The prevalence, risk factors and prognostic implications of dysphagia in elderly patients undergoing hip fracture surgery in Korea

Abstract Background Dysphagia is prevalent in geriatric patients, such as elderly hip fracture patients, and is associated with a poor prognosis. This study investigated (1) the prevalence of dysphagia based on clinical screening and a video-fluoroscopic swallowing study (VFSS), (2) the risk factors of dysphagia, and (3) the prognostic implications of dysphagia in elderly patients (≥ 65 years) undergoing hip fracture surgery. Methods In this retrospective study, data from 393 female and 153 male patients ≥65 years of age who underwent surgery for a hip fracture between 2015 and 2018 were analysed. Patients who were considered at high risk of dysphagia after screening underwent a VFSS. To identify risk factors of dysphagia, demographic factors, the American Society of Anesthesiologists classification, past medical history, known risk factors of dysphagia, and factors associated with surgery were analysed using a binary logistic regression model. Odds ratios (ORs) of dysphagia for having poor prognosis including postoperative pneumonia, intensive care unit (ICU) admission, and death within 6 months after surgery were obtained by logistic regression. The association of postoperative pneumonia with poor prognosis was also analysed. Results Dysphagia was seen in 5.3% of hip fracture patients. In multivariate regression analysis, a serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia (OR [95%CI] = 3.13 [1.40, 7.01]). Dysphagia was identified as a risk factor for postoperative pneumonia in regression analysis after adjustment (OR [95%CI] = 3.12 [1.05, 9.27]). Postoperative pneumonia was significantly associated with ICU admission (OR [95% CI] = 4.56 [1.85, 11.28]) and death within 6 months after surgery (OR [95% CI] = 2.56 [1.03, 6.33]). Conclusions Dysphagia in elderly hip fracture surgery patients was associated with postoperative pneumonia, a risk factor for poor outcomes including ICU admission and death within 6 months after surgery. A serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia. Therefore, diagnostic testing should be performed to detect dysphagia, especially in patients with a low serum albumin level. Finally, particular care should be taken to prevent postoperative complications in patients with dysphagia.

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Risk factors for extended length of stay following hip fracture surgery: A retrospective cohort study of patients aged 90 years and over in China

10.21203/rs.2.12969/v1 ◽

2019 ◽

Author(s):

Ling Lan ◽

Li-jian Pei ◽

Feifei Zhai ◽

Yuelun Zhang ◽

Jun Jing ◽

...

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Retrospective Cohort ◽

Binary Logistic Regression ◽

Postoperative Pneumonia ◽

Binary Logistic Regression Analysis ◽

Hip Fracture Surgery ◽

Extended Length ◽

Potential Risk Factors ◽

Fracture Surgery

Abstract Background Hip fractures are typical fractures in geriatric patients and are associated with a high risk of postoperative complications and extended length of stay (LOS) compared with other osteoporotic fractures, particularly among patients over age 90. We aimed to identify the risk factors for extended LOS (more than 14 days) in patients older than 90 years. Methods A single-centre retrospective cohort study was performed in 50 patients (over age 90) who experienced hip fracture between June 1, 2013, and August 31, 2017. Their medical records were retrospectively reviewed from the hospital’s electronic database. The baseline characteristics of the patients, intraoperative data and postoperative complications were collected for the assessment of potential risk factors. Univariate analysis and multivariate binary logistic regression analysis were performed to determine potential risk factors for extended LOS. Results The age of the patients in the cohort ranged from 90 to 101 years, and the analysis demonstrated that 70% (n = 35) of the patients experienced a complicated course of treatment with an in-hospital mortality rate of 4% (n = 2). The most common complication was the occurrence of postoperative pneumonia (38%). The median duration of hospital stay was 18 (IQR 11, 21) days. Multivariate binary logistic regression analysis showed that a LOS of more than 14 days was significantly associated with a lower mean diastolic blood pressure during surgery [odds ratio (OR) =0.86, 95% confidence interval (CI)=0.76-0.98, P = 0.018] and the occurrence of postoperative pneumonia (OR=8.95, 95% CI=1.45-55.3, P = 0.018). The occurrence of postoperative pneumonia was significantly associated with the neutrophil-to-lymphocyte ratio (NLR) at admission (D0) [odds ratio (OR) =1.20, 95% confidence interval (CI)=1.02-1.41, P = 0.029]. Neither the LOS nor postoperative pneumonia was found to be associated with the anaesthesia technique. Conclusions A lower mean diastolic blood pressure during surgery and the occurrence of postoperative pneumonia may extend the LOS in patients aged 90 years and over who undergo hip fracture surgery. The use of regional anaesthesia was not associated with a shorter LOS.

