scholarly journals Higher Charlson Comorbidity Index Increases 90-Day Readmission Rate with Poorer Functional Outcomes in Surgically Treated Hip Fracture Patients

2021 ◽  
Vol 12 ◽  
pp. 215145932110362
Author(s):  
Cheryl Gatot ◽  
Evan Shern-En Tan ◽  
Ming Han Lincoln Liow ◽  
Jerry Yongqiang Chen ◽  
Meng Ai Png ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Charlson Comorbidity Index ◽  
Functional Outcomes ◽  
Readmission Rate ◽  
Care Pathway ◽  
Short Form ◽  
Readmission Rates ◽  
Mortality And Morbidity ◽  
Sf 36 ◽  
Comorbidity Index

Introduction The associated mortality and morbidity in hip fracture patients pose a major healthcare burden for ageing populations worldwide. We aim to analyse how an individual’s comorbidity profile based on age-adjusted Charlson Comorbidity Index (CCI) may impact on functional outcomes and 90-day readmission rates after hip fracture surgery. Materials and Methods Surgically treated hip fracture patients between 2013 and 2016 were followed up for 1-year and assessed using Parker Mobility Score (PMS), EuroQol-5D (EQ-5D) and Physical and Mental Component Scores (PCS and MCS, respectively) of Short Form-36 (SF-36). Statistical analysis was done by categorising 444 patients into three groups based on their CCI: (1) CCI 0–3, (2) CCI 4–5 and (3) CCI ≥ 6. Results PMS, EQ-5D and SF-36 PCS were significantly different amongst the CCI groups pre-operatively and post-operatively at 3, 6 and 12 months (all P < 0.05), with CCI ≥ 6 predicting for poorer outcomes. In terms of 90-day readmission rates, patients who have been readmitted have poorer outcome scores. Multivariate analysis showed that high CCI scores and 90-day readmission rate both remained independent predictors of worse outcomes for SF-36 PCS, PMS and EQ-5D. Discussion CCI scores ≥6 predict for higher 90-day readmission rates, poorer quality of life and show poor potential for functional recovery 1-year post-operation in hip fracture patients. 90-day readmission rates are also independently associated with poorer functional outcomes. Peri-operatively, surgical teams should liaise with medical specialists to optimise patients’ comorbidities and ensure their comorbidities remain well managed beyond hospital discharge to reduce readmission rates. With earlier identification of patient groups at risk of poorer functional outcomes, more planning can be directed towards appropriate management and subsequent rehabilitation. Conclusion Further research should focus on development of a stratified, peri-operative multidisciplinary, hip-fracture care pathway treatment regime based on CCI scores to determine its effectiveness in improving functional outcomes.

scholarly journals Evaluation of Nottingham Hip Fracture Score, Age-Adjusted Charlson Comorbidity Index and the Physiological and Operative Severity Score for the enumeration of Mortality and morbidity as predictors of mortality in elderly neck of femur fracture patients

2020 ◽  
Vol 8 ◽  
pp. 205031212091826 ◽  
Author(s):  
Michael James Nelson ◽  
Justin Scott ◽  
Palvannan Sivalingam
Keyword(s):  
Hip Fracture ◽  
Charlson Comorbidity Index ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Mortality Prediction ◽  
Mortality And Morbidity ◽  
Operative Severity Score ◽  
Significant Difference ◽  
Comorbidity Index ◽  
Operating Characteristic Curve

Background: This study evaluated the use of several risk prediction models in estimating short- and long-term mortality following hip fracture in an Australian population. Methods: Data from 195 patients were retrospectively analysed and applied to three models of interest: the Nottingham Hip Fracture Score, the Age-Adjusted Charlson Comorbidity Index and the Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity. The performance of these models was assessed with receiver operating characteristic curve as well as logistic regression modelling. Results: The median age of participants was 83 years and 69% were women. Ten percent of patients were deceased by 30 days, 25% at 6 months and 31% at 12 months post-operatively. While there was no statistically significant difference between the models, the Age-Adjusted Charlson Comorbidity Index had the largest area under the receiver operating characteristic curve for within 30 day and 12 month mortality, while the Nottingham Hip Fracture Score was largest for 6-month mortality. There was no evidence to suggest that the models were selecting a specific subgroup of our population, therefore, no indication was present to suggest that using multiple models would improve mortality prediction. Conclusions: While there was no statistically significant difference in mortality prediction, the Nottingham Hip Fracture Score is perhaps the best suited clinically, due to its ease of implementation. Larger prospective data collection across a variety of sites and its role in guiding clinical management remains an area of interest.

