Frailty Score as a Predictor of Outcomes in Geriatric Patients with Isolated Hip Fractures

2021 ◽  
pp. 000313482110586
Author(s):  
Whiyie A. Sang ◽  
Hamza Durrani ◽  
Huazhi Liu ◽  
Jason M. Clark ◽  
Laurence Ferber ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Nutritional Status ◽  
Hip Fractures ◽  
Hospice Care ◽  
Geriatric Population ◽  
Icu Length Of Stay ◽  
Frail Patients ◽  
Risk Patients ◽  
Objective Tool ◽  
Frailty Score

Background Isolated hip fractures (IHFs) are a cause of morbidity and mortality in the geriatric population aged >65 years. Frailty has been identified as a determinant for patient outcomes in other surgical specialties. The purpose of this study is to determine if frailty severity is a predictor of outcomes in IHF in the geriatric population. Methods This is a retrospective study in a state and ACS Level 2 trauma center. Patients with IHF were reviewed between January 2018 and January 2020. Primary outcome was in-patient mortality. Secondary outcomes include perioperative outcome measures such as UTI, HCAP, DVT, readmission, length of stay, ICU length of stay, nutritional status, and discharge destination. Patients were stratified into mild (1-2), moderate (3-5), and severe (5-7) frailty using the Rockwood Frailty Score (RFS). Clinical characteristics and outcomes were analyzed. Results We identified 470 patients with IHF who were stratified by mild (N=316), moderate (N-123), and severe (N=31) frailty. Frailty worsened with increasing age (P < .0001). Those who were less frail were more likely discharged home (P < .04). Severely frail patients were more likely discharged to hospice (P < .01). Severely frail patients also were more likely to develop DVT (P < .04) and have poorer nutritional status (P < .02). There were no differences among groups for in-patient mortality. Conclusion Severely frail patients are more likely to be malnourished at baseline and be discharged to hospice care. The RFS is a reliable objective tool to identify high-risk patients and guide goals of care discussion for operative intervention in isolated traumatic hip fractures.

scholarly journals Traumatic vertebral artery injuries in the geriatric population: a retrospective cohort study

2020 ◽  
Vol 32 (5) ◽  
pp. 657-660 ◽  
Author(s):  
Paul S. Page ◽  
Darnell T. Josiah
Keyword(s):  
Cervical Spine ◽  
Length Of Stay ◽  
Vertebral Artery ◽  
Adult Population ◽  
Ground Level ◽  
Common Finding ◽  
Adult Group ◽  
Geriatric Population ◽  
Icu Length Of Stay ◽  
Common Etiology

OBJECTIVETraumatic vertebral artery injuries (TVAIs) are a common finding in cervical spine trauma and can predispose patients to posterior circulation infarction. While extensive research has been conducted regarding the management and criteria for imaging in patients with suspected blunt vascular injury, little research has been conducted highlighting these injuries in the geriatric population.METHODSThe authors performed a retrospective review of all patients evaluated at a level 1 trauma center and found to have TVAIs between January 1, 2010, and January 1, 2018. Biometric, clinical, and imaging data were obtained from a trauma registry database. Patients were divided into 2 groups on the basis of age, a geriatric group (age ≥ 65 years) and an adult group (age 18 to < 65 years). Variables evaluated included type of trauma, mortality, Injury Severity Score (ISS), and ICU length of stay. The Student t-test was used for continuous variables, and Pearson’s chi-square test was used for categorical variables.RESULTSOf the 2698 of patients identified with traumatic cervical spine injuries, 103 patients demonstrated evidence of TVAI. Of these patients, 69 were < 65 and 34 were ≥ 65 years old at the time of their trauma. There was no difference in the incidence of TVAIs between the 2 groups. The ICU length of stay (4.71 vs 4.32 days, p > 0.05), hospital length of stay (10.71 vs 10.72 days, p > 0.05), and the ISS (21.50 vs 21.32, p > 0.05) did not differ significantly between the 2 groups. Mortality was significantly higher in the geriatric group, occurring in 9 of 34 patients (26.5%) compared with only 3 of 69 patients (4.4%) in the adult group (p < 0.001). Ground-level falls were the most common inciting event in the geriatric group (44% vs 14.5%, p < 0.001), whereas motor vehicle accidents were the most common etiology in the younger population (72.5% vs 38.2%, p < 0.001). Incidence of ischemic stroke did not vary significantly between the 2 groups (p > 0.05).CONCLUSIONSTVAI in the older adult population is associated with a significantly greater risk of mortality than in the younger adult population, despite the 2 groups having similar ISSs. Additionally, low-velocity mechanisms of injury, such as ground-level falls, are a greater risk factor for acquired TVAI in older adults than in younger adults, in whom it is a significantly less common etiology.