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Preoperative Serum Albumin Level As A Predictor Of Postoperative Pneumonia After Femoral Neck Fracture Surgery In A Geriatric Population

Clinical Interventions in Aging ◽

10.2147/cia.s231736 ◽

2019 ◽

Vol Volume 14 ◽

pp. 2007-2016 ◽

Cited By ~ 2

Author(s):

Yakang Wang ◽

Xiaoli Li ◽

Yahong Ji ◽

Hua Tian ◽

Xiaofang Liang ◽

...

Keyword(s):

Femoral Neck ◽

Serum Albumin ◽

Femoral Neck Fracture ◽

Serum Albumin Level ◽

Albumin Level ◽

Postoperative Pneumonia ◽

Geriatric Population ◽

Preoperative Serum ◽

Neck Fracture ◽

Fracture Surgery

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Prognostic factor of the two-year mortality after revascularization in patients with critical limb ischemia

Vascular ◽

10.1177/1708538116651216 ◽

2016 ◽

Vol 25 (2) ◽

pp. 123-129 ◽

Cited By ~ 4

Author(s):

Koichi Morisaki ◽

Takuya Matsumoto ◽

Yutaka Matsubara ◽

Kentaro Inoue ◽

Yukihiko Aoyagi ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ejection Fraction ◽

Serum Albumin ◽

Critical Limb Ischemia ◽

Serum Albumin Level ◽

Limb Ischemia ◽

Albumin Level ◽

Surgical Revascularization ◽

Hybrid Therapy

Purposes The aim of this study was to evaluate the risk factors for the two-year survival after revascularization of critical limb ischemia. Methods Between 2008 and 2012, 142 patients underwent revascularization. A retrospective analysis was performed to measure the risk factor. Results A total 85 patients underwent surgical revascularization, 31 patients underwent endovascular therapy while 26 patients underwent hybrid therapy. By multivariate analysis, the following variables were considered to be risk factors: ejection fraction <50 % (HR, 3.14; 95% CI, 1.22–7.95; P = 0.02), serum albumin level <2.5 g/dL (HR, 3.45; 95% CI, 1.01–11.7; P = 0.04) and nonambulatory status (HR, 4.11; 95% CI, 1.79–9.70; P < 0.01). The two-year survival rate of the patients with no risk factors was 85.5%, while the patients with at least one risk factor had an unfavorable prognosis (one; 56.7%, two; 45.4%). Conclusions The nonambulatory status, serum albumin level <2.5 g/dL and ejection fraction <50% were the risk factors for the two-year mortality after revascularization in critical limb ischemia patients. These risk factors may be useful for the treatment strategy of critical limb ischemia patients.

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End-Stage Renal Failure Is an Independent Risk Factor for 1-Year Mortality After Hip Fracture Surgery

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318770561 ◽

2018 ◽

Vol 9 ◽

pp. 215145931877056 ◽

Cited By ~ 5

Author(s):

Louise Woon Theng Lo ◽

Xu Yanling ◽

Andrew Chia Chen Chou ◽

Tet Sen Howe ◽

John Carson Allen ◽

...

Keyword(s):

