scholarly journals Geriatric Proximal Femur Fractures During the Covid-19 Pandemic - Fewer Cases, But More Comorbidities

2021 ◽  
Vol 12 ◽  
pp. 215145932110096
Author(s):  
Christina Polan ◽  
Heinz-Lothar Meyer ◽  
Manuel Burggraf ◽  
Monika Herten ◽  
Paula Beck ◽  
...  
Keyword(s):  
Nursing Home ◽  
Elderly Patients ◽  
Proximal Femur ◽  
Minor Trauma ◽  
Proximal Femur Fractures ◽  
Femur Fractures ◽  
Number Of Patients ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: The COVID-19 pandemic is challenging healthcare systems worldwide. This study examines geriatric patients with proximal femur fractures during the COVID-19 pandemic, shifts in secondary disease profile, the impact of the pandemic on hospitalization and further treatment. Methods: In a retrospective monocentric study, geriatric proximal femur fractures treated in the first six months of 2020 were analyzed and compared with the same period of 2019. Pre-traumatic status (living in a care home, under supervision of a legal guardian), type of trauma, accident mechanism, geriatric risk factors, associated comorbidities, time between hospitalization and surgery, inpatient time and post-operative further treatment of 2 groups of patients, aged 65-80 years (Group 1) and 80+ years (Group 2) were investigated. Results: The total number of patients decreased (70 in 2019 vs. 58 in 2020), mostly in Group 1 (25 vs. 16) while the numbers in Group 2 remained almost constant (45 vs. 42). The percentage of patients with pre-existing neurological conditions rose in 2020. This corresponded to an increase in patients under legal supervision (29.3%) and receiving pre-traumatic care in a nursing home (14.7%). Fractures were mostly caused by minor trauma in a home environment. In 2020, total number of inpatient days for Group 2 was lower compared to Group 1 (p = 0.008). Further care differed between the years: fewer Group 1 patients were discharged to geriatric therapy (69.6% vs. 25.0%), whereas in Group 2 the number of patients discharged to a nursing home increased. Conclusions: Falling by elderly patients is correlated to geriatric comorbidities, consequently there was no change in the case numbers in this age group. Strategic measures to avoid COVID-19 infection in hospital setting could include reducing the length of hospital stays by transferring elderly patients to a nursing home as soon as possible and discharging independent, mobile patients to return home.

scholarly journals Bone remodeling features in elderly and senile patients with the proximal femur fractures after hip replacement

2020 ◽  
Vol 73 (2) ◽  
pp. 259-265
Author(s):  
Oleksandr M. Khvysyuk ◽  
Volodymyr O. Babalian ◽  
Serge B. Pavlov ◽  
Galina B. Pavlova
Keyword(s):  
Treatment Outcome ◽  
Proximal Femur ◽  
Enzyme Linked Immunosorbent Assay ◽  
Regulatory Pathways ◽  
Proximal Femur Fractures ◽  
Femur Fractures ◽  
Results Of Treatment ◽  
Group 2 ◽  
Tgf Β1 ◽  
Group 1

The aim of this study is to identify the dependence of the result of surgical treatment of patients of elderly and senile age with fractures of the proximal femur on the characteristics of the response cytokine-mediated regulatory response to trauma and surgery. Materials and methods: In 74 patients after hip arthroplasty, serum levels of bone metabolism markers were determined using enzyme-linked immunosorbent assay. Patients were divided into 2 groups depending on the results of treatment. Results: It was found that compared with group 2 (treatment outcome is worse) in group 1 (treatment outcome is better) there was a greater number of correlations. In group 1, correlations were found between OPG and RANKL (r = 0.88; p = 0.000), OPG and OPG/RANKL (r = 0.44; p = 0.006), TGF-β1 and OPG/RANKL (r = 0.66; p = 0.000) , IL-6 and OPG (r = 0.67; p = 0.000), IL-6 and RANKL (r = 0.53; p = 0.001), IL-6 and OPG/RANKL (r = 0.39; p = 0.016). In group 2, only between OPG and OPG/RANKL (r = 0.72; p = 0.000), RANKL and OPG/RANKL (r = −0.53; p = 0.0007). In patients of group 2, there was a decrease in the level of OPG relative to the control and a less significant increase in TGF-β1 and IL-6 relative to group 1. Conclusion: The prognosis of the results of treatment of patients with proximal femur fractures is largely determined by the nature of the adaptive response to injury and the implant, the synchronism of the mechanism of stress remodeling of the bone. A less favorable prognosis after arthroplasty is associated with exacerbation of the initial metabolic disorders in the bone tissue due to severe cytokine-mediated dysfunction of the regulatory pathways.

