Treatment of Intertrochanteric Fracture of the Femur with Ender Nail in the Elderly Patients with High Risk of Anesthesia

Abstract Objective The purpose of this study was to investigate the incidence, location, and related factors of deep venous thrombosis (DVT) of the bilateral lower extremities after intertrochanteric fractures in the elderly. Methods Retrospective analysis was performed on the elderly patients with intertrochanteric fracture who were admitted from January 2017 to December 2019. At admission, patients receive routine ultrasound Doppler scanning of bilateral lower extremities to detect DVT; those with DVT were assigned to the case group and those without DVT to the control group. Patient data on demographics, comorbidities, injury-related data, and laboratory test results at admission were extracted. Logistic regression analyses were conducted to identify the independent risk factors associated with DVT. Results Five hundred seventy-eight patients were included, among whom 116 (20.1%) had DVT. Among those with DV, 70.7% (82/116) had DVT of the distal type, 24 (29.6%) had DVT of the proximal type, and 10 (10.4%) had mixed DVT. In 76.7% (89/116) of patients, DVT occurred in the fractured extremity, 9.5% (11/116) in the bilateral and 13.8% (16/116) in the non-fractured extremity. Multivariate analyses identified obesity, delay to admission, increased D-dimer level (> 1.44 mg/L) and reduced albumin (< 31.7 g/L) as independent factors. Conclusions Admission incidence of DVT was high in elderly patients with intertrochanteric fractures, especially the proximal DVT. Identification of associated risk factors is useful for individualized assessment risk of DVT and early targeted interventions.

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P1558Clinical utility of the PRECISE-DAPT score in the prediction of hemorrhagic events in elderly patients with acute coronary syndrome

European Heart Journal ◽

10.1093/eurheartj/ehz748.0318 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Rioboo ◽

E Abuassi Alnakeeb ◽

S Raposeiras Roubin ◽

I Munoz Pousa ◽

M Cespon Fernandez ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Elderly Patients ◽

Age Groups ◽

Bleeding Event ◽

Bleeding Risk ◽

The Elderly ◽

Coronary Syndrome ◽

Risk Of Bleeding ◽

Risk Patients

Abstract Introduction The clinical utility and validity of the PRECISE-DAPT bleeding risk score for elderly patients with acute coronary syndrome (ACS) is unknown. We investigated the previous aspect in a contemporary population treated with percutaneous coronary intervention (PCI) and dual antiplatelet therapy (DAPT) at discharge. Methods Retrospectively, from 2010 to 2016, we studied 3,814 consecutive patients with the diagnosis of ACS. All patients were treated with in-hospital PCI and DAPT at discharge. Elderly was defined if patients aged ≥75 years. Patients were categorized into three risk strata according to their PRECISE-DAPT score (very low-low: <17 points, moderate: 18–24 points, and high risk: ≥25 points). We included the first bleeding event occurred during the first year after discharge. Bleeding events were defined according to the BARC classification system, and divided into two subgroups: BARC 2–5 and BARC 3–5. The ability to separate high bleeding risk patients from lower bleeding risk patients was checked by the cumulative incidence function curves and compared using the Fine-Gray test, thus adjusting for death (non-bleeding related) as a competing risk. Discrimination (C statistic) and calibration (Hosmer-Lemeshow test) were used to test the predictive capacity of the score in pts aged ≥75 years and <75 years. Results 25.2% (n=961/3814) were ≥75 years old, 38.4% of them were women. DAPT duration was 11.5 (interquartile range [IQR] 2.5–13.7) vs. 12.0 (RIQ 8.2–14.1) months in the elderly vs. younger; (p<0.001). 92.5% (n=889) of the elderly were at high risk of bleeding (PRECISE-DAPT≥25 points), compared to 21.3% (n=607) of the youngest. The incidence of BARC 2–5 and BARC 3–5 was 7.4% and 2.7% in the elderly compared to 5.1% and 1.4% among the younger patients (p<0.001). The figure shows the ability of the PRECISE-DAPT score at capturing the risk of BARC 2–5 bleeding (panel A and B), in both age groups. Using the cut-off point ≥25, the effect in the prediction of BARC 2–5 bleeding and BARC 3–5 did not differ significantly between the elderly and those <75 years: sHR = 1.9 (95% CI: 1.2–6.00) in the elderly vs. 1.8 (95% CI: 1.3–2.5) in the other group (p=0.99) and sHR = 3.3 (95% CI: 1.9–6.0) vs. 3.6 (95% CI: 1.9–6.7) (p=0.83), respectively. There were no significant differences between the elderly and those under 75 years in terms of statistical C values either for BARC 2–5 bleeding (0.60 vs. 0.58) or BARC 3–5 bleeding (0.64 vs. 0.67). The score performed well in term of calibration in both groups (all p-values >0.3). Conclusion Although the use of PRECISE-DAPT resulted in classifying the majority of elderly patients at high risk of bleeding and despite exhibiting modest discriminative power, it performed well at classifying patients according to their risk of 1-year out-of-hospital bleeding in both age groups. PRECISE-DAPT appears to identify the truly low risk patients among the elderly, as compared to the younger group.