Charlson Comorbidity Index Is Related to Organ Damage in Systemic Lupus Erythematosus: Data from KORean lupus Network (KORNET) Registry

2017 ◽  
Vol 44 (4) ◽  
pp. 452-458 ◽  
Author(s):  
Seong-Kyu Kim ◽  
Jung-Yoon Choe ◽  
Shin-Seok Lee
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Charlson Comorbidity Index ◽  
Short Form ◽  
Damage Index ◽  
Organ Damage ◽  
Systemic Lupus ◽  
Sf 36 ◽  
Comorbidity Index

Objective.The aim of this study was to identify whether comorbidity status is associated with organ damage in patients with systemic lupus erythematosus (SLE).Methods.A total of 502 patients with SLE enrolled in the KORean lupus Network were consecutively recruited. Data included demographics, age-adjusted Charlson Comorbidity Index (CCIa), disease activity indexes, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), the Medical Outcomes Study Short Form-36 health survey (SF-36) score, and the Beck Depression Inventory (BDI) score.Results.Of the total patients, 21.1% (n = 106) experienced organ damage (SDI ≥ 1). Univariate correlation analysis revealed that SDI was not statistically correlated with any clinical variables (correlation coefficient r < 0.3 of all). There were significant differences in the BDI, mental component score of the SF-36, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), CCIa, C-reactive protein, and mean dose of corticosteroid between non-damage (SDI = 0) and damage (SDI ≥ 1) groups. The presence of damage to at least 1 organ in patients with SLE was found to be closely related with higher CCIa, higher SLEDAI, and mean dose of corticosteroid (OR 1.884, 95% CI 1.372–2.586, p < 0.001; OR 1.114, 95% CI 1.041–1.192, p = 0.002; OR 1.036, 95% CI 1.004–1.068, p = 0.026; respectively) in binary logistic regression analysis.Conclusion.This study suggests that organ damage as assessed by the SDI in Korean patients with SLE is related to comorbidities together with disease activity and corticosteroid exposure.

scholarly journals Too Cool? Hip Fracture Care and Maintaining Body Temperature

2020 ◽  
Vol 11 ◽  
pp. 215145932094947
Author(s):  
James Arkley ◽  
Suhib Taher ◽  
Ján Dixon ◽  
Gemma Dietz-Collin ◽  
Stacey Wales ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Temperature Control ◽  
Functional Outcomes ◽  
Surgical Site Infections ◽  
Fragility Fractures ◽  
Perioperative Period ◽  
Readmission Rates ◽  
Comprehensive Review ◽  
Fracture Care ◽  
Increase Risk

Introduction: Patients with hip fractures can become cold during the perioperative period despite measures applied to maintain warmth. Poor temperature control is linked with increasing complications and poorer functional outcomes. There is generic evidence for the benefits of maintaining normothermia, however this is sparse where specifically concerning hip fracture. We provide the first comprehensive review in this population. Significance: Large studies have revealed dramatic impact on wound infection, transfusion rates, increased morbidity and mortality. With very few studies relating to hip fracture patients, this review aimed to capture an overview of available literature regarding hypothermia and its impact on outcomes. Results: Increased mortality, readmission rates and surgical site infections are all associated with poor temperature control. This is more profound, and more common, in older frail patients. Increasing age and lower BMI were recognized as demographic factors that increase risk of hypothermia, which was routinely identified within modern day practice despite the use of active warming. Conclusion: There is a gap in research related to fragility fractures and how hypothermia impacts outcomes. Inadvertent intraoperative hypothermia still occurs routinely, even when active warming and cotton blankets are applied. No studies documented temperature readings postoperatively once patients had been returned to the ward. This is a point in the timeline where patients could be hypothermic. More studies need to be performed relating to this area of surgery.

scholarly journals Charlson Comorbidity Index Predicts 5-Year Survivorship of Surgically Treated Hip Fracture Patients

2018 ◽  
Vol 9 ◽  
pp. 215145931880644 ◽  
Author(s):  
Lei Jiang ◽  
Andrew Chia Chen Chou ◽  
Nivedita Nadkarni ◽  
Caris En Qi Ng ◽  
Yun San Chong ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hip Fracture ◽  
Charlson Comorbidity Index ◽  
Demographic Data ◽  
Survival Rates ◽  
Predictive Ability ◽  
Fracture Pattern ◽  
Mortality Data ◽  
Comorbidity Index