Iliac Fascia Compartment Block and Analgesic Consumption in Patients Operated on for Hip Fracture

2017 ◽  
Vol 19 (5) ◽  
pp. 0-0 ◽  
Author(s):  
Mateusz Klukowski ◽  
Rafał Kowalczyk ◽  
Grzegorz Górniewski ◽  
Paweł Łęgosz ◽  
Marek Janiak ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Medical Records ◽  
Ultrasound Guidance ◽  
Postoperative Mortality ◽  
Early Mobilization ◽  
Femur Fractures ◽  
Study Results ◽  
Group 2 ◽  
Fascia Iliaca Compartment Block ◽  
Group 1

Background. Fractures of the proximal femur in elderly patients are a challenge for orthopedics, anesthe­sio­logy and geriatrics. Early mobilization reduces postoperative mortality among these patients. Effective anal­gesia is necessary to achieve this goal. Material and methods. A retrospective analysis of perioperative medical records of 78. patients undergoing surgical treatment of proximal femur fractures was performed. Group 1 (n=35)consisted of patients who were treated with pharmacologic analgesia only (systemic analgesics) and Group 2 (n=43) involved patients who re­ceived a preoperative fascia iliaca compartment block (FICB) and pharmacologic analgesia. FICB was per­formed under ultrasound guidance, and systemic analgesics were administered according to a standardized pro­to­col. Demographics, anesthesia and operation data as well as the dosage of analgesics used on postoperative day 0 were collected for the study. Results. Patients with antecedent iliac fascia blockade required fewer analgesic interventions (3 vs. 11, p <0.0001) and showed significantly less need for analgesics than non-block patients. No complications were observed after performing FICB. Conclusion. The iliac fascia compartment block produces effective postoperative analgesia and reduces postoperative opioid consumption.

scholarly journals How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases

2020 ◽  
pp. 1-9
Author(s):  
Ralph T. Schär ◽  
Shpend Tashi ◽  
Mattia Branca ◽  
Nicole Söll ◽  
Debora Cipriani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Elderly Patients ◽  
Age Groups ◽  
Head Ct ◽  
Estimated Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

OBJECTIVEWith global aging, elective craniotomies are increasingly being performed in elderly patients. There is a paucity of prospective studies evaluating the impact of these procedures on the geriatric population. The goal of this study was to assess the safety of elective craniotomies for elderly patients in modern neurosurgery.METHODSFor this cohort study, adult patients, who underwent elective craniotomies between November 1, 2011, and October 31, 2018, were allocated to 3 age groups (group 1, < 65 years [n = 1008], group 2, ≥ 65 to < 75 [n = 315], and group 3, ≥ 75 [n = 129]). Primary outcome was the 30-day mortality after craniotomy. Secondary outcomes included rate of delayed extubation (> 1 hour), need for emergency head CT scan and reoperation within 48 hours after surgery, length of postoperative intensive or intermediate care unit stay, hospital length of stay (LOS), and rate of discharge to home. Adjustment for American Society of Anesthesiologists Physical Status (ASA PS) class, estimated blood loss, and duration of surgery were analyzed as a comparison using multiple logistic regression. For significant differences a post hoc analysis was performed.RESULTSIn total, 1452 patients (mean age 55.4 ± 14.7 years) were included. The overall mortality rate was 0.55% (n = 8), with no significant differences between groups (group 1: 0.5% [95% binominal CI 0.2%, 1.2%]; group 2: 0.3% [95% binominal CI 0.0%, 1.7%]; group 3: 1.6% [95% binominal CI 0.2%, 5.5%]). Deceased patients had a significantly higher ASA PS class (2.88 ± 0.35 vs 2.42 ± 0.62; difference 0.46 [95% CI 0.03, 0.89]; p = 0.036) and increased estimated blood loss (1444 ± 1973 ml vs 436 ± 545 ml [95% CI 618, 1398]; p <0.001). Significant differences were found in the rate of postoperative head CT scans (group 1: 6.65% [n = 67], group 2: 7.30% [n = 23], group 3: 15.50% [n = 20]; p = 0.006), LOS (group 1: median 5 days [IQR 4; 7 days], group 2: 5 days [IQR 4; 7 days], and group 3: 7 days [5; 9 days]; p = 0.001), and rate of discharge to home (group 1: 79.0% [n = 796], group 2: 72.0% [n = 227], and group 3: 44.2% [n = 57]; p < 0.001).CONCLUSIONSMortality following elective craniotomy was low in all age groups. Today, elective craniotomy for well-selected patients is safe, and for elderly patients, too. Elderly patients are more dependent on discharge to other hospitals and postacute care facilities after elective craniotomy.Clinical trial registration no.: NCT01987648 (clinicaltrials.gov).

