scholarly journals Factors influencing early and long-term survival following hip fracture among nonagenarians

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Laurence Weinberg ◽  
Bobby Ou Yang ◽  
Luka Cosic ◽  
Sarah Klink ◽  
Peter Le ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Postoperative Complications ◽  
Mortality Rate ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Term Survival ◽  
Hip Fracture Surgery ◽  
The Relationship ◽  
Fracture Surgery

Abstract Background The outcomes of nonagenarian patients undergoing orthopaedic surgery are not well understood. We investigated the 30-day mortality after surgical treatment of unilateral hip fracture. The relationship between postoperative complications and mortality was evaluated. Methods We performed a single-centre retrospective cohort study of nonagenarian patients undergoing hip fracture surgery over a 6-year period. Postoperative complications were graded according to the Clavien–Dindo classification. Correlation analyses were performed to evaluate the relationship between mortality and pre-specified mortality risk predictors. Survival analyses were assessed using Cox proportional hazards regression modelling. Results The study included 537 patients. The 30-day mortality rate was 7.4%. The mortality rate over a median follow-up period of 30 months was 18.2%. Postoperative complications were observed in 459 (85.5%) patients. Both the number and severity of complications were related to mortality (p < 0.001). Compared to patients who survived, deceased patients were more frail (p = 0.034), were at higher ASA risk (p = 0.010) and were more likely to have preoperative congestive heart failure (p < 0.001). The adjusted hazard ratio for mortality according to the number of complications was 1.3 (95% CI 1.1, 1.5; p = 0.003). Up to 21 days from admission, any increase in complication severity was associated significantly greater mortality [adjusted hazard ratio: 3.0 (95% CI 2.4, 3.6; p < 0.001)]. Conclusion In a nonagenarian cohort of patients undergoing hip fracture surgery, 30-day mortality was 7.4%, but 30-month mortality rates approached one in five patients. Postoperative complications were independently associated with a higher mortality, particularly when occurring early.

scholarly journals Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures

2021 ◽  
Vol 12 ◽  
pp. 215145932110162
Author(s):  
Matthew S. Broggi ◽  
Philip O. Oladeji ◽  
Syed Tahmid ◽  
Roberto Hernandez-Irizarry ◽  
Jerad Allen
Keyword(s):  
Risk Factor ◽  
Hip Fracture ◽  
Postoperative Complications ◽  
Hip Fractures ◽  
Depressive Disorders ◽  
Surgical Site Infections ◽  
Wound Complications ◽  
Non Union ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Introduction: Intertrochanteric hip fractures are a common injury treated by orthopedic surgeons and the incidence rate is rising. Preoperative depression is a known risk factor for postoperative complications in orthopaedic surgery, however its effects on outcomes after geriatric hip fractures is relatively unknown. The purpose of this study was to investigate the relationship between preoperative depression and potential complications following open reduction internal fixation (ORIF) and intramedullary nailing (IMN) of geriatric hip fractures. Methods: In this retrospective study, the Truven Marketscan claims database was used to identify patients over age 65 who underwent ORIF or IMN for a hip fracture from January 2009 to December 2019. Patient characteristics, such as medical comorbidities, were collected and from that 2 cohorts were established (one with and one without depression). Chi-squared and multivariate analysis was performed to investigate the association between preoperative depression and common postoperative complications following intertrochanteric hip fracture surgery. Results: In total, 78,435 patients were identified for analysis. In those patients with preoperative depression, the complications associated with the greatest increased odds after undergoing ORIF were surgical site infections (OR 1.32; CI 1.23-1.44), ED visit for pain (OR 1.27; CI 1.16-1.39), wound complications (OR 1.26; CI 1.14-1.35), and non-union (OR 1.25; CI 1.17-1.33). In the patients with preoperative depression undergoing IMN, the complications associated with the greatest increased odds after were surgical site infections (OR 1.37; CI 1.31- 1.45), ED visit for pain (OR 1.31; CI 1.19-1.44), wound complications (OR 1.23; CI 1.10-1.39), and pneumonia (OR 1.22; CI 1.10-1.31). Conclusions: Preoperative depression in patients undergoing hip fracture surgery is associated with increased complications. Recognizing a patients’ preoperative depression diagnosis can allow physicians to adapt perioperative and postoperative surveillance protocols for these higher risk patients. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor

scholarly journals Diabetes Confers Little to No Increased Risk of Postoperative Complications After Hip Fracture Surgery in Geriatric Patients

