Faculty Opinions recommendation of Postoperative Mortality after Hip Fracture Surgery: A 3 Years Follow Up.

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.

Download Full-text

Effects of a home-based occupational therapy telerehabilitation via smartphone for outpatients after hip fracture surgery: A feasibility randomised controlled study

Journal of Telemedicine and Telecare ◽

10.1177/1357633x20932434 ◽

2020 ◽

pp. 1357633X2093243

Author(s):

Cabbee TL Li ◽

Goris KN Hung ◽

Kenneth NK Fong ◽

Pablo Cruz Gonzalez ◽

Shu-hong Wah ◽

...

Keyword(s):

Hip Fracture ◽

Occupational Therapy ◽

Comparison Group ◽

Post Intervention ◽

Hip Fracture Surgery ◽

Home Based ◽

Randomised Controlled ◽

Fracture Surgery ◽

Experimental Group

Introduction This study aimed to investigate the effects of a home-based occupational therapy telerehabilitation (TR) via smartphone in enhancing functional and motor performance and fall efficacy for outpatients receiving day hospital rehabilitation after hip fracture surgery in Hong Kong. Methods This was a feasibility randomised controlled trial with two groups – an experimental group and a comparison group – and a sample of 31 older adults attending a geriatric day hospital who had undergone hip fracture surgery within 12 weeks of diagnosis. Patients were assessed at baseline, immediately after a three-week intervention and at three-week post-intervention follow-up for motor performance, activities of daily living (ADL) functioning and fall efficacy. The experimental group received a home programme using the Caspar Health e-system and a mobile app for smartphones, while the comparison group received paper-and-pencil instructions for the home programme on a weekly basis for three weeks. Results Compared to the comparison group, significant improvements in fall efficacy and instrumental ADL performance at post intervention and follow-up were found in the experimental group. However, in the comparison group, inadequate social support was a factor contributing to better muscle strength testing in both the affected and non-affected legs. There were no significant differences between the two groups in regard to the other variables. Discussion This study supports the potential use of TR via smartphone as an alternative home programme for use in occupational therapy practice with older adults after hip fracture surgery.

Download Full-text

Patient-reported outcomes at acute hospital stay and four months after hip fracture surgery. A register and questionnaire study

European Journal for Person Centered Healthcare ◽

10.5750/ejpch.v6i1.1505 ◽

2018 ◽

Vol 6 (1) ◽

pp. 119

Author(s):

Berit Gesar ◽

Carina Baath ◽

Hanne Hedin ◽

Ami Hommel

Keyword(s):

Hip Fracture ◽

Hospital Stay ◽

Age Groups ◽

Acute Hospital ◽

Questionnaire Study ◽

Hip Fracture Surgery ◽

Quality Register ◽

Patient Reported ◽

Fracture Surgery

Introduction: The large and increasing number of hip fracture patients, in combination with the large impact that this is having on daily living activities, is emphasizing the importance of identifying factors that have a detrimental impact on post-operative outcomes. There are benefits to planning the ward in a way that prevents a steep decline in recovery after hip fracture surgery. Adding the patient`s perspective into the healthcare assessment, via shared healthcare decision-making, allows the patient’s needs and preferences to be taken fully into account. The aim of this study was to identify factors that predict how patients recover after hip fracture surgery.Methods: A descriptive quality register/questionnaire study in acute orthopaedic wards, 2 to 5 days after surgery, with a follow-up 4 months later. The patients included were ≥65 years of age and had been previously healthy and living independently before the hip fracture.Results: The participants in this study had returned to their own homes after 4 months, but only 21% reported themselves as being fully or almost fully recovered. In several domains of recovery, all 3 age groups (65-74, 75-84 and 85-97) reported different challenges both during their acute hospital stay and at the 4 months follow-up. The recovery phase is heterogeneous and requires individual care. The way that this is planned has an influence on patient outcome.Conclusion: Patients sustaining a hip fracture are heterogeneous and different age groups experience different challenges. At 4 months follow-up, one fifth of the participants reported themselves fully or almost fully recovered and most of them had returned to their own homes. The Swedish National Hip Fracture Register and the patient-reported questionnaires employed in this study are appropriate tools to audit further development of healthcare to improve quality of life after hip fracture surgery.

