scholarly journals Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Luigi Vetrugno ◽  
Enrico Boero ◽  
Elena Bignami ◽  
Andrea Cortegiani ◽  
Santi Maurizio Raineri ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Postoperative Complications ◽  
Observational Study ◽  
Elderly Patients ◽  
Fracture Fixation ◽  
Frail Elderly ◽  
Statistical Power ◽  
Lung Ultrasound ◽  
Preoperative Evaluation ◽  
Cardiac Complications

Abstract Background Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of “indirect” and “direct” cardiac and pulmonary lung ultrasound signs. Methods LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged  >  65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns—each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. Conclusions Lung ultrasound (LU), as a tool within the anesthesiologist’s armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracture patients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019.

Vitamin D levels in frail elderly patients with a hip fracture

2013 ◽  
Vol 4 ◽  
pp. S63 ◽  
Author(s):  
M. Abildgaard Pedersen ◽  
M. Gregersen ◽  
B. Lomholt Langdahl ◽  
E.M. Skjøde Damsgaard
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Frail Elderly ◽  
Vitamin D Levels

Operative delay and mortality in elderly patients with hip fracture: an observational study

2013 ◽  
Vol 24 (5) ◽  
pp. 783-788 ◽  
Author(s):  
Luigi de Palma ◽  
Marco Torcianti ◽  
Leonard Meco ◽  
Alessandro Catalani ◽  
Mario Marinelli
Keyword(s):  
Hip Fracture ◽  
Observational Study ◽  
Elderly Patients ◽  
Operative Delay

scholarly journals Orthogeriatrics in Italy: the Gruppo Italiano di Ortogeriatria (GIOG) audit on hip fractures in the elderly

2018 ◽  
Vol 4 (2) ◽  
Author(s):  
Amedeo Zurlo ◽  
Giuseppe Bellelli
Keyword(s):  
Hip Fracture ◽  
Observational Study ◽  
Elderly Patients ◽  
The Elderly ◽  
Study Group ◽  
Web Based ◽  
Italian Study ◽  
Multicenter Observational Study ◽  
Functional Deficit ◽  
High Prevalence

The Gruppo Italiano di Ortogeriatria (GIOG) is an Italian study group promoted by three Italian Scientific Geriatric Societies with the aim of disseminating orthogeriatric methodology in Italy. In 2015 it has supported a multicenter web-based audit to collect data on functioning of Italian orthogeriatrics. The study, still ongoing, has enrolled until now 2577 cases of elderly patients undergoing surgery for hip fracture from 14 Italian orthogeriatric units. The population in question consists of markedly elderly and frail subjects, due to high prevalence of pre-existing functional deficit conditions, but it is also clinically complex; the most frequent fracture is intertrochanteric and the most performed surgery approach is intramedullary nail. This is the largest multicenter observational study conducted so far in Italy on elderly patients with hip fracture.

scholarly journals Preoperative Thyroid Dysfunction Predicts 30-Day Postoperative Complications in Elderly Patients With Hip Fracture

2013 ◽  
Vol 4 (2) ◽  
pp. 43-49 ◽  
Author(s):  
Xi Wern Ling ◽  
Tet Sen Howe ◽  
Joyce Suang Bee Koh ◽  
Merng Koon Wong ◽  
Alvin Choong Meng Ng
Keyword(s):  
Hip Fracture ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Thyroid Dysfunction

scholarly journals Attributable Mortality of Hip Fracture in Older Patients: A Retrospective Observational Study

2020 ◽  
Vol 9 (8) ◽  
pp. 2370
Author(s):  
Lorène Zerah ◽  
David Hajage ◽  
Mathieu Raux ◽  
Judith Cohen-Bittan ◽  
Anthony Mézière ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Postoperative Complications ◽  
Mortality Rate ◽  
Observational Study ◽  
Older Patients ◽  
Final Analysis ◽  
Primary Objective ◽  
Retrospective Observational Study ◽  
Attributable Mortality ◽  
Baseline Characteristics

Hip fracture (HF) in older patients is associated with a high six-month mortality rate. Several clinical conditions may affect outcome, including baseline characteristics, co-existing acute illnesses, perioperative factors, and postoperative complications. Our primary objective was to estimate the respective effect of these four domains on six-month mortality after HF. A retrospective observational study using a monocentric cohort of older patients was conducted. All patients ≥ 70 years old admitted to the emergency department for HF and hospitalized in our perioperative geriatric care unit from June 2009 to September 2018 were included. Among 1015 included patients, five (0.5%) were lost to follow-up, and 1010 were retained in the final analysis (mean age 86 ± 6 years). The six-month mortality rate was 14.8%. The six-month attributable mortality estimates were as follows: baseline characteristics (including age, gender, comorbidities, autonomy, type of fracture): 62.4%; co-existing acute illnesses (including acute events present before surgery that could result from the fracture or cause it): 0% (not significantly associated with six-month mortality); perioperative factors (including blood transfusion and delayed surgery): 12.3%; severe postoperative complications: 11.9%. Baseline characteristics explained less than two-thirds of the six-month mortality after HF. Optimizing patients care by improving management of perioperative factors and thus decreasing postoperative complications, could reduce by a maximum of one quarter of the six-month mortality rate after HF.

scholarly journals Assessment of predictive validity and feasibility of Edmonton Frail Scale in identifying postoperative complications among elderly patients: a prospective observational study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yingke He ◽  
Lydia Weiling Li ◽  
Ying Hao ◽  
Eileen Yilin Sim ◽  
Kai Lee Ng ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Observational Study ◽  
Abdominal Surgery ◽  
Elderly Patients ◽  
Prospective Observational Study ◽  
Postoperative Morbidity ◽  
Preoperative Assessment ◽  
Major Abdominal Surgery ◽  
Assessment Clinic ◽  
Point Increase

Abstract Frailty is defined as diminished physiological reserve predisposing one to adverse outcomes when exposed to stressors. Currently, there is no standardized Frail assessment tool used perioperatively. Edmonton Frail Scale (EFS), which is validated for use by non-geriatricians and in selected surgical populations, is a candidate for this role. However, little evaluation of its use has been carried out in the Asian populations so far. This is a prospective observational study done among patients aged 70 years and above attended Preoperative Assessment Clinic (PAC) in Singapore General Hospital prior to major abdominal surgery from December 2017 to September 2018. The Comprehensive Complication Index (CCI) and Postoperative Morbidity Survey (POMS) were used to assess their postoperative morbidity respectively. Patient’s acceptability of EFS was measured using the QQ-10 questionnaire and the inter-rater reliability of EFS was assessed by Kappa statistics and Bland Altman plot. The primary aim of this study is to assess if frailty measured by EFS is predictive of postoperative complications in elderly patients undergoing elective major abdominal surgery. We also aim to assess the feasibility of implementing EFS as a standard tool in the outpatient preoperative assessment clinic setting. EFS score was found to be a significant predictor of postoperative morbidity. (OR 1.35, p < 0.001) Each point increase in EFS score was associated with a 3 point increase in CCI score. (Coefficient b 2.944, p < 0.001) EFS score more than 4 has a fair predictability of both early and 30-day postoperative complications. Feasibility study demonstrated an overall acceptance of the EFS among our patients with good inter-rater agreement.

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