GERIATRIC SYNDROMES IN OLDER SURGICAL PATIENTS: A LITERATURE REVIEW

With the ageing of the population, surgical wards are caring for an increased proportion of olderpatients. Geriatric syndromes are common in older hospitalised medical and hip fracture patients and areimportant predictors of poor outcomes in these groups, however the extent of presenting and hospital acquiredgeriatric syndromes in other older inpatients is less clear. This systematic literature review aimed to identify theproportion of patients aged 60 or older, cared for in usual-care surgical wards, who presented with and/ordeveloped geriatric syndromes. Observational studies in English were identified through searches in CINAHLand Medline databases from 1985-2012. Studies of hip fracture patients and those requiring surgical intensivecare (eg cardiac surgery) were excluded. The review included 25 studies. The majority of studies reported on theincidence of post-operative delirium, which ranged from 2% to 51% and varied with the type of surgery. Theprevalence of depression at pre-admission screening varied from 9% to 29%. No studies reported on functionaldecline. Estimates of falls, malnutrition, pressure ulcers and urinary incontinence were limited by the smallnumber of studies. These findings indicate the need for further studies to improve the understanding of geriatricsyndromes in older surgical patients in usual-care wards.

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An Outreach Rehabilitation Program for Nursing Home Residents After Hip Fracture May Be Cost-Saving

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa074 ◽

2020 ◽

Vol 75 (10) ◽

pp. e159-e165

Author(s):

Lauren A Beaupre ◽

Doug Lier ◽

Jay S Magaziner ◽

C Allyson Jones ◽

D William C Johnston ◽

...

Keyword(s):

Nursing Home ◽

Hip Fracture ◽

Cost Saving ◽

Incremental Cost ◽

Usual Care ◽

Nursing Home Residents ◽

Rehabilitation Program ◽

Study Entry ◽

Rehabilitation Intervention ◽

The Cost

Abstract Background We compared the cost-effectiveness of 10 weeks of outreach rehabilitation (intervention) versus usual care (control) for ambulatory nursing home residents after hip fracture. Methods Enrollment occurred February 2011 through June 2015 in a Canadian metropolitan region. Seventy-seven participants were allocated in a 2:1 ratio to receive a 10-week rehabilitation program (intervention) or usual care (control) (46 intervention; 31 control). Using a payer perspective, we performed main and sensitivity analyses. Health outcome was measured by quality-adjusted life years (QALYs), using the EQ5D, completed at study entry, 3-, 6-, and 12-months. We obtained patient-specific data for outpatient visits, physician claims, and inpatient readmissions; the trial provided rehabilitation utilization/cost data. We estimated incremental cost and incremental effectiveness. Results Groups were similar at study entry; the mean age was 87.9 ± 6.6 years, 54 (71%) were female and 58 (75%) had severe cognitive impairment. EQ5D QALYs scores were nonsignificantly higher for intervention participants. Inpatient readmissions were two times higher among controls, with a cost difference of −$3,350/patient for intervention participants, offsetting the cost/intervention participant of $2,300 for the outreach rehabilitation. The adjusted incremental QALYs/patient difference was 0.024 favoring the intervention, with an incremental cost/patient of −$621 for intervention participants; these values were not statistically significant. A sensitivity analysis reinforced these findings, suggesting that the intervention was likely dominant. Conclusion A 10-week outreach rehabilitation intervention for nursing home residents who sustain a hip fracture may be cost-saving, through reduced postfracture hospital readmissions. These results support further work to evaluate postfracture rehabilitation for nursing home residents.

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Hydroxyethyl starch 130/0.4 for volume replacement therapy in surgical patients: a systematic review and meta-analysis of randomized controlled trials

Perioperative Medicine ◽

10.1186/s13741-021-00182-8 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Yi Xu ◽

Siying Wang ◽

Leilei He ◽

Hong Yu ◽

Hai Yu

Keyword(s):