2014 ◽  
Vol 473 (3) ◽  
pp. 1043-1051 ◽  
Author(s):  
Nicholas S. Golinvaux ◽  
Daniel D. Bohl ◽  
Bryce A. Basques ◽  
Michael R. Baumgaertner ◽  
Jonathan N. Grauer
Keyword(s):  
Hip Fracture ◽  
Postoperative Complications ◽  
Geriatric Patients ◽  
Hip Fracture Surgery ◽  
Increased Risk ◽  
Fracture Surgery

scholarly journals A Case-Control Study of Hip Fracture Surgery Timing and Mortality at an Academic Hospital: Day Surgery May Be Safer than Night Surgery

2021 ◽  
Vol 10 (16) ◽  
pp. 3538
Author(s):  
Alim F. Ramji ◽  
Maxwell T. Trudeau ◽  
Michael R. Mancini ◽  
Matthew R. LeVasseur ◽  
Adam D. Lindsay ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Day Surgery ◽  
Multivariable Logistic Regression Analysis ◽  
Academic Hospital ◽  
Start Time ◽  
Hip Fracture Surgery ◽  
Surgery Timing ◽  
The Relationship ◽  
Fracture Surgery ◽  
Control Study

Time from hospital admission to operative intervention has been consistently demonstrated to have a significant impact on mortality. Nonetheless, the relationship between operative start time (day versus night) and associated mortality has not been thoroughly investigated. Methods: All patients who underwent hip fracture surgery at a single academic institution were retrospectively analyzed. Operative start times were dichotomized: (1) day operation—7 a.m. to 4 p.m.; (2) night operation—4 p.m. to 7 a.m. Outcomes between the two groups were evaluated. Results: Overall, 170 patients were included in this study. The average admission to operating room (OR) time was 26.0 ± 18.0 h, and 71.2% of cases were performed as a day operation. The overall 90-day mortality rate was 7.1% and was significantly higher for night operations (18.4% vs. 2.5%; p = 0.001). Following multivariable logistic regression analysis, only night operations were independently associated with 90-day mortality (aOR 8.91, 95% confidence interval 2.19–33.22; p = 0.002). Moreover, these patients were significantly more likely to return to the hospital within 50 days (34.7% vs. 19.0%; p = 0.029) and experience mortality prior to discharge (8.2% vs. 0.8%; p = 0.025). Notably, admission to OR time was not associated with in-hospital mortality (29.22 vs. 25.90 h; p = 0.685). Hip fracture surgery during daytime operative hours may minimize mortalities.

scholarly journals Sarcopenia index based on serum creatinine and cystatin C predicts the risk of postoperative complications following hip fracture surgery in older adults

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaoyan Chen ◽  
Yanjiao Shen ◽  
Lisha Hou ◽  
Binyu Yang ◽  
Birong Dong ◽  
...  
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Postoperative Complications ◽  
Serum Creatinine ◽  
Cystatin C ◽  
Binary Logistic Regression ◽  
Joint Replacement Surgery ◽  
Hip Fracture Surgery ◽  
Replacement Surgery ◽  
Fracture Surgery

