The effect of neutrophil-lymphocyte ratio on admission to postoperative intensive care and mortality in elderly patients undergoing hip fracture surgery with spinal anesthesia

Background. The diagnosis of osteoporosis is based on bone mineral density measurements expressed as a percentage of the young adult mean (YAM) in Japan. Osteoporosis is defined as YAM <70%, and intervention is recommended at this cutoff. Because osteoporosis has a strong association with systemic metabolic disorders, we postulated that patients with YAM <70% had higher inflammatory biomarker concentrations owing to the higher systemic stress compared with YAM >70%. Method. We retrospectively reviewed 94 patients with low-trauma hip fractures. Blood examinations were performed on postoperative day (POD) 1 and POD 7. We used neutrophil lymphocyte ratio (NLR) and monocyte lymphocyte ratio (MLR) to evaluate postoperative recovery. After dividing the 94 patients into two groups according to a YAM cutoff of 70%, we compared the differences in NLR and MLR. Results. On POD 1, patients with YAM >70% had a median NLR of 5.7 and a median MLR of 0.66, which were significantly lower than for patients with YAM <70% (8.8 and 0.9, respectively). Similarly, on POD 7, patients with YAM >70% had a median NLR of 2.0 and a median MLR of 0.31, which were significantly lower than for patients with YAM <70% (3.5 and 0.43, respectively). Conclusion. A YAM cutoff of 70% is an appropriate intervention threshold regarding postoperative recovery after hip fracture surgery. Mini-Abstract. Patients with YAM >70% showed lower NLR and MLR on POD 1 and POD 7. A YAM cuffoff of 70% is an appropriate intervention threshold regarding postoperative recovery after hip fracture surgery.

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Effects of Anesthesia Techniques on Outcomes after Hip Fracture Surgery in Elderly Patients: A Prospective, Randomized, Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm9061605 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1605

Author(s):

Seokyung Shin ◽

Seung Hyun Kim ◽

Kwan Kyu Park ◽

Seon Ju Kim ◽

Jae Chan Bae ◽

...

Keyword(s):

Hip Fracture ◽

Elderly Patients ◽

Spinal Anesthesia ◽

Troponin T ◽

Controlled Trial ◽

High Mobility ◽

Secondary Outcome ◽

Hip Fracture Surgery ◽

Balanced Anesthesia ◽

Fracture Surgery

The superiority of distinct anesthesia methods for geriatric hip fracture surgery remains unclear. We evaluated high mobility group box-1 (HMGB1) and interleukin-6 (IL-6) with three different anesthesia methods in elderly patients undergoing hip fracture surgery. Routine blood test findings, postoperative morbidity, and mortality were assessed as secondary outcome. In total, 176 patients were randomized into desflurane (n = 60), propofol (n = 58), or spinal groups (n = 58) that received desflurane-based balanced anesthesia, propofol-based total intravenous anesthesia (TIVA), or spinal anesthesia, respectively. The spinal group required less intraoperative vasopressors (p < 0.001) and fluids (p = 0.006). No significant differences in HMGB1 (pgroup×time = 0.863) or IL-6 (pgroup×time = 0.575) levels were noted at baseline, postoperative day (POD) 1, or POD2. Hemoglobin, albumin, creatinine, total lymphocyte count, potassium, troponin T, and C-reactive protein were comparable among groups at all time-points. No significant differences in postoperative hospital stay, intensive care unit (ICU) stay, and ventilator use among groups were observed. Postoperative pulmonary, cardiac, and neurologic complications; and in-hospital, 30-day, and 90-day mortality were not significantly different among groups (p = 0.974). In conclusion, HMGB1 and IL-6, and all secondary outcomes, were not significantly different between desflurane anesthesia, propofol TIVA, and spinal anesthesia.

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Comparison of Effects between Combined Lumbar-Sacral Plexus Block plus General Anesthesia and Unilateral Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery: A Pilot Randomized Controlled Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/6685497 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Lili Tang ◽

Panpan Fang ◽

Yuxin Fang ◽

Yao Lu ◽

Guanghong Xu ◽

...

Keyword(s):

Hip Fracture ◽

Elderly Patients ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Postoperative Delirium ◽

