Clostridium difficile colitis in patients undergoing surgery for hip fractures: an analysis of 17,474 patients

2019 ◽  
Vol 30 (1) ◽  
pp. 22-32
Author(s):  
Azeem Tariq Malik ◽  
Carmen E Quatman ◽  
Laura S Phieffer ◽  
Thuan V Ly ◽  
Safdar N Khan
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Clostridium Difficile ◽  
Hip Fractures ◽  
Healthcare Utilisation ◽  
Open Reduction Internal Fixation ◽  
Fracture Repair ◽  
Bundled Payment ◽  
Factors Associated ◽  
Incidence Risk

Background: We compiled evidence from a large national surgical database to identify the incidence, risk factors and postoperative impact of Clostridium difficile infection (CDI) in patients undergoing hip fracture repair. Methods: We identified 17,474 patients who underwent hip fracture repairs in 2015 using the ACS-NSQIP database. Interventions studied were open reduction/Internal fixation, total hip arthroplasty or hemiarthroplasty being performed for traumatic hip fractures. Outcomes studied were incidence, preoperative and postoperative risk factors for occurrence of CDI were studied using descriptive and statistical analysis. Results: A total of 92 patients (0.53%) developed CDI within 30 days of the operation. Following adjustment using multi-variate logistic regression, preoperative and hospital-associated factors associated with development of CDI were smoking (OR 1.75 [95% CI 1.03–2.99]), hypertension (OR 1.70 [95% CI 1.01–2.85]), hyponatraemia (OR 1.65 [95% CI 1.04–2.63]), prior systemic inflammatory response syndrome (SIRS) (OR 2.18 [95% CI 1.32-3.59]) and a length of stay >7 days (OR 1.98 [95% CI 1.11–3.53]. Postoperative factors associated with occurrence of CDI were occurrence of a deep surgical site infection (SSI) (OR 5.89 [95% CI 1.31–26.6]), a stay in the hospital >30 days (OR 6.56 [95% CI 2.56–16.9]) and unplanned reoperations (OR 2.78 [95% CI 1.29–5.99]). Conclusion: As we move toward an era of bundled-payment models, identification of risk factors associated with the occurrence of postoperative complications, such as CDI, will help curb excess healthcare utilisation and costs associated with the management of this complication.

scholarly journals Incidence and risk factors associated with postoperative stroke in the elderly patients undergoing hip fracture surgery

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Lili Yu ◽  
Yanbin Zhu ◽  
Wei Chen ◽  
Hui Bu ◽  
Yingze Zhang
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Individual Risk ◽  
Factors Associated ◽  
Postoperative Stroke

Abstract Objectives Stroke is one of the rare but devastating complications after hip fracture in the elderly. By far, there is still scarce data on postoperative stroke in elderly patients with hip fractures. Methods This was a retrospective study of prospectively collected data. Between October 2014 to December 2018, patients aged above 65 years who underwent operative treatment for hip fractures were included. Inpatient medical surveillance and scheduled telephone follow-up at 1, 3, 6, and 12 months after operation was conducted to identify who developed an incident stroke. Variables of interests were extracted from patients’ inpatient medical records. Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors associated with stroke. Results During the study period, a total of 3743 patients were included, among whom 56 were found to have a stroke after operation, representing an incidence of 1.5% (95% CI, 1.1 to 1.9%). The multivariate analyses showed that advanced age (1-year increment; OR, 1.32; 95% CI, 1.08 to 1.48), history of previous stroke (OR, 4.79; 95% CI, 1.86 to 6.56), ASA III and above (OR, 2.62; 95% CI, 1.27 to 3.68), long-term use of aspirin (OR, 3.63; 95% CI, 1.41 to 4.78), and elevated RDW level (each increment of 1%, OR, 1.21; 95% CI, 1.02 to 1.36) were independently associated with postoperative stroke. Conclusions Although most are not modifiable, these risk factors help in counseling patients regarding the risk of postoperative stroke, individual risk stratification, and targeted optimization of medical conditions and should be firmly kept in treating surgeon’s mind.

scholarly journals Risk Factors Associated With Hip Fractures among Adult People in Babylon City, Iraq