Download Full-text

Postoperative mortality in hip fracture patients stratified by the Revised Cardiac Risk Index: a Swedish nationwide retrospective cohort study

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000778 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000778

Author(s):

Maximilian Peter Forssten ◽

Ahmad Mohammad Ismail ◽

Tomas Borg ◽

Rebecka Ahl ◽

Per Wretenberg ◽

...

Keyword(s):

Hip Fracture ◽

Risk Index ◽

Postoperative Mortality ◽

Cardiac Risk ◽

Significant Linear Trend ◽

Hip Fracture Surgery ◽

Cardiac Risk Index ◽

Postoperative Myocardial Infarction ◽

National Quality ◽

Fracture Surgery

ObjectivesThe Revised Cardiac Risk Index (RCRI) is a tool that can be used to evaluate the 30-day risk of postoperative myocardial infarction, cardiac arrest and mortality. This study aims to confirm its association with postoperative mortality in patients who underwent hip fracture surgery.MethodsAll adults who underwent primary emergency hip fracture surgery in Sweden between January 1, 2008 and December 31, 2017 were included in this study. The database was retrieved by cross-referencing the Swedish National Quality Register for hip fractures with the Swedish National Board of Health and Welfare registers. The outcomes of interest were the association between the RCRI score and mortality at 30 days, 90 days and 1 year postoperatively.Results134 915 cases were included in the current study. There was a statistically significant linear trend in postoperative mortality with increasing RCRI scores at 30 days, 90 days and 1 year. An RCRI score ≥4 was associated with a 3.1 times greater risk of 30-day postoperative mortality (adjusted incidence rate ratio (IRR) 3.13, p<0.001), a 2.5 times greater risk of 90-day postoperative mortality (adjusted IRR 2.54, p<0.001) and a 2.8 times greater risk of 1-year postoperative mortality (adjusted HR 2.81, p<0.001) compared with that observed with an RCRI score of 0.ConclusionAn increasing RCRI score is strongly associated with an elevated risk 30-day, 90-day and 1-year postoperative mortality after primary hip fracture surgery. The objective and easily retrievable nature of the variables included in the RCRI calculation makes it an appealing choice for risk stratification in the clinical setting.Levels of evidenceLevel III.

Download Full-text

Artificial Neural Network and Cox Regression Models for Predicting Mortality after Hip Fracture Surgery: A Population-Based Comparison

Medicina ◽

10.3390/medicina56050243 ◽

2020 ◽

Vol 56 (5) ◽

pp. 243

Author(s):

Cheng-Yen Chen ◽

Yu-Fu Chen ◽

Hong-Yaw Chen ◽

Chen-Tsung Hung ◽

Hon-Yi Shi

Keyword(s):

