scholarly journals The impact of direct oral anti-coagulants on hip fracture management : a systematic review and meta-analysis

2021 ◽  
Vol 87 (2) ◽  
pp. 321-326
Author(s):  
Samuel Holmes ◽  
Sarmad Bahnam
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Mortality Risk ◽  
Meta Analysis ◽  
The Elderly ◽  
Operative Management ◽  
Control Group ◽  
Independent Analysis ◽  
Fracture Management ◽  
The Impact

Hip fractures are a common presentation in the elderly, a group who commonly have co-morbidities requiring the use of anticoagulants. Recently, direct oral anti-coagulants (DOAC) have become a popular method of anticoagulating patients. The primary aim of this review is to determine if the use of DOAC in elderly patients with hip fractures results in delays to theatre and/or an increased mortality risk. Major databases including Pubmed, MEDLINE and Embase were searched for relevant studies and the included studies reference lists were screened for further studies. A total of 6 studies were included in meta-analysis which was undertaken using RevMan software with 95% confidence interval (CI). Compared to control groups, patients who were anticoagulated with DOAC and required operative management of a hip fracture experienced a statistically significant delay to treatment. However independent analysis showed these patients did not experience an increased mortality risk when compared to the control group. While data is limited, treating clinicians should be comforted by these findings as operative manage- ment can be safely delayed to reduce the risk of intraoperative bleeding.

scholarly journals The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽  
2021 ◽  
pp. 146040862094972
Author(s):  
Ahmed Fadulelmola ◽  
Rob Gregory ◽  
Gavin Gordon ◽  
Fiona Smith ◽  
Andrew Jennings
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Hospital Admissions ◽  
The Elderly ◽  
Primary Outcome Measure ◽  
Time To Death ◽  
Significant Difference ◽  
The Mean ◽  
The Impact ◽  
Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

scholarly journals Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Firas J. Raheman ◽  
Djamila M. Rojoa ◽  
Jvalant Nayan Parekh ◽  
Reshid Berber ◽  
Robert Ashford
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Case Fatality Rate ◽  
Excess Mortality ◽  
Meta Analysis ◽  
Case Fatality ◽  
Pooled Analysis ◽  
Fatality Rate ◽  
Increased Risk ◽  
The Impact

AbstractIncidence of hip fractures has remained unchanged during the pandemic with overlapping vulnerabilities observed in patients with hip fractures and those infected with COVID-19. We aimed to investigate the independent impact of COVID-19 infection on the mortality of these patients. Healthcare databases were systematically searched over 2-weeks from 1st–14th November 2020 to identify eligible studies assessing the impact of COVID-19 on hip fracture patients. Meta-analysis of proportion was performed to obtain pooled values of prevalence, incidence and case fatality rate of hip fracture patients with COVID-19 infection. 30-day mortality, excess mortality and all-cause mortality were analysed using a mixed-effects model. 22 studies reporting 4015 patients were identified out of which 2651 (66%) were assessed during the pandemic. An excess mortality of 10% was seen for hip fractures treated during the pandemic (OR 2.00, p = 0.007), in comparison to the pre-pandemic controls (5%). Estimated mortality of COVID-19 positive hip fracture patients was four-fold (RR 4.59, p < 0.0001) and 30-day mortality was 38.0% (HR 4.73, p < 0.0001). The case fatality rate for COVID-19 positive patients was 34.74%. Between-study heterogeneity for the pooled analysis was minimal (I2 = 0.00) whereas, random effects metaregression identified subgroup heterogeneity for male gender (p < 0.001), diabetes (p = 0.002), dementia (p = 0.001) and extracapsular fractures (p = 0.01) increased risk of mortality in COVID-19 positive patients.

scholarly journals The Benefits of Streamlined Hip Fracture Management in a Regional Hospital

2017 ◽  
Vol 8 (2) ◽  
pp. 99-103 ◽  
Author(s):  
T. C. Mow ◽  
Jen Lukeis ◽  
A. G. Sutherland
Keyword(s):  
Surgical Treatment ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Performance Indicator ◽  
Cost Benefit ◽  
Standard Of Care ◽  
Regional Hospital ◽  
Time To Surgery ◽  
Fracture Management ◽  
The Impact

