scholarly journals Do we really need a surgery for hip fractures in elderly patients? Mortality rate and influencing factors

Arthroplasty ◽  
2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Kyu-Tae Hwang ◽  
Jun-Ki Moon ◽  
Young-Ho Kim
Keyword(s):  
Heart Disease ◽  
Treatment Group ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Influencing Factors ◽  
Hip Fractures ◽  
Mortality Rates ◽  
Factors Associated ◽  
Surgical Methods ◽  
Significant Difference

Abstract Background Hip fractures are associated with notable mortality rates in elderly patients. The purpose of the study was to evaluate the mortality rate and influencing factors associated with mortality in the elderly patients with hip fractures. Methods Between October 2000 and December 2009, 807 elderly patients with hip fractures were enrolled in this study. There were 197 men and 610 women. The mean age at injuries were 78 years (range, 65–99 years). The fractures consisted of 390 femoral neck fractures and 417 intertrochanteric fractures. The mortality rate was evaluated between patients who underwent surgical and nonsurgical treatments. The influencing factors associated with mortality rate were evaluated statistically. Results Overall, 691 (85.6%) patients treated surgically and 116 (14.4%) patients treated nonsurgically were included. The overall mortality rates one and two years after injuries were 16.6 and 39.4%, respectively. In surgical treatment group, the mortality rate one and two years after injuries were 12.0 and 35.7%, respectively. In nonsurgical treatment group, the mortality rates were 44.0 and 61.2%, respectively (p < 0.05). No significant difference was noted between the types of fractures and the time from injury to surgery. Regardless of surgical methods, a significantly higher mortality rate was observed in patients with heart disease, chronic renal disease, dementia, and cancer, or in patients with 3 or more comorbidities. Conclusions In elderly patients with hip fractures, surgical treatments can decrease the mortality rate as compared with nonsurgical treatments. In addition, patients who had three or more comorbidities (heart disease, chronic renal failure, dementia, and history of cancer) are associated with a higher risk of mortality. Trial registration Retrospectively registered.

scholarly journals 274 Use of DHS For Fixation of Unstable Hip Fractures – Are Outcomes Any Different from Nails?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Arora
Keyword(s):  
Mortality Rate ◽  
Retrospective Analysis ◽  
Hip Fractures ◽  
Mortality Rates ◽  
Ao Classification ◽  
Significant Difference ◽  
Acute Complications ◽  
Delayed Complications

Abstract Aim To determine if the outcomes and rate of complications differ based on choice of implant for unstable hip fractures. Method Retrospective analysis of 105 hip fractures operated in 2015 + 2016 with AO classification A2.2. A2.3 or A3. These were divided into 2 groups depending on whether DHS/Plate implant was selected (n = 86) or Nail implant was used (n = 19). Any complications occurring in their subsequent management or performance of any revision procedures were recorded. 6-month mortality rate was also calculated for both groups. Results When A2 and A3 fractures were assessed together the rate of acute complications was similar in both groups. 21% for nails and 19% for plates. The rate of delayed complications was not significantly different either, 16% for nails and 10% for plates. Revision procedures were more common where nails had been used (16%) compared to only 6% of plate fixations. Mortality rates were identical. When looking at A3 fractures in isolation, the rate of delayed complications is significantly higher when plates are used (24%) compared to 12% when nails are selected. Conclusions We did not identify any significant difference in acute complications including bleeding and infection based on choice of implant. This goes against common arguments raised against use of nails. Successful use of DHS fixation in unstable A2 hip fractures is possible, as evidenced by similar rates of delayed complications. Revisions were higher when nail was selected. It is however noted that for reverse oblique fractures nails perform demonstrably better, with half as frequent delayed complications and revisions.

scholarly journals Treatment of cyanotic heart diseases in children

2004 ◽  
Vol 132 (suppl. 1) ◽  
pp. 9-13
Author(s):  
Ida Jovanovic ◽  
Vojislav Parezanovic ◽  
Slobodan Ilic ◽  
Djordje Hercog ◽  
Milan Vucicevic ◽  
...  
Keyword(s):  
Heart Disease ◽  
Mortality Rate ◽  
Surgical Procedures ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Arterial Switch Operation ◽  
Open Heart Surgery ◽  
Age Groups ◽  
Mortality Rates ◽  
Cyanotic Heart Disease

