scholarly journals Longitudinal Study on Functional and Cognitive Outcomes in Patients with Postoperative Delirium after Femoral Fracture

2019 ◽  
Author(s):  
Monika Balzer-Geldsetzer ◽  
Benjamin Buecking ◽  
Steffen Ruchholtz ◽  
Bernhard Kis ◽  
Richard Dodel ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Postoperative Delirium ◽  
Femoral Fractures ◽  
Cognitive Capacity ◽  
Cognitive State ◽  
Multiple Logistic Regression ◽  
Proximal Femoral Fractures

Abstract Background Proximal femoral fractures are frequent injuries of elderly people and are often associated with declines in physical function and high rates of morbidity and mortality. A severe and frequent complication after hip surgery is postoperative delirium (POD), potentially associated with poorer clinical outcomes. We hypothesized that elderly patients with POD after hip fracture showed significantly worse clinical outcomes within one year after the fracture, compared to patients not suffering from POD. Additionally, relevant predictors of POD were evaluated. Methods Patients with proximal femoral fractures aged ≥ 60 years were included in a prospective, single-center observational study in Germany and followed up for 12 months. POD was evaluated by daily application of the Confusion Assessment Method (CAM) during the acute hospital stay. A variety of standardized instruments were used to evaluate patients’ functional and cognitive capacity, mobility, quality of life (HrQoL), depression, pain, etc., at baseline, discharge, and follow-up. A multiple logistic regression analysis was conducted to determine socio-demographic and clinical predictors of POD. Results Among 402 included patients (mean age: 81.3 ± 8.2 years), 184 (45.8%) developed POD (mean duration: 6.5 ± 4.4 days). At baseline, POD patients were significantly older, more often institutionalized, cognitively and physically more impaired, reported lower HrQoL, and had significantly more complications during the hospital stay. Multiple logistic regression analyses explained 22% of the variance, while prolonged intensive care unit stays, level of pain after surgery, and diminished pre-operative physical and cognitive state were significant predictors of POD. In-hospital mortality and overall mortality after 12 months were significantly higher in POD patients. Twelve months after the fracture, POD was significantly associated with diminished mobility, HrQoL, cognitive and functional capacity, and higher risk of falls. Conclusions Pain management is an important and controllable variable during hospital stay and should be a specific focus of the postoperative period, especially in functionally and cognitively impaired patients. Since patients with POD showed significantly worse clinical outcomes at discharge and 12 months post-fracture, prevention and effective treatment of POD should be of high priority in elderly patients with hip fractures.

scholarly journals Delirium after hip hemiarthroplasty for proximal femoral fractures in elderly patients: risk factors and clinical outcomes

2019 ◽  
Vol Volume 14 ◽  
pp. 427-435 ◽  
Author(s):  
Louis de Jong ◽  
Veronique van Rijckevorsel ◽  
Jelle W. Raats ◽  
Taco M.A.L. Klem ◽  
Tjallingius M. Kuijper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Femoral Fractures ◽  
Proximal Femoral Fractures ◽  
Hip Hemiarthroplasty

Preoperative Circulating MiR-210, a Risk Factor for Postoperative Delirium Among Elderly Patients with Gastric Cancer Undergoing Curative Resection

2020 ◽  
Vol 26 (40) ◽  
pp. 5213-5219
Author(s):  
Yun Chen ◽  
Jinwei Zheng ◽  
Junping Chen
Keyword(s):  
Gastric Cancer ◽  
Logistic Regression ◽  
Risk Factor ◽  
Elderly Patients ◽  
Curative Resection ◽  
Postoperative Delirium ◽  
Area Under The Curve ◽  
Multivariate Logistic Regression Model ◽  
Multivariate Logistic Regression ◽  
Clinicopathologic Characteristics

Background: Postoperative delirium (POD) is a very common complication in elderly patients with gastric cancer (GC) and associated with poor prognosis. MicroRNAs (miRNAs) serve as key post-transcriptional regulators of gene expression via targeting mRNAs and play important roles in the nervous system. This study aimed to investigate the potential predictive role of miRNAs for POD. Methods: Elderly GC patients who were scheduled to undergo elective curative resection were consequently enrolled in this study. POD was assessed at 1 day before surgery and 1-7 days after surgery following the guidance of the 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM V, 2013). The demographics, clinicopathologic characteristics and preoperative circulating miRNAs by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) were compared between patients with or without POD. Risk factors for POD were assessed via univariate and multivariate logistic regression analyses. Results: A total of 370 participants were enrolled, of which 63 had suffered from POD within postoperative 7 days with an incidence of 17.0%. Preoperative miR-210 was a predictor for POD with an area under the curve (AUC) of 0.921, a cut-off value of 1.67, a sensitivity of 95.11%, and a specificity of 92.06%, (P<0.001). In the multivariate logistic regression model, the relative expression of serum miR-210 was an independent risk factor for POD (OR: 3.37, 95%CI: 1.98–5.87, P=0.003). Conclusions: In conclusion, the present study highlighted that preoperative miR-210 could serve as a potential predictor for POD in elderly GC patients undergoing curative resection.