Introduction: Hip fracture is an increasingly common injury in the growing elderly population. The morbidity and mortality associated with this injury can be reduced by minimizing delays to surgical treatment. We describe the impact of a regional hospital service redesign project that utilized the principles of smart simplicity, a management strategy that lays emphasis on collaboration to achieve desired goals. Methods: Prior to the redesign, patients with hip fractures were taking an average of 72 hours for surgical treatment. A hip fracture working group was created to examine closely the process of hip fracture care, and a single key performance indicator (KPI) of “surgery within 48 hours” was adopted. This allowed identification of processes that could be clarified and streamlined, with the agreement of relevant stakeholders, in the creation of a new hip fracture pathway. Results: In the first 3 months of the pathway’s implementation, 16 of 18 patients had surgery within 48 hours of presentation. In a 6-month follow-up audit after 2 years of implementation, 36 of 39 patients were treated within 48 hours. This was significantly different to the time to surgery seen in the 12 months prior to the redesign ( P < .001, Student t test). The mean time to surgery was reduced from 72 hours to 36 hours, a saving in an annual acute bed stay cost of A$152 000. Discussion: Decreased time to the operating room, the cost savings inherent to this, can be achieved with the introduction of the best standard of care. A redesign that mandates collaboration in achieving a single KPI has allowed a significant culture shift in the treatment of hip fractures in our institution in the months following its institution. Conclusion: Collaborative, multidisciplinary collaboration has facilitated a higher standard of care and demonstrated significant cost benefit.

The factors associated with nosocomial infection in elderly hip fracture patients: gender, age, and comorbidity

2021 ◽  
Author(s):  
Yuan Deng ◽  
Zhong Zheng ◽  
Shi Cheng ◽  
Yuan Lin ◽  
Duanyang Wang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Nosocomial Infection ◽  
Hip Fractures ◽  
Area Under The Curve ◽  
The Elderly ◽  
Chronic Respiratory Disease ◽  
Fracture Pattern ◽  
Control Group ◽  
Retrospective Case ◽  
Elderly Cohort

Abstract Purpose This is a retrospective case–control study to ascertain the factors influencing nosocomial infection (NI) in elderly patients with hip fractures. Methods A total of 80,174 patients (≥ 60 years) who suffered hip fractures between 2006 and 2017 were identified through a national inquiry of 94 hospitals. The patients were divided into an NI group and control group according to the occurrence or lack of occurrence of NI within 48 hours after surgery, respectively. Age, gender, hip fracture pattern, whether to operate, surgical treatments, and comorbidities were recorded as variables. Results A total of 9806 elderly hip fracture patients (60 years) were included, 1977 of whom were patients diagnosed with NI. The control group consisted of randomly drawn cases from the 9806 patients from different hospitals with a rate of one NI patient: four patients without NI. Patient gender, age, and in particular the number of comorbidities were associated with occurrence of NI. Using regression models to predict infection outcomes based on the number of comorbidities had an area under the curve (AUC) of 0.714, while using the Charlson comorbidity index (CCI) yielded a smaller value of 0.694. The most common comorbidities of this elderly cohort were chronic respiratory disease, hypertension, diabetes mellitus, cerebrovascular disease, and coronary heart disease. Conclusions Older age, male gender, and greater number of comorbidities were found to be associated with the occurrence of NI. In particular, the number of comorbidities was the most accurate predictor of NI occurrence, and when used to build a regression model, it had greater predictive capability than CCI to predict NI in elderly hip fracture patients. Additionally, the common diseases of the elderly should be primarily considered when investigating the relationship between comorbidities and NI in older patients.

scholarly journals Important perioperative factors, guidelines and outcomes in the management of hip fracture

2020 ◽  
pp. 175045892091565
Author(s):  
Harry Kyriacou ◽  
Wasim S Khan
Keyword(s):  
Hip Fracture ◽  
Postoperative Complications ◽  
Psychosocial Factors ◽  
Hip Fractures ◽  
The Elderly ◽  
Timing Of Surgery ◽  
Significant Morbidity ◽  
Fracture Management ◽  
Fracture Outcome ◽  
Type Of Anaesthesia

Hip fractures are common injuries in the elderly and are associated with significant morbidity and mortality. There are multiple perioperative factors that must be considered when managing these patients. These include analgesia, timing of surgery, choice of operation, type of anaesthesia, postoperative complications and comorbidities. Guidelines from The National Institute for Health and Care Excellence and the National Hip Fracture Database have been updated to reflect many of the above, but the importance of psychosocial factors is still emerging. This article focuses on the evidence for the key perioperative factors in hip fracture management and the tools available to predict hip fracture outcome.

scholarly journals Rehabilitation guidance for hip fracture patients during the COVID-19 pandemic using chat software: A new model

2021 ◽  
pp. 1-6
Author(s):  
Shuai-Shuai Gao ◽  
Yan-Jun Wang ◽  
Guo-Xun Zhang ◽  
Wen-Ting Zhang
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
The Elderly ◽  
Social Software ◽  
Harris Hip Score ◽  
Control Group ◽  
Observation Group ◽  
New Model ◽  
Complications And Mortality