Cyanotic heart diseases are relatively rare, but they are severe and heterogeneous congenital heart diseases, which require complex surgery. Development of different advanced surgical procedures, such as arterial switch operation (ASO), Fontan and its modifications, Norwood etc. operations, as well as better perioperative care significantly improved survival rate and quality of life of these children. The study group included 308 children treated for cyanotic heart disease in Yugoslavia, in the period January 2000 to July 2004. Some of them (239, 77.6%) were treated at the University Children?s Hospital in Belgrade, and others (69, 22.4%) in different institutions abroad. The age of the operated patients varied between 1 day and 19 years (median 12 months). The patients (pts) were divided into four groups, according to the disease and type of the operation. In the whole group of 308 patients treated due to cyanotic heart disease, there were 232 (75.3%) cases with open heart surgery and 76 (24.7%) with closed procedures. The mortality rate was significantly different between disease/operation groups, and age groups. Average mortality rates differed from 11.8% for palliative procedures to 12.5% for complete corrections. Mortality rate and achieved surgical results in treatment of chil?dren with cyanotic heart diseases were significantly worse than those published by leading cardiac surgery centers in the world. However, there is a clear tendency in introducing new surgical procedures, lowering the age at which the operation is done and decreasing the mortality rates.

scholarly journals One-year postoperative mortality rate among the elderly with hip fractures at a single tertiary care center

2020 ◽  
Vol 40 (4) ◽  
pp. 298-304
Author(s):  
Khalid A. Alsheikh ◽  
Firas M. Alsebayel ◽  
Faisal Abdulmohsen Alsudairy ◽  
Abdullah Alzahrani ◽  
Ali Alshehri ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Mortality Rate ◽  
Hip Fractures ◽  
Surgical Intervention ◽  
Care Center ◽  
Tertiary Care ◽  
The Elderly ◽  
Tertiary Care Center ◽  
Factors Associated ◽  
One Year

ABSTRACT BACKGROUND: Hip fractures are one of the leading causes of disability and dependency among the elderly. The rate of hip fractures has been progressively increasing due to the continuing increase in average life expectancy. Surgical intervention is the mainstay of treatment, but with an increasing prevalence of comorbid conditions and decreased functional capacity in elderly patients, more patients are prone to postoperative complications. OBJECTIVES: Assess the value of surgical intervention for hip fractures among the elderly by quantifying the 1-year mortality rate and assessing factors associated with mortality. DESIGN: Medical record review. SETTING: Tertiary care center. PATIENTS AND METHODS: All patients 60 years of age or older who sustained a hip fracture between the period of 2008 to 2018 in a single tertiary healthcare center. Data was obtained from case files, using both electronic and paper files. MAIN OUTCOME MEASURES: The 1-year mortality rate for hip fracture, postoperative complications and factors associated with mortality. SAMPLE SIZE: 802 patients. RESULTS: The majority of patients underwent surgical intervention (93%). Intra- and postoperative complications were 3% and 16%, respectively. Four percent of the sample died within 30 days, and 11% died within one year. In a multivariate analysis, an increased risk of 1-year mortality was associated with neck of femur fractures and postoperative complications ( P =.034, <.001, respectively) CONCLUSION: The 1-year mortality risk in our study reinforces the importance of aggressive surgical intervention for hip fractures. LIMITATION: Single-centered study. CONFLICT OF INTEREST: None.

scholarly journals Therapeutic effect of nifedipine combined with enalapril on elderly patients with coronary heart disease complicated with hypertension

2018 ◽  
Vol 2 (6) ◽  
Author(s):  
Xiaoye Wang
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Elderly Patients ◽  
Adverse Reactions ◽  
Effective Rate ◽  
Control Group ◽  
Significant Difference ◽  
Pre Treatment ◽  
Experimental Group

【Abstract】Objective: Toanalyze the efficacy of combined drug therapy for elderly patients with coronary heart disease and hypertension.METHODS:Sixty-six elderly patients with coronary heart disease and hypertension were enrolled from December 2017 to November 2018. They were randomly divided into two groups, 33 patients in each group. Patients in the experimental group received nifedipine. In combination with enalapril, patients enrolled in the control group received nifedipine monotherapy.RESULTS:Compared with the control group, the total effective rate, Serum Nitric Oxide (Serum NO) after treatment, CRP after treatment, HCY after treatment, and blood pressure after treatment were significantly improved (P<0.05). Serum NO and treatment before treatment in the 2 groups. There was no significant difference in pre-CRP, pre-treatment HCY, pre-treatment blood pressure, and adverse reactions during treatment (P>0.05).Conclusion: Theelderly patients with coronary heart disease and hypertension are treated with nifedipine and enalapril.

