scholarly journals Identification of hypercoagulability with thrombelastography in patients with hip fracture receiving thromboprophylaxis

2021 ◽  
Vol 64 (3) ◽  
pp. E324-E329
Author(s):  
Daniel You ◽  
Leslie Skeith ◽  
Robert Korley ◽  
Paul Cantle ◽  
Adrienne Lee ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Point Of Care ◽  
Common Complication ◽  
Maximal Amplitude ◽  
Clot Strength ◽  
Hip Fracture Surgery ◽  
Point Of Care Test ◽  
Trochanteric Region ◽  
Fracture Surgery ◽  
Over Time

Background: Venous thromboembolism (VTE) is the second most common complication after hip fracture surgery. We used thrombelastography (TEG), a whole-blood, point-of-care test that can provide an overview of the clotting process, to determine the duration of hypercoagulability after hip fracture surgery. Methods: In this prospective study, consecutive patients aged 51 years or more with hip fractures (trochanteric region or neck) amenable to surgical treatment who presented to the emergency department were eligible for enrolment. Thrombelastography, including calculation of the coagulation index (CI) (combination of 4 TEG parameters for an overall assessment of coagulation) was performed daily from admission until 5 days postoperatively, and at 2 and 6 weeks postoperatively. All patients received 28 days of thromboprophylaxis. We used single-sample t tests to compare mean maximal amplitude (MA) values (a measure of clot strength) to the hypercoagulable threshold of greater than 65 mm, a predictor of in-hospital VTE. Results: Of the 35 patients enrolled, 11 (31%) were hypercoagulable on admission based on an MA value greater than 65 mm, and 29 (83%) were hypercoagulable based on a CI value greater than 3.0; the corresponding values at 6 weeks were 23 (66%) and 34 (97%). All patients had an MA value greater than 65 mm at 2 weeks. Patients demonstrated normal coagulation on admission (mean MA value 62.2 mm [standard deviation (SD) 6.3 mm], p = 0.01) but became significantly hypercoagulable at 2 weeks (mean 71.6 mm [SD 2.6 mm], p < 0.001). There was a trend toward persistent hypercoagulability at 6 weeks (mean MA value 66.2 mm [SD 3.8 mm], p = 0.06). Conclusion: More than 50% of patients remained hypercoagulable 6 weeks after fracture despite thromboprophylaxis. Thrombelastography MA thresholds or a change in MA over time may help predict VTE risk; however, further study is needed.

Prognostic Implications of Preoperative Pneumonia to Patients Undergoing Hip Fracture Surgery or Arthroplasty

2020 ◽  
Author(s):  
Jiawei Shen ◽  
Peixun Zhang ◽  
Youzhong An ◽  
Baoguo Jiang
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Regional Anesthesia ◽  
Protective Factor ◽  
Cox Regression ◽  
Pneumonia Severity ◽  
Hip Fracture Surgery ◽  
Risk Of Mortality ◽  
Fracture Surgery ◽  
Over Time

Abstract BACKGROUND: Preoperative pneumonia is one of the underlying comorbidities of patients undergoing hip fracture surgery or arthroplasty, which had been reported with an increased 30-day mortality. However, the influences that preoperative pneumonia or its different severity had to long term survival were hardly been reported. METHODS: In this retrospective observational study, we reported outcomes of patients undergoing hip fracture surgery or arthroplasty with or without a diagnosis of preoperative pneumonia. We analyzed risk factors of 1-year mortality for patients with preoperative pneumonia and calculated the adjusted risk of 1-year mortality that stratified for pneumonia severity evaluated with CURB-65 score. Survival rates of patients free of pneumonia or with different pneumonia severity were also reported with COX regression. RESULTS: The incidence of preoperative pneumonia was 7.86% in our cohort. Compared to patients without preoperative pneumonia, patients with this condition had longer hospital stay (15 vs. 12, p<0.001）and ICU length of stay (7 vs. 0, p<0.001), higher 30-day mortality (11.9% vs. 5%, p=0.002) and 1-year mortality(33.9% vs. 16.3%, p<0.001). BMI<18.5 kg/m 2 , CURB-65 score ≥3 were risk factors of 1-year mortality in patients with preoperative pneumonia, while regional anesthesia was a protective factor for 1-year mortality. There was a linear trend of CURB-65 score to 1-year mortality after adjustment for BMI and anesthesia type (p for trend = 0.006). when CURB-65 score ≥3, patients had significant risk of 1-year mortality (OR: 3.85-7.87). COX regression reveals a higher risk of mortality over time in patient with preoperative pneumonia, as severity increases (CURB-65 score ≥3), the difference of risk to patients without preoperative pneumonia became significant. CONCLUSION: In this single center retrospective study that consists of patients undergoing hip fracture surgery or arthroplasty, patients with preoperative pneumonia had worse prognoses than patients without this condition. BMI<18.5 kg/m 2 , CURB-65 score ≥3 were risk factors of 1-year mortality in patients with preoperative pneumonia, while regional anesthesia was a protective factor for 1-year mortality. In patients with preoperative pneumonia, CURB-65 score ≥3 indicated higher risk of mortality over time.

