Low haemoglobin at admission is associated with mortality after hip fractures in elderly patients

2019 ◽  
Vol 101-B (9) ◽  
pp. 1122-1128 ◽  
Author(s):  
Jean C. Yombi ◽  
Dan C. Putineanu ◽  
Olivier Cornu ◽  
Patricia Lavand’homme ◽  
Pascale Cornette ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Hip Fracture Surgery ◽  
Short And Long Term ◽  
Male Patients ◽  
One Year

Aims Low haemoglobin (Hb) at admission has been identified as a risk factor for mortality for elderly patients with hip fractures in some studies. However, this remains controversial. This study aims to analyze the association between Hb level at admission and mortality in elderly patients with hip fracture undergoing surgery. Patients and Methods All consecutive patients (prospective database) admitted with hip fracture operated in a tertiary hospital between 2012 and 2016 were analyzed. We collected patient characteristics, time to surgery, duration and type of surgery, comorbidities, Hb at admission, nadir of Hb after surgery, the use and amount of red blood cells (RBCs) transfusion products, postoperative complications, and death. The main outcome measures were mortality at 30 days, 90 days, 180 days, and one year after surgery. Results We included 829 patients; the mean age was 81 years (sd 11). Mortality at 30 days, 90 days, 180 days, and one year was 5.7%, 12.3%, 18.1%, and 23.5%, respectively. The highest mortality was observed in patients aged over 80 years (162/557, 29%) and in male patients (85/267, 32%). Survival at 90 days, 180 days, and one year after surgery was significantly lower in patients with a Hb level below 120 g/l at admission. In multivariate analysis, Hb level below 120 g/l at admission was found to be an independent factor associated with mortality (adjusted hazard ratio (aHR) 1.68 (95% confidence interval (CI) 1.22 to 2.31); p = 0.001), along with age (aHR 1.06 (95% CI 1.04 to 1.06); p < 0.001), male sex (aHR 2.19 (95% CI 1.61 to 2.96); p < 0.001), and need for RBC transfusions (aHR 1.10 (95% CI 1.02 to 1.19); p = 0.01). Conclusion Our results suggest that low Hb at admission along with age and RBC transfusions is significantly associated with short- and long-term mortality after hip fracture surgery, independently of comorbidity confounders. Further studies should be performed to understand how preoperative Hb could be taken into account in perioperative management. Cite this article: Bone Joint J 2019;101-B:1122–1128.

Atrial Fibrillation and Mortality in the Oldest Old after Surgery for Hip Fractures

Gerontology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Amit Frenkel ◽  
Vladimir Zeldetz ◽  
Roni Gat ◽  
Yair Binyamin ◽  
Asaf Acker ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Hip Fractures ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Oldest Old ◽  
Postoperative Mortality ◽  
Patient Characteristics ◽  
One Year

Introduction: One-year mortality following hip fractures increases steeply with age, from 2% in the 60- to 69-year-old population up to 28% in the oldest old (older than 90 years). Of the various factors that contribute to hip fractures, atrial fibrillation (AF) is an independent risk factor at any age. Objective: The objective of this study was to assess the association of AF with mortality among the oldest old with hip fractures. Method: This is a retrospective cohort study of 701 persons above age 90 years who underwent orthopedic repair for a hip fracture during 2000–2018. Of them, 218 (31%) had AF at hospital admission. The primary outcome was survival following surgery. We compared patient characteristics and 30-day, 180-day, 1-year, and 3-year survival between patients with and without AF. Results: The adjusted odds ratio for 30-day postoperative mortality for those with AF versus without AF group was 1.03 (95% confidence interval [CI] 0.63–1.66). Survival estimates were higher among those without AF than with AF at 180 days postoperative: 0.85 (95% CI 0.82–0.89) versus 0.68 (95% CI 0.61–0.74), p < 0.001; at 1 year postoperative: 0.68 (95% CI 0.63–0.72) versus 0.48 (95% CI 0.42–0.55), p < 0.001; and at 3 years postoperative: 0.47 (95% CI 0.42–0.52) versus 0.28 (95% CI 0.27–0.34), p < 0.001. Conclusions: Among individuals aged >90 years, operated for hip fractures, mortality was similar for those with and without AF at 30 days postoperative. However, the survival curves diverged sharply after 180 days. Our findings suggest that AF is not an immediate surgical risk factor, but rather confers increased long-term risk in this population.

scholarly journals Simultaneous Hip and Distal Radius Fractures—Does It Make a Difference with Respect to Rehabilitation?

