scholarly journals Preoperative risk factors for postoperative blood transfusion after hip fracture surgery: establishment of a nomogram

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fu Cheng Bian ◽  
Xiao Kang Cheng ◽  
Yong Sheng An
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Hip Fracture ◽  
Blood Transfusion ◽  
Multivariate Logistic Regression ◽  
Preoperative Risk ◽  
Hip Fracture Surgery ◽  
Preoperative Risk Factors ◽  
Independent Risk Factors ◽  
Fracture Surgery

Abstract Background This study aimed to explore the preoperative risk factors related to blood transfusion after hip fracture operations and to establish a nomogram prediction model. The application of this model will likely reduce unnecessary transfusions and avoid wasting blood products. Methods This was a retrospective analysis of all patients undergoing hip fracture surgery from January 2013 to January 2020. Univariate and multivariate logistic regression analyses were used to evaluate the association between preoperative risk factors and blood transfusion after hip fracture operations. Finally, the risk factors obtained from the multivariate regression analysis were used to establish the nomogram model. The validation of the nomogram was assessed by the concordance index (C-index), the receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and calibration curves. Results A total of 820 patients were included in the present study for evaluation. Multivariate logistic regression analysis demonstrated that low preoperative hemoglobin (Hb), general anesthesia (GA), non-use of tranexamic acid (TXA), and older age were independent risk factors for blood transfusion after hip fracture operation. The C-index of this model was 0.86 (95% CI, 0.83–0.89). Internal validation proved the nomogram model’s adequacy and accuracy, and the results showed that the predicted value agreed well with the actual values. Conclusions A nomogram model was developed based on independent risk factors for blood transfusion after hip fracture surgery. Preoperative intervention can effectively reduce the incidence of blood transfusion after hip fracture operations.

scholarly journals Sex Differences in Hip Fracture Surgery: Preoperative Risk Factors for Delirium and Postoperative Outcomes

2016 ◽  
Vol 64 (8) ◽  
pp. 1616-1621 ◽  
Author(s):  
Esther S. Oh ◽  
Frederick E. Sieber ◽  
Jeannie-Marie Leoutsakos ◽  
Sharon K. Inouye ◽  
Hochang B. Lee
Keyword(s):  
Risk Factors ◽  
Sex Differences ◽  
Hip Fracture ◽  
Postoperative Outcomes ◽  
Preoperative Risk ◽  
Hip Fracture Surgery ◽  
Preoperative Risk Factors ◽  
Fracture Surgery

scholarly journals Preoperative risk factors for delirium in hip-fracture surgery under regional anesthesia: A nationwide population-based study

2019 ◽  
Author(s):  
Eun-Jin Ahn ◽  
Si Ra Bang
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Hip Fracture ◽  
Regional Anesthesia ◽  
Medical Center ◽  
Stepwise Logistic Regression ◽  
Preoperative Risk ◽  
Hip Fracture Surgery ◽  
Preoperative Risk Factors ◽  
Fracture Surgery

Abstract Background Delirium is common, but is frequently undetected by clinicians, despite the fact that it can be life-threatening. The objective of this study was to identify the incidence of delirium and the preoperative factors associated with postoperative delirium in elderly patients who underwent hip fracture surgery under regional anesthesia. Methods We retrospectively reviewed records of all patients ≥65 years who underwent hip fracture surgery under regional anesthesia, covered by the Korean National Health Insurance, between January 1, 2009 and December 31, 2015. A univariate and stepwise logistic regression model with the occurrence of delirium as the dependent variable was used to identify perioperative factors for this sample of patients. Results Among the 70696 patients who underwent hip fracture surgery, 58972 patients were who received regional anesthesia during surgery were included in our study. Delirium was detected in 8680 (14.7%) patients. Performing stepwise logistic regression, preoperative variables including female gender, included age ≥85 years, hospital type (medical center), ICU and ventilator care, neurodegenerative disorders, uncomplicated diabetes mellitus, peptic ulcer disease, psychoses, and depression (OR=1.49[1.42-1.58], 4.7[4.15-5.37], 13.3[7.57-23.8], 1.52[1.43-1.60], 1.19[1.01-1.40], 1.20[1.14-1.27], 1.09[1.04-1.14], 0.87[0.96-0.00], 2.23[1.48-3.37], and 1.38[1.32-1.46], respectively) were identified to be associated with delirium. Conclusion Delirium could occur in approximately 15% of elderly hip fracture surgery cases in which regional anesthesia is used. Multiple preoperative risk factors were found to be associated with delirium.