BACKGROUND: Hip fractures are serious fractures for the elderly. The rehabilitation of patients with hip fractures has been greatly affected by the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: We have piloted a new model for tracking patients and providing rehabilitation guidance that uses WeChat. The purpose of this study is to explore the role of chat software in rehabilitation guidance for hip fracture patients during COVID-19. METHODS: Patients treated for hip fractures from February 1 to April 30, 2020 were randomly divided into a control group and an observation group. The control group was given conventional discharge guidance, while the observation group also followed up the patients using WeChat to guide the exercise. Satisfaction, the Harris Hip Score, complications and the mortality of the two groups after discharge were compared. RESULTS: The incidence of complications and mortality in the observation group were significantly lower than in the control group: p= 0.022 and p= 0.048, respectively. The Harris Hip Score and satisfaction were significantly better than the control group’s: p= 0.000 and p= 0.007, respectively. CONCLUSION: During the COVID-19 pandemic, it is very helpful to use WeChat software or other social software with similar functions (such as WhatsApp and Facebook) to guide the rehabilitation of hip fractures.

scholarly journals “Hidden” Preoperative Blood Loss With Extracapsular Versus Intracapsular Hip Fractures: What Is the Difference?

2017 ◽  
Vol 8 (4) ◽  
pp. 202-207 ◽  
Author(s):  
Katharine D. Harper ◽  
Paul Navo ◽  
Frederick Ramsey ◽  
Sainabou Jallow ◽  
Saqib Rehman
Keyword(s):  
Hip Fracture ◽  
Blood Loss ◽  
Hip Fractures ◽  
Proximal Femur ◽  
Femur Fracture ◽  
Skilled Nursing Facility ◽  
Operative Management ◽  
Proximal Femur Fracture ◽  
Fracture Management ◽  
The Difference

Purpose: Excessive blood loss with hip fracture management has been shown to result in increased rates of complications. Our goal is to compare blood loss and transfusion rates between patients with intracapsular and extracapsular (both intertrochanteric (IT) and subtrochanteric (ST)) hip fractures. Methods: 472 patients were evaluated over a five-year period. Those who presented to the hospital with a proximal femur fracture (femoral neck, IT or ST) were considered for the study. Exclusion criteria included polytrauma, gunshot injuries, periprosthetic fractures, and non-operative management. Primary endpoint was hemoglobin (Hgb) drop from admission to day of surgery (DOS); secondary endpoint was need for pre-op transfusion and discharge location. Results: 304 patients were analyzed who sustained a proximal femur fracture. Median IC Hgb drop was 0.6g/dL; median EC Hgb drop was 1.1g/dL from admission to DOS ( p = 0.0272). Rate of pre-operative transfusions was higher in EC (36/194 = 18.6%) than IC fractures (5/105 = 4.5%) ( p = 0.0006), and overall transfusion rates remained higher throughout hospital stay (55.7% EC vs. 32.7% IC; p = 0.0001). Breakdown of bleeding rate and tranfusion rates between IT and ST fractures were not significant ( p = 0.07; p = 0.4483). Extracapsular hip fractures were more likely to be discharged to a skilled nursing facility (SNF) (84.4% EC vs. 73.8% IC; p = 0.027). Conclusion: Intracapsular hip fractures have significantly less pre-operative blood loss and fewer pre-operative transfusions than their extracapsular counterparts. These findings can be used to establish appropriate pre-operative resuscitative efforts, ensuring that hip fracture protocols account for the increased likelihood of blood loss in extracapsular fractures.

The effect of brain vitalization activity on dementia incidence in elderly at Budi Luhur Nursing Home of Yogyakarta, Kasongan, Bantul

2020 ◽  
Vol 1 (3) ◽  
pp. 43-50
Author(s):  
Firstyono Miftahul Aziz ◽  
Suratini Suratini
Keyword(s):  
Nursing Home ◽  
The Elderly ◽  
Control Group ◽  
P Value ◽  
Sampling System ◽  
Randomized Sampling ◽  
Care For The Elderly ◽  
Dementia Incidence ◽  
The Family ◽  
The Impact