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Abstract TMP105: High Utilization Of CAS Procedures Among The Elderly In The Post Crest Era

Stroke ◽

10.1161/str.44.suppl_1.atmp105 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Mahmoud Rayes ◽

Pratik Bhattacharya ◽

Rahul Damani ◽

Seemant Chaturvedi

Keyword(s):

High Risk ◽

Elderly Patients ◽

Medical Center ◽

Significant Proportion ◽

The Elderly ◽

Carotid Revascularization ◽

Choice Of Procedure ◽

Asymptomatic Patients ◽

Risk Criterion ◽

Specific Symptoms

Background: An important interaction of age with outcome was revealed in Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) where elderly patients ≥70 years had worse outcomes with Carotid stenting (CAS) than with Endarterectomy (CEA). Our hypothesis was that following the CREST study, the proportion of CAS procedures in the elderly would decrease. Methods: We performed a retrospective review of carotid revascularization procedures between June 2009 and April 2012 at a large volume urban medical center. Demographics, indications, surgical high-risk criteria and outcomes of in-hospital stroke/death/MI were collected. Data analysis was performed in subjects over 70 years. Time trends were examined in the post-CREST period. Results: A total of 701 procedures (CEA 36%, CAS 64%) were performed during the study period, of which 360 (51.4%) were in patients ≥70 years (CEA 33%, CAS 67%). A significant proportion (22.1%) was in those ≥80 years. The choice of procedure did not change following CREST. The majority of CAS procedures in elderly (90.8%) were performed by cardiologists. Asymptomatic patients (47.3%) and patients with non-specific symptoms (18.7%) comprised a large proportion of this subgroup. A third of elderly patients with asymptomatic and nonspecific symptoms did not have any surgical high-risk criterion. The proportion of elderly patients receiving CAS for non-specific symptoms increased progressively over time post CREST (27.9% in the most recent months). A similar rise in non-specific indications was noted in the subgroup of patient ≥80 years receiving CAS. About half of this subgroup did not have any surgical high-risk criterion. Conclusion: Two years after CREST results, CAS continues to be performed among the elderly, often for non-specific symptoms or in asymptomatic patients. The lack of a decrease in CAS procedures in the elderly raises questions about whether evidence-based carotid revascularization occurs in the real world.