scholarly journals O33: PROSPECTIVE RISK ASSESSMENT ALONE DOES NOT IMPROVE 30-DAY MORTALITY IN EMERGENCY LAPAROTOMY PATIENTS

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
S Vavilov ◽  
P Pockney
Keyword(s):  
Risk Assessment ◽  
Length Of Stay ◽  
New England ◽  
Favourable Effect ◽  
Mortality Data ◽  
Emergency Laparotomy ◽  
Icu Length Of Stay ◽  
Possum Score ◽  
Prospective Risk ◽  
American Society

Abstract Introduction Emergency laparotomy still carries a high mortality risk. According to the latest National Emergency Laparotomy Audit (NELA) report, half of the patients without pre-operative risk scoring had a higher observed than predicted mortality. Data from Perth, Australia also suggests that pre-operative scoring improves mortality. The aim of this study was to determine if a prospective risk assessment has an independent favourable effect on outcomes. Method A retrospective review of all emergency abdominal surgeries meeting NELA inclusion criteria undertaken at four different-sized Australian surgical centres was performed between April 2015 and December 2018. A predicted and observed mortality was assessed in prospectively and retrospectively risk-stratified patients. Result There were 852 patients charts reviewed during the study period. Patient demographics included 404 males (47.4%), mean age: 69 years, median American Society of Anaesthesiologists score: 3, mean length of stay: 14.0 days and mean ICU length of stay: 1.8 days. There were 72 patients who died within 30 days (8.5%). Median preoperative P-POSSUM score was 6.9%, median preoperative NELA score – 5.2%. A total of 27/133 (20.3%) patients who were scored prospectively died within 30 days; 45/719 (6.3%) retrospectively scored patients died within 30 days. Neither of these rates was very different from the predicted. Conclusion 30-day mortality in emergency laparotomy patients in Hunter New England region, Australia, compares favourably with the latest mortality figures reported by NELA. However, contrary to other publications, prospective scoring alone did not have any beneficial effect on 30-day mortality in our cohort Take-home message Patients undergoing emergency abdominal surgery require preoperative risk assessment to improve outcomes. However, just the fact of assigning a risk score preoperatively alone does not help to improve mortality.

Vitamin C, Thiamine, and Hydrocortisone in the Treatment of Sepsis: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

2021 ◽  
pp. 088506662098780
Author(s):  
Yazan Zayed ◽  
Bashar N. Alzghoul ◽  
Momen Banifadel ◽  
Hima Venigandla ◽  
Ryan Hyde ◽  
...  
Keyword(s):  
Septic Shock ◽  
Length Of Stay ◽  
Vitamin C ◽  
Sofa Score ◽  
Sequential Analysis ◽  
Trial Sequential Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Icu Length Of Stay ◽  
Significant Difference

