scholarly journals Red Blood Cell Transfusion and Postoperative Delirium in Hip Fracture Surgery Patients: A Retrospective Observational Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Jacob Raphael ◽  
Nadia B. Hensley ◽  
Jonathan Chow ◽  
K. Gage Parr ◽  
John S. McNeil ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Postoperative Delirium ◽  
Observational Cohort Study ◽  
Hip Fracture Surgery ◽  
Observational Cohort ◽  
Fracture Surgery ◽  
Rbc Transfusion

Background. Patients having hip fracture surgery are at high risk for postoperative delirium. Red blood cell (RBC) transfusion may increase postoperative delirium risk by causing neuroinflammation. We hypothesized that RBC transfusion would be associated with postoperative delirium in patients having hip fracture surgery. Methods. An observational cohort study was performed using the United States National Surgical Quality Improvement Program (NSQIP) participant use files for hip fracture from 2016 to 2018. Propensity score analysis and inverse probability of treatment weighting (IPTW) were used to reduce bias from confounding. An IPTW adjusted odds ratio for developing postoperative delirium was calculated for patients who received RBC transfusion during surgery or in the 72 hours after. Results. There were 20,838 patients who had eligible current procedural terminology (CPT) codes for primary hip fracture surgery and complete study data. After employing strict exclusions to balance covariates and reduce bias, 3,715 patients remained in the IPTW cohort. Of these, 626 patients (16.9%) received RBC transfusion and 665 patients (17.9%) developed postoperative delirium. IPTW adjustment led to good covariate balance between patients who received RBC transfusion and those who did not. Patients who received RBC transfusion had significantly higher odds of postoperative delirium, IPTW adjusted odds ratio = 1.21, 95% CI = 1.03 to 1.43, and P  = 0.02. Discharge location also differed significantly between patients who received RBC transfusion and those who did not ( P  < 0.001) with in-hospital mortality or referral to hospice occurring in 1.6% of patients who received RBC transfusion and 1.3% of patients who were not transfused. Conclusion. RBC transfusion is associated with increased odds of postoperative delirium after hip fracture surgery and may be associated with worse clinical outcome.

scholarly journals A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery

2021 ◽  
Author(s):  
Rebecka Ahl ◽  
Ahmad Mohammad Ismail ◽  
Tomas Borg ◽  
Gabriel Sjölin ◽  
Maximilian Peter Forssten ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Beta Blocker ◽  
Observational Cohort Study ◽  
Blocker Therapy ◽  
Beta Blocker Therapy ◽  
Hip Fracture Surgery ◽  
All Cause Mortality ◽  
Observational Cohort ◽  
Fracture Surgery

Abstract Purpose Despite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery. Methods This is a retrospective nationwide observational cohort study. All adults $$\ge$$ ≥ 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality. Results 134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26–0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure. Conclusions Beta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.

Impact of length of red blood cells transfusion on postoperative delirium in elderly patients undergoing hip fracture surgery: A cohort study

Injury ◽  
2016 ◽  
Vol 47 (2) ◽  
pp. 408-412 ◽  
Author(s):  
Zhuang-Yun Zhang ◽  
Da-Peng Gao ◽  
Jiao-jiao Yang ◽  
Xiao-ru Sun ◽  
Hui Zhang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Postoperative Delirium ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals A Population-based Comparative Effectiveness Study of Peripheral Nerve Blocks for Hip Fracture Surgery

2019 ◽  
Vol 131 (5) ◽  
pp. 1025-1035 ◽  
Author(s):  
Gavin M. Hamilton ◽  
Manoj M. Lalu ◽  
Reva Ramlogan ◽  
Gregory L. Bryson ◽  
Faraj W. Abdallah ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Resource Use ◽  
Odds Ratio ◽  
Instrumental Variable ◽  
Adjusted Odds Ratio ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Adverse outcomes and resource use rates are high after hip fracture surgery. Peripheral nerve blocks could improve outcomes through enhanced analgesia and decreased opioid related adverse events. We hypothesized that these benefits would translate into decreased resource use (length of stay [primary outcome] and costs), and better clinical outcomes (pneumonia and mortality). Methods The authors conducted a retrospective cohort study of hip fracture surgery patients in Ontario, Canada (2011 to 2015) using linked health administrative data. Multilevel regression, instrumental variable, and propensity scores were used to determine the association of nerve blocks with resource use and outcomes. Results The authors identified 65,271 hip fracture surgery patients; 10,030 (15.4%) received a block. With a block, the median hospital stay was 7 (interquartile range, 4 to 13) days versus 8 (interquartile range, 5 to 14) days without. Following adjustment, nerve blocks were associated with a 0.6-day decrease in length of stay (95% CI, 0.5 to 0.8). This small difference was consistent with instrumental variable (1.1 days; 95% CI, 0.9 to 1.2) and propensity score (0.2 days; 95% CI, 0.2 to 0.3) analyses. Costs were lower with a nerve block (adjusted difference, −$1,421; 95% CI, −$1,579 to −$1,289 [Canadian dollars]), but no difference in mortality (adjusted odds ratio, 0.99; 95% CI, 0.89 to 1.11) or pneumonia (adjusted odds ratio, 1.01; 95% CI, 0.88 to 1.16) was observed. Conclusions Receipt of nerve blocks for hip fracture surgery is associated with decreased length of stay and health system costs, although small effect sizes may not reflect clinical significance for length of stay.

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