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Type 2 diabetes mellitus in elderly patients treated with endocrinologists in clinical practice

Diabetes Mellitus ◽

10.14341/dm10315 ◽

2020 ◽

Vol 22 (6) ◽

pp. 582-591

Author(s):

Elena V. Biryukova

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

High Risk ◽

Elderly Patients ◽

Large Scale ◽

The Elderly ◽

Modern Medicine ◽

Aged Patients

A large-scale epidemic of type 2 diabetes mellitus (T2DM) is observed with advanced ageing worldwide. The prevalence of T2DM significantly increases with age. Therefore, this review aimed to summarise the data on T2DM in advanced and older aged patients. The primary geriatric syndromes, which should be considered for the management of older patients (cognitive impairment, sarcopenia, orthostatic hypotension, falls, urinary incontinence, senile asthenia, etc.), are presented. The causes of the high risk for hypoglycaemia in elderly patients are analysed. Improving the treatment for T2DM is a priority of modern medicine. Using antihyperglycaemic therapy is especially difficult in this population due to the high risk of hypoglycaemia and the multi-organ pathology leading to polypharmacy. Therefore, special attention is paid to treatment recommendations. Hypoglycaemic drugs used in elderly patients should be low risk of hypoglycaemia, without nephro- and hepatic toxicity, safe for cardiovascular organs, easy to administer. Furthermore, advantages and limitations of using various groups of hypoglycaemic drugs in elderly patients are discussed. DPP-4 inhibitors are also considered in detail. Modern data on mechanisms of hypoglycaemic action of DPP-4 inhibitors are presented. Possibilities of using sitagliptin in elderly patients were also considered. Finally, evidence-based studies demonstrating the obvious advantages of sitagliptin for the treatment of T2DM in the elderly and advanced aged population are discussed.

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The Perioperative Nursing of Treating the Elderly Patients of Femoral Intertrochanteric Fracture with PFNA

Journal of Nursing ◽

10.18686/jn.v4i1.1 ◽

2015 ◽

Vol 4 (1) ◽

pp. 1

Author(s):

Ying Zhang

Keyword(s):

Elderly Patient ◽

Elderly Patients ◽

Intertrochanteric Fracture ◽

Perioperative Period ◽

The Elderly ◽

Good Recovery ◽

Surgical Risk ◽

Perioperative Nursing ◽

Femoral Intertrochanteric Fracture ◽

Pull Through

Objective: Summarize the perioperative nursing of the elderly patient of femoral intertrochanteric fracture. Method: Retrospectively analyze the preoperative preparations as well as the postoperative nursing of treating the 75 elderly patients of femoral intertrochanteric fracture with PFNA. Results: Those 75 patients all pull through perioperative period and their functions are in good recovery. Conclusion: The elderly patient of femoral intertrochanteric fracture has much surgical risk together with many complications during perioperative period. Adopting effective comprehensive nursing can improve the treatment effect of the operation, and can also reduce the complications.

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Research Progress of Nursing Care for Elderly Patients With Complicating Postoperative Hip Fracture Deep Vein Thrombosis in China

International Journal of Studies in Nursing ◽

10.20849/ijsn.v6i4.948 ◽

2021 ◽

Vol 6 (4) ◽

pp. 81

Author(s):

Dandan Zheng ◽

Wentao Cheng ◽

Heyu Wu ◽

Haichao Wu ◽

Yuqi Cao

Keyword(s):