Background: There is a conflicting body of evidence regarding the benefit of vitamin C, thiamine, and hydrocortisone in combination as an adjunctive therapy for sepsis with or without septic shock. We aimed to assess the efficacy of this treatment among predefined populations. Methods: A literature review of major electronic databases was performed to include randomized controlled trials (RCTs) evaluating vitamin C, thiamine, and hydrocortisone in the treatment of patients with sepsis with or without septic shock in comparison to the control group. Results: Seven studies met our inclusion criteria, and 6 studies were included in the final analysis totaling 839 patients (mean age 64.2 ± 18; SOFA score 8.7 ± 3.3; 46.6% female). There was no significant difference between both groups in long term mortality (Risk Ratio (RR) 1.05; 95% CI 0.85-1.30; P = 0.64), ICU mortality (RR 1.03; 95% CI 0.73-1.44; P = 0.87), or incidence of acute kidney injury (RR 1.05; 95% CI 0.80-1.37; P = 0.75). Furthermore, there was no significant difference in hospital length of stay, ICU length of stay, and ICU free days on day 28 between the intervention and control groups. There was, however, a significant difference in the reduction of SOFA score on day 3 from baseline (MD −0.92; 95% CI −1.43 to −.41; P < 0.05). In a trial sequential analysis for mortality outcomes, our results are inconclusive for excluding lack of benefit of this therapy. Conclusion: Among patients with sepsis with or without septic shock, treatment with vitamin C, thiamine, and hydrocortisone was not associated with a significant reduction in mortality, incidence of AKI, hospital and ICU length of stay, or ICU free days on day 28. There was a significant reduction of SOFA score on day 3 post-randomization. Further studies with a larger number of patients are needed to provide further evidence on the efficacy or lack of efficacy of this treatment.

scholarly journals Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic

2021 ◽  
Author(s):  
Răzvan Bologheanu ◽  
Mathias Maleczek ◽  
Daniel Laxar ◽  
Oliver Kimberger
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Specialty ◽  
Routine Care ◽  
Treatment Pathways ◽  
Icu Length Of Stay ◽  
Matched Study ◽  
The Impact

Summary Background Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. Methods The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. Results A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2–6) compared to 2020: 4 days (IQR 2–7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. Conclusion In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.

Preoperative nutritional status impacts clinical outcome and hospital length of stay in pelvic exenteration patients – a retrospective study

2021 ◽  
pp. 026010602110090
Author(s):  
Sophie Hogan ◽  
Daniel Steffens ◽  
Kenneth Vuong ◽  
Anna Rangan ◽  
Michael Solomon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Nutritional Status ◽  
Pelvic Exenteration ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Major Surgery ◽  
High Morbidity ◽  
Nutrition Screening ◽  
Patient Cohort ◽  
Post Surgery

Background: Preoperative malnutrition is common in surgical oncology patients and can have negative effects on postoperative outcomes. Pelvic exenteration is major surgery associated with high morbidity rates. Associations between preoperative malnutrition, determined using the patient-generated subjective global assessment, and postoperative outcomes in this patient cohort has not yet been investigated. Aim: To determine if preoperative nutritional status is associated with postoperative surgical and quality of life (QoL) outcomes after pelvic exenteration surgery. Methods: A retrospective cohort study was conducted at a quaternary hospital investigating 123 patients who had pelvic exenteration surgery from January 2017 to August 2019. Preoperative nutritional status and postoperative surgical and QoL outcomes were collected and analysed to determine any associations. Results: Overall, 49.6% of patients were female with a median age of 59 years. Forty patients (32.5%) were malnourished and 83 (67.5%) were well nourished before surgery. Well-nourished patients had a shorter length of hospital stay ( p = 0.034) and at 6 months post-surgery, presented with a significantly better physical and mental QoL score ( p = 0.038 and p = 0.001 respectively). The regression analyses showed that intensive care unit (ICU) readmission rates were 7.19 times more likely to occur in malnourished patients ( p = 0.022). Conclusions: Preoperative malnutrition is associated with increased length of stay, ICU readmissions and poorer QoL following pelvic exenteration. Nutrition screening, assessment and optimisation of management are essential in this patient cohort to improve patient outcomes. Future studies are needed to measure the effect of interventions and identify the most beneficial model of care for this complex patient group.