The impact of 2013 UK NICE guidelines on the management of varicose veins at the Heart of England NHS Foundation Trust, Birmingham, UK

2016 ◽  
Vol 31 (9) ◽  
pp. 612-616 ◽  
Author(s):  
Huw OB Davies ◽  
Matthew Popplewell ◽  
Gareth Bate ◽  
Lisa Kelly ◽  
Katy Darvall ◽  
...  
Keyword(s):  
Varicose Veins ◽  
Health Care Expenditure ◽  
Evidence Based ◽  
Foam Sclerotherapy ◽  
Number Of Patients ◽  
Group 2 ◽  
Uk National Health Service ◽  
The Uk ◽  
The Impact ◽  
Group 1

Objective Although varicose veins are a common cause of morbidity, the UK National Health Service and private medical insurers have previously sought to ration their treatment in a non-evidence based manner in order to limit health-care expenditure and reimbursement. In July 2013, the UK National Institute for Health and Care Excellence published new national Clinical Guidelines (CG168) to promote evidence-based commissioning and management of varicose veins. The aim of this study was to evaluate the impact of CG168 on the referral and management of varicose veins at the Heart of England NHS Foundation Trust, Birmingham, UK. Methods Interrogation of a prospectively gathered database, provided by the Heart of England NHS Foundation Trust Performance Unit, of patients undergoing interventions for varicose veins since 1 January 2012. Patients treated before (group 1) and after (group 2) publication of CG168 were compared. Results There were 253 patients, 286 legs (48% male, mean (range) age 54 (20–91) years) treated in group 1, and 417 patients, 452 legs, (46% male, mean (range) age 54 (14–90) years) treated in group 2, an increase of 65%. CG168 was associated with a significant reduction in the use of surgery (131 patients (52%) group 1 vs. 127 patients (30%) group 2, p = 0.0003, χ2), no change in endothermal ablation (30 patients (12%) group 1 vs. 45 patients (11%) group 2), a significant increase in ultrasound-guided foam sclerotherapy (92 patients (36%) group 1 and 245 patients (59%) group 2, p = 0.0001, χ2) and an increase in treatment for C2/3 disease (53% group 1 and 65.2% group 2, p = 0.0022, χ2). Conclusions Publication of National Institute for Health and Care Excellence CG168 has been associated with a significant increase (65%) in the number of patients treated, referral at an earlier (CEAP C) stage and increased use of endovenous treatment. CG 168 has been highly effective in improving access to, and quality of care, for varicose veins at Heart of England NHS Foundation Trust.

scholarly journals Mortality Following Distal Femur Fractures Versus Proximal Femur Fractures in Elderly Population: The Impact of Best Practice Tariff

Cureus ◽  
2020 ◽  
Author(s):  
Islam Mubark ◽  
Amr Abouelela ◽  
Ahmed Genena ◽  
Abdallah Al Ghunimat ◽  
Islam Sarhan ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Best Practice ◽  
Elderly Population ◽  
Distal Femur ◽  
Proximal Femur Fractures ◽  
Femur Fractures ◽  
The Impact

P1025Incidence and characteristics of pulmonary vein reconduction after second-generation cryoballoon-based pulmonary vein isolation: Impact of different ablation strategies

