Modifiable risk factors for mortality in revision total hip arthroplasty for periprosthetic fracture

2020 ◽  
Vol 102-B (5) ◽  
pp. 580-585
Author(s):  
Victoria N. Gibbs ◽  
Robert A. McCulloch ◽  
Paula Dhiman ◽  
Andrew McGill ◽  
Adrian H. Taylor ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Modifiable Risk Factors ◽  
Revision Total Hip Arthroplasty ◽  
Factors Associated ◽  
Time To Surgery ◽  
Revision Tha ◽  
Hospital Acquired Pneumonia ◽  
One Year ◽  
Hospital Acquired

Aims The aim of this study was to identify modifiable risk factors associated with mortality in patients requiring revision total hip arthroplasty (THA) for periprosthetic hip fracture. Methods The electronic records of consecutive patients undergoing revision THA for periprosthetic hip fracture between December 2011 and October 2018 were reviewed. The data which were collected included age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, the preoperative serum level of haemoglobin, time to surgery, operating time, blood transfusion, length of hospital stay, and postoperative surgical and medical complications. Univariate and multivariate logistic regression analyses were used to determine independent modifiable factors associated with mortality at 90 days and one year postoperatively. Results A total of 203 patients were identified. Their mean age was 78 years (44 to 100), and 108 (53%) were female. The median time to surgery was three days (interquartile range (IQR) 2 to 5). The mortality rate at one year was 13.8% (n = 28). The commonest surgical complication was dislocation (n = 22, 10.8%) and the commonest medical complication within 90 days of surgery was hospital-acquired pneumonia (n = 25, 12%). Multivariate analysis showed that the rate of mortality one year postoperatively was five-fold higher in patients who sustained a dislocation (odds ratio (OR) 5.03 (95% confidence interval (CI) 1.60 to 15.83); p = 0.006). The rate of mortality was also four-fold higher in patients who developed hospital-acquired pneumonia within 90 days postoperatively (OR 4.43 (95% CI 1.55 to 12.67); p = 0.005). There was no evidence that the time to surgery was a risk factor for death at one year. Conclusion Dislocation and hospital-acquired pneumonia following revision THA for a periprosthetic fracture are potentially modifiable risk factors for mortality. This study suggests that surgeons should consider increasing constraint to reduce the risk of dislocation, and the early involvement of a multidisciplinary team to reduce the risk of hospital-acquired pneumonia. We found no evidence that the time to surgery affected mortality, which may allow time for medical optimization, surgical planning, and resource allocation. Cite this article: Bone Joint J 2020;102-B(5):580–585.

Postoperative Spinal Fluid Infections After Neurosurgical Shunting Procedures

PEDIATRICS ◽  
1977 ◽  
Vol 59 (5) ◽  
pp. 793-793
Author(s):  
Maurice F. McCarthy ◽  
Richard P. Wenzel
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Csf Shunt ◽  
Factors Associated ◽  
Infection Surveillance ◽  
One Year ◽  
Few Data ◽  
Hospital Acquired ◽  
Shunt Infections

Although cerebrospinal fluid (CSF) shunt infections are recognized as a complication of central nervous system procedures, there are few data on the postoperative (30 days) risk of developing meningitis after neurosurgery and little epidemiologic information as to probable causes. Information provided by a continual nosocomial infection surveillance system1 identified the problem of CSF infections, and we wish to report a one-year study of the risk of developing meningitis in a postoperative period. A controlled retrospective study was performed to identify risk factors associated with hospital-acquired meningitis.

scholarly journals Factors associated with urinary and double incontinence in a geriatric post-hip fracture assessment in older women

2022 ◽  
Author(s):  
Aino Tuulikki Hellman-Bronstein ◽  
Tiina Hannele Luukkaala ◽  
Seija Sinikka Ala-Nissilä ◽  
Minna Anneli Kujala ◽  
Maria Susanna Nuotio
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Older Women ◽  
Functional Disability ◽  
Real Life ◽  
Depressive Mood ◽  
Falls Prevention ◽  
Modifiable Risk Factors ◽  
Factors Associated ◽  
Double Incontinence

