is postoperative delirium rate. Secondary outcome measures include pain, anxiety, medication requirement, postoperative complications, hospital length of stay and 30-day mortality. A 90-day follow-up will be performed in order to assess nursing home length of stay, readmission rate and functional ability to perform daily living activities. Furthermore, the cost and cost-effectiveness of the music intervention will be assessed. Data will be analysed according to an intention-to-treat principle.Ethics and disseminationThe study protocol has been approved by the Medical Research Ethics Committee Erasmus MC on 8 October 2018 (MEC-2018–110, NL64721.078.18). The trial will be carried out following the Declaration of Helsinki principles, Good Clinical Practice guidelines and Dutch Medical Research Involving Human Subjects Act. Research data will be reported following Consolidated Standards of Reporting Trials guidelines and study results will be published in a peer-reviewed journal.Trial registration numberNTR7036.

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Early mortality in hip fracture patients admitted during first wave of the COVID-19 pandemic in Northern Italy: a multicentre study

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00577-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Dante Dallari ◽

Luigi Zagra ◽

Pietro Cimatti ◽

Nicola Guindani ◽

Rocco D’Apolito ◽

...

Keyword(s):

Hip Fracture ◽

Mortality Rate ◽

Multicentre Study ◽

Proximal Femur ◽

Femur Fracture ◽

Northern Italy ◽

Proximal Femur Fracture ◽

Time To Surgery ◽

Fracture Management ◽

The Mean

Abstract Background Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. Materials and methods For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C− group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month. Results Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C− group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group. Conclusions Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended. Level of evidence Therapeutic study, level 4.

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PP065-SUN EFFECT OF NUTRITIONAL INTERVENTION ON LENGTH OF STAY, POSTOPERATIVE COMPLICATIONS, FUNCTIONAL STATUS AND MORTALITY IN HIP FRACTURE PATIENTS: A MULTI-CENTRE RANDOMISED CONTROLLED TRIAL (RCT)

Clinical Nutrition Supplements ◽

10.1016/s1744-1161(12)70117-5 ◽

2012 ◽

Vol 7 (1) ◽

pp. 51 ◽

Cited By ~ 1

Author(s):

C.E. Wyers ◽

P.L. Reijven ◽

J.J. Breedveld-Peters ◽

S. van Helden ◽

M. Schotanus ◽

...

Keyword(s):

Hip Fracture ◽

Randomised Controlled Trial ◽

Postoperative Complications ◽

Length Of Stay ◽

Functional Status ◽

Controlled Trial ◽

Nutritional Intervention ◽

Randomised Controlled

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Proximal femur fracture in older patients - rehabilitation and clinical outcome

Age and Ageing ◽

10.1093/ageing/32.1.74 ◽

2003 ◽

Vol 32 (1) ◽

pp. 74-80 ◽

Cited By ~ 48

Author(s):

F. Roder

Keyword(s):

Clinical Outcome ◽

Proximal Femur ◽

Older Patients ◽

Femur Fracture ◽

Proximal Femur Fracture

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Preoperative Ascorbic Acid Levels in Proximal Femur Fracture Patients Have No Postoperative Clinical Impact, While Ascorbic Acid Levels upon Discharge Have a Major Effect on Postoperative Outcome

Journal of Clinical Medicine ◽

10.3390/jcm9010066 ◽

2019 ◽

Vol 9 (1) ◽

pp. 66

Author(s):

Katharina Hill-Mündel ◽

Johannes Schlegl ◽

Hans Konrad Biesalski ◽

Sabrina Ehnert ◽

Steffen Schröter ◽

...

Keyword(s):

Ascorbic Acid ◽

Clinical Outcome ◽

Elderly Patients ◽

Proximal Femur ◽

Nutritional Assessment ◽

Femur Fracture ◽

Mini Nutritional Assessment ◽

Nutritional Risk ◽

Proximal Femur Fracture ◽

Femur Fractures

Proximal femur fractures show a high prevalence in elderly patients and are associated with an elevated risk of multimorbidity and early mortality. Recovery is impaired by malnutrition and oxidative stress, which is affected by antioxidants such as ascorbic acid (AA). This study monitored AA levels during hospitalization of patients with a proximal femur to investigate the influence of AA status to the clinical outcome. AA levels of 25 elderly patients with a proximal femur fracture were measured during hospitalization using high performance liquid chromatography. Plasma samples were collected preoperatively, on the first day after surgery, on the third day after surgery and on the day of discharge. Nutritional Risk Screening 2002 (NRS) and Mini Nutritional Assessment (MNA) were assessed to evaluate the nutritional status. In patients with proximal femoral fractures, preoperative AA concentrations were significantly lower compared to elderly patients without an acute fracture. A significant decrease of 33.8% in AA plasma level was measured on the day after surgery with a significant recovery up to the time of discharge. The preoperative AA status did not have any significant effect on clinical outcome. However, inadequate AA levels (<50 µmol/L) upon discharge significantly increased the incidence and the severity of postoperative complications. These results indicate that the AA status upon discharge has a greater impact on clinical outcome than assumed, and therefore, AA supplementation during hospitalization should be considered.

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“Hidden” Preoperative Blood Loss With Extracapsular Versus Intracapsular Hip Fractures: What Is the Difference?

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458517729615 ◽

2017 ◽

Vol 8 (4) ◽

pp. 202-207 ◽

Cited By ~ 2

Author(s):

Katharine D. Harper ◽

Paul Navo ◽

Frederick Ramsey ◽

Sainabou Jallow ◽

Saqib Rehman

Keyword(s):

Hip Fracture ◽

Blood Loss ◽

Hip Fractures ◽

Proximal Femur ◽

Femur Fracture ◽

Skilled Nursing Facility ◽

Operative Management ◽

Proximal Femur Fracture ◽

Fracture Management ◽

The Difference

Purpose: Excessive blood loss with hip fracture management has been shown to result in increased rates of complications. Our goal is to compare blood loss and transfusion rates between patients with intracapsular and extracapsular (both intertrochanteric (IT) and subtrochanteric (ST)) hip fractures. Methods: 472 patients were evaluated over a five-year period. Those who presented to the hospital with a proximal femur fracture (femoral neck, IT or ST) were considered for the study. Exclusion criteria included polytrauma, gunshot injuries, periprosthetic fractures, and non-operative management. Primary endpoint was hemoglobin (Hgb) drop from admission to day of surgery (DOS); secondary endpoint was need for pre-op transfusion and discharge location. Results: 304 patients were analyzed who sustained a proximal femur fracture. Median IC Hgb drop was 0.6g/dL; median EC Hgb drop was 1.1g/dL from admission to DOS ( p = 0.0272). Rate of pre-operative transfusions was higher in EC (36/194 = 18.6%) than IC fractures (5/105 = 4.5%) ( p = 0.0006), and overall transfusion rates remained higher throughout hospital stay (55.7% EC vs. 32.7% IC; p = 0.0001). Breakdown of bleeding rate and tranfusion rates between IT and ST fractures were not significant ( p = 0.07; p = 0.4483). Extracapsular hip fractures were more likely to be discharged to a skilled nursing facility (SNF) (84.4% EC vs. 73.8% IC; p = 0.027). Conclusion: Intracapsular hip fractures have significantly less pre-operative blood loss and fewer pre-operative transfusions than their extracapsular counterparts. These findings can be used to establish appropriate pre-operative resuscitative efforts, ensuring that hip fracture protocols account for the increased likelihood of blood loss in extracapsular fractures.

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