Deep Vein Thrombosis ◽

Hip Fracture ◽

High Risk ◽

Elderly Patients ◽

The Elderly ◽

Nursing Intervention ◽

Psychological State ◽

Research Progress ◽

Vein Thrombosis ◽

Deep Vein

Introduction: The aging of China's population has further deepened, and according to the results of the seventh national census, the population aged 60 years and above in China was 264.02 million, accounting for 18.70% (China.2021).The rapid growth of the elderly population has led to an increase a geriatric orthopedic morbidity. The hip fracture is one of the common orthopedic diseases, which has posed a severe threat to the elderly's life and health (Yu, 2019).Purpose: In this study, we investigated the domestic and international literature, focusing on the analysis of DVT nursing prevention programs for elderly patients after hip arthroplasty, and proposed the current nursing research progress in preventing DVT to help elderly patients actively cope with DVT, improve the quality of life in later life, and make DVT a truly preventable disease.Method: Electronic searches using scholarly databases were employed and only significant articles that met the review objective were utilized.Findings: Currently, the main treatment option for hip fracture patients in clinical practice is surgery, and how to prevent Deep Vein Thrombosis (DVT) is an important task in the postoperative care of elderly orthopedic patients (Li, 2016). Research studies have shown that all elderly patients are at a very high risk of DVT during hospitalization, but the current trend is that 50% of patients at high risk of thrombosis are still not actively and effectively prevented from developing thrombosis for various reasons.Conclusion: This disease, which has a high incidence, a high mortality rate, and is difficult to prevent, requires increased attention and necessitates exploration to derive effective nursing intervention programs and related nursing measures to prevent reduce the formation of DVT and alleviate suffering for patient (Xu, 2016).In this review, we summarized the main nursing methods for preventing deep vein thrombosis of the lower extremities after hip fracture surgery in the elderly. Elderly patients are a special group of people, both physically and psychologically in a relatively fragile state, especially after the operation, so they need to be more careful in nursing work. In addition to general physical care, the care of their psychological state is also extremely important. This article describes in detail the physiological and psychological nursing interventions for patients, which can effectively guide and help medical staff to cope with the clinical care of such patients, and enable patients to better recover from surgery and trauma, and obtain a good prognosis.

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Azacitidine Plus Gemtuzumab Ozogamicin (GO): A Novel Combination in the Treatment of Acute Myeloid Leukemia (AML) and High-Risk Myelodysplastic Syndromes (MDS) in the Elderly.

Blood ◽

10.1182/blood.v108.11.1981.1981 ◽

2006 ◽

Vol 108 (11) ◽

pp. 1981-1981 ◽

Cited By ~ 3

Author(s):

Sucha Nand ◽

John Godwin ◽

Scott Smith ◽

Kevin Barton ◽

Eliza Germano ◽

...

Keyword(s):

High Risk ◽

Elderly Patients ◽

Residual Disease ◽

The Elderly ◽

Gemtuzumab Ozogamicin ◽

Outpatient Setting ◽

Grade 3 ◽

Wbc Count ◽

Related Mortality

Abstract AML and high-risk MDS in the elderly carry a poor prognosis. Only 46% of AML patients receiving standard chemotherapy achieve complete remission (CR) and treatment-related mortality approaches 30% above age 60. In 2005, we initiated a Phase II trial for elderly patients with newly diagnosed AML or MDS, using the following outpatient treatment schema: If white blood cell (WBC) count at presentation was >10,000/ul, pt was started on hydroxyurea 1500 mg twice daily by mouth. Leukapheresis was performed if WBC >100,000/ul. Once WBC count was <10,000/ul, the patient received azacitidine 75 mg/m2 s/cu D1–7 and GO 3 mg/m2 on D8. A bone marrow was performed on D14 and induction therapy repeated for residual disease. Those who achieved CR were given one consolidation treatment with azacitidine+GO in same doses after recovery of blood counts. A total of 13 pts have been treated to date. Eleven had AML by WHO classification and 2 MDS (both RAEB). The median age was 77 (62–83) and 7 were male. Ten patients required retreatment on D14. Ten patients (76%) achieved CR. Six patients developed grade 3 toxicities: 5 neutropenic fever and 1 typhlitis, all requiring hospitalization. There were no treatment-related deaths. Median follow up is 7 months (2–13 months) and eleven patients remain alive. Two patients have died from relapsed or refractory disease. Nine patients remain in CR with a median duration of remission of 7 months (2–13 months). The trial is ongoing with an accrual goal of 20. Our early experience with this novel combination is quite encouraging. Cytoreduction with hydroxyurea and leukapheresis followed by azacitidine and GO appears to be a safe and effective regimen for elderly patients with AML and the therapy can be given in the outpatient setting. These preliminary results need to be confirmed in a larger cohort of patients.

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80% Dose R-CHOP Is Suitable Chemotherapy for Very Elderly Patients with DLBCL

Blood ◽

10.1182/blood.v126.23.5094.5094 ◽

2015 ◽

Vol 126 (23) ◽

pp. 5094-5094

Author(s):

Anna Takahashi ◽

Yuko Mishima ◽

Norihito Inoue ◽

Yoshiharu Kusano ◽

Tadahiro Gunji ◽

...