Abstract Background Incontinence and hip fractures are common in older people, especially women, and associated with multiple adverse effects. Incontinence is a risk factor for falls. Aims We aimed to investigate the prevalence of urinary (UI) and double incontinence (DI, concurrent UI and faecal incontinence), and to identify factors associated with UI and DI 6 months post-fracture. Methods A prospective real-life cohort study was conducted consisting of 910 women aged ≥ 65 who were treated for their first hip fracture in Seinäjoki Central Hospital, Finland, between May 2008 and April 2018. Continence status was elicited at baseline and 6 months postoperatively at our geriatric outpatient clinic where all participants underwent a multidisciplinary comprehensive geriatric assessment (CGA) consisting of an evaluation of cognition, nutrition, mood, mobility, and functional ability. Results At baseline, 47% of the patients were continent, 45% had UI and 8% had DI, and at follow up, 38%, 52%, and 11%, respectively. The mean age of the patients was 82.7 ± 6.8. Both UI and DI were associated with functional disability and other factors related to frailty. The associations were particularly prominent for patients with DI who also had the worst performance in the domains of CGA. We identified several modifiable risk factors: depressive mood (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.16–2.84) and constipation (OR 1.48, 95% CI 1.02–2.13) associated with UI and, late removal of urinary catheter (OR 2.33, 95% CI 1.31–4.14), impaired mobility (OR 2.08, 95% CI 1.05–4.15), and poor nutrition (OR 2.31, 95% CI 1.11–4.79) associated with DI. Conclusions This study demonstrates a high prevalence of UI and DI in older women with hip fracture and modifiable risk factors, which should be targeted in orthogeriatric management and secondary falls prevention. Patients with DI were found to be an especially vulnerable group.

scholarly journals Hip Fractures in Centenarians: Has Care Improved in the National Hip Fracture Database Era?

2017 ◽  
Vol 8 (3) ◽  
pp. 161-165 ◽  
Author(s):  
Alastair G. Dick ◽  
Dominic Davenport ◽  
Mohit Bansal ◽  
Therese S. Burch ◽  
Max R. Edwards
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
District General Hospital ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Retrospective Case ◽  
Time To Surgery ◽  
Surgery Mortality ◽  
Hospital Acquired

Introduction: The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications. Methods: A retrospective case note study of all centenarians managed for a hip fracture over a 7-year period at a London district general hospital. Results: We report on 22 centenarians sustaining 23 hip fractures between 2008 and 2015. Twenty-one fractures were managed operatively. For patients managed operatively, in-hospital, 30-day, 3-month, 6-month, 1-year, 2-year, 3-year, and 5-year cumulative mortalities were 30%, 30%, 39%, 50%, 77%, 86%, 95%, and 100%, respectively. In-hospital mortality was 100% for those managed nonoperatively. Mean time to surgery was 1.6 days (range: 0.7-6.3 days). Mean length of stay on the acute orthopedic ward was 23 days (range: 2-51 days). Seventy-one percent had a postoperative complication most commonly a hospital-acquired pneumonia or urinary tract infection. Conclusion: Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.

scholarly journals Modifiable risk factors associated with sudden cardiac arrest within hemodialysis clinics

2011 ◽  
Vol 79 (2) ◽  
pp. 218-227 ◽  
Author(s):  
Patrick H. Pun ◽  
Ruediger W. Lehrich ◽  
Emily F. Honeycutt ◽  
Charles A. Herzog ◽  
John P. Middleton
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Sudden Cardiac Arrest ◽  
Modifiable Risk Factors ◽  
Factors Associated

scholarly journals Risk factors associated with outcomes of hip fracture surgery in elderly patients

2015 ◽  
Vol 68 (6) ◽  
pp. 561 ◽  
Author(s):  
Byung Hoon Kim ◽  
Sangseok Lee ◽  
Byunghoon Yoo ◽  
Woo Yong Lee ◽  
Yunhee Lim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Factors Associated ◽  
Hip Fracture Surgery ◽  
Fracture Surgery ◽  
Surgery In Elderly

scholarly journals Factors associated with 90-day acute ischemic stroke in patients ≥70 years old with total hip arthroplasty for hip fracture

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Rui He ◽  
Guoyou Wang ◽  
Ting Li ◽  
Huarui Shen ◽  
LijuanZhang
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Ischemic Stroke ◽  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Older Age ◽  
Factors Associated ◽  
Independent Risk Factors ◽  
D Dimer