For some people, dementia is considered as a disease that is common in elderly, regardless the impact of dementia. Taking care for the elderly with dementia brings stress for the family. It can cause and increase the family burden. Brain vitalization gymnastics is one of the methods to improve memory. The study aims to investigate the effect of brain vitalization activity on dementia incidence in elderly at Budi Luhur Nursing Home of Yogyakarta. The study used Quasi Experimental with Pretest-Posttest control group and randomized sampling system. The samples were taken randomly as many as 26 respondents and were divided into two groups namely 13 respondents of experimental group and 13 respondents of control group. The statistical test used Wilcoxon Match Pairs Test. The result showed that Wilcoxon Match pairs test obtained p value 0,003, which is smaller than 0,005. There is an effect of brain vitalization activity on dementia incidence in elderly at Budi Luhur Nursing Home of Yogyakarta

The effects of information platform-based nursing on preventing venous thromboembolism (VTE) in patients with hip fractures (Preprint)

2020 ◽  
Author(s):  
Yuan Gao ◽  
Xiaojie Fu ◽  
Mingxing Lei ◽  
Pengbin Yin ◽  
Qingmei Wang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Subgroup Analysis ◽  
Nursing Intervention ◽  
Control Group ◽  
Study Group ◽  
Drug Compliance ◽  
Information Platform ◽  
The Difference ◽  
Length Of Hospitalization

BACKGROUND Mobile apps are becoming increasingly relevant to health care. Apps have been used to improve symptoms, quality of life, and adherence for oral drugs in patients with cancers, pregnancy, or chronic diseases, and the results were satisfying . OBJECTIVE This study aims to develop an information platform with the help of a mobile app and then evaluate whether information platform-based nursing can improve patient’s drug compliance and reduce the incidence of VTE in patients with hip fractures. METHODS We retrospectively analyzed hip fracture patients performed with traditional prevention and intervention of VTE (control group) between January 2008 and November 2012, and prospectively analyzed hip fracture patients conducted with nursing intervention based on the information platform (study group) between January 2016 and September 2017. The information platform can be divided into medical and nursing care end and the patient’s end. Based on the information platform, we could implement risk assessments, monitoring management and early warnings, preventions and treatments, health educations, follow-up and other aspects of nursing interventions for patients. We compared basic characteristics, outcomes including drug compliance, VTE occurrence, and mean length of hospitalization between the two groups. Besides, a subgroup analysis was performed in the study group according to different drug compliances. RESULTS Regarding baseline data, patients in the study group had more morbidities than those in the control group (P<0.05). The difference of drug compliance between the two groups was statistically significant (P<0.001): 64.7% of the patients in the control group had poor drug compliance and only 6.1% patients had poor drug compliance in the study group. In terms of VTE, 126 patients (10.7%) in the control group had VTE, while only 35 patients (7.1%) in the study group had VTE, and the difference was statistically significant (P=0.024). Moreover, the average length of hospitalization in the study group was also significantly lower than that in the control group (10.4 d vs. 13.7 d, P=0.000). Subgroup analysis of the study group showed that the incidence of VTE in patients with non-compliance, partial compliance, and good compliance was 56.7%, 5.8% and 2.8%, respectively (P=0.000). CONCLUSIONS Poor drug compliance leads to higher VTE occurrence. The information platform-based nursing can effectively improve the compliance of patients with hip fracture and thus significantly reduce the incidence of VTE.

scholarly journals Impact of interstitial lung disease on mortality in ANCA-associated vasculitis: A systematic literature review and meta-analysis

2021 ◽  
Vol 18 ◽  
pp. 147997312199456
Author(s):  
Peining Zhou ◽  
Jing Ma ◽  
Guangfa Wang
Keyword(s):  
Systematic Review ◽  
Interstitial Lung Disease ◽  
Confidence Interval ◽  
Lung Disease ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Anca Associated Vasculitis ◽  
Retrospective Cohort Studies

Several retrospectivee described the association of interstitial lung disease (ILD) and ANCA-associated vasculitis (AAV). However, the relationship between the ILD and mortality in AAV patients have not been established so far. This study aims to estimate the relevance of AAV-associated-ILD (AAV-ILD) and mortality risk by conducting a systematic review and meta-analysis.A comprehensive systematic review was conducted in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). PubMed, Embase.com and the Cochrane Library (Wiley) were searched for original observational studies. Summary estimates were derived with a random-effects model and reported as risk ratio (RR), tested for publication bias and heterogeneity. Ten retrospective cohort studies were included, comprising 526 AAV-ILD patients enrolled from 1974 to 2018. Meta-analysis yielded a pooled RR of 2.90 (95% confidence interval 1.77–4.74) for death among those with AAV-ILD compared to control group. UIP pattern was associated with an even poorer prognosis in comparison to non-UIP pattern (RR 4.36, 95% confidence interval 1.14–16.78). Sensitivity analysis suggested that the meta-RR result was not skewed by a single dominant study. ILD might be associated with a higher mortality risk in AAV patients.

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