Association of Acute Perioperative Myocardial Injury With All-Cause Mortality Within 90 Days After Hip Fracture Repair in the Elderly: A Prospective Study

Introduction It remains unclear whether acute perioperative myocardial injury (APMI) increases mortality in the elderly. This study aimed to investigate APMI’s association with mortality within 90 days after hip fracture repair in elderly patients. Materials and Methods This prospective study enrolled elderly patients admitted to the department of Traumatology and Orthopaedics in XXX Hospital, who underwent surgery in 2018–2019 with a 90-day follow-up. According to survival status within 90 days, survival and death groups were constituted. Clinical, demographic, and laboratory indicators and 90-day mortality post-surgery were recorded. APMI’s association with 90-day mortality post-surgery was analyzed by logistic regression. Results Totally 248 participants were enrolled, including 224 and 24 in the survival and death groups, respectively, for a mortality rate of 9.7%. Compared with surviving individuals, the death group was older [81 (75–86) vs 87 (82–89) years], and had higher incidence rates of APMI (24.6% vs 58.3%), intertrochanteric fractures (41.1% vs 62.5%), preoperative atrial fibrillation (8.9% vs 29.2%), and dementia (73.7% vs 95.8%) (all P<.05). They also showed higher pre-injury frail scale scores [1 (0–2) vs 3 (1–4)] and Nottingham hip fracture scores (NHFSs) [4 (4–5) vs 6.5 (5–7)], lower Glomerular filtration [62 (46.1–78.6) vs 44.37 (35–61.92) ml/min], and reduced odds of glomerular filtration rate <60 mL/min (75.0% vs 46.9%) (all P < .05). APMI (OR = 3.294, 95% CI: 1.217–8.913) and NHFS (OR = 2.089, 95% CI: 1.353–3.225) independently predicted 90-day mortality post-surgery (all P<.05). Conclusions APMI is associated with increased mortality risk within 90 days after hip fracture repair in elderly patients.

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Faculty Opinions recommendation of Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718369638.793494666 ◽

2014 ◽

Author(s):

Berrin Gunaydin ◽

Bülent Serhan Yurtlu

Keyword(s):

Hip Fracture ◽

Elderly Patients ◽

Spinal Anesthesia ◽

Fracture Repair

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The Risk Factors of Delirium in Elderly Patients with Hip Fracture: A Prospective Study

The Journal of the Korean Hip Society ◽

10.5371/jkhs.2008.20.4.293 ◽

2008 ◽

Vol 20 (4) ◽

pp. 293 ◽

Cited By ~ 7

Author(s):

Woo Suk Song ◽

Jun Cheol Choi ◽

Young Sang Lee ◽

Hwa Yeop Na ◽

Jun Won Choi ◽

...

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Elderly Patients ◽

Prospective Study ◽

A Prospective Study

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The role of the internal medicine specialist in the management of infective complications in general surgical wards

Italian Journal of Medicine ◽

10.4081/itjm.2008.2.12 ◽

2013 ◽

pp. 12-19

Author(s):

Patrizia Zoboli ◽

Giuseppe Chesi ◽

Fabrizio Boni ◽

Federica Maselli ◽

Lisa Zambianchi

Keyword(s):

Internal Medicine ◽

Elderly Patients ◽

Risk Evaluation ◽

Medical Condition ◽

The Elderly ◽

Operative Management ◽

Surgical Team ◽

Medical Consultant ◽

Post Surgery

BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population). Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection). Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.

