scholarly journals Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

2021 ◽  
Vol 18 (6) ◽  
pp. 3049
Author(s):  
Francisco José Tarazona-Santabalbina ◽  
Cristina Ojeda-Thies ◽  
Jesús Figueroa Rodríguez ◽  
Concepción Cassinello-Ogea ◽  
José Ramón Caeiro
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Economic Problem ◽  
Hip Fracture Surgery ◽  
The Past ◽  
Search Terms ◽  
Surgical Options ◽  
Fracture Surgery ◽  
Type Of Fracture

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

scholarly journals Orthogeriatric Care: Reviewing Improvements in Outcomes

2021 ◽  
Author(s):  
Francisco José Tarazona-Santabalbina ◽  
Cristina Ojeda-Thies ◽  
Jesús Figueroa Rodríguez ◽  
Concepción Cassinello-Ogea ◽  
José Ramón Caeiro
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Perioperative Management ◽  
State Of The Art ◽  
Economic Problem ◽  
The Past ◽  
Search Terms ◽  
Surgical Options ◽  
Type Of Fracture

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Orthogeriatric co-management units have increased quality of care, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

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.

scholarly journals Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures

2021 ◽  
Vol 12 ◽  
pp. 215145932110162
Author(s):  
Matthew S. Broggi ◽  
Philip O. Oladeji ◽  
Syed Tahmid ◽  
Roberto Hernandez-Irizarry ◽  
Jerad Allen
Keyword(s):  
Risk Factor ◽  
Hip Fracture ◽  
Postoperative Complications ◽  
Hip Fractures ◽  
Depressive Disorders ◽  
Surgical Site Infections ◽  
Wound Complications ◽  
Non Union ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Introduction: Intertrochanteric hip fractures are a common injury treated by orthopedic surgeons and the incidence rate is rising. Preoperative depression is a known risk factor for postoperative complications in orthopaedic surgery, however its effects on outcomes after geriatric hip fractures is relatively unknown. The purpose of this study was to investigate the relationship between preoperative depression and potential complications following open reduction internal fixation (ORIF) and intramedullary nailing (IMN) of geriatric hip fractures. Methods: In this retrospective study, the Truven Marketscan claims database was used to identify patients over age 65 who underwent ORIF or IMN for a hip fracture from January 2009 to December 2019. Patient characteristics, such as medical comorbidities, were collected and from that 2 cohorts were established (one with and one without depression). Chi-squared and multivariate analysis was performed to investigate the association between preoperative depression and common postoperative complications following intertrochanteric hip fracture surgery. Results: In total, 78,435 patients were identified for analysis. In those patients with preoperative depression, the complications associated with the greatest increased odds after undergoing ORIF were surgical site infections (OR 1.32; CI 1.23-1.44), ED visit for pain (OR 1.27; CI 1.16-1.39), wound complications (OR 1.26; CI 1.14-1.35), and non-union (OR 1.25; CI 1.17-1.33). In the patients with preoperative depression undergoing IMN, the complications associated with the greatest increased odds after were surgical site infections (OR 1.37; CI 1.31- 1.45), ED visit for pain (OR 1.31; CI 1.19-1.44), wound complications (OR 1.23; CI 1.10-1.39), and pneumonia (OR 1.22; CI 1.10-1.31). Conclusions: Preoperative depression in patients undergoing hip fracture surgery is associated with increased complications. Recognizing a patients’ preoperative depression diagnosis can allow physicians to adapt perioperative and postoperative surveillance protocols for these higher risk patients. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor

scholarly journals Re-Admissions Following Hip Fracture Surgery

2009 ◽  
Vol 91 (7) ◽  
pp. 591-595 ◽  
Author(s):  
James Hahnel ◽  
Hannah Burdekin ◽  
Sanjeev Anand
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
The Elderly ◽  
Index Admission ◽  
Study Cohort ◽  
Rehabilitation Care ◽  
Hip Fracture Surgery ◽  
Fatal Adverse Events ◽  
The Uk ◽  
Fracture Surgery