Keyword(s):

High Risk ◽

Elderly Patients ◽

Dose Group ◽

Risk Group ◽

The Elderly ◽

Very Elderly ◽

Full Dose ◽

Risk Patients ◽

Grade 3 ◽

Chop Therapy

Abstract Introduction: R-CHOP therapy is standard chemotherapy for DLBCL. In the LNH98-5 study, CR was 75% and 5-year EFS was 63% in low-risk patients and 41% in high-risk patients. Five-year OS was 80% in the low-risk group, and 48% in the high-risk group. R-CHOP is tolerable and commonly applied to outpatients. However, almost 20% of patients with DLBCL were very elderly, 75 years of age or more. Chemotherapy for very-elderly patients often causes many troubles, and thus the prognosis is worse than those of younger patients. The dose of R-CHOP therapy for the elderly patients varies among institutions because there are no suitable guidelines for it. Therefore, the optimal dose of R-CHOP therapy is needed to be determined to improve the outcome of the elderly patients with DLBCL. Methods: We reviewed the clinical records of 91 newly-diagnosed very-elderly (≥75 years) patients with DLBCL. All of the patients were diagnosed by hematopathologists, and treated with R-CHOP-based chemotherapy in our hospital from 2005 to 2015. Clinical stage and the effect of therapy were evaluated with PET/CT scan. Statistical analyses were performed with a software, EZR version 1. Results: The total number of patients with DLBCL in the study period was 373, including 91 very-elderly patients (24%). The characteristics of very elderly patients were following; the median age was 78 years (range 75-86), the median follow-up period was 1,068 days (range 39-2,989), 49 (54%) were male, 38 (43%) were at stage III or IV, 39 (43%) had IPI high or intermediate risk, bulky disease (≥10 cm) was observed in 18 (20%), and 75 (82%) showed ECOG PS 0 or 1. Twenty-six patients (29%) were treated with R-CHOP at full dose, 64 patients (70%) at 80%, and one was at 70%. In the 80% R-CHOP group, the dose was decreased to 70% in 5 patients, because of severe adverse events (febrile neutropenia in three, grade 3 nausea and grade 3 weakness, each in one). The median ages of patients were 76 years in the full dose group (range 75-79) and 78 years in the 80% dose group (range 75-86). In the all very-elderly patients, 5-year OS was 66% (95% CI, 52-77%) and 5-year PFS was 68% (95% CI, 55-78%). CR was achieved in 73% in the full-dose group, and 67% in the 80% dose group. Five-year OS were 77% in the full-dose group, and 61% in the 80% dose group (P=0.129). Five-year PFS were 82% in the full-dose group, and 63% in the 80% dose group (P=0.117). Five-year OS were 100% in the IPI low group, 65% in the low- and high-intermediate groups, 0% in the high group (P<0.001). Twenty-six patients died: 13 for progression of lymphoma, 7 for other diseases, and 6 for unknown causes. All patients with 5 IPI indexes died of lymphoma. Twenty-one patients completed the therapy (81%) in the full-dose R-CHOP group, and 55 (86%) in the 80% R-CHOP group. In the 14 patients who could not complete the therapy, 7 achieved CR without relapse. The most frequent adverse event was hematological toxicity. Neutropenia at grade 3 or 4 was observed in 17 (19%), and febrile neutropenia in 12 (13%). No treatment-related deaths were observed. Conclusions: In the very elderly patients, there were no significant differences in 5-year OS and PFS between the full-dose R-CHOP and the 80% R-CHOP groups. Prognosis was very poor for the patients with IPI high risk, especially with 5 IPI indexes. Our data suggested that 80% dose R-CHOP is enough tolerable and effective to very elderly patients with DLBCL categorized in IPI high-intermediate or lower risks. Disclosures Mishima: Chugai Pharmaceutical CO., LTD.: Consultancy. Nishimura:Chugai Pharmaceutical CO., LTD.: Consultancy. Yokoyama:Chugai Pharmaceutical CO., LTD.: Consultancy. Hatake:Chugai Pharmaceutical CO., LTD.: Other: lecture speaking.