Abstract Objective To assess the utility of the preoperative Sarcopenia index (SI) as a predictive marker of the risk of postoperative complications following hip fracture surgery in older adults. Study design This observational study enrolled older adults with hip fracture who were hospitalized in the Department of Orthopedics of West China Hospital, Sichuan University, from December 7, 2010 - June 14, 2017, and who underwent hip fracture surgery. Primary outcome and measures Clinical data were collected from medical records and serum creatinine and cystatin C were measured before surgery. Outcomes included postoperative complications such as pneumonia, urinary tract infection, respiratory failure, heart failure, and non-grade A healing. Binary logistic regression analyses were used to analyze association between SI and postoperative complications. Results A total of 897 patients aged 60 years and over were enrolled in this study (age range: 60 – 100 years), of whom 306(34.1%)were male, and 591(65.9%)were female. Postoperative complications included pneumonia (12%), urinary tract infections (1.8%), respiratory failure (1.5%), heart failure (1.6%), and non-A- grade healing (3.6%). In the patient group that received joint replacements, the incidence of pneumonia was negatively associated with SI values. After adjusting for potential confounding factors, binary logistic regression analyses showed that a higher SI was independently associated with a lower risk of pneumonia after joint replacement surgery (OR:0.39, 95% CI:0.18-0.89, P<0.05). However, we did not find statistically significant association between SI and the risk of postoperative complications other than pneumonia among patients with two types of hip fracture surgery. Conclusion The SI based on serum creatinine and cystatin C can predict pneumonia rather than other postoperative complications among older patients with hip fracture after joint replacement surgery.

scholarly journals Geriatric scores can predict long-term survival rate after hip fracture surgery

2019 ◽  
Author(s):  
Carmen da Casa ◽  
Carmen Pablos-Hernández ◽  
Alfonso González-Ramírez ◽  
José Miguel Julián-Enriquez ◽  
Juan F Blanco
Keyword(s):  
Hip Fracture ◽  
Survival Rate ◽  
Barthel Index ◽  
Charlson Index ◽  
Cumulative Survival Rate ◽  
Term Survival ◽  
Cumulative Survival ◽  
Hip Fracture Surgery ◽  
Katz Index ◽  
Fracture Surgery

Abstract Background: The management of hip fractures is nowadays mainly performed in Orthogeriatric Units, one of whose fundamental tools is the application of geriatric scores. The purpose of this study is to establish the potential usefulness of Barthel Index, Katz Index, Lawton-Brody Index and Physical Red Cross Scale geriatric scores as predictors of survival rate and readmission rate in older patients after hip fracture surgery. Methods: We designed a prospective single-center observational study, including 207 older adults over age 65 who underwent hip fracture surgery in the first half of 2014 and followed up to September 2018. Cumulative survival and readmission rates were analyzed by Kaplan-Meier; group comparison, by Log-Rank and hazard ratio, by Cox regression. Results: We found statistical differences (p<0.001) for cumulative survival rate by every geriatric score analyzed (BI HR=0.98 [0.97,0.99]; KI HR=1.24 [1.13-1.37]; LBI HR= 1.25 [1.16, 1.36]; PCRS HR=1.67 [1.37,2.04]). Furthermore, we could determinate an inflection point for survival estimation by Barthel Index (BI 0-55/60-100*, p<0.001, HR=2.37 [1.59,3.53]), Katz Index (KI A-B*/C-G, p<0.001, HR=2.66 [1.80, 3.93], and Lawton-Brody Index (LBI 0-3/4-8*, p<0.001, HR=3.40 [2.09,5.25]). We reveal a correlation of the Charlson Index (p=0.002) and Katz Index (p=0.041) with number of readmissions for the study period. Conclusions: The geriatric scores analyzed are related to the cumulative survival rate after hip fracture surgery for more than 4 years, independently of other clinical and demographic factors. Katz Index in combination with Charlson Index could also be a potential predictor of the number of readmissions after surgery for hip fracture patients.

scholarly journals Early Mobilization Post–Hip Fracture Surgery

2019 ◽  
Vol 10 ◽  
pp. 215145931982643 ◽  
Author(s):  
Timothy Kenyon-Smith ◽  
Eric Nguyen ◽  
Tarandeep Oberai ◽  
Ruurd Jarsma
Keyword(s):  
Hip Fracture ◽  
Postoperative Complications ◽  
Subgroup Analysis ◽  
Postoperative Delirium ◽  
Early Mobilization ◽  
Complication Rates ◽  
Hip Fracture Surgery ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Fracture Surgery