Replacement Therapy ◽

Meta Analysis ◽

Postoperative Mortality ◽

Kidney Injury ◽

Volume Replacement ◽

Surgical Patients ◽

Controlled Trials ◽

Randomized Controlled ◽

Volume Replacement Therapy ◽

Type Of Surgery

Abstract Background The safety of perioperative intravenous hydroxyethyl starch (HES) products, specifically HES 130/0.4, continues to be the source of much debate. The aim of this meta-analysis was to update the existing evidence and gain further insight into the clinical effects of HES 130/0.4 on postoperative outcomes for volume replacement therapy in surgical patients. Methods MEDLINE, EMBASE, and Cochrane Library databases were searched from inception to March 2020 for relevant randomized controlled trials (RCTs) on perioperative use of HES 130/0.4 in adult surgical patients. The primary outcome was postoperative mortality and secondary outcomes were the incidence of acute kidney injury (AKI) and requirement for renal replacement therapy (RRT). The analysis was performed using the random-effects method and the risk ratio (RR) with a 95% confidence interval (CI). We performed the risk-of-bias assessment of eligible studies and assessed the overall quality of evidence for each outcome. Results Twenty-five RCTs with 4111 participants were finally included. There were no statistical differences between HES 130/0.4 and other fluids in mortality at 30 days (RR 1.28, 95% CI 0.88 to 1.86, p = 0.20), the incidence of AKI (RR 1.23, 95% CI 0.99 to 1.53, p = 0.07), or requirement for RRT (RR 0.75, 95% CI 0.37 to 1.53, p = 0.43). Overall, there was a moderate certainty of evidence for all the outcomes. There was no subgroup difference related to the type of surgery (p = 0.17) in the incidence of AKI. As for the type of comparator fluids, however, there was a trend that was not statistically significant (p = 0.06) towards the increased incidence of AKI in the HES 130/0.4 group (RR 1.22, 95% CI 0.97 to 1.54) compared with the crystalloid group (RR 1.21, 95% CI 0.27 to 3.91). Subgroup analyses according to the type of surgery demonstrated consistent findings. Conclusions This systematic review and meta-analysis suggests that the use of HES 130/0.4 for volume replacement therapy compared with other fluids resulted in no significant difference in postoperative mortality or kidney dysfunction among surgical patients. Given the absent evidence of confirmed benefit and the potential trend of increased kidney injury, we cannot recommend the routine clinical use of HES 130/0.4 for volume replacement therapy in surgical patients from the perspective of benefit/risk profile. However, the results need to be interpreted with caution due to the limited sample size, and further well-powered RCTs are warranted. Trial registration PROSPERO registry reference: CRD42020173058

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Persistently higher serum sCD40L levels are associated with outcome in septic patients

BMC Anesthesiology ◽

10.1186/s12871-021-01241-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yingjian Liang ◽

Chengrui Zhu ◽

Yini Sun ◽

Zhiliang Li ◽

Liang Wang ◽

...

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Odds Ratio ◽

Cd40 Ligand ◽

Surgical Patients ◽

Soluble Cd40 Ligand ◽

Icu Admission ◽

Time Changes ◽

And Control ◽

Type Of Surgery

Abstract Background Soluble CD40 ligand (sCD40L) exhibits proinflammatory and procoagulant effects. Recent data indicated that sCD40L plays a significant role in septic patients. The aim of the present study was to determine sCD40L changes in surgical patients without sepsis (SWS) and surgical sepsis patients (SS) during the first 3 days after intensive care unit (ICU) admission and to observe the association between sCD40L and mortality. Methods Time changes in sCD40L levels were assessed for 3 days after ICU admission in 49 patients with SS and compared with those in 19 SWS patients. Serum sCD40L concentration was detected by ELISA. Survival at 28 days served as the endpoint. Results SS had significantly higher sCD40L levels than SWS and control patients. We observed an association between sCD40L levels ≥1028.75 pg/mL at day 2 and 28-day mortality (odds ratio = 7.888; 95% confidence interval = 1.758 to 35.395; P = 0.007). We could not discover any significant differences in sex, presence of septic shock, site of infection, length of stay in the ICU, PaO2/FiO2 ratio, incidence of AKI, ARDS, or type of surgery between nonsurvivors and survivors. Conclusions Septic patients show persistently higher circulating sCD40L levels in the first 3 days after ICU admission, and serum sCD40L levels are associated with the mortality of patients with sepsis. Thus, serum sCD40L may be used as a reliable biomarker and therapeutic target in sepsis.

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Effects of β-Cryptoxanthin on Improvement in Osteoporosis Risk: A Systematic Review and Meta-Analysis of Observational Studies

Foods ◽

10.3390/foods10020296 ◽

2021 ◽

Vol 10 (2) ◽

pp. 296

Author(s):

Sun Jo Kim ◽

Nguyen Hoang Anh ◽

Nguyen Co Diem ◽

Seongoh Park ◽

Young Hyun Cho ◽

...