Geriatrics ◽  
2019 ◽  
Vol 4 (4) ◽  
pp. 66
Author(s):  
Emilija Dubljanin-Raspopović ◽  
Marković-Denić Lj ◽  
Marko Kadija ◽  
Sanja Tomanović Vujadinović ◽  
Goran Tulić ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Functional Outcome ◽  
Hip Fractures ◽  
Wrist Fracture ◽  
Wrist Fractures ◽  
Short And Long Term ◽  
Actual Incidence ◽  
Prospective Investigation

Introduction: A minority of patients with hip fractures sustain concomitant wrist fractures. Little is known about the rehabilitation outcome in this group of patients. Aim of study: Prospective investigation of functional outcome and survival in patients with combined hip and wrist fractures compared with patients who sustain an isolated hip fracture. Methods: 341 patients who presented with an acute hip fracture during a 12 month period were included in the study. Outcome at discharge and 4 months follow-up was compared between patients with isolated hip fractures and those patients who sustained simultaneous distal wrist fractures. Results: The actual incidence of concurrent hip and wrist fractures in our cohort was 4.7%. Patients who sustained a concurrent hip and wrist fracture showed no differences regarding short- and long-term functional outcome and survival. Conclusion: Our results imply that patients with simultaneous hip and wrist fractures have no difference in rehabilitative outcome. Future studies should further investigate the distinctive characteristics of this patient subgroup.

scholarly journals Inpatient hip fractures: understanding and addressing the risk of this common injury

2020 ◽  
Vol 49 (3) ◽  
pp. 481-486 ◽  
Author(s):  
Inderpal Singh ◽  
Kate Hooton ◽  
Chris Edwards ◽  
Beverley Lewis ◽  
Anser Anwar ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Care Home ◽  
Patient Characteristics ◽  
Health Board ◽  
Falls Risk ◽  
Inpatient Falls ◽  
One Year ◽  
Home Placement ◽  
The Impact

Abstract Introduction The impact and outcome of hip fractures are well described for people living in the community, but inpatient hip fracture (IHF) have not been extensively studied. In this study, we examine the patient characteristics, common falls risk factors and clinical outcomes of this condition. Methods Between January 2016 and December 2017, we analysed all inpatient falls that resulted in hip fracture within Aneurin Bevan University Health Board (ABUHB) in Wales. Results The overall falls rate was 8.7/1000 occupied bed days (OBD). Over the 2 years, 118 patients sustained an IHF, giving a rate of 0.12/1000 OBD. The mean age was 81.8 ± 9.5 (range 49–97) years and 60% were women. Most patients (n = 112) were admitted from their own home. Mean Charlson Comorbidity Index and the number of medications on admission were 5.5 ± 1.9 and 8.5 ± 3.7, respectively. Fifty-three patients (45%) sustained the IHF following their first inpatient fall. Twenty-four IHF (20%) occurred within 72 h. Mean length of stay was 84.9 ± 55.8 days. Only 43% were discharged back to their original place of residence following an IHF; 27% were discharged to a care home (26 new care home discharges), and 30% died as an inpatient. One-year mortality was 54% (n = 64/118). The most common comorbidity was dementia (63%). Conclusion Mortality and need for care home placement are both much higher after IHF than following community hip fracture. Most people who suffer a hip fracture in hospital have already demonstrated their need for falls risk management by having fallen previously during the same admission.