INTRODUCTION Hip fractures in the elderly are a growing problem with a predicted incidence of 117,000 cases per year by 2016. Re-admission following a healthcare episode is an important outcome measure, which reflects non-fatal adverse events and indicates the natural history of disease. The purpose of this observational, multicentre audit was to examine rates and reasons for re-admission following hip fracture, to identify areas in the index admission and rehabilitation care that could be improved to prevent re-admission. PATIENTS AND METHODS A total of 535 patients (> 65 years old) in two district general hospitals in the UK who underwent hip fracture surgery were recruited into the study. RESULTS Of the study cohort, 72 patients (13.5%) died during their index admission and 88 (19.0%) of 463 patients were re-admitted once within 3 months. Causes of re-admission were attributed to medical (54.8%), failure to rehabilitate (23.8%), orthopaedic (19.0%) and surgical (2.4%) reasons. Infection was the most common (31.0%) reason for re-admission and arguably the most treatable. During the 3-month postoperative period, the mortality rate was 21.3%, increasing in those re-admitted to 35.1% representing the frailty of this group of patients. CONCLUSIONS High rates of re-admission are seen following discharge in elderly patients with hip fractures. Re-admitted patients have high mortality rates. Understanding causes of re-admission may help to reduce this burden.

scholarly journals Signs of Dehydration after Hip Fracture Surgery: An Observational Descriptive Study

Medicina ◽  
2020 ◽  
Vol 56 (7) ◽  
pp. 361
Author(s):  
Louise Ekman ◽  
Peter Johnson ◽  
Robert G. Hahn
Keyword(s):  
Hip Fracture ◽  
Plasma Concentrations ◽  
High Serum ◽  
Serum Osmolality ◽  
Urine Specific Gravity ◽  
Hip Fracture Surgery ◽  
The Past ◽  
Fluid Deficit ◽  
Fracture Surgery ◽  
Observational Descriptive Study

Background and Objectives: Dehydration might be an issue after hip fracture surgery, but the optimal tools to identify the dehydrated condition have not been determined. The aim of the present study was to compare the characteristics of elderly postoperative patients who were classified as dehydrated according to the methods used in the clinic. Materials and Methods: Thirty-eight patients aged between 65 and 97 (mean, 82) years were studied after being admitted to a geriatric department for rehabilitation after hip fracture surgery. Each patient underwent blood analyses, urine sampling, and clinical examinations. Results: Patients ingested a mean of 1,008 mL (standard deviation, 309 mL) of fluid during their first day at the clinic. Serum osmolality increased significantly with the plasma concentrations of sodium, creatinine, and urea. Seven patients had high serum osmolality (≥300 mosmol/kg) that correlated with the presence of tongue furrows (p < 0.04), poor skin turgor (p < 0.03), and pronounced albuminuria (p < 0.03). Eight patients had concentrated urine (urine-specific gravity ≥ 1.025) that correlated with a low intake of liquid and with a decrease in body weight during the past month of −3.0 kg (25–75 th percentiles, −5.1 to −0.9) versus +0.2 (−1.9 to +2.7) kg (p < 0.04). Conclusions: Renal fluid conservation of water, either in the form of hyperosmolality or concentrated urine, was found in 40% of the patients after hip fracture surgery. Hyperosmolality might not indicate a more severe fluid deficit than is indicated by concentrated urine but suggests an impaired ability to concentrate the urine.

scholarly journals Prognostic factors of depression and depressive symptoms after hip fracture surgery: systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
R. Milton-Cole ◽  
S. Ayis ◽  
K. Lambe ◽  
M. D. L. O’Connell ◽  
C. Sackley ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Depressive Symptoms ◽  
Hip Fracture ◽  
Data Extraction ◽  
High Quality Research ◽  
Hip Fracture Surgery ◽  
Modelling Studies ◽  
Underlying Mechanisms ◽  
Fracture Surgery