Hip Fracture ◽

Hospital Volume ◽

Global Sensitivity Analysis ◽

Cox Regression ◽

Postoperative Mortality ◽

Ann Model ◽

Performance Indices ◽

Global Sensitivity ◽

Hip Fracture Surgery ◽

Fracture Surgery

This study purposed to validate the accuracy of an artificial neural network (ANN) model for predicting the mortality after hip fracture surgery during the study period, and to compare performance indices between the ANN model and a Cox regression model. A total of 10,534 hip fracture surgery patients during 1996–2010 were recruited in the study. Three datasets were used: a training dataset (n = 7374) was used for model development, a testing dataset (n = 1580) was used for internal validation, and a validation dataset (1580) was used for external validation. Global sensitivity analysis also was performed to evaluate the relative importances of input predictors in the ANN model. Mortality after hip fracture surgery was significantly associated with referral system, age, gender, urbanization of residence area, socioeconomic status, Charlson comorbidity index (CCI) score, intracapsular fracture, hospital volume, and surgeon volume (p < 0.05). For predicting mortality after hip fracture surgery, the ANN model had higher prediction accuracy and overall performance indices compared to the Cox model. Global sensitivity analysis of the ANN model showed that the referral to lower-level medical institutions was the most important variable affecting mortality, followed by surgeon volume, hospital volume, and CCI score. Compared with the Cox regression model, the ANN model was more accurate in predicting postoperative mortality after a hip fracture. The forecasting predictors associated with postoperative mortality identified in this study can also bae used to educate candidates for hip fracture surgery with respect to the course of recovery and health outcomes.

Download Full-text

Risk factors and mortality of patients undergoing hip fracture surgery: a one-year follow-up study

Scientific Reports ◽

10.1038/s41598-020-66614-5 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Pierre Huette ◽

Osama Abou-Arab ◽

Az-Eddine Djebara ◽

Benjamin Terrasi ◽

Christophe Beyls ◽

...

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Hip Fracture Surgery ◽

Follow Up Study ◽

One Year ◽

Fracture Surgery

Download Full-text

End-Stage Renal Failure Is an Independent Risk Factor for 1-Year Mortality After Hip Fracture Surgery

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318770561 ◽

2018 ◽

Vol 9 ◽

pp. 215145931877056 ◽

Cited By ~ 5

Author(s):

Louise Woon Theng Lo ◽

Xu Yanling ◽

Andrew Chia Chen Chou ◽

Tet Sen Howe ◽

John Carson Allen ◽

...

Keyword(s):

Risk Factors ◽

Renal Failure ◽

Risk Factor ◽

Hip Fracture ◽

Independent Risk Factor ◽

Postoperative Mortality ◽

End Stage Renal Failure ◽

Hip Fracture Surgery ◽

End Stage ◽

Fracture Surgery

Introduction: End-stage renal failure (ESRF) with its associated comorbidities increase postoperative mortality in hip fracture patients. This study investigated the association of ESRF with various comorbidities in patients on dialysis and assessed rates ESRF as an independent risk factor for all-cause postoperative 1- year mortality rates. Methods: This was a retrospective cohort study on patients aged 55 years and older who underwent their first nonpathological, low-energy hip fracture surgery at an Asian tertiary hospital from June 2007 to 2012. Patients were identified as cases with ESRF on dialysis (study group) or non-ESRF patients (controls). Various comorbidity factors and postoperative 1-year mortality status were obtained from institutional electronic medical records. Univariate and multivariate logistic regression were used to identify significant risk factors for all-cause, 1-year mortality. Results: With no loss to follow-up, the 1-year postoperative mortality rate was 19.6% for the 46 patients with ESRF on dialysis and 8.4% for non-ESRF controls ( P = .028). Fisher exact test showed that hypertension, ischemic heart disease (IHD), diabetes mellitus (DM), anemia, cerebrovascular disease, and vascular disease were significantly associated with ESRF ( P < .05). Multivariable logistic regression analysis identified ESRF (adjusted odds ratio[AOR] = 2.85, P = .021), cancer (AOR = 3.04, P = .003), IHD (AOR = 2.07, P = .020), DM (AOR = 2.03, P = .022), and age (AOR = 1.08, P <.0001) as independent risk factors for 1-year mortality following hip fracture surgery. The area under the receiver–operating characteristic curve (95% confidence interval) for the multivariable predictor of 1-year mortality was 0.75 (0.60-0.82). Conclusions: Although associated with multiple comorbidities, ESRF was found to be independently predictive of 1-year mortality in patients undergoing hip fracture surgery, second to cancer in terms of magnitude of risk posed. As ESRF is a negative prognostic factor for 1-year mortality after hip fracture surgery, its importance should be recognized with implications on preoperative counseling to patients about the increased risk and implications on fracture prevention.

Download Full-text