scholarly journals Predictors of Acute Kidney Injury After Hip Fracture in Older Adults

2020 ◽  
Vol 11 ◽  
pp. 215145932092008 ◽  
Author(s):  
Julie Braüner Christensen ◽  
Martin Aasbrenn ◽  
Luana Sandoval Castillo ◽  
Anette Ekmann ◽  
Thomas Giver Jensen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Hip Fracture ◽  
Blood Transfusion ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
C Reactive Protein ◽  
Hip Fracture Surgery ◽  
Reactive Protein ◽  
Fracture Surgery

Introduction: This study aimed to investigate the prevalence of acute kidney injury (AKI) following hip fracture surgery in geriatric patients and to identify predictors for development of AKI with a focus on possible preventable risk factors. Methods: In this retrospective cohort study, we reviewed electronic medical records of all patients above 65 years of age who underwent hip fracture surgery at Copenhagen University Hospital, Bispebjerg, Denmark, in 2018. Acute kidney injury was assessed according to the Kidney Disease Improving Global Outcomes guidelines. Multivariate logistic regression analyses were used to identify independent risk factors for AKI. Results: Postoperative AKI developed in 28.4% of the included patients (85/299). Acute kidney injury was associated with increased length of admission (11.3 vs 8.7 days, P < .001) and 30-day mortality (18/85 vs 16/214, P = .001). In multivariable analysis, higher age (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.08, P = .004), heart disease (OR: 1.78, 95% CI: 1.01-3.11, P = .045), and postoperative blood transfusion (OR: 1.84, 95% CI: 1.01-3.36, P = .048) were associated with AKI. Moreover, a higher postoperative C-reactive protein (199.0 ± 99.9 in patients with AKI, 161.3 ± 75.2 in patients without AKI) and lower postoperative diastolic blood pressure were observed in patients developing AKI. Discussion and Conclusion: Acute kidney injury was common following hip fracture surgery and associated with longer admissions and increased mortality. Patients developing AKI were older and showed several postoperative similarities, including higher C-reactive protein, lower postoperative diastolic pressure, and the need for blood transfusion.

Blood transfusion rates and predictors following geriatric hip fracture surgery

2020 ◽  
pp. 112070001989787 ◽  
Author(s):  
Armin Arshi ◽  
Wilson C Lai ◽  
Brenda C Iglesias ◽  
Edward J McPherson ◽  
Erik N Zeegen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Blood Transfusion ◽  
Hip Fractures ◽  
Improvement Program ◽  
Hip Fracture Surgery ◽  
Femur Fractures ◽  
Postoperative Blood Transfusion ◽  
Geriatric Hip Fracture ◽  
Fracture Surgery

Background: Postoperative blood product transfusions in elderly hip fracture patients cause concern for morbidity and mortality. The purpose of this study was to identify predictors and short-term sequelae of postoperative transfusion following geriatric hip fracture surgery. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to identify geriatric (⩾65 years) patients who sustained operative femoral neck, intertrochanteric, and subtrochanteric hip fractures in 2016. Multivariate regression was used to determine risk-adjusted odds ratios (OR) of associated perioperative risk factors and sequelae of postoperative transfusion. Results: In total, 8416 geriatric hip fracture patients were identified of whom 28.3% had documented postoperative transfusion. In multivariate analysis, age (OR 1.03 [1.02–1.04], p < 0.001), preoperative anaemia (OR 4.69 [3.99–5.52], p = 0.001), female sex (OR 1.61 [1.39–1.87], p < 0.001), lower BMI (OR 0.97 [0.96–0.98], p < 0.001), American Society of Anesthesiologists (ASA) classification (OR 1.14 [1.01–1.27], p = 0.031), COPD (OR 1.30 [1.06–1.59], p = 0.011), hypertension (OR 1.17 [1.01–1.35], p = 0.038), increased OR time (OR 1.02 [1.01–1.03], p < 0.001), and intertrochanteric (OR 2.99 [2.57–3.49], p < 0.001) and subtrochanteric femur fractures (OR 5.07 [3.84–6.69], p < 0.001) were independent risk factors for receiving postoperative blood transfusion. Patients with postoperative transfusion had a significantly higher risk-adjusted 30-day mortality (8.4% vs. 6.4%, OR 1.29 [1.02–1.64], p = 0.035), hospital readmission rate (9.4% vs. 7.7%, OR 1.27 [1.04–1.55], p = 0.018), and total hospital LOS (7.3 vs. 6.3 days, p < 0.001). Conclusions: Postoperative transfusion is a common occurrence in geriatric fragility hip fractures with multiple risk factors. Careful preoperative planning and multidisciplinary management efforts are warranted to reduce use of postoperative transfusions.