Is Gastrectomy Safe in the Elderly? A Single Institution Review

2011 ◽  
Vol 77 (4) ◽  
pp. 488-492 ◽  
Author(s):  
Eric S. Hager ◽  
Hamid Abdollahi ◽  
Albert G. Crawford ◽  
Neil Moudgill ◽  
Ernest L. Rosato ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Gastric Resection ◽  
Tertiary Care ◽  
The Elderly ◽  
The United States ◽  
Mortality Rates ◽  
Significant Difference ◽  
Group A ◽  
Group B

The population of the United States is aging. Studies within the last several years have demonstrated that major abdominal operations in elderly patients can be done safely, but with increased rates of complications. We set out to determine the rates of morbidity and mortality in elderly patients undergoing gastric resection at a tertiary care university hospital. A retrospective analysis was performed of 157 consecutive gastric resections between January 1998 and July 2007. Group A (n = 99) consisted of patients < 75-years-old at surgery, whereas group B (n = 58) included patients who were ≥ 75 years of age at time of surgery. These two groups had their clinical and demographic data analyzed. Postoperative length of hospital stay, perioperative major morbidity, and in-hospital mortality were analyzed using analysis of variance, χ2, and multivariate analyses. The average age of patients in group A was 57 years, compared with 81 years in group B. We found no significant difference in the percentage of gastric resections for malignancy (group A, 49% vs group B, 62%) or emergency surgery (group A, 10% vs group B, 10%) between age groups. There was a significant increase in length of stay in the older patients (11.7 days vs 17.6 days; P = 0.032), as well as major complications (11.1% in group A vs 27.6% in group B; P = 0.008). The in-hospital mortality rates approached significance (group A, 4% vs group B, 12%; P = 0.057). Gastric resection in elderly patients carries with it longer hospital stays, higher risk of complications, and in-hospital mortality rates despite similarity in patient disease. This information is imperative to convey to the elderly patients in the preoperative period before gastric resection.

Impact of ischemic heart disease and atrial fibrillation on survival after spontaneous intracerebral hemorrhage

2008 ◽  
Vol 108 (6) ◽  
pp. 1172-1177 ◽  
Author(s):  
Sami Tetri ◽  
Liisa Mäntymäki ◽  
Seppo Juvela ◽  
Pertti Saloheimo ◽  
Juhani Pyhtinen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Mortality Rate ◽  
Intracerebral Hemorrhage ◽  
Ischemic Heart Disease ◽  
Mortality Rates ◽  
Ischemic Heart ◽  
University Hospital ◽  
Spontaneous Intracerebral Hemorrhage

Object The well-known predictors for increased early deaths after spontaneous intracerebral hemorrhage (ICH) include the clinical and radiological severity of bleeding as well as being on a warfarin regimen at the onset of stroke. Ischemic heart disease and atrial fibrillation may also increase early deaths. In the present study the authors aimed to elucidate the role of the last 2 factors. Methods The authors assessed the 3-month mortality rate in patients with spontaneous ICH (453 individuals) who were admitted to the stroke unit of Oulu University Hospital within a period of 11 years (1993–2004). Results The 3-month mortality rate for the 453 patients was 28%. The corresponding mortality rates were 42% for the patients who had ischemic heart disease and 61% for those with atrial fibrillation on admission. The following independent predictors of death emerged after adjustment for sex and the use of warfarin or aspirin at the onset of ICH: 1) ischemic heart disease (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.12–2.48, p < 0.02); 2) atrial fibrillation on admission (HR 1.79, 95% CI 1.12–2.86, p < 0.02); 3) the Glasgow Coma Scale score on admission (HR 0.82 per unit, 95% CI 0.79–0.87, p < 0.01); 4) size of hematoma (HR 1.11 per 10 ml, 95% CI 1.07–1.16, p < 0.01); 5) intraventricular hemorrhage (HR 2.62, 95% CI 1.71–4.02, p < 0.01); 6) age (HR 1.04 per year, 95% CI 1.02–1.06, p < 0.01); and 7) infratentorial location of the hematoma (HR 1.93, 95% CI 1.26–2.97, p < 0.01). Conclusions Both ischemic heart disease and atrial fibrillation independently and significantly impaired the 3-month survival of patients with ICH.

scholarly journals Single and Repeated Episodes of Candida Species Isolated From Cerebrospinal Fluid for Diagnosing Probable Candida meningitis

2021 ◽  
Vol 12 ◽  
Author(s):  
Lijun Xu ◽  
Handan Zhao ◽  
Minghan Zhou ◽  
Guanjing Lang ◽  
Haiyan Lou
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Odds Ratio ◽  
Mortality Rates ◽  
External Ventricular Drainage ◽  
Antifungal Treatment ◽  
Radiological Imaging ◽  
Vp Shunt ◽  
Factors Associated ◽  
Significant Difference