Risk Factors ◽

Renal Failure ◽

Risk Factor ◽

Hip Fracture ◽

Independent Risk Factor ◽

Postoperative Mortality ◽

End Stage Renal Failure ◽

Hip Fracture Surgery ◽

End Stage ◽

Fracture Surgery

Introduction: End-stage renal failure (ESRF) with its associated comorbidities increase postoperative mortality in hip fracture patients. This study investigated the association of ESRF with various comorbidities in patients on dialysis and assessed rates ESRF as an independent risk factor for all-cause postoperative 1- year mortality rates. Methods: This was a retrospective cohort study on patients aged 55 years and older who underwent their first nonpathological, low-energy hip fracture surgery at an Asian tertiary hospital from June 2007 to 2012. Patients were identified as cases with ESRF on dialysis (study group) or non-ESRF patients (controls). Various comorbidity factors and postoperative 1-year mortality status were obtained from institutional electronic medical records. Univariate and multivariate logistic regression were used to identify significant risk factors for all-cause, 1-year mortality. Results: With no loss to follow-up, the 1-year postoperative mortality rate was 19.6% for the 46 patients with ESRF on dialysis and 8.4% for non-ESRF controls ( P = .028). Fisher exact test showed that hypertension, ischemic heart disease (IHD), diabetes mellitus (DM), anemia, cerebrovascular disease, and vascular disease were significantly associated with ESRF ( P < .05). Multivariable logistic regression analysis identified ESRF (adjusted odds ratio[AOR] = 2.85, P = .021), cancer (AOR = 3.04, P = .003), IHD (AOR = 2.07, P = .020), DM (AOR = 2.03, P = .022), and age (AOR = 1.08, P <.0001) as independent risk factors for 1-year mortality following hip fracture surgery. The area under the receiver–operating characteristic curve (95% confidence interval) for the multivariable predictor of 1-year mortality was 0.75 (0.60-0.82). Conclusions: Although associated with multiple comorbidities, ESRF was found to be independently predictive of 1-year mortality in patients undergoing hip fracture surgery, second to cancer in terms of magnitude of risk posed. As ESRF is a negative prognostic factor for 1-year mortality after hip fracture surgery, its importance should be recognized with implications on preoperative counseling to patients about the increased risk and implications on fracture prevention.

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Clinical characteristics and risk factors of postoperative pneumonia after hip fracture surgery: a prospective cohort study

Osteoporosis International ◽

10.1007/s00198-016-3624-5 ◽

2016 ◽

Vol 27 (10) ◽

pp. 3001-3009 ◽

Cited By ~ 27

Author(s):

H. Lv ◽

P. Yin ◽

A. Long ◽

Y. Gao ◽

Z. Zhao ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Hip Fracture ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Clinical Characteristics ◽

Postoperative Pneumonia ◽

Hip Fracture Surgery ◽

Fracture Surgery

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A Meta-Analysis of Acute Kidney Injury in Patients Undergoing Hip Fracture Surgery: Prevalence and Risk Factors

10.21203/rs.3.rs-29764/v1 ◽

2020 ◽

Author(s):

Yan-Li Zhang ◽

Yan-Chuang Pu ◽

Jin Wang ◽

Zi-Cai Li ◽

Hu-Lin Wang

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Hip Fracture ◽

Serum Albumin ◽

Meta Analysis ◽

Kidney Injury ◽

Hip Fracture Surgery ◽

Pooled Prevalence ◽

Postoperative Serum ◽

Fracture Surgery

Abstract Objective: Acute kidney injury(AKI) was a frequent complication following hip fracture surgery, but recent studies reported inconsistent findings. The purpose of our study was to systematically clarify the prevalence and risk factors of AKI after hip fracture surgery. Methods: Pubmed, Embase, and Web of Science were searched from the inception to March 2020 to identify observational studies investigating the prevalence and risk factors of AKI in patients undergoing hip fracture surgery. Pooled prevalence and odds ratios(ORs) with 95% confidence intervals(CIs) were estimated using random-effect model. Publication bias was evaluated with a funnel plot and statistical test. All the statistical analyses were performed using STATA version 12.0. Results: A total of 11 studies with 16,421 patients were included in the current meta-analysis. The pooled prevalence of AKI in patients undergoing hip fracture surgery was 17%(95%CI, 14%-21%). Postoperative serum albumin(OR 1.80; 95%CI, 1.38–2.36) was a significant predictor for AKI. Age(OR 1.01; 95%CI, 0.95–1.07) and ACE inhibitors(OR 1.38; 95%CI, 0.92–2.07) were also associated with increased risk of AKI, but the results were not statistically significant. No significant publication bias was identified through statistical tests(Egger’s test, p = 0.258 and Begg’s test, p = 0.087). Conclusions: The pooled AKI following hip fracture surgery was approximately 17%. Postoperative serum albumin was a potential significant risk factor for AKI.

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