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Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2793-8 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 4

Author(s):

Shenghu Zhou ◽

Jun Liu ◽

Ping Zhen ◽

Weiwei Shen ◽

Yanfeng Chang ◽

...

Keyword(s):

Postoperative Complications ◽

Elderly Patients ◽

Intertrochanteric Fracture ◽

Operation Time ◽

The Elderly ◽

Proximal Femoral Nail ◽

Bipolar Hemiarthroplasty ◽

Intertrochanteric Fractures ◽

Intraoperative Bleeding ◽

Femoral Intertrochanteric Fracture

Abstract Background The treatment for unstable intertrochanteric fractures in the elderly has always been a controversial issue. The aim in this study was to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (CPH) on femoral intertrochanteric fracture in the elderly. Methods From March 2008 to December 2012, 108 elderly patients with femoral intertrochanteric fractures were treated by PFNA or CPH. There were 63 males and 45 females, aged 75.3–99.1 years [(83.7 ± 5.6) years]. The patients’ bone mineral density was routinely measured, and the fractures were classified according to Evans-Jensen. The patients were divided into CPH group and PFNA group. The differences in operation time, intraoperative bleeding, immobilization duration, hospitalization time, Harris scores and postoperative complications including deep venous thrombosis, lung and urinary infection were analyzed. Results All patients were followed for 12.5–36.2 months [(28.0 ± 6.3) months)]. The operation time was (53.7 ± 15.2) min and (77.5 ± 16.8) min in PFNA group and CPH group, respectively (P < 0.05); intraoperative bleeding was (132.5 ± 33.2) mL and (286.3 ± 43.2) mL, respectively (P < 0.05); immobilization duration was (28.2 ± 3.7) days and (3.1 ± 1.2) days, respectively (P < 0.05); hospitalization time was (7.6 ± 1.8) days and (6.9 ± 2.2) days, respectively (P > 0.05); and the Harris scores after 1 year were (87.7 ± 7.9) points and (88.3 ± 9.2) points, respectively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusion Both PFNA and CPH are safe and effective treatments for femoral intertrochanteric fracture in elderly patients. Nonetheless, CPH allows faster mobilization and recovery. Trial registration Registration Number: ChiCTR1900022846. Reg Date:2019-04-26 00:27:33 Retrospective registration

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The Role of Preoperative Computed Tomography on the Quality of Reduction and Outcomes in Intertrochanteric Fracture: A Controlled Trial

BioMed Research International ◽

10.1155/2021/8854292 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Tao Ma ◽

Lin-Jie Hao ◽

Peng-Fei Wen ◽

Ya-Kang Wang ◽

Hu Wang ◽

...

Keyword(s):

Elderly Patients ◽

Intertrochanteric Fracture ◽

Controlled Trial ◽

The Elderly ◽

Ct Examination ◽

Preoperative Ct ◽

And Function

Purpose. The study is aimed at assessing the role of preoperative computerised tomography (CT) examination in the quality of reduction and outcomes in elderly patients with intertrochanteric fracture. Methods. The elderly patients with an intertrochanteric fracture who were treated with proximal femoral nail antirotation were included. The patients were divided into the CT group and the no-CT group according to the presence of preoperative CT examination. Patients’ baseline characteristics, quality of reduction, and function were recorded at follow-up. Functional outcomes were evaluated using the Harris hip scores (HHS). Results. Totally, the study included 182 patients with intertrochanteric fractures, with 85 in the CT group and 97 in the no-CT group, admitted between January 2018 and June 2019. There was no difference in the quality of reduction, HHS, the fracture healing, or postoperative complications between the CT group and the no-CT group. However, the CT group experienced the shorter mean operative time and blood transfusion, compared to the no-CT group. Conclusions. The preoperative CT examination seems to be excessive for elderly patients with an intertrochanteric fracture.

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