2019 ◽  
Vol 7 (21) ◽  
pp. 3608-3614
Author(s):  
Alaa A. Hussein Al-algawy ◽  
Hasan Alwan Baiee ◽  
Sahar Hasan ◽  
Ismail Jassim ◽  
Maryam Razaq ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Tobacco Smoking ◽  
Potential Risk ◽  
Case Control ◽  
Control Group ◽  
Factors Associated ◽  
Fracture Neck Femur

BACKGROUND: The fractures of hip joint considered as a serious problem in public health in the medical and socioeconomic issues, the incidence of the fracture neck femur is significantly increased with the increment of general population life span. AIM: The goal of this study is to highlight and focus on the most important risk factor for the hip fractures in our Babylon society, and to improve our understanding of the medical and social aspects of these predisposing factors. PATIENTS AND METHODS: A case-control study of older adults (above 60 years old). The study was done on tow samples. First, one consisting of 75 cases those having fracture neck femur considered as cases, and second sample as a control group, consisting of 150 people as a healthy control group having no fracture. A pre-tested questionnaire was prepared to collect data from both samples; the questionnaire included demographic data and information about potential risk factors of hip fracture. RESULTS: Most of the people in the study samples in both groups were, married women, housekeepers, illiterate and from urban dwellers. There was highly significant association between case-control groups regarding, Continuous using of medication such as cortisone which was found to be a potential risk factor of hip fracture (Unadjusted OR = 3.636), low income was positively associated risk factor of hip fracture in this study (OR = 2.377), low milk intake, low sun exposure, tobacco smoking were positively associated with this health problem (OR = 1.794), while physical exercise was protective factor (OR = 0.489). CONCLUSION: The highest risk factors associated with increased occurrence of hip fracture were using cortisone, Osteoporosis, tobacco smoking, consuming soft drinks, and less exposure to sunlight.

scholarly journals Risk factors associated with outcomes of hip fracture surgery in elderly patients

2015 ◽  
Vol 68 (6) ◽  
pp. 561 ◽  
Author(s):  
Byung Hoon Kim ◽  
Sangseok Lee ◽  
Byunghoon Yoo ◽  
Woo Yong Lee ◽  
Yunhee Lim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Factors Associated ◽  
Hip Fracture Surgery ◽  
Fracture Surgery ◽  
Surgery In Elderly

scholarly journals Factors associated with 90-day acute ischemic stroke in patients ≥70 years old with total hip arthroplasty for hip fracture

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Rui He ◽  
Guoyou Wang ◽  
Ting Li ◽  
Huarui Shen ◽  
LijuanZhang
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Ischemic Stroke ◽  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Older Age ◽  
Factors Associated ◽  
Independent Risk Factors ◽  
D Dimer

Abstract Background Postoperative ischemic stroke is a devastating complication following total hip arthroplasty (THA). The purpose of the current study was to investigate the incidence of postoperative acute ischemic stroke (AIS) in patients ≥70 years old with THA for hip fracture after 90 days and independent risk factors associated with 90-day AIS. Methods A multicenter retrospective study was conducted, patients ≥70 years old with THA for hip fracture under general anesthesia were included from February 2017 to March 2020. Patients with AIS within 90 days after THA were identified as AIS group; patients with no AIS were identified as no AIS group. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors of 90-dayAIS. Results: 2517 patients (mean age 76.18 ± 6.01) were eligible for inclusion in the study. 2.50% (63/2517) of patients had 90-day AIS. Compared with no AIS, older age, diabetes, hyperlipidemia, atrial fibrillation (AF) and higher D-dimer value were more likely in patients with AIS (P < 0.05), and anticoagulant use was fewer in patients with AIS. ROC curve analysis showed that the optimal cut point of D-dimer for AIS was D-dimer≥4.12 μg/ml. Multivariate logistic regression analysis showed that D-dimer≥4.12 μg/ml [adjusted odds ratio (aOR), 4.44; confidence interval (CI), 2.50–7.72; P < 0.001], older age (aOR, 1.08; 95%CI, 1.03–1.12; P < 0.001), hyperlipidemia (aOR, 2.28; 95%CI, 1.25–4.16; P = 0.007), atrial fibrillation (aOR, 5.84; 95% CI, 1.08–15.68; P = 0.001), and diabetes (aOR, 2.60; 95% CI, 1.56–4.39; P < 0.001) were associated with increased risk of 90-day AIS after THA. Conclusions In conclusion, we found that the incidence of 90-day AIS in patients≥70 years old with THA for hip fracture was 2.5%. Older age, diabetes, hyperlipidemia, AF and higher D-dimer value were independent risk factors for 90-day AIS in patients≥70 years old with THA for hip fracture.