Introduction: This study aims to assess the correlation of the age-adjusted Charlson comorbidity index (ACCI) with 5-year mortality in a surgically treated hip fracture population. Materials and Methods: A retrospective analysis was performed on 1057 patients aged 60 years and above who underwent surgery for hip fracture with a minimum of 5-year follow-up (92.2% 5-year follow-up rate) in a tertiary hospital. Manual review of patients’ electronic hospital records was performed to record demographic data, comorbidities, and length of stay. Mortality data were extracted from the hospital’s electronic medical records and corroborated with the National Electronic Health Record. Results: Of the 1057 patients, 283 (26.8%) were male. The majority of patients were 80 years of age and above (42.5%), with the oldest patient operated on age 102 with a mean age of 77.8 (8.6) years. Four hundred eighteen (39.5%) patients sustained extracapsular intertrochanteric fractures. The mean follow-up duration was 8 years and 3 days with an overall survivorship of 37.2%. A multiple regression model constructed with ACCI, age, gender, and fracture pattern demonstrated satisfactory predictive ability with a concordance statistic of 0.68. Patients with a higher ACCI category (≥6) had an increased 5-year mortality rate (41.8%) with an odds ratio of 13.6 (6.7-31.8, P < .001) compared to those with an ACCI category of 3 and below (89.3%). Discussion: The study demonstrates that ACCI correlated with 5-year mortality after surgical treatment of hip fracture. This information is pertinent in the counseling of patients with regard to their midterm survival following hip fracture surgery and may inform policy makers of the varied midterm survival rates in patients with differing ACCI scores and educate the allocation of health-care resources. Conclusion: The ACCI correlates with 5-year mortality after surgical treatment of hip fracture.

scholarly journals Early Outcomes Following Dorsal Denervation of the Midfoot for Management of Arthritic Pain

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0038
Author(s):  
Glenn G. Shi ◽  
Arun Kumar ◽  
Meredith A. Williams ◽  
Benjamin K. Wilke ◽  
Joseph L. Whalen ◽  
...  
Keyword(s):  
Pain Relief ◽  
Functional Outcomes ◽  
Nonoperative Management ◽  
Short Form ◽  
Safe Alternative ◽  
Sf 36 ◽  
The Mean ◽  
Protective Sensation ◽  
And Function ◽  
Complications Rate

Category: Midfoot/Forefoot Introduction/Purpose: Debilitating midfoot arthritic pain is reported to affect up to 12% of adults over 50 years. After failure of nonoperative management, midfoot arthrodesis has been favored as the primary operative treatment producing acceptable outcomes with associated potentially long postoperative immobilization and 17% major complications rate. The aim of this study was to evaluate the pain and functional outcomes of dorsal midfoot surgical denervation by deep peroneal neurectomy as a safe alternative for management of dorsal midfoot pain. Methods: In this retrospective study, 18 patients (21 feet) who underwent dorsal denervation of the midfoot by deep peroneal neurectomy by a single surgeon were evaluated. There were 13 women and 5 men with mean age 70.4 (range, 47 to 88) at the time of surgery. Indications for the procedure include painful midfoot arthritis, lack of radiographic collapse, intact plantar protective sensation, failed nonoperative management for 6 months, and greater than 75% transient pain relief from preoperative diagnostic block of deep peroneal nerve. Preoperative and postoperative (3 months, 6 months) Visual Analog Scale (VAS), Short- Form 36 (SF-36), and Foot and Ankle Outcome Score (FAOS) were reviewed. Complications were recorded. Results: The mean VAS score improved from 7.4 +/-1.9 to 1.9 +/-1.9 at 3 months and 1.4 +/-1.9 at 6 months (p<0.001). Six patients reported being pain free (VAS=0) at 3 months. All subscales of FAOS showed significant improvement at both 3 and 6 months (Table 1). The mean SF-36 total score improved from 51.4 +/-17.9 to 72.5 +/-7.6 and 74.5 +/-7.5 at 3 and 6 months respectively (p<0.001). Available radiographs at 6 months showed no further collapse. Complications include one patient with delayed wound healing and another patient with inadequate pain relief. No patients reported symptomatic paresthesia. Conclusion: Deep peroneal neurectomy for dorsal midfoot denervation is a safe and effective alternative to arthrodesis for management of dorsal arthritic midfoot pain showing significant improvements in both pain and functional outcomes at early follow up. Our study demonstrated clinical and function outcomes similar to those previously reported for arthrodesis yet with the advantages of earlier postoperative weightbearing and lower complication rate.

scholarly journals Chronic Deltoid Ligament Insufficiency Repair with Internal Brace™ Augmentation

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Manuel Pellegrini ◽  
Giovanni Carcuro ◽  
Natalio Cuchacovic ◽  
Marcelo Somarriva ◽  
Mario Escudero Heldt ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Short Form ◽  
Stage Iv ◽  
Deltoid Ligament ◽  
Foot And Ankle ◽  
Ankle Pain ◽  
Ligament Repair ◽  
Sf 36 ◽  
Internal Brace