Abstract Background Postoperative ischemic stroke is a devastating complication following total hip arthroplasty (THA). The purpose of the current study was to investigate the incidence of postoperative acute ischemic stroke (AIS) in patients ≥70 years old with THA for hip fracture after 90 days and independent risk factors associated with 90-day AIS. Methods A multicenter retrospective study was conducted, patients ≥70 years old with THA for hip fracture under general anesthesia were included from February 2017 to March 2020. Patients with AIS within 90 days after THA were identified as AIS group; patients with no AIS were identified as no AIS group. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors of 90-dayAIS. Results: 2517 patients (mean age 76.18 ± 6.01) were eligible for inclusion in the study. 2.50% (63/2517) of patients had 90-day AIS. Compared with no AIS, older age, diabetes, hyperlipidemia, atrial fibrillation (AF) and higher D-dimer value were more likely in patients with AIS (P < 0.05), and anticoagulant use was fewer in patients with AIS. ROC curve analysis showed that the optimal cut point of D-dimer for AIS was D-dimer≥4.12 μg/ml. Multivariate logistic regression analysis showed that D-dimer≥4.12 μg/ml [adjusted odds ratio (aOR), 4.44; confidence interval (CI), 2.50–7.72; P < 0.001], older age (aOR, 1.08; 95%CI, 1.03–1.12; P < 0.001), hyperlipidemia (aOR, 2.28; 95%CI, 1.25–4.16; P = 0.007), atrial fibrillation (aOR, 5.84; 95% CI, 1.08–15.68; P = 0.001), and diabetes (aOR, 2.60; 95% CI, 1.56–4.39; P < 0.001) were associated with increased risk of 90-day AIS after THA. Conclusions In conclusion, we found that the incidence of 90-day AIS in patients≥70 years old with THA for hip fracture was 2.5%. Older age, diabetes, hyperlipidemia, AF and higher D-dimer value were independent risk factors for 90-day AIS in patients≥70 years old with THA for hip fracture.

scholarly journals Factores de riesgo asociados a distocias del mecanismo del parto en gestantes primíparas atendidas en el Hospital Dr. Verdi Cevallos Balda

2020 ◽  
Vol 4 (2) ◽  
pp. 1
Author(s):  
Olga Katherine Veintimilla Chinga ◽  
María Alicia Fernanda Ledezma Hurtado ◽  
Dadier Marrero González ◽  
Lizeet López ◽  
Hugo Loor Lino
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Rural Areas ◽  
Overweight And Obesity ◽  
Modifiable Risk Factors ◽  
Maternal Complications ◽  
Factors Associated ◽  
Factores De Riesgo ◽  
Uterine Malformations ◽  
Delivery Mechanism

  Las distocias del mecanismo del parto en gestantes pueden generar consecuencias significativas tanto maternas como fetales y neonatales, existiendo diversos factores de riesgo asociados a dicha condición. La prevalencia de las distocias es variable para cada localidad, presentándose en el 0,3 % a de los casos. En este sentido, el objetivo de este trabajo fue determinar los principales factores de riesgo que se asocian a distocias del mecanismo del parto en gestantes primíparas atendidas en el Hospital Dr. Verdi Cevallos Balda. Se realizó un estudio descriptivo y retrospectivo, con 250 embarazadas atendidas en el periodo de enero 2018 a diciembre 2019. Las distocias de los mecanismos del parto en primíparas en el Hospital Dr. Verdi Cevallos se presentaron con más frecuencia en las edades entre los 20 y 34 años, con grado de instrucción secundaria, y de zonas rurales. Los principales factores de riesgos modificables asociados a distocias fueron los controles prenatales insuficientes, sobrepeso y obesidad de las gestantes; además de ganancia de peso inadecuada durante el embarazo, bajo peso fetal, duración prolongada de la primera fase del trabajo de parto e inducción del mismo. Los factores de riesgos no modificables identificados fueron la presentación de cara, estrechez pélvica, malformaciones uterinas, hipertensión arterial como enfermedad crónica asociada, talla materna menor a 140 cm y parto prolongado de más de 20 horas. Las complicaciones maternas tuvieron una alta incidencia y dentro de ellas, las cesáreas fueron las más frecuentes, mientras que el distress respiratorio fue la complicación neonatal más presentada.   Palabras clave: Distocia, factores de riesgo, peso elevado, malformaciones uterinas, complicaciones.   Abstract Dystocia of the delivery mechanism in pregnant women can generate significant maternal, fetal and neonatal consequences, with various risk factors associated with this condition. The prevalence of dystocia is variable for each locality, occurring in 0.3% of cases. In this sense, the objective of this study was to determine the main risk factors associated with dystocia in the delivery mechanism in primiparous pregnant women treated at the Dr. Verdi Cevallos Balda Hospital. A descriptive and retrospective study was carried out, with 250 pregnant women seen in the period from January 2018 to December 2019. Dystocia of the labor mechanisms in primiparous women at the Dr. Verdi Cevallos Hospital occurred more frequently in the ages between 20 and 34 years old, with a secondary education degree, and from rural areas. The main modifiable risk factors associated with dystocia were insufficient prenatal care, overweight and obesity in pregnant women; as well as inadequate weight gain during pregnancy, low fetal weight, prolonged duration of the first phase of labor and its induction. The non-modifiable risk factors identified were face presentation, pelvic narrowing, uterine malformations, arterial hypertension as an associated chronic disease, maternal height less than 140 cm and prolonged labor of more than 20 hours. Maternal complications had a high incidence and within them, caesarean sections were the most frequent, while respiratory distress was the most common neonatal complication.   Keywords: Dystocia, risk factors, high weight, uterine malformations, complications.

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