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113SCREENING OF FRAILTY IN THE ELDERLY PATIENTS ADMITTED IN AN EMERGENCY UNIT. ABOUT A PROSPECTIVE STUDY

Age and Ageing ◽

10.1093/ageing/afy204.06 ◽

2019 ◽

Vol 48 (Supplement_1) ◽

pp. i32-i35

Author(s):

A -A Zulfiqar

Keyword(s):

Elderly Patients ◽

Prospective Study ◽

The Elderly ◽

Emergency Unit ◽

A Prospective Study

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27Levobupivacaine-fentanyl spinal anaesthesia for hip fracture repair in the elderly

Regional Anesthesia and Pain Medicine ◽

10.1016/j.rapm.2006.06.071 ◽

2006 ◽

Vol 31 (5) ◽

pp. 33-33

Author(s):

R KROBOT ◽

J PREMUZIC ◽

I BACAK

Keyword(s):

Hip Fracture ◽

Spinal Anaesthesia ◽

The Elderly ◽

Fracture Repair

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Incidence and risk factors of postoperative delirium in the elderly patients with hip fracture

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-018-0897-8 ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 14

Author(s):

Chen-guang Wang ◽

Ya-fei Qin ◽

Xin Wan ◽

Li-cheng Song ◽

Zhi-jun Li ◽

...

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Elderly Patients ◽

Postoperative Delirium ◽

The Elderly

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Sedation Depth During Spinal Anesthesia and the Development of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Repair

Mayo Clinic Proceedings ◽

10.4065/mcp.2009.0469 ◽

2010 ◽

Vol 85 (1) ◽

pp. 18-26 ◽

Cited By ~ 250

Author(s):

Frederick E. Sieber ◽

Khwaji J. Zakriya ◽

Allan Gottschalk ◽

Mary-Rita Blute ◽

Hochang B. Lee ◽

...

Keyword(s):

Hip Fracture ◽

Elderly Patients ◽

Spinal Anesthesia ◽

Postoperative Delirium ◽

Fracture Repair

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Prospective study of dietary Non Enzymatic Antioxidant Capacity on the risk of hip fracture in the elderly

Bone ◽

10.1016/j.bone.2016.05.006 ◽

2016 ◽

Vol 90 ◽

pp. 31-36 ◽

Cited By ~ 2

Author(s):

Essi Hantikainen ◽

Alessandra Grotta ◽

Weimin Ye ◽

Hans-Olov Adami ◽

Pamela J. Surkan ◽

...

Keyword(s):

Hip Fracture ◽

Prospective Study ◽

Antioxidant Capacity ◽

The Elderly ◽

Enzymatic Antioxidant

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Assessment of HIT Antibody Complex in Hip Fracture Patients Receiving Enoxaparin or Unfractionated Heparin

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029611398121 ◽

2011 ◽

Vol 17 (6) ◽

pp. 567-571

Author(s):

Justin W. Griffin ◽

William J. Hopkinson ◽

Michael R. Lassen ◽

Indermohan Thethi ◽

Evangelos Litinas ◽

...

Keyword(s):

Hip Fracture ◽

Elderly Patients ◽

Unfractionated Heparin ◽

Standard Of Care ◽

The Elderly ◽

Enzyme Linked Immunosorbent Assay ◽

Platelet Factor ◽

Surgical Fixation ◽

Thrombotic Complications ◽

Antibody Complex

Thromboembolic disease is a common complication of hip fracture in the elderly. Anticoagulants represent a standard of care in preventing postoperative thrombotic complications following surgical fixation. We asked whether levels of antibody to heparin–platelet factor 4 (PF4) complex were differentially present in unfractionated heparin (UFH) versus Enoxaparin, following hip fracture and whether one particular subtype of antibodies was more prevalent. Plasma samples from elderly patients sustaining a hip fracture treated with either enoxaparin or UFH were collected pre- and postoperatively and analyzed using enzyme-linked immunosorbent assay (ELISA) sandwich method for the prevalence of antiheparin-PF4 antibodies and later subtyped. The prevalence of antiheparin-PF4 antibodies was higher in the UFH group especially on postoperative day 7. Patients treated with UFH showed a greater prevalence of antiheparin-PF4 antibodies and a greater prevalence of immunoglobulin G (IgG) subtype. Heparin and enoxaparin are capable of generating heparin-induced thrombocytopenia (HIT) antibodies in elderly patients undergoing orthopedic surgery but perhaps not to the same extent. When comparing low-molecular-weight heparin (LMWH) with UFH, the incidence of new antiheparin-PF4 antibody production is higher in patients treated with UFH.

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