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C H Heeger ◽  
E R Rexha ◽  
S M Maack ◽  
L Rottner ◽  
T Fink ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Second Generation ◽  
Success Rates ◽  
Protocol Group ◽  
Number Of Patients ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract Funding Acknowledgements none Introduction The second-generation CB (CB2, Arctic Front Advance, Medtronic Inc., Minneapolis, USA) has demonstrated high procedural success rates, relatively short procedure times, high durability of PVI and convincing long-term clinical success rates. Nevertheless, data on the impact of different ablations protocols on durability after CB2 based PVI is limited. Purpose We aimed at comparing durability of pulmonary vein isolation (PVI) following three different ablation strategies utilizing the second-generation cryoballoon (CB2) in patients with recurrence of atrial fibrillation (AF) or atrial tachycardia (AT) undergoing repeat procedures. Methods In 192 patients a total of 751 PVs were identified. All PVs (751/751, 100%) were successfully isolated during index PVI. Thirty-one out of 192 (16%) patients were treated with a bonus-freeze protocol (group 1), 67/192 (35%) patients with a no bonus-freeze protocol (group 2), and 94/192 (49%) patients with a "time-to-effect"-guided ablation protocol without bonus freezes (group 3). Results Persistent PVI was documented in 419/751 (55.8%) PVs, and in 41/192 (21%) patients all PVs were persistently isolated. The number of patients with all PVs being persistently isolated was not significant between the groups (p = 0.594). The total rate of PV reconnection was not significantly different between the three groups (p = 0.134) and the comparison of individual PVs revealed also no differences for different ablation protocols (p-values for RSPV: 0.424, RIPV: 0.541, LSPV: 0.788, LIPV: 0.346, LCPV: 0.865). The procedure times were significantly reduced in non-bonus freeze ablation protocols and/or when applying individualized application times (group 1: 123.4 ± 31.5min, group 2: 112.9 ± 39.8 min, group 3:  86.67 ± 28.4 min, p &lt;0.001). Conclusions A considerably high rate of persistent PVI was demonstrated in patients after index CB2-based PVI. No differences for durable PVI were detected for different ablation protocols. Therefore, individualized ablation protocols might be a beneficial ablation strategy during CB2-based PVI.

scholarly journals The impact of COVID-19 on primary retinopexy in preventing retinal detachment in a tertiary eye hospital emergency department

2021 ◽  
pp. 112067212199472
Author(s):  
George Moussa ◽  
Emma Samia-Aly ◽  
Walter Andreatta ◽  
Kim Son Lett ◽  
Arijit Mitra ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Case Series ◽  
Significant Shift ◽  
Number Of Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
Male Patients ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Purpose: To review the effect of COVID-19 on rhegmatogenous retinal detachment (RRD) rate following primary retinopexy. Methods: Retrospective consecutive case series of 183 patients attending Birmingham and Midlands Eye Centre undergoing primary retinopexy (cryotherapy and laser) between March 23rd to June 30th in 2019 (Group 1) and 2020 (Group 2). Results: In total we reviewed 183 retinopexies, 122 in Group 1 and 61 in Group 2, a reduction of 50%. In Group 2 compared to Group 1, we showed a significant difference in characteristics of patients having primary retinopexy with an increase in proportion of male patients from 50 (41.0%) to 39 (63.9%) ( p = 0.005), increase in high myopes from 1 (0.8%) to 4 (6.6%) ( p = 0.043), more slit lamp laser retinopexy from 83 (68.0%) to 52 (85.2%) ( p = 0.013) and less cryopexy from 21 (17.2%) to 2 (3.3%) ( p = 0.008). In Group 2, primary retinopexy resulted in significantly more 3-month RRD rate 1 (0.8%) to 5 (8.2%) ( p = 0.016). There were no changes in number of patients requiring further retinopexy ( p = 1.000) Conclusion: This study demonstrates a reduction of primary retinopexy, an increased risk for RRD following primary retinopexy and a significant shift in type of primary retinopexy performed, demographics, operator and change in characteristics of type of retinal break observed during this pandemic. This study contributes to the growing literature of the secondary effects of the COVID-19 pandemic on other aspects of healthcare that is not just limited to the virus itself.

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