Abstract Background Patients with hip fracture and depression are less likely to recover functional ability. This review sought to identify prognostic factors of depression or depressive symptoms up to 1 year after hip fracture surgery in adults. This review also sought to describe proposed underlying mechanisms for their association with depression or depressive symptoms. Methods We searched for published (MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection) and unpublished (OpenGrey, Greynet, BASE, conference proceedings) studies. We did not impose any date, geographical, or language limitations. Screening (Covidence), extraction (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist), and quality appraisal (Quality in Prognosis Studies tool) were completed in duplicate. Results were summarised narratively. Results In total, 37 prognostic factors were identified from 12 studies included in this review. The quality of the underlying evidence was poor, with all studies at high risk of bias in at least one domain. Most factors did not have a proposed mechanism for the association. Where factors were investigated by more than one study, the evidence was often conflicting. Conclusion Due to conflicting and low quality of available evidence it is not possible to make clinical recommendations based on factors prognostic of depression or depressive symptoms after hip fracture. Further high-quality research investigating prognostic factors is warranted to inform future intervention and/or stratified approaches to care after hip fracture. Trial registration Prospero registration: CRD42019138690.

scholarly journals Prognostic Factors for Mortality, Activity of Daily Living and Quality of Life in Taiwanese Older Patients within 1 Year following Hip Fracture Surgery

2022 ◽  
Vol 12 (1) ◽  
pp. 102
Author(s):  
Ming-Hsiu Chiang ◽  
Yu-Yun Huang ◽  
Yi-Jie Kuo ◽  
Shu-Wei Huang ◽  
Yeu-Chai Jang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Hip Fracture ◽  
Daily Living ◽  
Estimating Equation ◽  
Generalized Estimating Equation ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Background. Hip fractures among older adults are a major public health concern worldwide. This study investigated the potential clinical factors that predict postoperative 1-year activities of daily living (ADL), quality of life (QoL), and mortality in Taiwanese older adults following hip fracture. Methods. This is a prospective cohort study enrolling older adults (≥60 years) who had undergone hip fracture surgery in a single medical center. The comprehensive clinical history of each patient was examined. QoL, ADL, and mortality events were recorded consecutively at 3, 6, and 12 months after operation. The multiple logistic regression model and the generalized estimating equation (GEE) were adopted to identify contributing factors for mortality and postoperative ADL and QoL prognosis, respectively. Results. Among 377 participants with hip fracture, 48 died within 1 year of the index operation. ADL and QoL considerably decreased at 3 months following hip surgery. Old age, high Charlson Comorbidity Index, and American Society of Anesthesiologists grading were crucial predictors for mortality at the 1-year follow-up. The generalized estimating equation analysis indicated that the length of postoperative follow-up time, serum albumin level, patient cognitive status, and handgrip strength were considerably associated with QoL and ADL recovery prognosis in the Taiwanese older adults following hip fracture. Conclusions. Hip fractures have long-lasting effects on the older adults. Our data imply several prognosis predicting parameters that may assist clinicians in accounting for an individual’s personalized risks in order to improve functional outcomes and reduce mortality.

Does perioperative use of tranexamic acid in hip fracture patients increase the risk of venous thromboembolism and reduce the need for postoperative transfusions?

2020 ◽  
Vol 30 (12) ◽  
pp. 378-382
Author(s):  
James Geddes ◽  
Greg McConaghie
Keyword(s):  
Venous Thromboembolism ◽  
Hip Fracture ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Fractures ◽  
Hip Fracture Surgery ◽  
Postoperative Blood Transfusion ◽  
Increased Risk ◽  
Fracture Surgery ◽  
Postoperative Haemoglobin

Perioperative tranexamic acid use is a popular choice among many surgeons for reducing surgical blood loss and its sequelae. While there is evidence in the literature that tranexamic acid use is effective in reducing blood loss in surgery for patients with hip fractures, there is less information on whether it leads to thromboembolic complications. We undertook a retrospective study in patients with hip fractures at two local hospitals to investigate if there was an increased risk of venous thromboembolism in patients who received tranexamic acid, and whether it reduced perioperative blood loss and the need for transfusion. We found that tranexamic acid used in patients undergoing hip fracture surgery reduced the drop in postoperative haemoglobin and the need for postoperative blood transfusion but was not associated with an increased risk of venous thromboembolism.

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