scholarly journals Az ellenoldali csípőtáji törésig eltelt időt befolyásoló prognosztikai tényezők vizsgálata

2018 ◽  
Vol 159 (38) ◽  
pp. 1543-1547
Author(s):  
Krisztina Juhász ◽  
Imre Boncz ◽  
Péter Kanizsai ◽  
Andor Sebestyén
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Hip Fracture ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Hip Fractures ◽  
Age Groups ◽  
Significant Difference ◽  
Neck Fracture ◽  
The Impact

Abstract: Introduction: Although several national studies reported on the risk factors for contralateral hip fracture, there are no data about the prognostic factors of the time until contralateral hip fractures. Aim: The aim of the study was to analyse the impact of different prognostic factors on the time until the development of contralateral fracture and to determine the incidence of contralateral hip fractures after femoral neck fractures. Method: Patients aged 60 years and over with contralateral hip fracture between 01 Jan 2000 and 31 Dec 2008 were identified among those who suffered their femoral neck fracture in Hungary in 2000. Risk factors as age, sex, comorbidities, type of fracture and surgery, place of living and hospitals providing treatment for primary fracture were analysed by one way ANOVA focusing on the time until the development of contralateral hip fracture. Results: 312 patients met the inclusion criteria. The incidence of contralateral hip fracture after femoral neck fracture ranged between 1.5% and 2.1%, the cumulative incidence was 8.24%. The mean time until the development of contralateral hip fracture was 1159.8 days. The incidence of contralateral hip fracture showed no significant deviation. Significantly shorter time (p = 0.010) was detected until the contralateral hip fracture in older patients with femoral neck fracture. Conclusions: The yearly incidence of contralateral hip fracture showed no significant difference by patients with femoral neck fracture over 60 years. The shorter time until the contralateral hip fracture by the older age groups highlights the need of elaboration of prevention strategies. Orv Hetil. 2018; 159(38): 1543–1547.

scholarly journals Incidence, risk factors, and clinical impact of non-home discharge following surgical management of proximal humerus fractures

2018 ◽  
Vol 11 (6) ◽  
pp. 430-439
Author(s):  
Azeem T Malik ◽  
Jonathan D Barlow ◽  
Nikhil Jain ◽  
Safdar N Khan
Keyword(s):  
Risk Factors ◽  
Shoulder Arthroplasty ◽  
Proximal Humerus ◽  
Total Shoulder Arthroplasty ◽  
Open Reduction Internal Fixation ◽  
Clinical Impact ◽  
Proximal Humerus Fractures ◽  
Factors Associated ◽  
Discharge Disposition ◽  
Humerus Fractures

Introduction There has been a reported increase in the number of proximal humerus fractures being surgically managed. In an attempt to manage increasing costs associated with increasing volume, there is a need for identification of factors associated with discharge destinations. Methods The 2012–2016 American College of Surgeons—National Surgical Quality Improvement Program database was queried using Current Procedural Terminology codes for open reduction internal fixation, hemiarthroplasty, and total shoulder arthroplasty being performed for proximal humerus fractures. Results Five hundred and seventy-six (21.5%) patients had nonhome discharge disposition. Following adjusted analysis, age > 65 years (p < 0.001), partially dependent functional health status prior to surgery(p = 0.027), inpatient surgery (p = 0.010), American Society of Anesthesiologists (ASA) grade>II (p < 0.001), transfer from nursing home/chronic care facility (p < 0.001), undergoing a total shoulder arthroplasty versus open reduction internal fixation (p = 0.012), length of stay > 2 days (p < 0.001), and the occurrence of any predischarge complication (p < 0.001) were significant predictors associated with a nonhome discharge disposition. Conclusion The study identifies significant risk factors associated with a nonhome discharge and assesses clinical impact of nonhome discharge destination on postdischarge outcomes. Providers can utilize these data to preoperatively risk stratify those at an increased risk of a nonhome discharge, counsel patients on discharge expectations, and tailor a more appropriate postoperative course of care.

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