scholarly journals Acute kidney injury can predict in-hospital and long-term mortality in elderly patients undergoing hip fracture surgery

PLoS ONE ◽  
2017 ◽  
Vol 12 (4) ◽  
pp. e0176259 ◽  
Author(s):  
Seong Eun Hong ◽  
Tae-Young Kim ◽  
Je-Hyun Yoo ◽  
Jwa-Kyung Kim ◽  
Sung Gyun Kim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Kidney Injury ◽  
Hip Fracture Surgery ◽  
Fracture Surgery ◽  
Long Term Mortality

Effect of heart failure on postoperative short and long-term mortality in elderly patients with hip fracture

Injury ◽  
2020 ◽  
Vol 51 (3) ◽  
pp. 694-698 ◽  
Author(s):  
Yong-Han Cha ◽  
Yong-Chan Ha ◽  
Hyun-Jun Ryu ◽  
Young-Kyun Lee ◽  
Sang Hyun Park ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Short And Long Term ◽  
Long Term Mortality

scholarly journals Long-term Patient-reported Quality of Life and Pain After a Multidisciplinary Clinical Pathway for Elderly Patients With Hip Fracture: A Retrospective Comparative Cohort Study

2019 ◽  
Vol 10 ◽  
pp. 215145931984174 ◽  
Author(s):  
Pishtiwan H. S. Kalmet ◽  
Stijn G. C. J. de Joode ◽  
Audrey A. A. Fiddelers ◽  
Rene H. M. ten Broeke ◽  
Martijn Poeze ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Hip Fracture ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Patient Reported Outcome ◽  
Patient Reported

Introduction: There is an increase in incidence of hip fractures in the ageing population. The implementation of multidisciplinary clinical pathways (MCP) has proven to be effective in improving the care for these frail patients, and MCP tends to be more effective than usual care (UC). The aim of this study was to analyze potential differences in patient-reported outcome among elderly patients with hip fractures who followed MCP versus those who followed UC. Materials and Methods: This retrospective cohort study included patients aged 65 years or older with a low-energy hip fracture, who underwent surgery in the Maastricht University Medical Center, Maastricht, the Netherlands. Two cohorts were analyzed; the first one had patients who underwent UC in 2012 and the second one contained patients who followed MCP in 2015. Collected data regarded demographics, patient-reported outcomes (Short Form 12 [SF-12] and the Numeric Rating Scale [NRS] to measure pain), and patient outcome. Results: This cohort study included 398 patients, 182 of them were included in the MCP group and 216 were in the UC group. No differences in gender, age, or American Society of Anesthesiologists classification were found between the groups. No significant differences were found in SF-12 and the NRS data between the MCP group and UC group. In the MCP group, significantly lower rates of postoperative complications were found than in the UC group, but mortality within 30 days and one year after the hip fracture was similar in both groups. Discussion: Although the effects of hip fractures in the elderly on patient-reported outcome, pain and quality of life have been addressed in several recent studies, the effects of MCP on long-term outcome was unclear. Conclusion: A multidisciplinary clinical pathway approach for elderly patients with a hip fracture is associated with a reduced time to surgery and reduced postoperative complications, while no differences were found in quality of life, pain, or mortality.

Policy encouraging earlier hip fracture surgery can decrease the long-term mortality of elderly patients

Injury ◽  
2014 ◽  
Vol 45 (7) ◽  
pp. 1085-1090 ◽  
Author(s):  
Kobi Peleg ◽  
Michael Rozenfeld ◽  
Irina Radomislensky ◽  
Ilya Novikov ◽  
Laurence S. Freedman ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Hip Fracture Surgery ◽  
Fracture Surgery ◽  
Long Term Mortality

scholarly journals Delay to Surgery of Less Than 12 Hours Is Associated With Improved Short- and Long-Term Survival in Moderate- to High-Risk Hip Fracture Patients