Sacral Plexus ◽

Hip Fracture Surgery ◽

Unilateral Spinal Anesthesia ◽

Plexus Block ◽

Fracture Surgery

Purpose. Hip fracture is a common injury in geriatric populations, which is associated with poor quality of life. However, the ideal anesthesia technique for this disease is yet to be identified. This study aimed to compare the combined lumbar-sacral plexus block (CLSB) plus general anesthesia (bispectral index (BIS) 60–80) with the unilateral spinal anesthesia (SA) on activity of daily living in elderly patients undergoing hip fracture surgery. Methods. A total of 124 elderly patients undergoing hip fracture surgery were randomly assigned to two groups. Patients in the SA group received light-specific gravity spinal anesthesia, and patients in the CLSB group received lumbar and sacral plexus block with general anesthesia (BIS 60–80). The primary outcomes were 30-day activity of daily living (ADL). The secondary outcomes were postoperative pain scores, postoperative delirium, in-hospital cost, and major complications. Results. The ADL scores of postoperative day 30 (POD30) in the CLSB group are higher than those in the SA group (27.34 ± 7.01 versus 24.70 ± 6.40, P = 0.045 ). Compared to preoperative ADL scores, there were higher increased scores in the CLSB group than in POD30 (CLSB group 8.09 ± 3.39 versus SA group 4.87 ± 3.90, P < 0.001 ). Mild-to-moderate pain did not have differences between the two groups (rest pain: 3 versus 2, P = 0.344 ; motion pain: 5 versus 4, P = 0.073 ). There were no significant differences in incidence of postoperative delirium, PONV, and other complications. Conclusion. The unilateral SA can reduce the deterioration of ADL after hip fracture surgery and provide a better postoperative recovery.

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Comparison of general anaesthesia and regional anaesthesia in terms of mortality and complications in elderly patients with hip fracture: a nationwide population-based study

BMJ Open ◽

10.1136/bmjopen-2019-029245 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029245 ◽

Cited By ~ 8

Author(s):

Eun Jin Ahn ◽

Hyo Jin Kim ◽

Kyung Woo Kim ◽

Hey Ran Choi ◽

Hyun Kang ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Health Insurance ◽

Hip Fracture ◽

Elderly Patients ◽

Regional Anaesthesia ◽

Secondary Outcome ◽

Hip Fracture Surgery ◽

Ventilator Care ◽

Fracture Surgery

ObjectiveTo evaluate the effects of anaesthesia on postoperative outcome in elderly patients who underwent hip fracture surgery.SettingNationwide National Health Insurance Sharing Service database of Korea.ParticipantsAll patients aged ≥65 years old who underwent hip fracture surgery, covered by the Korean National Health Insurance, between 1 January 2009 and 31 December 2015.InterventionsHip fracture surgery under general anaesthesia (group GA) or regional anaesthesia (group RA), with a principal diagnosis of femoral fracture.Primary and secondary outcome measuresThe primary outcome was the anaesthetic-type effect on 30-day mortality and the secondary outcome was postoperative delirium requiring pharmacological intervention.ResultsAmong the 96 289 patients who underwent hip fracture surgery, 25 593 and 70 696 patients received GA and RA, respectively. After propensity score matching, 25 593 remained in each group. Postmatching mortality was lower in the RA than in the GA group (574 (2.24%) vs 654 (2.55%), p=0·0047, 95% CI −0.0099 to 0.0159). Delirium incidence was lower in the RA than in the GA group (5187 (20.27%) vs 5828 (22.77%), p<0·0001, 95% CI 0.019 to 0.045). The incidence of intensive care unit stay and ventilator care was lower in the RA than in the GA group (5838 (22.1%) vs 8055 (31.47%), p<0·0001, 95% CI 0.046 to 0.070 and 459 (1.73%) vs 1207 (4.72%), p<0·0001, 95% CI −0.0024 to 0.023, respectively).ConclusionRA was associated with better outcomes than GA, in terms of mortality, delirium, intensive care unit admission and ventilator care, in elderly patients who underwent hip fracture surgery.

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Morbidity and Mortality following Surgery for Hip Fractures in Elderly Patients

Journal of Aging Research ◽

10.1155/2019/7084657 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Hebattu-allah E. Zaki ◽

Shereen M. Mousa ◽

Salma M. S. El Said ◽

Ahmed K. Mortagy

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hip Fracture ◽

Elderly Patients ◽

High Specificity ◽

Multivariate Regression Analysis ◽

Morbidity And Mortality ◽

University Hospital ◽

Hip Fracture Surgery ◽

Fracture Surgery

Aim. To determine morbidity and mortality in elderly patients following hip fracture surgery in Egypt and its correlates and to determine the utility of the POSSUM scale to predict morbidity and mortality among our population. Methodology. We assessed postoperative morbidity and mortality following hip fracture surgery in a 6-month prospective observational study of 100 elderly patients who were undergoing surgical repair at the beginning of the study. The exclusion criteria included surgically unfit patients and patients refusing to participate in the study. The study was conducted in Ain Shams University Hospital, Ain Shams Specialized Hospital, and El-helal Hospital. Results. The subjects were categorized as survivors and nonsurvivors according to the 6-month mortality, and the groups were compared statistically according to this classification. The observed 6-month mortality was 19.56%. POSSUM had high specificity for predicting 6-month survival (97.3%). A multivariate regression analysis revealed that postoperative admission to the intensive care unit and lack of ambulation were major risk factors associated with the 6-month mortality. Conclusions. The POSSUM system had high specificity for predicting survivors (97.3%) but failed to predict mortality (sensitivity = 5.6%). The major risks for 6-month mortality are intensive care unit admission and lack of ambulation.

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