Introduction: Early mobilization after hip fracture surgery is a widely practiced component of postoperative care. However, there is little evidence to suggest that early mobilization post–hip fracture surgery is beneficial in reducing postoperative complications. This study aims to investigate the effect of early mobilization following hip fracture surgery on postoperative complications. Materials and Methods: This study retrospectively included 240 patients (female = 165, male = 75, mean age: 82.2 years) admitted to a level 1 trauma center in Adelaide, Australia, for hip fracture surgery. The effect of early mobilization on postoperative complications was assessed along with premorbid status. Subgroup analysis of patients stratified by premorbid health was subsequently analyzed to reduce confounding. Results: The odds of developing a complication were 1.9 times higher if the patient remained bedbound compared to mobilizing. Early mobilization was favorable to delayed mobilization. On average, complication-free patients mobilized earlier (mean [M] = 29 hours) compared to patients who experienced complications (M = 38 hours). In particular, rates of delirium was significantly reduced in patients who mobilized compared to remaining bedbound. However, premorbid status varied greatly. Early mobilizers had significantly better premorbid health than patients who remained bedbound. Overall subgroup analysis of patients with similar premorbid health showed mobilization was not associated with a reduction in complications. With an exception of patients with poor premorbid health, who experienced a reduction in complications following early mobilization. Discussion: In general, early mobilization was associated with the same complication rates as delayed mobilization and remaining bedbound. Patients with poor premorbid health benefited most from early mobilization with reduced complication rates. Conclusion: Postoperative delirium and premorbid health were better indicators of postoperative outcomes than time to mobilization.

scholarly journals Geriatric scores as single-handed tools in the risk of 30-day mortality after hip fracture

2020 ◽  
Author(s):  
Carmen da Casa ◽  
Carmen Pablos-Hernández ◽  
Alfonso González-Ramírez ◽  
Juan F Blanco
Keyword(s):  
Hip Fracture ◽  
Mortality Rate ◽  
Barthel Index ◽  
Inflection Point ◽  
Binary Logistic Regression ◽  
High Energy ◽  
Red Cross ◽  
Hip Fracture Surgery ◽  
Katz Index ◽  
Fracture Surgery

Abstract Background The 30-day mortality rate after hip fracture surgery has been considered as an indirect indicator of the quality of care. This work aims to validate the Barthel Index, Katz Index, Lawton-Brody Index, and Physical Red Cross Scale analyzed in the Comprehensive Geriatric Assessment at admission as predictors of 30-day mortality after hip fracture surgery. Methods Prospective study including 899 hip fracture patients over 65. Bed-ridden, non- surgically treated patients, and high energy trauma or tumoral etiology fractures were excluded. Variables distribution were assessed by χ2, and we performed binary logistic regression for risk assessment. P < 0.05 was considered statistically significant. Results We noted a 30-day mortality rate of 5.9%. We related Barthel Index (OR = 0.986 [0.975–0.996], p = 0.010), Katz Index (OR per point = 1.254 [1.089–1.444], p = 0.002), Lawton-Brody Index (OR = 0.885 [0.788–0.992], p = 0.037), and Physical Red Cross Scale (OR = 1.483 [1.094–2.011], p = 0.011) with the 30-day mortality of patients after hip fracture surgery. We also validate the Barthel Index inflection point (0–55) (ORBI(0−55) = 2.428 [1.379–4.275], p = 0.002) and Katz Index inflection point (A-B) (ORKI(A−B) = 0.493 [0.273–0.891], p = 0.019) for the assessment of the highest risked patients. Conclusions The geriatric scores would be useful multifunctional tools in the assessment of hip fracture patients as singly predictors of 30-day mortality.

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