Keyword(s):

Systematic Review ◽

Hip Fracture ◽

Bone Health ◽

Observational Studies ◽

Meta Analysis ◽

Random Effects Model ◽

High Intake ◽

Quantitative Evidence ◽

Osteoporosis Risk ◽

Reduced Risk

Many studies have analyzed the effects of β-cryptoxanthin (BCX) on osteoporosis and bone health. This systematic review and meta-analysis aimed at providing quantitative evidence for the effects of BCX on osteoporosis. Publications were selected and retrieved from three databases and carefully screened to evaluate their eligibility. Data from the final 15 eligible studies were extracted and uniformly summarized. Among the 15 studies, seven including 100,496 individuals provided information for the meta-analysis. A random effects model was applied to integrate the odds ratio (OR) to compare the risk of osteoporosis and osteoporosis-related complications between the groups with high and low intake of BCX. A high intake of BCX was significantly correlated with a reduced risk of osteoporosis (OR = 0.79, 95% confidence interval (CI) 0.70–0.90, p = 0.0002). The results remained significant when patients were stratified into male and female subgroups as well as Western and Asian cohorts. A high intake of BCX was also negatively associated with the incidence of hip fracture (OR = 0.71, 95% CI 0.54–0.94, p = 0.02). The results indicate that BCX intake potentially reduces the risk of osteoporosis and hip fracture. Further longitudinal studies are needed to validate the causality of current findings.

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Lantox—The Chinese Botulinum Toxin Drug—Complete English Bibliography and Comprehensive Formalised Literature Review

Toxins ◽

10.3390/toxins13060370 ◽

2021 ◽

Vol 13 (6) ◽

pp. 370

Author(s):

Dirk Dressler ◽

Lizhen Pan ◽

Junhui Su ◽

Fei Teng ◽

Lingjing Jin

Keyword(s):

Literature Review ◽

Observational Studies ◽

Similar Efficacy ◽

Conversion Ratio ◽

Brand Names ◽

Efficacy And Safety ◽

Paper Citation ◽

Safety Features ◽

Randomised Controlled ◽

Nose And Throat

In 1997, lanbotulinumtoxinA (LAN) was introduced in China. It is now available in Asia, Latin America and Eastern Europe under various brand names including Hengli®, Lantox®, Prosigne®, Lanzox®, Redux®, Liftox®, HBTX-A and CBTX-A. The literature on LAN is mostly published in Chinese language, restricting its international accessibility. We, therefore, wanted to generate a complete English bibliography of all LAN publications and then use it for a comprehensive formalised literature review. Altogether, 379 LAN publications (322 in Chinese and 57 in English) were retrieved from PubMed and Science and Technology Paper Citation Database. Indications covered are motor (257), glandular (16), pain (32) and aesthetics (48). Topics are neurological (250), aesthetic (48), paediatric (38), ophthalmological (18), urological (9), methodological (6), gastroenterological (5), ear, nose and throat (4) and surgical (1). Seventy-one publications are randomised controlled trials, forty-one publications are interventional studies and observational studies, fifteen publications are case studies, eighteen publications are reviews, and two publications are guidelines. LAN publications cover all relevant topics of BT therapy throughout a period of more than 20 years. This constitutes a publication basis resembling those of other BT drugs. None of the LAN publications presents data contradictory to those generated with other BT type-A drugs. LAN seems to have a similar efficacy and safety features when compared to onabotulinumtoxinA using a 1:1 LAN– onabotulinumtoxinA conversion ratio. Large controlled multicentre studies will become necessary for LAN’s registrations in Europe and North America.

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Hip Fracture, Causes, Classification, and Management: A Literature Review

World Journal of Environmental Biosciences ◽

10.51847/vfoniokgxc ◽

2021 ◽

Vol 10 (2) ◽

pp. 49-55

Author(s):

Mokhtar Ahmed Alsayed ◽

Mushari Mana Alqhtani ◽

Ziyad Mohammed Alkhammash ◽

Abdullah Hassan Algarni ◽

Naif Murayh Alsharif ◽

...