Background: The clinical relevance of single or repeated episodes of Candida spp. in cerebrospinal fluid (CSF) in adult patients is debatable.Methods: Forty-two patients with positive Candida episodes in CSF were enrolled in this retrospective study.Results: A total of 42.9% (18/42) were determined to have probable Candida meningitis (PCM). Neurosurgery [odds ratio (OR) (95% confidence interval), OR: 14.4 (1.6–126.1), P = 0.004], lumbar drainage [OR: 5.8 (1.5–23.3), P = 0.009], VP shunt [(OR: 5.6 (1.2–25.8), P = 0.020)], external ventricular drainage [OR: 4.7 (1.3–17.7), P = 0.018], CRP ≥ 10.0 mg/L [OR: 4.9 (1.3–18.1), P = 0.034], and postsurgical broad-spectrum antibiotics [OR: 9.5 (1.8–50.5), P = 0.004] were risk factors associated with PCM. A single CSF Candida episode for the diagnosis of PCM had 7.7% (0.4–37.9%) sensitivity and 20.7% (8.7–40.3%) specificity, whereas repeated episodes of Candida had 66.7% (41.2–85.6%) sensitivity and 95.8% (76.9–99.8%) specificity. No significant difference was found in radiological imaging or CSF profiles between PCM and non-PCM patients. A total of 37.5% (9/24) of patients without PCM received empirical antifungal treatment, and 88.9% (16/18) of patients with PCM received preemptive antifungal treatment. PCM patients had hospitalized mortality rates of 50.0% (9/18). The odds ratio of mortality was 23.0 (2.5–208.6) for PCM patients compared with non-PCM patients (P = 0.001).Conclusion: Both single and repeated positive CSF samples have low validity for the diagnosis of PCM, suggesting that novel strategies for diagnosis algorithms of PCM are urgently needed. Empirical antifungal treatment should be started immediately for suspicious patients with risk factors.

scholarly journals Factors Associated with Severe Lower Respiratory Tract Infection from Respiratory Syncytial Virus (RSV) in Thai Children

2021 ◽  
Vol 73 (12) ◽  
pp. 808-814
Author(s):  
Atipotsawee Tungsupreechameth ◽  
Klaita Srisingh
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Hospital Stay ◽  
Logistic Model ◽  
Congenital Heart ◽  
Clinical Manifestations ◽  
Factors Associated ◽  
Duration Of Hospital Stay ◽  
Significant Difference ◽  
Syncytial Virus

Objective: To determine the factors associated with severe ALRTI from RSV in children.Materials and Methods: A retrospective study of children aged 1-60 months were conducted from 2014 to 2018. Out of 269 patients diagnosed with RSV ALRTI, 100 children were enrolled in the study, 20 had severe RSV ALRTI, while 80 had non-severe RSV ALRTI as identified by the ReSVinet scale. A multivariable logistic model was conducted to select significant variables.Results: During the study period, 269 patients were diagnosed with RSV ALRTI. Mean age was 10.45 ± 3.53 months. Clinical manifestations of severe RSV ALRTI group had significant difference in abnormal general condition (P < 0.001), tachypnea (P < 0.001), SpO2 < 85% (P < 0.001), poor air entry in lungs (P < 0.001), and retraction (P < 0.001). The factors associated with severe RSV ALRTI group, were underlying congenital heart disease [aOR32.45; 95% CI 3.38-311.87, P = 0.003] and duration of hospital stay >5 days [aOR 19.56; 95% CI 1.81-212.05, P = 0.014].Conclusion: Factors associated with severe RSV ALRTI in children were underlying congenital heart disease andduration of hospital stay >5 days.

scholarly journals A study on transformation in infant mortality rates in India: mortality indicators as major tool for indicating status of nation’s health

2020 ◽  
Vol 7 (3) ◽  
pp. 647
Author(s):  
Chandramohan Reddy S. ◽  
Dharna Reddy
Keyword(s):  
Mortality Rate ◽  
Infant Mortality ◽  
Sex Ratio ◽  
Rural Areas ◽  
Population Change ◽  
Principal Component ◽  
Mortality Rates ◽  
Infant Mortality Rate ◽  
P Value ◽  
Significant Difference

Background: Mortality is important to study population change in the country; infant mortality is considered as principal component balancing the child sex ratio. In this study authors aimed to analyze how mortality rates and child sex ratios are different in urban and rural areas and how its growth statistics are changing over years. Objectives of the study were to quantify infant mortality rates change over time and check the means among mortality indicators.Methods: The study was conducted using secondary data obtained from various issues and reports published by Registrar General and Census Commissioner, India for a period of 10 years from 2006 to 2016. The obtained data on mortality indicators were subjected to basic statistical analysis using percent change and paired t-test.Results: The Infant mortality rate which was reduced by 23 points indicating reduction of 67.65 percent control over a period from 2006 to 2016. Further, results show that, in case of urban mortality, there was significant difference between mortality indicators during study period, the p-value (0.011) was less than level of significance (0.05) so we reject the null hypothesis and it is concluded that there is significant difference between the means of urban mortality indicators over a period of from 2006 to 2016.Conclusions: The infant mortality rate frequently provided as a key indicator of overall the development. There is need for stable child sex ratio; health of children and women are essential for better growth and reaching stable child sex ratio for the ever increasing population.

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