scholarly journals Predictors of 30-day mortality in orthogeriatric fracture patients aged 85 years or above admitted from the emergency department

2019 ◽  
Author(s):  
Henk Jan Schuijt ◽  
Jelle Bos ◽  
Diederik Pieter Johan Smeeing ◽  
Olivia Geraghty ◽  
Detlef van der Velde
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hip Fracture ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Geriatric Fracture ◽  
Hip Fracture Surgery ◽  
Independent Risk Factors ◽  
Male Sex ◽  
Fracture Surgery

Abstract Purpose Orthogeriatric trauma patients are at risk for functional decline and mortality. It is important to identify high-risk patients in an early stage, to improve outcomes and make better informed treatment decisions. The aim of this study was to identify independent risk factors for 30-day mortality in patients aged 85 years or above admitted from the emergency department with a fracture. Methods All orthopaedic trauma patients 85 years or above admitted from the emergency department were included. After a 30-day follow-up, mortality was determined by consulting the patient records. Multivariable logistics regression analysis generated odd ratios for mortality risk factors. A subgroup analysis was performed for patients undergoing hip fracture surgery. Results The 30-day mortality in geriatric fracture patients admitted to the hospital was 12%. Risk factors for 30-day mortality were: increased age, male sex, decreased hemoglobin levels, living in an institutional care facility and a decreased BMI. For geriatric patients undergoing hip fracture surgery 30-day mortality was 11%. Independent risk factors for this group were: increased age, male sex, and a decreased BMI. Conclusion Orthopaedic trauma patients aged 85 years or above who are admitted to the hospital with a fracture are at high risk for mortality. This study identified older age, male sex, and decreased BMI as predictors of 30-day mortality in admitted geriatric fracture patients and in geriatric hip fracture patients undergoing surgery.

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

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.

scholarly journals Risk factors affecting the 1-year outcomes of minor ischemic stroke: results from Xi’an stroke registry study of China[1]

2020 ◽  
Author(s):  
Zhongzhong Liu ◽  
Wenjuan Lin ◽  
Qingli Lu ◽  
Jing Wang ◽  
Pei Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Recurrence ◽  
Multivariate Logistic Regression ◽  
Factors Affecting ◽  
Nihss Score ◽  
Minor Ischemic Stroke ◽  
Independent Risk Factors

Abstract Background: The incidences of stroke recurrence, disability, and all-cause death of patients with minor ischemic stroke (MIS) remain problematic. The aim of the present was to identify risk factors associated with adverse outcomes at 1-year after MIS in the Xi’an region of China. Methods: The cohort of this prospective cohort study included MIS patients aged 18–97 years with a National Institutes of Health Stroke Scale (NIHSS) score of ≤ 3 who were treated in any of four hospitals in Xi’an region of China between January and December 2015. The 1-year percentage of stroke recurrence, disability, and all-cause death were evaluated. Multivariate logistic regression analysis was performed to assess the association between the identified risk factors and clinical outcomes. Results: Among the 1,121 patients included for analysis, the percentage of stroke recurrence, disability, and all-cause death at 1 year after MIS were 3.4% (38/1121), 9.3% (104/1121), and 3.3% (37/1121), respectively. Multivariate logistic regression analysis identified age, current smoking, and pneumonia as independent risk factors for stroke recurrence. Age, pneumonia, and alkaline phosphatase were independent risk factors for all-cause death. Independent risk factors for disability were age, pneumonia, NIHSS score on admission, and leukocyte count. Conclusions: The 1-year outcomes of MIS is not optimistic in the Xi’an region of China, especially high percentage of disability. In this study, we found the risk factors affecting 1-year stroke recurrence, disability and, all-cause death which need further verification in the subsequent studies.

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