Clinical outcomes of proximal femoral fractures treated with a novel carbon fiber-reinforced polyetheretherketone intramedullary nail

Injury ◽  
2020 ◽  
Vol 51 (3) ◽  
pp. 678-682 ◽  
Author(s):  
Kazuma Takashima ◽  
Ichiro Nakahara ◽  
Keisuke Uemura ◽  
Hidetoshi Hamada ◽  
Wataru Ando ◽  
...  
Keyword(s):  
Carbon Fiber ◽  
Clinical Outcomes ◽  
Intramedullary Nail ◽  
Femoral Fractures ◽  
Proximal Femoral Fractures ◽  
Fiber Reinforced ◽  
Carbon Fiber Reinforced

scholarly journals The association between neutrophil–lymphocyte ratio and poor outcomes following infant cardiac surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Peng Gao ◽  
Jinping Liu ◽  
Xu Wang ◽  
Peiyao Zhang ◽  
Yu Jin ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Time Length ◽  
Mechanical Ventilation Time ◽  
Poor Outcomes

Abstract Background Neutrophil–lymphocyte ratio (NLR) is a valuable indicator for evaluating inflammation and adverse outcomes after cardiac surgery. The objective of this study was to evaluate the association of perioperative NLR with clinical outcomes in infants undergoing congenital heart surgery with cardiopulmonary bypass. Methods We performed a retrospective review of 424 consecutive infants (≤ 1 year) undergoing cardiac surgery between January 2019 and September 2019. Neonates (≤ 28 days) and patients with incomplete NLR data were excluded. The study endpoint was a composite of poor outcomes after surgery. We assess the correlation between perioperative NLR and clinical outcomes. A receiver operating characteristic curve and multivariable logistic regression were applied to identify the prognosis performance of postoperative NLR for poor outcomes. Results A total of 68 (16%) infants experienced at least one of the poor outcomes. Postoperative NLR on the third day after the surgery showed the best prognostic significance (AUC = 0.763, 95%CI 0.700–0.826) among perioperative period, with a cut-off value of 2.05. Postoperative NLR was also strongly correlated with mechanical ventilation time, length of ICU and hospital stay (p < 0.001). Multivariable logistic regression revealed that elevated postoperative NLR (OR 3.722, 95%CI 1.895–7.309, p < 0.001) was an independent risk factor for poor outcomes in infants after cardiac surgery. Conclusions Postoperative NLR was correlated with increased mechanical ventilation time, length of ICU and hospital stay. Elevated postoperative NLR was an independent predictor for poor outcomes after cardiac surgery in infants.

scholarly journals Incidence and Clinical Outcomes of Hip Fractures Involving Both the Subcapital Area and the Trochanteric or Subtrochanteric Area

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Takayuki Tani ◽  
Hiroaki Kijima ◽  
Natsuo Konishi ◽  
Hitoshi Kubota ◽  
Shin Yamada ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Clinical Outcomes ◽  
Failure Rate ◽  
Femoral Fractures ◽  
Prosthetic Replacement ◽  
Proximal Femoral Fractures ◽  
Posterior Aspect ◽  
Anterior Aspect ◽  
Area Classification

Purpose. Proximal femoral fractures involving both the subcapital area and the trochanteric or subtrochanteric area have rarely been reported, but they are not uncommon. However, few studies have reported the incidence or clinical outcomes of such fractures. This study investigated such fractures.Methods. In area classification, the proximal femur is divided into 4 areas by 3 boundary planes: the first plane is the center of femoral neck; the second plane is the border between femoral neck and femoral trochanter; and the third plane links the inferior borders of greater and lesser trochanters. A fracture only in the first area is classified as a Type 1 fracture; one in the first and second areas is classified as a Type 1-2 fracture. Therefore, proximal femoral fractures involving both the subcapital area and the trochanteric area are classified as Type 1-2-3, and those involving both the subcapital area and the subtrochanteric area are classified as Type 1-2-3-4. In this study, a total of 1042 femoral proximal fractures were classified by area classification, and the treatment methods and the failure rates were investigated only for Types 1-2-3 and 1-2-3-4 cases. The failure rate was defined as the incidence of internal fixator cut-out or telescoping >10 mm.Results. Types 1-2-3 and 1-2-3-4 fractures accounted for 1.72%. Surgical treatment was performed for 89%. Of these, 56% underwent osteosynthesis, but the failure rate was 33%. The other patients (44%) underwent prosthetic replacement. Fracture lines of all these fractures were present along trochanteric fossa to intertrochanteric fossa in posterior aspect and just below the femoral head in anterior aspect.Conclusion. Fracture involving the subcapital area to the trochanteric or subtrochanteric area was found in approximately 2%. In patients for whom prosthetic replacement was selected, good results were obtained. However, 1/3 of patients who underwent osteosynthesis had poor results.

The Effect of Time-to-Surgery on Outcome in Elderly Patients with Proximal Femoral Fractures

2007 ◽  
Vol 79 (2) ◽  
Author(s):  
Rüdiger Smektala ◽  
Burghard Dasch ◽  
Helmut Endres ◽  
Michael Lungenhausen ◽  
Christoph Mayer ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Femoral Fractures ◽  
Proximal Femoral Fractures ◽  
Time To Surgery
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