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Patients with chronic deltoid ligament insufficiency (CDLI) present a challenging situation in foot and ankle surgery. Although numerous surgical procedures have been described, optimal treatment is still a matter of debate. While the treatment armamentarium ranges from simple ligament repair to complex deltoid reconstructions with or without realignment osteotomies, direct repair augmented with an Internal Brace™ (Arthrex, Inc., Naples FL, USA) device appears to be an attractive intermediate option. We investigated functional outcomes and complications in patients with CDLI operated on using Internal Brace™ augmentation. Methods: After IRB approval, a prospective study was conducted. Patients were included if they were older than 18 years, presented medial ankle pain and/or giving way, exhibited asymmetric flexible hindfoot valgus, failed conservative treatment, and had a positive MRI evaluated by an independent radiologist. Patients with less than six months of follow-up, stage IV flatfoot deformity, neuropathy and/or inflammatory arthritis were excluded from the study. CDLI diagnosis was confirmed intraoperatively with the arthroscopic ankle drive-through sign. Patients were evaluated preoperatively and postoperatively using foot and ankle ability measure (FAAM) score, 36-item short form survey (SF-36), and grade of satisfaction. Paired t-tests were used to assess the pre- and postoperative FAAM and SF-36 scores. Results: Eleven patients met inclusion criteria. Nine patients were male and two female, with a mean age of 32 (18-61). Six ankles were right and five left. 88% presented with medial ankle pain, 67% medial drawer, 88% asymmetric hindfoot valgus, and 44% multidirectional ankle instability. No patient was lost to follow-up, with a mean follow-up time of 13.5 months (6-21). Preoperative FAAM and SF-36 scores improved from 58.7 to 75.3 and from 60.2 to 84.4 postoperatively, respectively (p<0.05). Two implant failures were observed, with no apparent compromise of construct stability. No patient was re-operated. Conclusion: Our results suggest that deltoid ligament repair with Internal Brace™ augmentation in patients with CDLI is a reliable option with good functional outcomes and high satisfaction grade in short term follow-up.

Arthroscopic Microfracture for Osteochondral Lesions of the Talus: Functional Outcomes at a Mean of 6.7 Years in 165 Consecutive Ankles

2019 ◽  
Vol 48 (1) ◽  
pp. 153-158 ◽  
Author(s):  
Seung-Won Choi ◽  
Gun-Woo Lee ◽  
Keun-Bae Lee
Keyword(s):  
Functional Outcomes ◽  
Short Form ◽  
Arthroscopic Surgery ◽  
Case Series ◽  
Osteochondral Lesions ◽  
Study Cohort ◽  
Arthroscopic Microfracture ◽  
Sf 36 ◽  
The Mean

Background: Arthroscopic microfracture for osteochondral lesions of the talus (OLT) has shown good functional outcomes. However, some studies have reported that functional outcomes deteriorate over time after surgery. Purpose: To use various functional scoring systems to evaluate functional outcomes in a large sample of patients with OLT treated by arthroscopic microfracture. Study Design: Case series; Level of evidence, 4. Methods: The study cohort consisted of 165 ankles (156 patients) that underwent arthroscopic microfracture for small to mid-sized OLT. The mean lesion size was 73 mm2 (range, 17-146 mm2), and the mean follow-up period was 6.7 years (range, 2.0-13.6 years). The Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, visual analog scale (VAS) for pain, and 36-Item Short Form Health Survey (SF-36) were used to compare the functional outcomes between the preoperative and final follow-up assessments. Results: The mean FAOS significantly improved in regard to all subscores ( P < .001). The AOFAS ankle-hindfoot scale showed an improvement from 71.0 points (range, 47.0-84.0) preoperatively to 89.5 points (range, 63.0-100) at the final follow-up ( P < .001). The VAS score showed an improvement from 6.2 points (range, 4.0-9.0) preoperatively to 1.7 points (range, 0-6.0) at the final follow-up ( P < .001). The mean SF-36 score improved from 62.4 points (range, 27.4-76.6) preoperatively to 76.2 points (range, 42.1-98.0) at the final follow-up ( P < .001). Among 165 ankles, 22 ankles (13.3%) underwent repeat arthroscopic surgery for evaluation of repaired cartilage status. Conclusion: Arthroscopic microfracture showed good functional outcomes and improved quality of life with maintenance of satisfactory outcomes at a mean follow-up of 6.7 years. Therefore, arthroscopic microfracture seems to be reliable as a first-line treatment for OLT at an intermediate-term follow-up.

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