scholarly journals A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery

2021 ◽  
Author(s):  
Rebecka Ahl ◽  
Ahmad Mohammad Ismail ◽  
Tomas Borg ◽  
Gabriel Sjölin ◽  
Maximilian Peter Forssten ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Beta Blocker ◽  
Observational Cohort Study ◽  
Blocker Therapy ◽  
Beta Blocker Therapy ◽  
Hip Fracture Surgery ◽  
All Cause Mortality ◽  
Observational Cohort ◽  
Fracture Surgery

Abstract Purpose Despite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery. Methods This is a retrospective nationwide observational cohort study. All adults $$\ge$$ ≥ 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality. Results 134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26–0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure. Conclusions Beta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.

scholarly journals Effects of hospital funding reform on wait times for hip fracture surgery: a population-based interrupted time-series analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Pincus ◽  
Jessica Widdifield ◽  
Karen S. Palmer ◽  
J. Michael Paterson ◽  
Alvin Li ◽  
...  
Keyword(s):  
Time Series ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Wait Times ◽  
Hospital Funding ◽  
Hip Fracture Surgery ◽  
After Hours ◽  
Fracture Surgery

Abstract Background Health care funding reforms are being used worldwide to improve system performance but may invoke unintended consequences. We assessed the effects of introducing a targeted hospital funding model, based on fixed price and volume, for hip fractures. We hypothesized the policy change was associated with reduction in wait times for hip fracture surgery, increase in wait times for non-hip fracture surgery, and increase in the incidence of after-hours hip fracture surgery. Methods This was a population-based, interrupted time series analysis of 49,097 surgeries for hip fractures, 10,474 for ankle fractures, 1,594 for tibial plateau fractures, and 40,898 for appendectomy at all hospitals in Ontario, Canada between April 2012 and March 2017. We used segmented regression analysis of interrupted monthly time series data to evaluate the impact of funding reform enacted April 1, 2014 on wait time for hip fracture repair (from hospital presentation to surgery) and after-hours provision of surgery (occurring between 1700 and 0700 h). To assess potential adverse consequences of the reform, we also evaluated two control procedures, ankle and tibial plateau fracture surgery. Appendectomy served as a non-orthopedic tracer for assessment of secular trends. Results The difference (95 % confidence interval) between the actual mean wait time and the predicted rate had the policy change not occurred was − 0.46 h (-3.94 h, 3.03 h) for hip fractures, 1.46 h (-3.58 h, 6.50 h) for ankle fractures, -3.22 h (-39.39 h, 32.95 h) for tibial plateau fractures, and 0.33 h (-0.57 h, 1.24 h) for appendectomy (Figure 1; Table 3). The difference (95 % confidence interval) between the actual and predicted percentage of surgeries performed after-hours − 0.90 % (-3.91 %, 2.11 %) for hip fractures, -3.54 % (-11.25 %, 4.16 %) for ankle fractures, 7.09 % (-7.97 %, 22.14 %) for tibial plateau fractures, and 1.07 % (-2.45 %, 4.59 %) for appendectomy. Conclusions We found no significant effects of a targeted hospital funding model based on fixed price and volume on wait times or the provision of after-hours surgery. Other approaches for improving hip fracture wait times may be worth pursuing instead of funding reform.

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