2019 ◽  
Vol 10 ◽  
pp. 215145931985314 ◽  
Author(s):  
Markus T. Hongisto ◽  
Maria S. Nuotio ◽  
Tiina Luukkaala ◽  
Olli Väistö ◽  
Harri K. Pihlajamäki
Keyword(s):  
Adverse Effect ◽  
Hip Fracture ◽  
Living Arrangements ◽  
Great Influence ◽  
Term Survival ◽  
Long Term Survival ◽  
Hip Fracture Surgery ◽  
Short And Long Term ◽  
Fracture Surgery

Introduction: The effect of delays before surgery of 24 hours, 48 hours, and 72 hours on short- and long-term survival has been investigated comprehensively in hip fracture patients, but with controversial results. However, there is only limited evidence for how a threshold of 12-hour delay before hip fracture surgery affects survival. Materials and Methods: A prospective observational study of 884 consecutive hip fracture patients (age ≥ 65 years) undergoing surgery was carried out in terms of 30- and 365-day survival. A Cox hazard regression survival model was constructed for 724 patients with American Society of Anesthesiologists score ≥3 with adjustments of age, gender, cognition, number of medications on admission, hip fracture type, and prior living arrangements. Results: Patients who underwent surgery within 12 hours had better chances of survival than did those with 12 to 24 hours (hazard ratio [HR]: 8.30; 95% confidence interval [CI]: 1.13-61.4), 24 to 48 hours (HR: 7.21; 95% CI: 0.98-52.9), and >48 hours (HR: 11.75; 95% CI: 1.53-90.2) delay before surgery. Long-term survival was more influenced by nonadjustable patient features, but the adverse effect of >48 hours delay before surgery was noticed with HR: 2.02; 95% CI: 1.08-3.80. Increased age and male gender were significantly associated with worse short- and long-term survival. Discussion/Conclusions: Early hip fracture surgery within 12 hours of admission is associated with improved 30-day survival among patients with ASA score ≥3. Delay to surgery of more than 48 hours has an adverse effect on 365-day survival, but factors related to patients’ comorbidities have a great influence on long-term survival.

scholarly journals Influences of Dementia on Long-Term Surgical Outcomes in Older Adults After Hip Fracture

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 878-879
Author(s):  
Tingzhong (Michelle) Xue ◽  
Eleanor McConnell ◽  
Chiyoung Lee ◽  
Hideyo Tsumura ◽  
Sijia Wei ◽  
...  
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Surgical Outcomes ◽  
Hip Surgery ◽  
Hip Fracture Surgery ◽  
Discharge Disposition ◽  
Risk Of Death ◽  
One Year ◽  
Fracture Surgery

Abstract Older adults with dementia are more prone to have adverse health outcomes following hip fracture surgery. However, individuals with dementia and hip fracture are older and have more co-morbidities; these baseline differences can bias estimates of the influence of dementia. This study aims to investigate how dementia influences disposition, mortality rates and readmission rates at 365 days after hip surgery in older adults over age 65, after accounting for baseline factors such as socioeconomic status, health behaviors, co-morbidities, and type of hip fracture repair. A cohort of 1172 patients who had hip fracture surgery between October 2015 and December 2018 was extracted from electronic health records; among those, 376 had a diagnosis of dementia. Inverse probability of treatment weighting using propensity scores method was used to reduce the influence of factors that may confound the relationship between dementia status and hip surgery outcomes. Logistic regression was applied to estimate influences on discharge disposition and Cox proportional hazards model for one-year mortality. To account for competing risk of death, a Fine and Gray regression model was used to calculate subdistribution hazard ratios of readmission. Disparities in long-term surgical outcomes in patients with dementia were found. Results show that dementia was a significant predictor for being discharged to facilities (OR=1.92, 95% CI 1.09, 3.39, p=.025), death (HR=1.98, 95% CI 1.50-2.62, p&lt;.0001) and being readmitted within one year (HR=1.31, 95% CI 1.15-1.50, p&lt;.0001). These findings call for more efforts in developing effective multidisciplinary perioperative assessments and rehabilitation for patients with dementia.

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