106 Frailty Assessment in the Burn Population: A Single Center Retrospective Review

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S71-S72
Author(s):  
Erin Wolf Horrell ◽  
Ronnie Mubang ◽  
Sarah A Folliard ◽  
Robel Beyene ◽  
Stephen Gondek ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Level Of Care ◽  
Post Discharge ◽  
Patients Âgés ◽  
Injury Characteristics ◽  
Frail Patients ◽  
Discharge Care ◽  
Patients Experience

Abstract Introduction Burn morbidity and mortality increases with advancing age. Frailty is characterized by reduced homeostatic reserves and is associated with an increased biological age compared to chronological age. Our primary aim was to determine whether frailty as assessed on admission would be predictive of outcomes in the burn population. Methods We conducted a single institution 7-month retrospective chart review of all admitted acute burn patients ages 45 and older. Patient and injury characteristics were collected and compared using standard statistical analysis. Frailty scores were assessed upon admission using the FRAIL Scale. Results Eighty-five patients met inclusion criteria and were able to complete the FRAIL assessment. Patient and injury characteristics are listed in Table 1. Mean burn size was 6.7%TBSA (95%CI 4.9–8.4%). 34 patients (40%) were classified as robust (FRAIL score 0), 26(30.6%) as pre-frail (FRAIL score 1-Patients in the pre-frail/frail cohort received more palliative care consultations (p=.096) and had a longer length of stay (3.3d vs 7.55d p = .002), while prefrail patients had a similar LOS to frail patients (7.46 vs 7.64d p =.938). Patients in the pre-frail/frail cohort were also more likely to be discharged to a higher level of care than they were admitted from(p=.032) with prefrail patients experience an escalation in level of care more frequently than frail patients. The distribution by age by half-decade ranges is in Figure 1. By age 55–59, the majority of patients were prefrail or frail. Conclusions We demonstrated that frailty as assessed by the FRAIL score was predictive of increased length of stay and an escalation in post discharge care. In addition, patients characterized as pre-frail experience outcomes similar to frail patients and should be managed as such. Given the prevalence of frailty and prefrailty in the younger group of patients, we advocate for routine frailty screening beginning at age 55.

503 Clinical Frailty Score (CFS) Vs Antibiotics, Time to Surgery and Time to Computerised Tomography (CT) Scan in An Emergency Surgical Population

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Palaniappan ◽  
R Soiza ◽  
S Moug ◽  
P Myint
Keyword(s):  
Ct Scan ◽  
Emergency Laparotomy ◽  
Antibiotic Administration ◽  
Process Measures ◽  
Time To Surgery ◽  
Performance Time ◽  
Frail Patients ◽  
Management Plans ◽  
Administration Time ◽  
Frailty Score

Abstract Introduction Frail patients have increased mortality after surgery. However, it is not known if pre-operative process measures such as antibiotic administration, time to CT and time to surgery are influenced by patient frailty. Method The Emergency Laparotomy and Laparoscopy Scottish Audit (ELLSA) assessed outcome after emergency surgery across Scottish hospitals (November 2017 – October 2018). Frailty was measured using the 7-point Clinical Frailty Score (CFS). Outcome measures were antibiotic provision for sepsis, admission to CT time, admission to surgery time, CT request to performance time and CT request to surgery time. Results 1302 patients (median age 63 years [IQR 49-74]; 49% male) with complete data were included. Median time from admission to CT and surgery increased between those with CFS 1 to 6/7 from 597 to 1724 minutes (p &lt; 0.0001) and 1556 to 4120 minutes (p &lt; 0.0001) respectively. Time from CT request to surgery also significantly increased with CFS (p &lt; 0.042). There was no significant association between CFS and antibiotic administration or CT request to performance. Conclusions Frail patients have to wait longer for CT scan requests and surgery, but frailty was not associated with antibiotic administration or delays in CT request to performance time. Possible explanations include frailty-related challenges making correct diagnoses and optimal management plans.

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