Keyword(s):

Hip Fracture ◽

Literature Review

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Sarcopenia determined by hand grip strength and calf circumference as predictor of mortality in older inpatients with hip fracture

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2021.09.104 ◽

2021 ◽

Vol 46 ◽

pp. S577

Author(s):

F.J.Sanchez Torralvo ◽

M. García Olivares ◽

V. Pérez del Río ◽

J. Abuín Fernández ◽

G. Olveira

Keyword(s):

Hip Fracture ◽

Grip Strength ◽

Hand Grip Strength ◽

Calf Circumference ◽

Hand Grip ◽

Older Inpatients

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ACUTE KIDNEY INJURY FOLLOWING SURGERY FOR HIP FRACTURE

Acta Ortopédica Brasileira ◽

10.1590/1413-785220202803226779 ◽

2020 ◽

Vol 28 (3) ◽

pp. 128-130

Author(s):

PHILIP MCKEAG ◽

ANDREW SPENCE ◽

BRIAN HANRATTY

Keyword(s):

Acute Kidney Injury ◽

Hip Fracture ◽

Kidney Injury ◽

Factors Associated ◽

Chi Squared ◽

Student’S T ◽

Retrospective Comparative Study ◽

Type Of Surgery ◽

Preoperative Creatinine ◽

Student’S T Test

ABSTRACT Objective: An observational study was carried out to determine the rate of acute kidney injury (AKI) following surgery for hip fracture at our institution and to look for factors associated with AKI. Methods: Preoperative creatinine values were compared to post-operative results for all patients who underwent surgery for hip fracture at our institution between 1st January 2015 and 30th September 2016. AKI was defined as an increase in postoperative creatinine, greater than or equal to 1.5 times the preoperative value within 7 days. Chi-squared test and Student’s t-test were used to look for factors associated with AKI. Results: Out of 500 patients, 96 developed an AKI (19.2%). Patients with chronic kidney disease (CKD) were more likely to develop AKI (30.8%) that those without it (17.2%, p = 0.018). Similarly, patients with 2 or more comorbidities were more likely to develop AKI (22.0%) than those without it (12.4%, p = 0.009). No statistically significant association was observed between type of surgery and AKI. Conclusion: A large proportion of patients following surgery for hip fracture developed AKI. Patients with CKD and the presence of 2 or more comorbidities had significantly higher rates of AKI. Level III evidence, Retrospective comparative study.

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The association of fracture risk in atrial fibrillation patients and long-term anticoagulant therapy category: a systematic review and meta-analysis

PeerJ ◽

10.7717/peerj.10683 ◽

2021 ◽

Vol 9 ◽

pp. e10683

Author(s):

Jun Chen ◽

Lingchun Lyu ◽

Jiayi Shen ◽

Chunlai Zeng ◽

Cheng Chen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Hip Fracture ◽

Fracture Risk ◽

Hip Fractures ◽

Observational Studies ◽

Meta Analysis ◽

Cochrane Library ◽

Hip Fracture Risk ◽

Significant Difference

Objective Our study aimed to assess the risk of all fractures and hip fractures in patients with atrial fibrillation (AF) who took non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin. Methods We searched PubMed, Embase, and Cochrane Library and Clinical Trials.gov Website. Reviewed related researches up to January 31, 2020, to identify studies with more than 12 months of follow-up data. The protocol for this systematic review and meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO Number: CRD42020156893). Results We included five RCT studies, and five observational studies that contained a total of 326,846 patients in our meta-analysis. Our meta-analysis showed that patients taken NOACs had no significant all fracture risk (RR = 0.91, 95% CI [0.81–1.01]) and hip fracture risk (RR = 0.92, 95% CI [0.82–1.03]) compared with those taken warfarin. Subanalysis showed that the risk of all fractures and hip fractures treated by NOACs were significant lower compared with warfarin in observational studies compared with RCT studies. Also, a subanalysis across the duration of anticoagulation showed the NOACs users have lower all fracture risk than warfarin users when the duration of anticoagulation ≤2 years (RR = 0.89, 95% CI [0.80–0.99]). Further analysis, significant lower all fracture risk in the rivaroxaban therapy (RR = 0.81; 95% CI [0.76–0.86]) compared with warfarin but no statistical significance in hip fracture. There were no significant difference of all fracture risk and hip fracture risk in dabigatran, apixaban, and edoxaban therapy compared with warfarin. Conclusion The meta-analysis demonstrated that NOACs associated with a significantly lower all fracture risk compared with warfarin when the duration of anticoagulation more than 2 years. Rivaroxaban users had lower risk of all fracture than warfarin users in AF patients. But there was no evidence to verify apixaban, edoxaban, and dabigatranin could decrease all fracture and hip fracture risk compared with warfarin.

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